An uncommon cause of sub-acute intestinal obstruction in young adult: Wilkie's syndrome.

Abstract: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen. It has a clinical presentation similar to intestinal obstruction and is often missed during diagnosis. Reduced weight leading to loss of fat pad between SMA and aorta is the main pathophysiology. Diagnosis is made through barium meal and CT scan. Conservative management remains the treatment of choice; however, surgery is opted for in refractory cases. Key Clinical Message: Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare disease presenting as an acute abdomen with clinical features similar to intestinal obstruction. This is a case of SMA syndrome in an adult male with a decrease in aortomesenteric angle, with no predisposing condition.

Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty.

PURPOSE: To report the indications for keratoplasty and analyze trends in two decades in India. METHODS: This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed. RESULTS: Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy. CONCLUSION: Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.

Infectious Keratitis: An Update on Role of Epigenetics.

Epigenetic mechanisms modulate gene expression and function without altering the base sequence of DNA. These reversible, heritable, and environment-influenced mechanisms generate various cell types during development and orchestrate the cellular responses to external stimuli by regulating the expression of genome. Also, the epigenetic modifications influence common pathological and physiological responses including inflammation, ischemia, neoplasia, aging and neurodegeneration etc. In recent past, the field of epigenetics has gained momentum and become an increasingly important area of biomedical research As far as eye is concerned, epigenetic mechanisms may play an important role in many complex diseases such as corneal dystrophy, cataract, glaucoma, diabetic retinopathy, ocular neoplasia, uveitis, and age-related macular degeneration. Focusing on the epigenetic mechanisms in ocular diseases may provide new understanding and insights into the pathogenesis of complex eye diseases and thus can aid in the development of novel treatments for these diseases. In the present review, we summarize the clinical perspective of infectious keratitis, role of epigenetics in infectious keratitis, therapeutic potential of epigenetic modifiers and the future perspective.

Delhi Infectious Keratitis Study: Update on Clinico-Microbiological Profile and Outcomes of Infectious Keratitis.

PURPOSE: To study the clinico-microbiological profile and outcomes of infectious keratitis (IK) at a tertiary eye care center in North India. METHODS: This is a retrospective, hospital-based, cross-sectional study. One thousand seven hundred and eighty-six corneal microbiological reports were identified from January 2017 to December 2018, out of which 625 patients of IK fulfilled the inclusion criteria. They underwent microbiological examination which included corneal scrapings, culture, and antibiotic sensitivity. Demographic features, signs and symptoms, risk factors such as associated trauma, previous ocular surgery, and use of corticosteroids were also recorded. RESULTS: Of the 625 patients, 68.2% were male and 31.8% were female. The age group affected most was the sixth decade; 21.9% (137 cases). Trauma was the most common associated risk factor in 151 cases (24.2%) followed by previous ocular surgery in 111 (17.8%). Out of the 625 corneal scrapings, 393 (62.9%) were culture-positive. Bacterial culture accounted for 60.6% (238/393) and fungal cultures were 143 (36.4%). More than 50% of the bacterial keratitis cases and more than 60% of the fungal cases had a favorable outcome. Staphylococcus sp. and Fusarium sp. were the most common bacteria and fungus isolated, respectively. Only one-third of the cases required surgical intervention, and the remaining two-thirds were managed medically. CONCLUSIONS: In the current study, cultures were positive in 63% of cases, and the majority of cases had bacterial growth. Surgical intervention was needed in one-third of the cases. Management of corneal infections is incomplete without a good microbiological workup. Ophthalmologists should be encouraged to learn and practice basic staining procedures, and this should start early in the training years.

Acute stromal keratitis in clinics - are we missing microsporidia?

Purpose: To report 3 cases of microsporidial stromal keratitis presenting as a diagnostic dilemma to a tertiary eye care center in north India. Methods: Three eyes of 3 patients underwent therapeutic keratoplasty for microsporidial stromal keratitis. A decision for early surgery was taken as the patients were not responding to conventional medical management and were worsening clinically. The diagnosis of microsporidia was made by corneal scraping and confirmed on histopathological evaluation of the corneal button. Results: Out of the 3 patients, one maintained a clear graft, one had a recurrence and one had graft rejection, 6 months postoperatively. The patients were not started on steroids in the postoperative period and were given topical antibiotics and polyhexamethylene biguanide (PHMD). Oral Albendazole 400 mg was also given twice a day for a month. Conclusion: Many questions remained unanswered about the management protocol of stromal keratitis caused by microsporidia. The role of topical steroids, antifungal agents, oral Albendazole needs to be discussed. Clinicians should be aware of recurrences which may mimic as rejections. There needs to be more awareness regarding microsporidia as a cause of acute stromal keratitis, so that its not overlooked or underdiagnosed.

