Bilateral Internuclear Ophthalmoplegia Caused by Dengue Fever.

A 22-year-old male was referred from the medicine department with the chief complaint of double vision for 2 months. The patient had suffered from dengue viral hemorrhagic encephalitis for 2 months for which intensive medical care was given. On ocular examination, both eyes (OU) showed limited adduction with contralateral abducting nystagmus on attempted horizontal gaze. Magnetic resonance imaging of brain showed pontine and midbrain hemorrhages which involved the region of medial longitudinal fasciculus and caused bilateral internuclear ophthalmoplegia (INO). Bilateral INO is very rare and most commonly caused by multiple sclerosis. The presentation of dengue fever causing midbrain and pontine hemorrhages which resulted in bilateral INOs has not been previously reported, to our knowledge.

Efficacy of supplemental Occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia.

Purpose: To study the efficacy of supplemental occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia. Methods: Thirty-one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu-pad for 1 h per day and three such sessions in a week. Results: The mean age was 6.8+/-1.4 years (range 5-9 years). A significant improvement of 3.2+/-1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 months. Conclusion: Occlu-pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia.

Comparison of the effectiveness of amblyopia treatment with eye-patch and binocular Occlu-tab for the same treatment duration.

Purpose: This study aimed to compare the conventional eye patch with Occlu-tab-a binocular open-type amblyopia training device-and evaluate their effectiveness in amblyopia treatment. Methods: In this prospective, multi-center study, 40 patients between ages 3 to 12 years, diagnosed with anisometropic amblyopia (refraction difference of both eyes ≥ 2 D, best-corrected visual acuity [BCVA] of the amblyopic eye ≤ 0.1 [logMAR]) were treated with Occlu-tab or conventional eye patch for 1 h per day thrice a week. We compared the visual acuity of both groups before and after 6, 7, and 8 weeks of amblyopia treatment. One-way repeated-measures analysis of variance and Tukey's test were used to compare the visual acuity of both groups pre- and post-treatment. Results: Both groups had significantly improved visual acuity at 6, 7, and 8 weeks compared to that before treatment (all P < 0.001). The improvement in BCVA of the Occlu-tab group (0.33 ± 0.25) was significantly greater than that of the eye patch group (0.16 ± 0.17) after 8 weeks of treatment (P = 0.02). Conclusion: Amblyopia treatment using binocular open game training with Occlu-tab led to greater improvement in visual acuity than that with a conventional eye patch for the same treatment duration.

Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India.

Purpose: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors. Methods: Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports. Results: Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]. Conclusion: With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.

Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1.

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Bilateral medial rectus palsy due to midbrain infarction following concussion head injury.

Here, we report a rare case of bilateral medial rectus palsy following closed head injury. An adult male had an accidental fall which rendered him unconscious. This was followed by diplopia and restricted ocular motility. He received supportive medical therapy. He was examined for systemic medical and ophthalmic findings. Routine laboratory tests and imaging techniques were employed as per the symptoms. Diffusion-weighted imaging on magnetic resonance imaging proved it to be a rare presentation of small bilateral midbrain infarct. He recovered fully after 8 months.

Congenital double crystalline lenses.

We report an unusual case of an eye with 2 congenital crystalline lenses; ie, a duplicated lens. The horizontal axis of the eye was obliquely placed. One lens was situated in the upper temporal quadrant and the other, in the lower nasal quadrant. One lens was larger than the other.

Differential expression of the lenticular antioxidant system in laboratory animals: a determinant of species predilection to oxidative stress-induced ocular toxicity?

PURPOSE: Various animal species have been used to study oxidative stress-induced cataractogenesis; however, given that differences in the expression of the lens antioxidant system may influence species susceptibility to oxidative stress, we compared and contrasted a broad spectrum of components of the lens antioxidant system in dog, rat, marmoset, and rabbit. METHODS: Lenses collected from beagle dogs, Sprague-Dawley rats, marmosets, and New Zealand white rabbits were assayed for reduced glutathione (GSH), and activities of copper-zinc and manganese superoxide dismutase (CuZn-SOD; Mn-SOD), catalase (CAT), glutathione peroxidase (GPX), gamma-Glutamylcysteine synthetase (GCS), glutathione reductase (GR), glutathione-S-transferases (GST), and glucose-6-phosphate dehydrogenase (GPDH), and Trolox equivalent antioxidant capacity (TEAC). RESULTS: Expression of the lens antioxidant system varied considerably between species. Marmoset lens contained the highest levels of GSH, its respective biosynthetic and recycling enzymes GCS and GR, and the associated H(2 )O(2)-dismutation enzyme GPX. Activities of both SOD isoforms were also highest in marmoset lens. However, activities of the xenobiotic-conjugating enzyme GST and NADPH-generating enzyme GPDH were relatively low. In contrast, dog lens had the lowest levels of GSH, GCS, GR, and Cu-Zn SOD (1/2, 1/2 and 1/33, and 1/63 that in marmoset) but highest levels of GST and GPDH. Rabbit lens contained the highest CAT activity, at up to 3.5-fold that for marmoset and rat. CONCLUSION: These results demonstrate substantial variation in lens antioxidant systems between different laboratory animal species. Given that such variation may affect relative susceptibility to oxidative stress-mediated ocular toxicity, our findings may provide useful information when choosing different animal species for lens research.

Role of echography in diagnostic dilemma in choroidal masses.

