Secondary Glaucoma after Cataract Surgery performed in Infancy in Congenital Rubella Syndrome -A Case Control Study.

OBJECTIVE: To compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with non-rubella cataracts and to identify associated risk factors. DESIGN: Retrospective case control study. PARTICIPANTS: Children with CRS who had undergone cataract surgery in infancy and age matched infants who had undergone cataract surgery for infantile cataracts were included. METHODS: Incidence of glaucoma and probability of survival was compared among the two groups. Risk factors for the development of glaucoma were assessed. The minimum follow up was 1 year after cataract surgery. RESULTS: The study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the non-rubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the two groups (p=0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (p=0.19). Mean follow-up was 5.8 ± 3.7years for CRS group and 6.4± 3.4years for the non-rubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 versus controls 0.8; log rank p-0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (p>0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83, 95% confidence interval 1.44-5.57; p=0.002) in CRS eyes. CONCLUSION: There was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared to infants who had undergone surgery for infantile cataracts. Since the ten year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow up is recommended especially in eyes with at-risk features.

Cataract surgery outcomes in children and adolescents with type 1 diabetes mellitus.

PURPOSE: To report the outcomes of cataract surgery in children and adolescents with type 1 diabetes mellitus. METHODS: The medical records of all pediatric patients (<18 years of age) with a diagnosis of type 1 diabetes mellitus who had undergone surgery for cataract between January 2000 and December 2019 at a tertiary care center were reviewed retrospectively. RESULTS: A total of 27 eyes of 15 patients who met the inclusion criteria were included. Median age at cataract surgery was 13 (IQR, 9.5-16) years, and median follow-up was 3.8 (IQR, 1.25-7.2) years, with 11 eyes followed for more than 5 years. Visual acuity improved from a median preoperative value of 0.8 (IQR, 0.55-1.3) logMAR to 0.15 (IQR, 0-0.45) logMAR at final follow-up. Posterior capsular visual axis opacification in 40.7% and diabetic retinopathy in 14.8% were the common complications requiring additional intervention, including laser capsulotomy and panretinal photocoagulation, respectively. CONCLUSIONS: Cataract surgery in children and adolescents with type 1 diabetes leads to improvement in visual acuity. Proliferative diabetic retinopathy can lead to poor visual outcomes in these children. Visual axis opacification occurs at similar rates with or without primary posterior capsulorhexis.

Orbital leiomyoma presenting as inverse globe retraction syndrome: a unique presentation of a rare disease.

Inverse globe retraction syndrome is a rare ocular motility disorder characterized by limited abduction, with globe retraction and up- or downshoots on attempted abduction, differentiating it from globe retraction due to Duane retraction syndrome, seen on attempted adduction. It can be congenital or acquired. We report the case of a 3-year-old girl who presented with classical features of inverse globe retraction syndrome secondary to an underlying orbital tumor involving the medial rectus muscle. Incisional biopsy confirmed the diagnosis of a leiomyoma. At 10 months' follow-up, vision, ocular alignment, and ocular motility had improved.

Glaucoma and optical coherence tomography changes in migraine: A comparative cross-sectional study.

PURPOSE: To study the prevalence of glaucoma among adults with migraine and the effect of migraine on peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) using optical coherence tomography (OCT) compared to those without migraine headache, i.e. in tension-type headache (TTH) and normal group. METHODS: One hundred and eleven patients (222 eyes) were recruited in three groups. migraine, TTH, and normal subjects visiting hospital outpatient services. After noting demographic details and pertinent history, ophthalmological evaluation including optic disc for glaucomatous changes along with computerized visual field testing and OCT for pRNFL thickness and CMT was performed in all eyes. Continuous variables were compared using ANOVA or Kruskal-Wallis test, while categorical variables including the association of glaucoma with migraine were analyzed using Chi-square or Fisher's exact test. RESULTS: Prevalence of glaucoma in migraine group (12.2%) was more than in comparison groups (6.8% in TTH, 4.1% in normal) which was however not significant (Fisher's exact P = 0.207). Average pRNFL thickness (103.59 ± 12.82 µm) and thickness in nasal (90.49 ± 19.19 µm) and temporal quadrants (70.58 ± 16.13 µm) and CMT (213.78 ± 19.81 µm) were significantly reduced (ANOVA P < 0.05) in migraine patients when compared to the other groups and this was independent of the presence of glaucoma. CONCLUSION: Prevalence of glaucoma is not significantly higher in migraine patients. However, migraine causes thinning of retinal layers on OCT that is statistically significant.

