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1.
Indian J Ophthalmol ; 72(6): 920, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38804806

RESUMEN

BACKGROUND: A healthy lid-wiper is an important component of a healthy ocular surface. Any abnormality or irregularity of the lid wiper can potentially damage a relatively healthy ocular surface. Stevens-Johnson syndrome, toxic epidermal necrolysis, and ocular cicatricial pemphigoid are some of the examples that can result in lid-margin keratinization during the course of the disease. These permanent changes at the lid margin mechanically abrade the corneal surface and facilitate corneal neovascularization. The corneal clarity is lost over time, and the patients have corneal blindness. PURPOSE: This video discusses the role of a healthy lid-wiper, conditions causing lid-margin keratinization and subsequent lid-wiper keratopathy, and surgical technique in mucous membrane grafting. SYNOPSIS: The video demonstrates the technique of restoration of a healthy lid margin by doing a mucous membrane graft for lid-margin keratinization and its role in the prevention of corneal blindness. HIGHLIGHTS: Lid-margin keratinization is essentially a chronic sequela and is often ignored till irreversible corneal changes develop. Early intervention in the form of mucous membrane grafting can prevent corneal vascularization and loss of corneal clarity. VIDEO LINK: https://youtu.be/NGMlqUp_qLU.


Asunto(s)
Enfermedades de la Córnea , Membrana Mucosa , Humanos , Enfermedades de la Córnea/cirugía , Enfermedades de la Córnea/diagnóstico , Membrana Mucosa/cirugía , Párpados/cirugía , Enfermedades de los Párpados/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Córnea/cirugía
3.
Int Ophthalmol ; 44(1): 160, 2024 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-38536560

RESUMEN

PURPOSE: To compare anterior chamber angle (ACA) parameters measured by Anterior Segment Optical Coherence Tomography (ASOCT) and biometric parameters measured by Swept-Source (SS) OCT-based biometry among patients with suspected occludable angles and open angles. METHODS: An analytical, cross-sectional study was performed on subjects attending our ophthalmology outpatient department with suspected occludable angles (van Herick grades 0, 1, and 2) in group 1, and with open angles (van Herick grades 3 and 4) in group 2. Each subject underwent a complete ophthalmic examination to exclude any intraocular pathology like cataract. We recruited 128 eyes of 64 subjects, 34 in group 1 and 30 in group 2. Each eye was henceforth subjected to ASOCT (Spectralis, Heidelberg Engineering, Heidelberg) and SS-OCT-based optical biometry (IOL Master 700, Carl Zeiss Meditec AG). Anatomical parameters were recorded and compared between the two groups. RESULTS: The main outcome measures of the study included nine ASOCT parameters (central corneal thickness [CCT], lens vault, AOD750, ACA, TISA750 [nasal and temporal], and ACW) and five optical biometric parameters (CCT, ACD, WTW, LT, and axial length). We found a significant difference (p < 0.05) among all the anatomical parameters between the two groups, except CCT which was not significantly different (p = 0.297). CONCLUSIONS: ASOCT and SSOCT biometry overcome the challenges of gonioscopy and allow screening for angle closure disease in otherwise normal subjects. ASOCT may serve as an alternative to gonioscopy as it clearly separates occludable angles from open angles in a non-invasive and objective manner.


Asunto(s)
Glaucoma de Ángulo Cerrado , Tomografía de Coherencia Óptica , Humanos , Tomografía de Coherencia Óptica/métodos , Estudios Transversales , Presión Intraocular , Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Cerrado/patología , Cámara Anterior/diagnóstico por imagen , Cámara Anterior/patología , Biometría , Gonioscopía , Segmento Anterior del Ojo/diagnóstico por imagen , Segmento Anterior del Ojo/patología
5.
Indian J Ophthalmol ; 72(2): 190-194, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38099361

