Ocular and adnexal rhinosporidiosis : the clinical profile and treatment outcomes in a tertiary eye care centre.

INTRODUCTION: Rhinosporidiosis may mimic a burst chalazion or a simple conjunctival polyp. OBJECTIVE: To study the demography, histopathological evaluation, treatment modalities, their outcomes and recurrence rates in patients clinically and histopathologically diagnosed as ocular and adnexal rhinosporidiosis. PATIENTS AND METHODS: The study was conducted in the Department of Orbit, Oculoplasty and Oncology at a tertiary eye care centre in South India. Fifty patients were included who were diagnosed with ocular and adnexal rhinosporidiosis. The conjunctival and lid mass underwent complete excision. All patients with rhinosporidiosis of the lacrimal system under went dacryocystectomy (DCT) with care taken to avoid spilling the spores. Diagnosis was confirmed histopathologically. RESULTS: The mean age at presentation was 30.42 years, standard deviation( SD) being 16.89 (1 - 70 years). The mean follow-up was 14.2 months (12 months - 18 months) . The most common site was conjunctiva (n = 26 eyes, 52 %), followed by the lacrimal sac ( n = 13, 26 %) and lids (n = 11, 22 %). All the cases were treated by surgical excision with cautery at the base. There was a single recurrence (2 %) involving the lacrimal sac. Endonasal polypectomy combined with exploration in the sac region was done. There were no further recurrences during subsequent follow-up. CONCLUSION: Rhinosporidiosis is an ocular disorder with high recurrence rates reported. We recommend histopathological examination in every case following excision biopsy for conclusive diagnosis. Recurrence rates can be very low if a complete meticulous excision coupled with cauterization of the lesion is performed.

Microbial contamination in open globe injury.

INTRODUCTION: Endophthalmitis is the most dreaded complication of ocular trauma and knowledge of the microbial contaminants is essential to start empirical antibiotic therapy. PURPOSE: To determine incidence of contamination after open globe injuries (OGI) in our setup and to identify the spectrum of microorganisms contaminating open globe injuries. MATERIAL AND METHODS: A prospective study including 50 consecutive eyes of open globe injury over a period of two years was conducted. Intra-operatively, 4 - 5 samples were taken from the inferior conjunctival sac and anterior chamber at the beginning and end of the open globe injury repair. Any abscised tissue or foreign body was also sent for culture sensitivity. A vitreous tap was taken from eyes with posterior segment trauma with signs of endophthalmitis. RESULTS: Microbial cultures were positive in13 eyes (26 %). The microbial spectrum included Aspergillus species in 45.6 %, Alternaria in 15.2 %, Curvularia in 15.2 %, Staphylococcus aureus in 7.6 %, Bacillus species in 7.6 %, and Streptococcus pneumoniae in 7.6 %. Of these 13 eyes, nine eyes developed clinically evident frank endophthalmitis during follow-up. Overall, endophthalmitis developed in 20 eyes (40 %). There was a significant association between the initial contamination and development of endophthalmitis (p less than 0.05). 53 % of culture positive cases achieved ambulatory vision compared to 73 % of culture-negative cases. CONCLUSION: Initial contamination was seen in 26 % of OGI cases. Aspergillus (fungus) was the commonest contaminant. There was a strong correlation between the initial contamination and development of endophthalmitis. Culture-negative cases had a trend towards better final visual outcome than culture-positive cases. Close follow up of cases showing contamination following OGI is recommended.

Outcomes of manual small incision cataract surgery under topical anesthesia with lignocaine 2% jelly.

INTRODUCTION: The manual small incision cataract surgery (MSICS) is the surgery of choice in countries with a huge back-log of cataract blindness. OBJECTIVE: To evaluate the outcome of manual small incision cataract surgery (MSICS) under topical anesthesia with lignocaine 2 % jelly. MATERIALS AND METHODS: This study was a prospective interventional case series. One hundred and twenty eight patients of senile cataract were operated by MSICS under topical anesthesia using lignocaine 2% jelly. No intra-cameral anesthesia was used. The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience and complications. RESULTS: The mean pain score was 0.82 (SD +/- 0.97). Seventy-one patients (55.4 %) had a pain score of zero, that is, no pain. One hundred and twenty one patients (94.5 %) had a score of 3 or less, that is, mild to none pain. All the surgeries except two were complication- free and the surgeon's experience was favorable in terms of the patient's cooperation, anterior chamber stability, difficulty, and complications. CONCLUSIONS: MSICS can be performed under topical anesthesia with lignocaine jelly, which makes the surgery patient-friendly, without compromising the outcome.

Pterygium surgery with conjunctival limbal autograft with fibrin glue under topical anaesthesia with lignocaine 2% jelly.

OBJECTIVE: To evaluate the efficacy of lignocaine 2 % jelly as topical anesthesia in pterygium surgery with conjunctival limbal autograft using fibrin glue. MATERIALS AND METHODS: A non-randomized interventional study was carried out including twenty-one patients who presented with primary pterygium. Under 2% lignocaine jelly, surgical dissection of the pterygium, scraping of corneal bed with crescent blade, excision of Tenons capsule, harvesting conjunctival limbal autograft superiorly, and securing it with respect to limbus and stromal orientation with fibrin glue were done. Postoperatively, the patients discomfort and pain were evaluated by Wongs pain scoring system. RESULTS: The mean pain score was 0.70 ± 0.97. Only one patient (4.76%) out of the whole series experienced pain who rated more than three on the visual analog scale of 5. Thirteen patients (61.9%) had pain score of zero, that is, no pain. The surgeons evaluation of the technique in terms of surgical ease and complications was favorable. There were no dislodged grafts and no cases required suturing. There were no cases of infection, significant inflammation, epithelial problems and reduction in visual acuity. There was a single case of recurrence (4.76%) five months postoperatively which was managed conservatively. CONCLUSIONS: Topical anesthesia with lignocaine 2% jelly using fibrin sealant is safe and effective in pterygium surgery allowing for short operative times. It results in low pain and good aesthetic and functional outcomes.