Rhegmatogenous retinal detachment following femtosecond laser-assisted cataract surgery.

Rhegmatogenous retinal detachment (RRD) following femtosecond laser-assisted cataract surgery (FLACS) has not been reported till date. We described the first case of RRD after FLACS. A 29-year-old male presented with complaints of sudden, painless dimness of vision in the left eye (LE) for the past 2 days. He was operated for refractive lens exchange in both eyes for high myopia using FLACS 3 months back. On examination, his LE vision was perception of light and accurate projection of rays with fundus showing bullous RRD. His right eye fundus was absolutely normal with 20/20 vision. A 25-gauge vitrectomy was performed in LE. The retina was settled with silicone oil (1300 centistokes) endotamponade. After 4 weeks, the patient gained 20/60 vision in LE with attached retina under silicone oil. RRD is a potential complication following FLACS and thus frequent follow-ups are required for high-risk patients after FLACS.

B-HEX pupil expander in vitreoretinal surgery - A case series.

We describe the successful use of the B-HEX pupil expansion device in four cases of combined phacovitrectomy with significant cataract, non-dilating pupil, and surgical vitreoretinal pathologies including vitreous hemorrhage, inferior retinal detachment (RD) with proliferative vitreoretinopathy in an oil filled eye, recurrent rhegmatogenous RD, and macular hole with RD localized to the posterior pole in an eye with uveitic sequelae. The B-HEX remained well engaged and maintained excellent mydriasis throughout the surgery despite wide fluctuations in intraocular pressure and anterior chamber fluidics. This is the first series describing use of B-HEX for combined phacovitrectomy due to myriad causes.

Keratitis After Post-Kala-Azar Dermal Leishmaniasis.

PURPOSE: To report 2 cases of keratitis occurring after post-kala-azar dermal leishmaniasis (PKDL) in immunocompetent patients. METHODS: Case report and literature review. RESULTS: Two male patients presented with a dense stromal infiltrate in the temporal and superior aspects of the cornea, respectively. Microbiological workup in both patients did not show any offending organism. Both patients were undergoing treatment for PKDL in the form of oral miltefosine. After careful deliberation, topical prednisolone was started under antibiotic cover for both patients with close follow-up. There was a dramatic improvement with resolution of the infiltrate and a good visual outcome. CONCLUSIONS: We present the first reported cases of keratitis after PKDL, which responded to topical corticosteroid therapy. The treating clinician must be made aware of such a presentation of leishmaniasis especially in endemic areas.

Bacillus cereus infection after Descemet stripping endothelial keratoplasty.

PURPOSE: To report the first case of Bacillus cereus keratitis leading to panophthalmitis in a patient operated for combined Descemet stripping endothelial keratoplasty (DSEK) and phacoemulsification with intraocular lens implantation. METHODS: A 40-year-old woman with corneal decompensation underwent DSEK with phacoemulsification and posterior chamber intraocular lens implantation and developed corneal infiltrate in the host cornea progressing to ring corneal abscess and panophthalmitis within 72 hours of surgery. RESULTS: The microbiological examination of the patient's corneal scraping revealed Gram-positive rods on the smear and the culture grew B. cereus. The source of the organism was found to be in the conjunctival sac of the patient because the conjunctival swab culture from the other eye revealed B. cereus. Despite vigorous topical and systemic antibacterial therapy, and immediate therapeutic penetrating keratoplasty, the infection progressed to panophthalmitis and required evisceration on the fifth day. CONCLUSIONS: Bacillus cereus is a rare potential cause of postoperative infective keratitis after DSEK. The fulminant nature of the infection and its spread resulting in the loss of vision poses diagnostic and therapeutic challenges to corneal surgeons.

Ocular toxicity by latex of Calotropis procera (Sodom apple).

We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.

Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India.

PURPOSE: To determine the epidemiological pattern and risk factors involved in suppurative corneal ulceration in Gangetic West Bengal, eastern India, and to identify the specific microbial agents responsible for corneal infections. METHODS: All patients with suspected microbial keratitis presenting to the corneal clinic at Disha Eye Hospital, Barrackpore, West Bengal, India, from January 2001 to December 2003 were evaluated. Sociodemographic data and information pertaining to the risk factors were recorded. After diagnosing infective corneal ulcer clinically, corneal scraping and cultures were performed. RESULTS: Over a three-year period, 1198 patients with suppurative keratitis were evaluated. Ocular trauma was the most common predisposing factor in 994 (82.9%) patients (P< 0.0001), followed by use of topical corticosteroids in 231 (19.28%) patients. Cultures were positive in 811 (67.7%) patients. Among these culture positive cases, 509 (62.7%) patients had pure fungal infections (P< 0.001), 184 (22.7%) patients had pure bacterial infections and 114 (14.1%) had mixed fungal with bacterial infections. Acanthamoeba was detected in 4 (0.49%) patients. The most common fungal pathogen was Aspergillus spp representing 373 (59.8%) of all positive fungal cultures (P< 0.0001), followed by Fusarium spp in 132 (21.2%) instances. Most common bacterial isolate was Staphylococcus aureus, representing 127 (42.6%) of all the bacterial culture (P< 0.0001) followed by Pseudomonas spp 63 (21.1%). CONCLUSION: Suppurative keratitis in Gangetic West Bengal, most often occurs after a superficial corneal trauma with vegetative or organic materials. Fungal ulcers are more common than bacterial ulcers. Aspergillus spp and Staphylococcus aureus were the most common fungus and bacteria respectively. These "regional" findings have important public health implications for the treatment and prevention of suppurative corneal ulceration in this region of India.