RESUMEN

PURPOSE: There has been a sudden increase in the number of rhino-orbital mucormycosis cases, primarily affecting patients recovering from COVID-19 infection. The local health authorities have declared the current situation an epidemic. In this study, we assess the role of exenteration in preventing disease progression and improving survival in patients with rhino-orbital mucormycosis. METHODS: The patients undergoing exenteration were grouped into the exenteration arm and those denying exenteration were grouped into the nonexenteration arm. The patients were followed at 1 month and 3 months. The 6-month survival data were collected telephonically. Continuous data were presented as Mean ± SD/Median (IQR) depending on the normality distribution of data, whereas the frequency with percentages was used to present the categorical variables. Kaplan-Meier survival curves were created to estimate the difference in survival of patients with exenteration in rhino-orbital mucormycosis versus those without exenteration. RESULTS: A total of 14 patients were recruited for our study based on the inclusion and exclusion criteria. All the patients were qualified for exenteration; however, only eight patients underwent exenteration and six patients did not consent to exenteration. At the end of 3 months in the exenteration group, four (50%) patients died. Two patients died within a week of exenteration, whereas two patients died after 2 weeks of exenteration. The deaths in the first week were attributed to septic shock and the deaths happening beyond 2 weeks were attributed to severe meningitis. The Kaplan-Meier survival analysis showed the cumulative probability of being alive at 1 month in the exenteration arm to be 85%, and it decreased to 67% by 53 days and subsequently remained stable until the end of 3 months. CONCLUSION: The Kaplan-Meier survival analysis did not show a survival benefit of exenteration at 3 months and 6 months in COVID-associated rhino-orbital mucormycosis.


Asunto(s)
COVID-19 , Oftalmopatías , Infecciones Fúngicas del Ojo , Mucormicosis , Enfermedades Orbitales , Humanos , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Mucormicosis/cirugía , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/tratamiento farmacológico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , COVID-19/complicaciones , Antifúngicos/uso terapéutico
7.
Indian J Ophthalmol ; 71(11): 3522-3527, 2023 11.
Artículo en Inglés | MEDLINE | ID: mdl-37870018

RESUMEN

Purpose: To determine the demographic and microbiological profile involved in the causation of corneal ulcers in Eastern India during the COVID era. Method: Patients presenting with corneal ulcers fulfilling the inclusion and exclusion criteria were taken as the case. The study duration was from January 2021 to December 2021. Socio-demographic details and information about risk factors were noted. A detailed corneal examination followed by corneal scraping was performed for microbiological evaluation. Results: In 1 year, 99 infective corneal ulcer patients were evaluated. Farmers (24.2%) were found to be maximally affected by corneal ulcers. The peak in cases was recorded from October to December (38.4%). Ocular trauma was the commonest risk factor (42.4%). The majority (80.8%) of patients were already on some topical antimicrobials. 22.2% of samples showed fungal filaments on KOH mount; 54.5% of these cases turned out to be culture-positive. 17.56% of KOH-negative samples turned out to be culture-positive (fungal). Overall, the culture positivity rate was 28.28% out of which fungal isolates were 89.28% and bacterial isolates were 10.72%. Fusarium species were identified as the most common organism contributing 42.85%, followed by Aspergillus fumigatus (14.28%). 10.72% of cases were culture positive for Pseudomonas aeuroginosa. Conclusion: Trauma with the organic matter was the predominant cause of fungal keratitis. In this study, fungal keratitis was found to be more common. Fusarium was the most common isolate.


Asunto(s)
COVID-19 , Úlcera de la Córnea , Infecciones Fúngicas del Ojo , Humanos , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/epidemiología , Úlcera de la Córnea/microbiología , Estudios Transversales , Atención Terciaria de Salud , Úlcera , Incidencia , COVID-19/epidemiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/epidemiología , Infecciones Fúngicas del Ojo/microbiología , Centros de Atención Terciaria , India/epidemiología , Estudios Retrospectivos
8.
BMJ Case Rep ; 16(9)2023 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-37751986

RESUMEN

Management of subluxated cataracts is challenging, especially in cases with more than 5 clock hours of subluxation. Capsular bag stabilising devices are of utmost importance in these cases. We report two cases of post-traumatic lens subluxation of more than 6 clock hours, in which the bag was stabilised intraoperatively using two capsular tension rings (CTRs) placed diametrically opposite to each other, in place of the conventional Cionni ring. Slow phacoemulsification was done followed by intraocular lens (IOL) implantation. Postoperatively, the IOLs were found to be well centred. Also, the use of two CTRs maintains the shape of the capsular bag and prevents lens epithelial cell migration and capsular cocontraction.


