Rhinoorbitocerebral actinomycosis.

PURPOSE: To report a case of actinomycotic orbital abscess with subdural empyema and pansinusitis, an unusual presentation of a rarely seen infection. METHODS: Case report. RESULTS: A 35-year-old man sought treatment for signs and symptoms of an orbital abscess 22 days after a dental extraction. Computed tomography demonstrated a left orbital abscess with left pansinusitis and a large subdural empyema. Surgical clearance of all purulent material was done followed by prolonged penicillin therapy. Culture of pus from all sources yielded Actinomycosis israelii. At the time of discharge and 1-month follow-up, the patient had 20/20 vision with no neurologic deficits. CONCLUSIONS: In orbital infections with atypical presentations, unusual pathogens should be considered as the causative agents.

Occupational open globe injuries.

PURPOSE: Occupational ocular trauma is an important cause of acquired monocular blindness in a rapidly industrialising country like India. Knowledge of the epidemiology of occupational eye injuries is essential to formulate viable industrial safety measures. METHOD: We retrospectively reviewed all patients with occupational open globe injuries between 1994 and 1998. We documented the circumstances of the injuries, their clinical findings and the use of appropriate protective eyewear at the time of the injury. The visual acuity 6 months after the injury was the final outcome measure. RESULTS: In this study period we examined 43 patients with open globe injuries sustained at the work place. Thirty-four (79.1%) patients were young males. The iron and steel industry accounted for 19 (44.2%) cases while 8 (18.6%) patients each were from the agricultural, mining and other small scale industrial sectors. At the time of the injury, 33 (76.7%) were not wearing the recommended protective eyewear and 6 (13.9%) were under the influence of alcohol. The injuries were mild in 6 (13.9%), moderate in 18 (41.9%) and severe in 19 (44.2%) patients. At the end of 6 months, 2 (4.7%) patients had a visual acuity of 6/12 or better, 4 (9.3%) had a visual acuity of 6/18 to 6/60 and 29 (67.4.%) had a vision of <6/60. Eight (18.6%) patients were not available for follow up. CONCLUSIONS: Occupational open globe injuries are usually severe and are associated with a poor visual outcome. Mandatory use of protective eyewear and alcohol-free environment at the work place is likely to reduce the incidence of severe occupational open globe injuries.

Congenital retinoschisis: successful collapse with photocoagulation.

We report a case of progressive congenital retinoschis is where the schisis cavity collapsed following argon laser photocoagulation. Despite reports to the contrary, we feel that in the absence of significant vitreous or inner layer traction, photocoagulation applied as light burns in the schisis cavity may be beneficial in collapsing the cavity. Whether or not this collapse of the schisis cavity reduces the risk of rhegmatogenous retinal detachment is unclear.

Orbital abscess: management and outcome.

PURPOSE: To discuss the diagnosis, management and outcome of various types of orbital abscess. METHODS: The medical records of 13 patients diagnosed and treated for orbital abscess were reviewed. The sources of infection included: paranasal sinusitis (n = 5), odontogenic origin of infection (n = 4), one each, temporal fossa abscess, palatal abscess, furuncle on the nose, and secondary to retrobulbar injection of steroid. Computed tomographic scans revealed the presence of an abscess in all 13 cases. Associated findings on CT scan included: sinus disease (n = 8), cavernous sinus thrombosis (n = 2) and subdural empyema (n = 2). All patients were treated with intensive, multiple, intravenous antibiotics and early surgical drainage. RESULTS: Purulent material collected surgically from the orbit cultured Staphylococcus aureus (n = 3), two each Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter species and one each beta-haemolytic Streptococci, Citrobacter frundi and Enterobacter. Final visual acuity was good in 6 patients (6/12-6/6) and no light perception in 6 others. Visual acuity could not be recorded in the infant. The other complications were intracranial abscess (n = 4), cavernous sinus thrombosis (n = 2) and restricted ocular motility (n = 1). CONCLUSIONS: A high index of suspicion is necessary, along with early institution of appropriate diagnostic imaging, and aggressive medical and surgical treatment for a favourable outcome in cases of orbital abscess.

