Hyaluronidase hypersensitivity: A rare complication of peribulbar block.

Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight-threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.

Colour Doppler Imaging of Ophthalmic Artery and Central Retinal Artery in Glaucoma Patients with and without Diabetes Mellitus.

PURPOSE: To assess the ocular blood flow in Diabetic and non-Diabetic Primary Open Angle Glaucoma (POAG) patients. DESIGN: Prospective comparitive study. MATERIAL AND METHODS: A total 100 eyes of 50 POAG patients was included in the study and divided into two groups, Group 1 (25 POAG patients without Diabetes mellitus) and Group 2 (25 POAG patients with Diabetes mellitus). Colour Doppler Imaging (CDI) of Ophthalmic artery and Central retinal artery were studied and peak systolic velocity (V max), End diastolic velocity (V min) and Resistivity Index (RI) were assessed. RESULTS: Ocular blood flow in Group 2 showed a reduction in V max, V min and increased RI compared to Group I with a statistically significant reduction in the central retinal artery flow (V max (p=0.01), V min (p=0.07) and RI (p=0.03). CONCLUSION: CDI showed a significant reduction in the ocular blood flow of POAG patients with Diabetes mellitus.

Differential expression analysis of transcripts related to oil metabolism in maturing seeds of Jatropha curcas L.

Jatropha curcas has been widely studied at the molecular level due to its potential as an alternative source of fuel. Many of the reports till date on this plant have focussed mainly on genes contributing to the accumulation of oil in its seeds. A suppression subtractive hybridization strategy was employed to identify genes which are differentially expressed in the mid maturation stage of J. curcas seeds. Random expressed sequence tag sequencing of the cDNA subtraction library resulted in 385 contigs and 1,428 singletons, with 591 expressed sequence tags mapping for enzymes having catalytic roles in various metabolic pathways. Differences in transcript levels in early and mid-to-late maturation stages of seeds were also investigated using sequence information obtained from the cDNA subtraction library. Seven out of 12 transcripts having putative roles in central carbon metabolism were up regulated in early seed maturation stage while lipid metabolism related transcripts were detected at higher levels in the later stage of seed maturation. Interestingly, 4 of the transcripts revealed putative alternative splice variants that were specifically present or up regulated in the early or late maturation stage of the seeds. Transcript expression patterns from the current study using maturing seeds of J. curcas reveal a subtle balancing of oil accumulation and utilization, which may be influenced by their energy requirements.

CRAO in Moyamoya Disease.

Moyo Moya Disease (MMD) is a rare, progressively stenotic condition of the intracranial arteries with various cerebrovascular manifestations. Ocular manifestations are seen very rarely and there are only few case reports of ocular perfusion anomalies. Central Retinal Artery Occlusion (CRAO) can be caused by atherosclerosis related thrombosis, carotid embolism, cardiac embolism, thrombophilic disorders, giant cell arteritis, etc. We are reporting a 26 years old patient with CRAO in the right eye, who was found to have the typical features of MMD on cerebral angiography. CRAO with MMD is a rare occurrence.

Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease.

Expulsive suprachoroidal hemorrhage can be surgical or spontaneous. Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare entity. Most of the reported cases of SESCH were caused by a combination of corneal pathology and glaucoma. We are reporting a rare presentation of SESCH with no pre-existing glaucoma or corneal pathology and caused by massive intra- and peri-ocular hemorrhage due to decompensated liver disease.

Keratomycosis caused by Exserohilum rostratum.

We report a case of keratomycosis caused by Exserohilum rostratum. A 46-year-old farmer presented with history of pain, watery discharge and redness of the right eye for the past 2 weeks following trauma with vegetable matter. On ocular examination, a central corneal ulcer of about 8 mm with a greyish-white slough, feathery edges and diffuse corneal edema was seen in the right eye. KOH examination of corneal scrapings revealed thick, brown, branched, septate hyphae. Culture of corneal scrapings on Sabouraud dextrose agar showed velvety greenish-black colony with a black pigment on the reverse. The culture was identified as E. rostratum on the basis of microscopic morphology. The patient responded well to treatment with topical natamycin and oral itraconazole.

Spontaneous globe luxation associated with chronic obstructive pulmonary disease.

Spontaneous globe luxation is a rarely reported condition which can lead to complications like optic neuropathy. Common causes are thyroid eye disease, shallow orbit and floppy eyelid syndrome. We report a case of spontaneous globe luxation with the onset and severity associated with chronic obstructive pulmonary disease (COPD). To our knowledge, this is the first case of spontaneous globe luxation associated with COPD.

Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.

AIM: To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics. MATERIALS AND METHODS: Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured. RESULTS: Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates' correction). CONCLUSION: Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.

Descemet's membrane detachment managed with perfluro-n-octane liquid.

We report the case of a 68-year-old male who developed Descemet's membrane detachment after temporal clear corneal phacoemulsification which did not settle with air or viscoelastic injection. The Descemet's membrane was successfully reattached with restoration of 20/50 vision with the help of perfluro-n-octane liquid. To our knowledge, this is the first such case to be reported.

Iatrogenic descemetorhexis as a complication of phacoemulsification.

During clear corneal temporal phacoemulsification, an accidental iatrogenic descemetorhexis occurred. The entire cornea was hazy and edematous on the first postoperative day. By the 1-month postoperative review, the cornea had become clear with visible descemetorhexis margins; best corrected visual acuity was 20/25, and the pachymetry was 556 microm. The patient remained stable at the 2-years postoperative follow-up, and specular microscopy done at this time showed a cell density of 1301 cells/mm2 with evidence of pleomorphism and polymegethism. This is the first report of iatrogenic descemetorhexis in which the cornea had become clear and nonedematous by as early as 1 month postoperatively. This case highlights that a healthy endothelium can maintain corneal deturgescence despite a low endothelial cell count. Corneal thickness increases only when the number of endothelial cells has gone below a physiologic lower limit.