Asunto(s)
Extracción de Catarata , Catarata , Luxaciones Articulares , Subluxación del Cristalino , Cristalino , Lentes Intraoculares , Facoemulsificación , Humanos , Implantación de Lentes Intraoculares , Catarata/complicaciones , Subluxación del Cristalino/etiología , Subluxación del Cristalino/cirugía , Luxaciones Articulares/cirugía
9.
Indian J Ophthalmol ; 71(3): 957-961, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36872717

RESUMEN

Purpose: To analyze the correlation between the mean retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness with axial length and refractive errors among children aged 5-15 years. Methods: This cross-sectional, observational study was done on 130 eyes of 65 consecutive subjects with refractive errors. The patients were evaluated for RNFL thickness and macular GCL thickness using spectral domain- optical coherence tomography. Results: One hundred and thirty eyes of 65 subjects aged between 5 and 15 years were divided into three groups based on their spherical equivalent in diopters (D). The children with a spherical equivalent of ≤-0.50 D were considered myopic, ≥-0.5 to ≤+0.5 D were considered emmetropic, and ≥+0.50 D were considered hypermetropic. RNFL thickness and GCL thickness were correlated with age, gender, spherical equivalent, and axial length. The mean global RNFL thickness was 104.58 µm ± 7.567. Conclusion: There exists a negative correlation between RNFL thickness and macular GCL thickness with increasing severity of myopia and increase in axial length, and the possible reason could be stretching of the sclera, which further leads to stretching of the retina, resulting in thinner RNFL and macular GCL thickness.


Asunto(s)
Miopía , Errores de Refracción , Humanos , Niño , Preescolar , Adolescente , Estudios Transversales , Retina , Fibras Nerviosas
10.
Indian J Ophthalmol ; 71(1): 249-256, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36588245

RESUMEN

Purpose: To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the "second wave" of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.


Asunto(s)
COVID-19 , Mucormicosis , Enfermedades Orbitales , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Mucormicosis/diagnóstico , Mucormicosis/epidemiología , Estudios Transversales , Centros de Atención Terciaria , Pandemias , COVID-19/complicaciones , COVID-19/epidemiología , Factores de Riesgo
11.
Indian J Ophthalmol ; 71(1): 320, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36588275

RESUMEN

Background: In acute chemical injury, damage can range from ocular surface epithelial defects to limbal and scleral ischemia. This may subsequently progress to corneal or scleral melting and perforation and finally result in phthisis bulbi. Thus, acute chemical injury is a potentially blinding condition and warrants attention. The accurate technique to assess the damage incurred should be practiced to avoid undertreatment and subsequent complications. Surgical intervention wherever needed should be appropriately timed and should be performed. The primary aim of medical or surgical intervention in acute chemical injury is to attain a stable and epithelized ocular surface. Even a conjunctival phenotype over the cornea is a desirable outcome. Purpose: This video discusses the nuances involved in the assessment and planning of Tenon advancement with amniotic membrane grafting for treating limbal ischemia in acute chemical injury. Synopsis: The video demonstrates the technique of restoration of limbal vascularization by performing Tenon advancement with amniotic membrane grafting and its outcome. Highlights: Ocular surface painting with fluorescein dye is essential to assess the areas of surface involvement. Merely instilling the fluorescein dye in the cul-de-sac will underestimate the extent of the damage. Tenon advancement should ideally be planned between 7 and 10 days following an injury when actual limbal blanching is obvious. A stable and epithelized ocular surface is the desirable outcome irrespective of the epithelial phenotype. Video Link: https://youtu.be/06XhwLKnsIA.