Curvularia infection of corneoscleral tunnel.

Corneoscleral tunnel infection is a potentially sight threatening complication of cataract surgery. Microbiological investigations are mandatory and early surgical intervention helps in achieving favourable outcomes. Fungal infection of tunnel incisions can pose a diagnostic and therapeutic challenge. We report a case of post-operative tunnel infection with curvularia. Prompt surgical intervention and intensive topical therapy helped attain a good tectonic as well as visual recovery.

18S rDNA sequencing aided diagnosis of Acanthamoeba jacobsi keratitis -A case report.

Identification of Acanthamoeba cysts and trophozoites in cases of keratitis is traditionally done with microbiological techniques such as smear examination with 10% potassium hydroxide (KOH) and culture. Double walled cyst with hexagonal inner wall is characteristic of Acanthamoeba. We report a unique case of a 9 year old boy who presented with dense anterior corneal stromal infltration, which on smear examination showed atypical double walled spherical cysts, leading to a diagnostic dilemma. An 18S rRNA gene-based PCR done on the growth on culture, subsequently identifed a rarely reported species of Acanthamoeba. The patient was advised combination therapy with polyhexamethylene biguanide (PHMB 0.02%) and chlorhexidine (0.02%) eye drops. Three weeks post treatment, the keratitis resolved with scarring and vascularisation and visual acuity improved to 20/60. At 8 weeks follow up Best corrected visual acuity further improved to 20/30 with contact lens.

Sphingomonas paucimobilis keratitis post cataract surgery: First case report from India.

Sphingomonas paucimobilis is a rare, aerobic Gram-negative soil bacillus rarely associated with intraocular infections. With only 3 cases of ophthalmic manifestations reported so far, we are presenting the fi rst case of S. Paucimobilis, causing keratitisafter cataract surgery, from India. The organism, which was resistant to initial medical treatment, eventually responded to a patch graft and the patient improved to a final visual acuity of 20/40.

Nocardia infection following intraocular surgery: Report of seven cases from a tertiary eye hospital.

PURPOSE: To study the outcome of ocular nocardiosis following intraocular surgery. MATERIALS AND METHODS: A retrospective review of medical records of all postoperative cases of culture proven Nocardia infection over a period of 3 years, from October 2010 to September 2013, was performed. Microbiological analysis was performed for all cases and included smears and cultures. Fortified 2% amikacin eye drops were the mainstay of treatment. Surgical intervention was performed in case of nonresponse to medical therapy or suspected endophthalmitis. RESULTS: Seven cases of culture proven Nocardia infection were seen. All cases had been operated in a hospital surgical facility. Six followed phacoemulsification, and one followed a secondary intraocular lens implantation. Four patients were part of a cluster infection. The mean duration between the primary surgical procedure and presentation was 16.14 ± 9.82 days. Five patients had infiltrates at the site of the surgical incision. One each had endophthalmitis and panophthalmitis. Six eyes required surgical intervention. Infection was seen to resolve in four eyes. Two eyes went into phthisis, and one was eviscerated. Only two of the six eyes, where in surgical intervention was performed early, obtained a final visual acuity of 20/60. CONCLUSION: Early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.

Outcomes of Descemetopexy with Isoexpansile Perfluoropropane after Cataract Surgery.

PURPOSE: To report the indications, anatomical outcomes, functional outcomes and limitations of descemetopexy with intracameral injection of isoexpansile perfluoropropane (14% C3F8) in eyes with Descemet's membrane (DM) detachment after cataract surgery. METHODS: This retrospective non-comparative interventional case series included 67 eyes of 67 patients who underwent descemetopexy at a tertiary eye hospital. The procedure consisted of descemet's membrane reattachment by injecting isoexpansile perfluoropropane (14% C3F8)intracamerally. Outcome measures were reattachment of DM, improvement in visual acuity, resolution of corneal edema, causes for failure of DM reattachment and complications. RESULTS: Sixty-seven eyes of 74 patients were analyzed. Phacoemulsification (56.71%) had the highest DM detachment as compared to manual SICS in 19 (28.36%) and ECCE in 10 (14.93%) eyes. Descemetopexy with 14% C3F8 resulted in anatomical reattachment of DM in 71.64% and functional improvement in visual acuity in 74.63% of treated eyes. The location and the extent of DM detachment did not influence DM reattachment. Complete reattachment of DM occurred in all 26 eyes (100%) with planar type detachments, whereas with non-planar type detachments only 22 eyes (53.7%) achieved complete reattachment. CONCLUSION: Descemetopexy with isoexpansile perfluoropropane offers good surgical outcomes regarding visual acuity and resolution of corneal edema.

Conjunctival erosion after glaucoma drainage device surgery: a feasible option.

Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.