Corneal ulcer in reactive arthritis.

A 20-year-old male presented with acute lower limb oligoarthritis and enthesitis followed by acute onset redness, watering, pain and decreased vision in the right eye. He had recent history of diarrhoea with fever. Erythrocyte sedimentation rate and high-sensitivity C-reactive protein (hsCRP) were raised and human leukocyte antigen-B27 was positive. The best corrected visual acuity (BCVA) in the right eye was 20/120 and it showed a paracentral shallow corneal ulcer of size 3 × 4 mm with underlying dense stromal infiltrates and haze. Microbiological evaluation of corneal scrapings was reported as Staphylococcus hominis. The epithelium healed on topical antibiotics in one week, but there were persistent punctate erosions and pleomorphic anterior stromal infiltrates and haze. The residual keratitis healed completely on topical steroids in ten days, with BCVA improving to 20/20. A diagnosis of reactive arthritis with immune-mediated keratitis was made.

Bilateral compressive optic neuropathy secondary to sphenoid sinus mucocele mimicking bilateral retrobulbar neuritis.

Sphenoid sinus mucoceles (SSMs) can rarely cause acute bilateral vision loss. We, hereby, report such a rare case of SSM in a 20-year-old female who presented with sudden onset bilateral diminution of vision. The best-corrected visual acuity was 20/400 in the right eye (RE) and hand movements in the left eye (LE). Both eyes had sluggish pupillary reactions. Both eyes had normal fundus. Initial treatment was started with a provisional diagnosis of bilateral retrobulbar neuritis, but imaging revealed a large SSM compressing bilateral optic nerves. The patient underwent urgent surgical decompression. Vision in RE improved to 20/20 and LE to 20/400. A high index of clinical suspicion for compressive lesions is needed in all cases of atypical optic neuritis.

Endophthalmitis due to Delftia acidovorans: An unusual ocular pathogen.

Endophthalmitis is a dreaded postoperative complication of cataract surgery. Delftia acidovorans is usually nonpathogenic and an unusual ocular pathogen. Isolated reports of delftia-associated sepsis, otitis media, endocarditis, keratitis, etc. exist in literature. We report a rare and unique case of delftia-related endophthalmitis in a 67-year-old male diagnosed 2 weeks after uneventful cataract surgery. He was treated successfully with core vitrectomy and intravitreal antibiotics. Microbiological evaluation of vitreous sample identified the causative organism as Delftia acidovorans. Post-vitrectomy fundus evaluation at 1 week revealed the presence of retinal vascular sheathing and sclerosis along with few retinal hemorrhages. Final visual recovery was poor due to the presence of macular edema, epiretinal membrane, and temporal disc pallor.

A study for the development of K-sound based automatic blood pressure device using PVDF film.

Traditional indirect standard measurement of blood pressure is based on hearing Korotkoff sounds to determine systolic and diastolic blood pressure. However, the problem exists among different types of automatic blood pressure monitoring devices because of no standard algorithm for estimating accurate blood pressure values. Aim of the study was to develop an automatic blood pressure measurement device based on Korotkoff sounds. PVDF(poliyvinylidene fluoride) film was used as a contact microphone to detect Korotkoff sounds on the brachial artery, and pressure sensor was used to obtain cuff pressure. With those two variables, an algorithm to determine systolic and diastolic blood pressure was established. Correlation coefficients between auscultatory method and developed device were 0.977 and 0.968 for systolic and diastolic, respectively. Validation results based on the international protocol shows 95% and 91.6% of accuracies.