Zia Chaudhuri

Effect of Levodopa and Carbidopa in Human Amblyopia

BACKGROUND To assess the role of continuous therapy for 3 weeks with levodopa and carbidopa in the management of human amblyopia in children and adults. METHOD There were 88 amblyopic eyes of 82 subjects included in this double masked randomized prospective clinical trial. Levodopa and carbidopa combination in 2 different dosage schedules were given to both adults and children. The response was monitored of the improvement in visual acuity, contrast sensitivity, and visually evoked potentials. RESULT Patients receiving higher dosages of levodopa and carbidopa in both adults and children showed a better response to treatment. However, the effect did not last beyond 9 weeks of stopping treatment. CONCLUSION Though levodopa and carbidopa therapy may not be able to ameliorate amblyopia on its own on a long-term basis, it may be considered nonetheless to be an important adjunct to conventional therapy because it may improve patient compliance for occlusion by improving visual acuity in the amblyopic eye. Thus, it offers promise of improving the functional outcome in these cases. However, longer follow-up trials are needed to substantiate these conclusions.

Congenital Eyelid Colobomas in 51 Patients

PURPOSE To review the clinical observations in the management of congenital eyelid coloboma. METHODS Fifty-one cases of congenital eyelid colobomas including the functional and cosmetic rehabilitation of patients who were treated over a period of 18 years with an average follow-up of 4.7 years were retrospectively reviewed. RESULTS Thirty-eight patients had an upper eyelid coloboma and 13 patients had a lower eyelid coloboma. Systemic associations included Goldenhar syndrome and Treacher-Collins-Franceschetti syndrome. Twenty-two patients with upper eyelid colobomas underwent surgery by direct apposition, eyelid sharing procedures, or a lateral rotation flap. Lower eyelid colobomas were repaired in 4 patients. CONCLUSION Gratifying cosmetic and functional results could be achieved in all 26 patients who underwent surgery.

Electrical cataract: a case study.

A case of bilateral cataract sustained after electrical trauma was seen in a referral practice. We examined a young patient with dense anterior and posterior subcapsular cataract in his right eye and pseudophakia in his left eye who gave a history of gradually progressive painless loss of vision after sustaining injury from a high voltage electric current. Extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation was performed in his right eye. Visual rehabilitation in both eyes after ECCE with PCIOL implantation was good with the patient attaining uncorrected visual acuity of 20/30 in both eyes postoperatively. It appears that the surgical results and visual rehabilitation after ECCE with PCIOL implantation in patients with electrical cataract without any other ocular damage is excellent.

A Comparative Study of Small Incision Trabeculectomy Avoiding Tenon's Capsule With Conventional Trabeculectomy

BACKGROUND AND OBJECTIVE The purpose of this study was to compare the results of small incision trabeculectomy (SIT) avoiding Tenons capsule vis-à-vis conventional trabeculectomy, and find a safe, effective alternative to conventional trabeculectomy with or without pharmacological wound modulation. PATIENTS AND METHODS A controlled prospective study was conducted on 80 consecutive open-angle glaucoma patients requiring glaucoma filtration surgery. They were divided into two groups: Group I (n = 40): patients undergoing conventional trabeculectomy; and Group II (n = 40): patients undergoing limbal approach SIT. Patients were followed up serially for a minimum of 12 months and their intraocular pressure was monitored. Success of the procedure was defined as an intraocular pressure (IOP) <22 mm Hg with no additional antiglaucoma medication or surgery, and achieving at least a 30% reduction from the initial IOP at which optic disc cupping and/or visual field changes occurred. RESULTS A significant fall (P <0.0001) in the final mean IOP was present in both groups at all time intervals in comparison to their preoperative values. The final mean intraocular pressure achieved with conventional trabeculectomy was 18.90 +/- 4.86 mm Hg versus 16.60 +/- 5.93 mm Hg with SIT. The final success rate of 90% was obtained with SIT vs 80% with conventional trabeculectomy. No major complications were encountered with either procedure although complications such as shallow anterior chamber and progression of cataractogenesis were seen more often in patients undergoing conventional trabeculectomy. CONCLUSION Small incision trabeculectomy avoiding Tenons capsule is a low-cost and safe alternative to conventional trabeculectomy that effectively reduces IOP in 90% of cases. The use of a small 2.5 mm limbal incision, which obviates the dissection of Tenons capsule and absence of any major complication, suggests that this procedure be used more often in glaucomatous eyes needing filtering surgery.