PURPOSE: To evaluate the role of echography in diagnosis and management of a diverse array of choroidal masses. MATERIALS AND METHODS: Sixty-two cases of clinically suspected choroidal masses were prospectively analyzed with B-scan (10 Hz), A-scan, and ultrasound biomicroscopy (UBM) (50 Hz) after a meticulous history and ocular examination. Ancillary investigations and systemic evaluation were also done. RESULTS: Based on clinical suspicion, acoustic features, response to treatment, and other ancillary tests combined together, the various masses were differentiated. The cases included in the study were as follows: n = 10 malignant melanomas, n = 16 metastasis and infiltrations, n = 9 hemangioma, n = 7 tuberculoma, n = 8 nonspecific inflammatory masses, n = 2 disciform plaques, n = 4 macular cysts or retinoschisis, n = 2 Coat's disease, n = 1 melanocytoma, and n = 2 osteomas. Ultrasonography (USG) alone could identify n = 51 lesions, while UBM in combination with USG was needed in remaining 11 masses. CONCLUSION: Standardized echography is an important adjunct in the diagnosis and management of eyes with intraocular masses. A better understanding of the clinicopathological and echographic picture of the diverse lesions can help in detection, differentiation, diagnosis, proposing a therapeutic approach, and also monitoring response to treatment. Echography is essential to evaluate tumors for extrascleral and anterior segment extension.

Tryptophan-NAD+ pathway metabolites as putative biomarkers and predictors of peroxisome proliferation.

The present study was designed to provide further information about the relevance of raised urinary levels of N-methylnicotinamide (NMN), and/or its metabolites N-methyl-4-pyridone-3-carboxamide (4PY) and N-methyl-2-pyridone-3-carboxamide (2PY), to peroxisome proliferation by dosing rats with known peroxisome proliferator-activated receptor alpha (PPARalpha) ligands [fenofibrate, diethylhexylphthalate (DEHP) and long-chain fatty acids (LCFA)] and other compounds believed to modulate lipid metabolism via PPARalpha-independent mechanisms (simvastatin, hydrazine and chlorpromazine). Urinary NMN was correlated with standard markers of peroxisome proliferation and serum lipid parameters with the aim of establishing whether urinary NMN could be used as a biomarker for peroxisome proliferation in the rat. Data from this study were also used to validate a previously constructed multivariate statistical model of peroxisome proliferation (PP) in the rat. The predictive model, based on 1H nuclear magnetic resonance (NMR) spectroscopy of urine, uses spectral patterns of NMN, 4PY and other endogenous metabolites to predict hepatocellular peroxisome count. Each treatment induced pharmacological (serum lipid) effects characteristic of their class, but only fenofibrate, DEHP and simvastatin increased peroxisome number and raised urinary NMN, 2PY and 4PY, with simvastatin having only a transient effect on the latter. These compounds also reduced mRNA expression for aminocarboxymuconate-semialdehyde decarboxylase (ACMSDase, EC 4.1.1.45), the enzyme believed to be involved in modulating the flux of tryptophan through this pathway, with decreasing order of potency, fenofibrate (-10.39-fold) >DEHP (-3.09-fold) >simvastatin (-1.84-fold). Of the other treatments, only LCFA influenced mRNA expression of ACMSDase (-3.62-fold reduction) and quinolinate phosphoribosyltransferase (QAPRTase, EC 2.4.2.19) (-2.42-fold) without any change in urinary NMN excretion. Although there were no correlations between urinary NMN concentration and serum lipid parameters, NMN did correlate with peroxisome count (r2=0.63) and acyl-CoA oxidase activity (r2=0.61). These correlations were biased by the large response to fenofibrate compared to the other treatments; nevertheless the data do indicate a relationship between the tryptophan-NAD+ pathway and PPARalpha-dependent pathways, making this metabolite a potentially useful biomarker to detect PP. In order to strengthen the observed link between the metabolites associated with the tryptophan-NAD+ pathway and more accurately predict PP, other urinary metabolites were included in a predictive statistical model. This statistical model was found to predict the observed PP in 26/27 instances using a pre-determined threshold of 2-fold mean control peroxisome count. The model also predicted a time-dependent increase in peroxisome count for the fenofibrate group, which is important when considering the use of such modelling to predict the onset and progression of PP prior to its observation in samples taken at autopsy.

Effect of diquat on the antioxidant system and cell growth in human neuroblastoma cells.

Oxidative stress elicits an adaptive antioxidant response, which varies with tissue type. Diquat, a potent redox cycler that generates reactive oxygen species, has been used to study oxidative stress; however, its effect on the antioxidant system has not been characterized in neuronal cells. Accordingly, we measured antioxidant parameters and cell growth in human neuroblastoma SH-SY5Y cells cultured for 48 h in medium containing 5, 10, or 25 microM diquat dibromide or phosphate-buffered saline. Viable cells were assayed for glutathione (GSH) and activities of catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), glutathione peroxidase (GPX), and glucose-6-phosphate dehydrogenase (GPDH). Mitochondrial function was evaluated by glutamate dehydrogenase (GDH) activity and MTT reduction. Diquat caused a marked concentration-related decrease in viable cell count ( by 26, 51, and 87% at 5, 10, and 25 microM diquat). Cell viability was only affected at 10 and 25 microM diquat and did not fully account for the decreased viable cell count. Concentration-related increases also occurred with GSH levels and a majority of antioxidant enzymes activities; however, the mode and magnitude varied with parameter. Increases in GSH, CAT, SOD, and GR were maximal at 25 microM diquat (to 3-, 6-, 2-, and 1.5-fold control values, respectively). GPDH activity was maximal at 10 microM diquat and then decreased to 86% of control activity at 25 microM diquat. GPX activity showed a concentration-related decrease (to 35% of control). Activity of the mitochondrial enzyme GDH increased 3-fold at 25 microM diquat, along with a lesser increase in MTT reduction. We conclude that diquat reduces cell growth in neuroblastoma cells and induces an adaptive antioxidant response, which are concentration dependent and occur at sublethal concentrations. At higher concentrations, diquat alters mitochondrial function and becomes increasingly toxic.