Asunto(s)
Quemaduras Químicas , Quemaduras Oculares , Limbo de la Córnea , Humanos , Córnea , Esclerótica , Conjuntiva , Isquemia , Fluoresceínas , Quemaduras Químicas/complicaciones , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/cirugía , Limbo de la Córnea/cirugía , Quemaduras Oculares/inducido químicamente , Quemaduras Oculares/complicaciones , Quemaduras Oculares/diagnóstico
13.
Indian J Ophthalmol ; 70(12): 4470-4471, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36453378

RESUMEN

Background: Steven-Johnson syndrome (SJS) is a serious disorder affecting the skin and mucous membrane, causing multiple flaccid bullae and purpuric rashes with sheet-like epithelial detachment including the ocular surface. The long-term outcomes following SJS are dismal and manifest as corneal vascularization, lid-wiper keratopathy, and severe dry eyes. The disease course can be modified if amniotic membrane graft is performed at the first week of disease, and the above-said complications can be avoided. This procedure thus not only decreases the morbidity but also improves the quality of life. Purpose: This video discusses the long-term sequelae of SJS which can be modified with timely intervention during the acute stage and thus significantly decreases morbidity. Synopsis: The video demonstrates the simple technique of amniotic membrane transplantation in the acute stage in SJS and its impact in long run. Highlights: There should be a low threshold for doing early amniotic membrane transplantation in patients with SJS with ocular surface involvement. Early intervention can change the disease course and decrease disease morbidity significantly. Video link: https://youtu.be/qgIiVcW56Oo.


Asunto(s)
Amnios , Calidad de Vida , Humanos , Ojo , Cara , Piel , Progresión de la Enfermedad
14.
Discoveries (Craiova) ; 10(3): e154, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36540091

RESUMEN

Tetralogy of Fallot is the most common cyanotic heart disease in children. While doing echocardiographic examination of children with Tetralogy of Fallot, we observed that many older children with this condition had congestion in their bulbar conjunctiva, easily recognizable even from some distance. This observation led us to design and perform a research study in order to find out the presence of conjunctival congestion in children with Tetralogy of Fallot. 85% of children in the ≥ 5-years of age group had conjunctival congestion without any ocular symptom. This novel clinical finding can act as an adjunct clinical sign for recognizing Tetralogy of Fallot in older children.

15.
Pharm Dev Technol ; 27(10): 989-998, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36322702

RESUMEN

Eutectics are multicomponent systems which are an alternative to the conventional techniques for modulating the biopharmaceutical properties of a pharmaceutical. Ezetimibe (ETZ) is a hypocholesterolemic agent with limited dissolution, poor water solubility, and subsequently demonstrates low oral bioavailability. Additionally, ETZ exhibits poor mechanical properties, leading to difficulties in developing dosage forms through direct compression. The present work highlights the applicability of eutectics in the simultaneous improvement of physicochemical along with mechanical properties of ETZ. A pharmaceutical eutectic of ETZ with succinimide (SUC) was prepared by mechanochemical grinding and thoroughly characterized using thermoanalytical, X-ray diffraction, and spectroscopic methods. Intrinsic dissolution rate and pharmacokinetic analysis were also performed for ezetimibe-succinimide (ETZ-SUC) eutectic in contrast to pure ETZ. The eutectic demonstrated ∼2-fold increase in the solubility and dissolution rate. In pharmacokinetic studies, the area under the curve (AUC) for ETZ-SUC eutectic (28.03 ± 2.22 ng*h/mL) was found to be higher than ETZ (8.98 ± 0.36 ng*h/mL), indicating improved oral bioavailability for eutectics. Also, it was observed that enhanced material functionality aids in designing directly compressed tablets, where the eutectic formulation showed an improved dissolution profile over the ETZ formulation. The study demonstrates that eutectic conglomerates could be utilized to develop ideal oral solid dosage formulations.


Asunto(s)
Productos Biológicos , Ezetimiba/química , Solubilidad , Difracción de Rayos X , Preparaciones Farmacéuticas , Disponibilidad Biológica
16.
Cureus ; 14(10): e29953, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36348841