Clinical evaluation of refractive changes following brow suspension surgery in pediatric patients with congenital blepharoptosis.

BACKGROUND AND OBJECTIVE To evaluate the postoperative visual acuity and refractive changes occurring after bilateral frontalis brow suspension surgery in pediatric patients with congenital blepharoptosis. PATIENTS AND METHODS Twenty-three patients between 4 and 12 years old with severe congenital blepharoptosis (unilateral in 21 cases and bilateral in 2 cases; total of 25 eyes) and poor levator function underwent bilateral frontalis brow suspension surgery by Crawfords double triangle method with 4:0 expanded polytetrafluoroethylene sutures. The non-ptotic eyes (21 eyes) undergoing frontalis brow suspension surgery served as the control group. All patients had best-corrected spectacle visual acuity (BCSVA) of more than 6/9 preoperatively in both eyes. Changes in the postoperative BCSVA, binocularity, relevant refractive parameters, lid position, lagophthalmos, lid lag, and tear break-up time were evaluated in both groups for 12 weeks and appropriate statistical tests were applied. RESULTS Significant differences were found in the baseline characteristics and the postoperative changes in the eyes with and without ptosis. However, these were found to be transient and did not result in any new cases of amblyopia postoperatively. No complications requiring revision of surgery were seen. CONCLUSIONS The changes in the BCSVA after frontalis brow suspension surgery are transient. Retinoscopy, manual keratometry, and corneal videokeratoscopy are simple and effective methods to evaluate the sequential refractive changes occurring in these eyes.

Rhinosporidiosis and Peripheral Keratitis

Report of a case of peripheral keratitis caused by Rhinosporidium seeberi. The patient was seen in a referral practice. Corneal scraping was performed on a middle-aged female patient presenting with peripheral keratitis and progressive nasal obstruction that revealed spores suggestive of rhinosporidiosis. The patient was started on topical amphotericin B 0.15% eye drops. Ear, nose, and throat (ENT) examination showed presence of a polypoid lesion in the left nostril for which a polypectomy was performed. Histopathological examination confirmed rhinosporidiosis. Complete resolution of the keratitis was observed. Topical amphotericin B is an effective drug in the management of this condition. Keratitis secondary to rhinosporidial infection has not been described although occasional patients with limbal and scleral involvement have been reported. Corneal scraping was effective in helping us make a tentative diagnosis.

Sensory Deviations Subsequent to Senile Cataract

PURPOSE To evaluate the effect of extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation in patients with sensory deviations subsequent to senile cataract. METHODS Twenty patients with dense cataract and associated sensory deviations underwent follow-up between April 1996 and April 1998 after extracapsular cataract extraction with posterior chamber IOL implantation in the deviating eye. All patients underwent follow-up for a minimum period of 6 months. RESULTS Preoperatively, all patients had a visual acuity of PL positive (perception of light present) and PR (projection of rays) accurate in the deviating eye. Two patients had an esodeviation, and 18 patients had an exodeviation. Postoperatively, all patients had a corrected visual acuity of 20/40 or better in the operated eye at 12 weeks. Nineteen patients had ocular alignment within +/-8 prism diopters of orthophoria at 12 weeks. CONCLUSION Sensory deviations subsequent to senile cataract usually resolve spontaneously after cataract surgery if visual gains are 20/40 or better. The prognosis for binocular vision is good.

Morning glory anomaly with bilateral choroidal colobomas in a patient with Goldenhar's syndrome.

A child with Goldenhars syndrome, bilateral choroidal colobomas, and a morning glory anomaly of the optic disk in one eye is described. Bilateral posterior segment anomalies associated with Goldenhars syndrome are rare. An association between the morning glory anomaly and Goldenhars syndrome has not been previously reported.

An Optic Nerve Hypoplasia and Coloboma in a Patient With Hemifacial Microsomia

Posterior segment anomalies are rare features of the oculoauriculovertebral complex. Our patient had hemifacial microsomia with an optic nerve hypoplasia in one eye and an optic nerve coloboma in the other eye. The optic nerve hypoplasia was ipsilateral to the side with hemifacial microsomia and microtia.

Bilateral retrobulbar neuritis in an adolescent boy with lymphoma

A 13-year-old boy presented with bilateral retrobulbar neuritis. Three months later he presented with unilateral proptosis and cervical lymphadenopathy. Lymph node biopsy confirmed non-Hodgkins lymphoma, B-cell type. To the best of our knowledge, this is the first reported case of bilateral retrobulbar neuritis as the presumptive initial presentation of non-Hodgkins lymphoma.