Correction of preexisting astigmatism by penetrating arcuate keratotomy in femtosecond laser-assisted cataract surgery.

Purpose: To evaluate the astigmatism correcting effect of penetrating arcuate keratotomy (AK) done during femtosecond laser-assisted cataract surgery (FLACS). Methods: In this nonrandomized prospective study, 80 eyes of 70 patients were studied. The study included patients who underwent combined FLACS and AK, with corneal astigmatism ranging from 0.4 to 1.5 diopters (D). Femtosecond laser-assisted penetrating arcuate keratotomies were created at 8 mm optical zone at 80% depth and were centered at the limbus. Keratometric astigmatism was measured prior to and 3 months post-surgery. Vector analysis was performed using Power vector analysis method. Results: The mean preoperative keratometric astigmatism without accounting for axis was 0.85 ± 0.27 D, which reduced significantly to 0.47 ± 0.27 D at 3-month follow-up. The mean astigmatism correction attained without accounting for axis was 0.38 ± 0.32 D. The vector corrected mean preoperative astigmatism was 0.85 ± 0.27 D which reduced significantly to 0.50 ± 0.31 D postoperatively (P < 0.001, 95% CI). Vector corrected mean astigmatism correction attained was 0.35 ± 0.38 D. There were no significant intraoperative or postoperative complications. Conclusion: Preexisting astigmatism can be tackled effectively with penetrating AK during FLACS although under correction is observed with present nomograms. Further refinements may achieve better correction.

Comparison of sub-Tenon's block with i.v. fentanyl for paediatric vitreoretinal surgery.

BACKGROUND: Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery. METHODS: In a randomized, observer-blinded trial, after obtaining institutional ethical committee approval and parental consent, 200 ASA grade I-II children aged 5-16 yr were allocated to receive either a sub-Tenon's block (Group SB) or 2 microg kg(-1) i.v. fentanyl (Group F) after induction of anaesthesia and topical anaesthesia of the conjunctiva with proparacaine 0.5% drops. Patients in Group F received fentanyl 0.5 microg kg(-1) and those in Group SB were given a corresponding volume of normal saline i.v. every hour from preloaded syringes. Increases in heart rate or mean arterial pressure by more than 20% of baseline were treated with additional 0.5 microg kg(-1) i.v. fentanyl boluses in both groups. The incidence of oculocardiac reflex (OCR), need for additional analgesics, postoperative pain, and PONV were recorded for the first 24 h after surgery. RESULTS: More patients in Group F (47.96%) had moderate to severe pain in the first 24 h when compared with Group SB (31.36%) (P=0.023). The need for postoperative ibuprofen was higher in Group F (66.3%) compared with Group SB (47.95%) (P=0.012). The incidence of OCR was significantly higher in Group F (31.6%) compared with Group SB (5.1%) (P<0.001). The incidence of PONV was similar in both groups. CONCLUSIONS: Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.

Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. METHODS: This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. RESULTS: Mean preinjection central macular thickness was 531.84+/-132 microm in Group I, 458.4+/-149 microm in Group II, and 750.81+/-148 microm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7+/-119 microm in Group I, 218.2+/-99 microm in Group II, and 210.5 +/-56 microm in Group III) and 3 months (253.19+/-109 microm in Group I, 187+/-47 microm in Group II, and 182+/-50 microm in Group III) after injection (p < 0.05). Mean follow-up was 22+/-2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2+/-0.4 logMAR units; Group II, 1.24+/-0.5 logMAR units; Group III, 1.1+/-0.4 logMAR units; 1 month postinjection in Group I, 0.88+/-0.3 logMAR units; Group II, 0.67+/-0.3 logMAR units; Group III, 0.86+/-0.4 logMAR units; 3 months postinjection in Group I, 0.84+/-0.4 logMAR units; Group II, 0.59+/-0.3 logMAR units; Group III, 0.82+/-0.5 logMAR units) (p < 0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.

Cytomegalovirus retinitis in a patient with non-Hodgkin's lymphoma: a diagnostic dilemma.

PURPOSE: Patients with lymphoma can rarely develop cytomegalovirus (CMV) retinitis. Clinically it is difficult to distinguish from intraocular lymphoma. Also, in such cases the CD4+ count may be high. The authors report a rare case of bilateral CMV retinitis in a patient with non-Hodgkin's lymphoma with high CD4+ counts. METHODS: Observational case report with review of literature. RESULTS: CMV retinitis was clinically suspected due to the presence of large areas of retinal necrosis and hemorrhages in one eye and a demarcation line with white mottled retina in the other eye. Other differential diagnoses considered were intraocular lymphomatous infiltration and acute retinal necrosis due to herpes group of viruses. The diagnosis of CMV retinitis was confirmed by polymerase chain reaction performed on vitreous sample. CONCLUSIONS: CMV retinitis can develop in cases of lymphoma despite high CD4+ counts. An early diagnosis can be established by performing PCR on vitreous biopsy.

Cytomegalovirus retinitis in a patient with non-Hodgkins lymphoma: A diagnostic dilemma.