RESUMEN

A paradoxical reaction, in patients with tuberculous meningitis, is described as either worsening of pre-existing tuberculous lesions or the appearance of new tuberculous lesions after initial improvement with anti-tuberculosis treatment. The condition is often difficult to predict. When severe, it may also result in considerable neurological morbidity and even death. We aim to report such a rare case of severe paradoxical response in a young female with tuberculous meningitis. An 18-year-old female developed severe headache, vomiting, altered sensorium, decreased vision, and paraparesis. She was on anti-tuberculosis treatment (ATT) for tuberculous meningitis for the past two months. Radiological findings revealed tuberculomas in the left cerebral and cerebellar hemispheres, adhesive arachnoiditis in the cervical spine, and moderate communicating hydrocephalus. Visual evoked potential tests provided electrophysiological evidence of optic neuropathy in the left eye. The appearance of new (tuberculoma and adhesive arachnoiditis in the cervical spine), as well as aggravation of pre-existing tuberculous lesions (worsened hydrocephalus and worsened clinical features), were evident in the patient, suggestive of severe paradoxical response (with HIV negative serology). The patient was treated with corticosteroids, and antibiotics, and continued the ATT programme in a conservative manner. Nonetheless, as the patient had severe CNS manifestations, severe disabilities (poor vision, paraparesis, or quadriparesis) and fatalities were inevitable. Notwithstanding, it is crucial to recognize the paradoxical manifestations of tuberculous meningitis to avoid misleading diagnoses and unwarranted management strategies.

17.
BMJ Case Rep ; 15(3)2022 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-35361668

RESUMEN

We aim to highlight the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in cases of rhino-orbital mucormycosis. With the COVID-19 pandemic a rapid surge in the number of cases of rhino-orbital mucormycosis has been noted. The gold standard treatment for the progressive orbital disease is exenteration; however, organ salvage should be attempted, when possible. Here comes the role of TRAMB injection. We present a case of a man in his 70s, a known diabetic, who recovered from COVID-19 pneumonia but developed left-sided axial proptosis with orbital apex syndrome and ophthalmic artery occlusion secondary to rhino-orbital mucormycosis. The patient underwent debridement of paranasal sinuses and received intravenous liposomal amphotericin-B and three TRAMB injections. After three TRAMB injections significant improvement in extraocular movements, proptosis and ptosis was noted. An early intervention in orbital disease can avert a more radical procedure.


Asunto(s)
COVID-19 , Mucormicosis , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Humanos , Masculino , Mucormicosis/tratamiento farmacológico , Pandemias
18.
BMJ Case Rep ; 15(2)2022 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-35228223

RESUMEN

A young boy in his 20s presented with sudden diminution of vision in right eye 2 days ago. Best-corrected visual acuity was hand movement in right eye and 20/20 in left eye. Funduscopy demonstrated diffuse retinal opacification and swelling at the posterior pole with a cherry red spot at the macula. There was sparing of the superonasal macula with a patent cilioretinal artery. OCT showed diffuse inner retinal thickening of the temporal macula. He was diagnosed as central retinal artery occlusion with cilioretinal sparing in right eye. He was a known case of Eisenmenger syndrome secondary to a large congenital ventricular septal defect. Medical history was notable for prominent pulmonary hypertension and shortness of breath on exertion. Physical examination revealed a harsh systolic murmur. Extremities showed digital erythema and severe clubbing. Chest X-ray demonstrated cardiomegaly. Laboratory examination revealed haemoglobin-220 g/L, haematocrit-60%, serum iron-20 µg/dL.


Asunto(s)
Complejo de Eisenmenger , Oclusión de la Arteria Retiniana , Arterias Ciliares , Complejo de Eisenmenger/complicaciones , Complejo de Eisenmenger/diagnóstico , Angiografía con Fluoresceína , Humanos , Masculino , Oftalmoscopía , Oclusión de la Arteria Retiniana/complicaciones , Oclusión de la Arteria Retiniana/diagnóstico
20.
Semin Ophthalmol ; 37(1): 49-56, 2022 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-33896370

RESUMEN

PURPOSE: To review the surgical management options in ocular chemical burn, including newer advances. METHODS: Online literature search of published articles over last 5 years on surgical management of ocular chemical burn and newer advances were performed on December 30, 2020. RESULTS: Following literature search and screening using adequate filters, 67 review articles on surgical management of ocular chemical burns were retrieved. The review talks about the surgical management options starting from Debridement in acute stage to various visual rehabilitative procedures in the chronic stage. The review also highlights the evolving surgical advances in this field. CONCLUSION: It is imperative to choose adequate surgical tool wherever applicable; current review discusses the role of each surgical option at different clinical stages in detail.


Asunto(s)
Quemaduras Químicas , Quemaduras Químicas/cirugía , Humanos
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