Postoperative endophthalmitis caused by sequestered Acinetobacter calcoaceticus.

PURPOSE: To describe postoperative endophthalmitis caused by sequestered Acinetobacter calcoaceticus. METHOD: Case report. A 40-year-old woman developed recurrence of inflammation after extracapsular cataract extraction with intraocular lens (IOL) implantation. At last recurrence, the capsular bag was studded with white deposits. Intraocular lens was removed along with capsular bag during pars plana vitrectomy. RESULTS: The capsular bag, when cultured, grew A calcoaceticus. The media remained clear with no evidence of recurrence of infection over a 3-month follow-up. CONCLUSION: Postoperative endophthalmitis similar to that caused by sequestered Propionibacterium acnes can be caused by A calcoaceticus.

Papilloedema with peripapillary retinal haemorrhages in an acquired immunodeficiency syndrome (AIDS) patient with cryptococcal meningitis.

A case of cryptococcal meningitis in an AIDS patient who presented with optic disc edema, bilateral retinal and peripapillary haemorrhages is reported.

Topical diclofenac sodium for treatment of postoperative inflammation in cataract surgery.

PURPOSE: To study the effect of a topical non-steroidal anti-inflammatory drug as an alternative to topical steroids for postoperative control of inflammation in cataract surgery. METHODS: The effect of diclofenac sodium 0.1% following cataract surgery was studied and compared to routine corticosteroid, dexamethasone phosphate 1% in a prospective, double-blind randomized study. Both groups were similar in baseline parameters. Postoperative inflammatory response, intraocular pressure and best-corrected visual acuity following standard extracapsular cataract extraction were assessed in both groups in the initial 21 days and the severity of these parameters was graded. The severity of postoperative inflammatory response to the two drugs was graded at 1, 3, 7, 14 and 21 days. Intraocular pressure and visual acuity at baseline and endpoint were compared and statistically analyzed. RESULTS: The two groups did not differ statistically in treatment effect for any of the variables including aqueous cells, flare, ciliary congestion, Descemet's folds, visual acuity and intraocular pressure (p < 0.001). However there seemed to be a trend towards quicker improvement with corticosteroid when cells in the anterior chamber were considered. There were no side effects from topical diclofenac, and it was well tolerated. CONCLUSION: Diclofenac sodium is as effective as topical corticosteroid and can be used as an alternative in routine postoperative treatment following uncomplicated cataract surgery.

Retinopathy of prematurity: incidence and risk factors.

OBJECTIVE: To determine the incidence of Retinopathy of Prematurity (ROP) in high risk babies admitted to the neonatal unit and to study risk factors for it's development. DESIGN: Prospective cohort study. SETTING: Level II Neonatal Intensive Care Unit. SUBJECTS: 100 babies admitted to the neonatal unit during a 4 year period who were below 1500 g or whose gestation was < or = 34 weeks. METHODS: Examination of the eye was done in the neonatal unit or in the neonatal follow up clinic by an Ophthalmologist by indirect Ophthalmoscopy at 4-6 weeks postnatal age. RESULTS: The incidence of ROP was 46%. Of the 100 babies screened, 21 had stage I, 14 had stage II, 8 had stage III and 3 had stages IV and V. The incidence of ROP was 73.3% among < 1000 g babies and 47.3% among < 1500 g babies. The incidence of ROP among 28-29 weeks, 30-31 weeks and 32-33 weeks babies was 83%, 60% and 50%, respectively. The maximum stage of ROP developed between 37-42 weeks post conceptional age in 69% subjects. On univariate analysis, gestation < or = 32 weeks, anemia, Blood transfusions, apnea and exposure to oxygen significantly increased the risk of developing ROP. On multivariate logistic regression analysis, anemia and duration of oxygen therapy were the significant independent predictors of development of ROP. Nine of the 46 babies underwent cryotherapy for threshold ROP. CONCLUSION: The incidence of ROP among high risk babies is significant and duration of oxygen therapy and anemia are independent factors predicting the development of ROP. All high risk babies should be screened for ROP. Cryotherapy is a relatively simple procedure which can be done in the neonatal unit.