PURPOSE: Patients with lymphoma can rarely develop cytomegalovirus (CMV) retinitis. Clinically it is difficult to distinguish from intraocular lymphoma. Also, in such cases the CD4+ count may be high. The authors report a rare case of bilateral CMV retinitis in a patient with non-Hodgkins lymphoma with high CD4+ counts. METHODS: Observational case report with review of literature. RESULTS: CMV retinitis was clinically suspected due to the presence of large areas of retinal necrosis and hemorrhages in one eye and a demarcation line with white mottled retina in the other eye. Other differential diagnoses considered were intraocular lymphomatous infiltration and acute retinal necrosis due to herpes group of viruses. The diagnosis of CMV retinitis was confirmed by polymerase chain reaction performed on vitreous sample. CONCLUSIONS: CMV retinitis can develop in cases of lymphoma despite high CD4+ counts. An early diagnosis can be established by performing PCR on vitreous biopsy. (Eur J Ophthalmol 2005; 15: #-7).

Comparison of observed lung retention and urinary excretion of thorium workers and members of the public in India with the values predicted by the ICRP biokinetic model.

The daily intake of natural Th and its contents in lungs, skeleton and liver of an Indian adult population group were estimated using radiochemical neutron activation analysis (RNAA) technique. These data on daily intake (through inhalation and ingestion) were used to compute Th contents in lungs and other systemic organs such as skeleton and liver using the new human respiratory tract model (HRTM) and the new biokinetic model of Th. The theoretically computed Th contents in lungs, skeleton and liver of an average Indian adult are 2.56, 4.00 and 0.17 microg, respectively which are comparable with the corresponding experimentally measured values of 4.31, 3.45 and 0.14 microg in an urban population group living in Mumbai. The measured lung contents of Th in a group of five occupational workers were used to compute their total body Th contents and the corresponding daily urinary excretions. The computed total body contents and daily urinary excretions of Th in the five subjects compared favourably with their measured values. These studies, thus, validate the new biokinetic model of Th in natural as well as in occupational exposures in Indian conditions.

Intraocular live cysticercus larva.

Ocular cysticercosis is one of the most common parasitic infections of the eye in humans. Although the adult pork tapeworm, Taenia solium, resides in the lumen of the intestine, the only structural element of an adult worm is usually found within a tissue cyst in the eye, its adenexa, or other places in the body with a single invaginated scolex. An unusual case is described in which a 13- to 14-mm live cysticercus larva was found, removed from the eye, and confirmed by histopathologic examination.

Osseous choristoma of the choroid.

Osseous choristoma of the choroid, also called choroidal osteoma, is a very rare and unusual form of intraocular ossification. We report a case of choroidal osteoma in a young healthy male that to the best of our knowledge is the first report from India.

Neodymium: YAG laser iridolenticular synechiolysis in uveitis.

Fifteen patients with "bound down" pupil or ring synechiae associated with chronic granulomatous uveitis in whom dilatation could not be obtained pharmacologically underwent iris-lens synechiolysis using relatively low energies from a Q-switched Nd:YAG laser. Pupil size increased significantly in all of the treated eyes; visual acuity improved in 40%. Postlaser elevated intraocular pressure developed in a significant number, but there were no serious long-term complications associated with the procedure. Although acuity improved in less than half of the patients, because this laser treatment is relatively safe and offers some possibility of visual improvement, we recommend it for routine use, but only if performed by an experienced laser microsurgeon.

Serous macular detachment in lymphoproliferative disorders.

Two patients, one with Hodgkin's disease and the other with non-Hodgkin's lymphoma, presented with bilateral diminution of vision. Examination showed bilateral serous detachment of the macula. To our knowledge, this is only the second report in the literature of serous detachment of the macula in lymphomatous disorders.

Conjunctival microbial flora in leprosy.

Conjunctival sacs of seventy one leprosy patients, paramedical and medical personnel working in a leprosy home were cultured. None of these eyes had any pathology in the outer eye. Surprisingly, 46.2% of the eyes which showed a positive culture carried accepted pathogens; Staphylococcus aureus being the commonest. Determining the preoperative bacterial flora and their elimination before undertaking intraocular surgery is recommended.

Iris neovascularization in Sturge-Weber syndrome.

An unusual case of Sturge-Weber syndrome with raised intraocular pressure is presented. The slit lamp examination and anterior segment fluorescein angiography were consistent with iris neovascularization. Cause and effect relationship of iris neovascularization with glaucoma in this syndrome is discussed.

Metastatic endophthalmitis: a reappraisal.

In view of the lack of studies of metastatic endophthalmitis and the controversies surrounding its management, we did a retrospective study of ten cases of metastatic endophthalmitis admitted to our center in 1987. A disproportionately high incidence of pediatric patients was found. The etiologic diagnosis was possible in eight of the ten cases. Bacterial infection was responsible in five of the eight cases where positive cultures were grown. Pseudomonas aeruginosa was the most common bacterial pathogen isolated. Most of the cases responded poorly to medical management. Seven of the ten patients finally underwent vitrectomy. Four of these seven cases had a postoperative visual acuity equal to or greater than 6/60 after vitrectomy. We believe that pars plana vitrectomy has a definite role in the management of metastatic endophthalmitis.