Donor demographics and factors affecting corneal utilisation in Eye Bank of North India.

INTRODUCTION: Nearly 6.8 million people in India have vision less than 6/60 in at least one eye due to corneal diseases; of these, about a million had bilateral involvement. PURPOSE: To identify the challenges faced; the trends in collection, storage and utilisation of corneal tissues in an eye bank in north India. MATERIALS AND METHODS: The past records of Eye Bank linked to a tertiary hospital in northern India were analysed from November'1999 to October'2015 with respect to number of eye donations per year, donor demographics and utilisation of corneal tissues. RESULTS: The number of donations during the first 6 years were 100, 279 in the next 5 years and 473 in the last 5 years. The mean donor age was 63.2 ± 19.5 years. The percentage of donors less than 30, 31-60 and more than 60 years was 10%, 28% and 62%. Forty-two percent donations were from the hospital. The average time between the death and enucleation was 4.74 ± 5.31 hours. The percentage of corneas used in the donor age groups less than 30, 31-60 and above 60 years was 61.9%, 61.6% and 53.8%, respectively. The usability rate of the corneas from home and hospital was 63.7% and 55.3%, respectively. CONCLUSIONS: The eye bank had a lukewarm response in the beginning, but gained momentum with time. The myths and beliefs prevalent in our society deter people from donating eyes freely. Each eye bank needs to individualise its problems and find solutions for adequate procurement and utilisation of tissue.

Usability of donor corneas harvested from the deceased having septicaemia or malignancy.

CONTEXT: There is a wide gap between supply and demand in relation to healthy corneal grafts. Specific contraindications like infection and malignancy lead to non-usage of many grafts, despite the fact that deeming graft unhealthyness for these two contraindications is debatable. AIMS: This study was conceptualized to assess if corneas donated from the deceased with septicaemia or malignancy can be deemed fit for implantation. SETTINGS AND DESIGN: Retrospective histopathological and microbiological analysis of cadaveric donor corneas. METHODS: A total of 76 donor corneas from 38 patients rejected for corneal transplantation in view of patient having septicaemia or malignancy were analysed for pathological and microbiological workup, to look for dissemination of disease within corneal tissue. Pathology workup included gross and microscopic histopathological evaluation of tissue. Microbiology workup included Grams stain and KOH with calcofluor mount, culture in blood agar, chocolate agar, Sabourauds dextrose agar and Mc Conkeys broth. RESULTS: A total of 46 donor corneas of 23 septicaemia patients when evaluated showed presence of culture positive infection in 18 patients (78.2%). Histopathological examination done for 30 donor corneas from 15 cancer patients did not reveal presence of tumour cells in the specimen. Corneas of two of cancer patients having septicaemia revealed growth on cultures. CONCLUSIONS: Corneal tissues harvested from septicaemia donors showed significantly higher incidence of corneal contamination, confirming their unsuitability for usage. However, there was no incidence of tumour transmission in corneal tissues of the patients with malignancies, suggesting that they can be considered for ophthalmic purpose.

Effect of Variable Oxidation States of Vanadium on the Structural, Optical, and Dielectric Properties of B2O3-Li2O-ZnO-V2O5 Glasses.

In the present study, the effect of variable vanadium oxidation states on the structural, optical, and dielectric properties of vanadium oxide containing lithium borate glasses has been investigated. Electron paramagnetic resonance studies indicate that vanadium in these glasses is mostly in the V4+ state, having a tetragonal symmetry. As the glass composition of V2O5 increases, tetragonality also increases at the cost of octahedral symmetry. The photoluminescence (PL) spectra of these glasses are dominated by zinc oxide transition, whereas the peaks pertaining to the vanadyl group are not visible in the PL spectra. The optical absorption spectra show a single wide absorption band, which is attributed to V4+ ions in these glasses. The ac conductivity of the glasses increases with an increase in vanadium content. The highest electrical conductivity observed is ∼10-5 S cm-1 at 250 °C for the glass with 2.5 mol % V2O5. Electrical conductivity is dominated by electron conduction, as indicated by the activation energy calculation.

Correlation of progression of diabetic retinopathy with the alterations in retrobulbar circulation.

INTRODUCTION: Color Doppler Imaging (CDI) is used widely to study retrobulbar circulation. OBJECTIVES: To determine the association between progression of diabetic retinopathy (DR) and alterations in retrobulbar arterial circulation using CDI studies. MATERIALS AND METHODS: Prospective observational case series. It is single institutional study of 50 eyes of nonproliferative diabetic retinopathy in 50 patients with type II diabetes mellitus. DR was graded according to ETDRS system. Retrobulbar circulation was studied in patients for Peak systolic velocity (PSV), End diastolic velocity (EDV) and Resistive index (RI) in Central retinal artery (CRA), Ophthalmic artery (OA) and Posterior ciliary artery (PCA) using CDI initially and reevaluated after 6 months or later for any change in retinopathy grade and arterial circulation parameters. The patients were grouped as Group I not showing progression of DR and Group II showing progression. The two groups were compared for any significant change in CDI parameters. RESULTS: The baseline resistive indices were higher than normal population. There was significant increase in RI in PCA and CRA in all patients after 6 months. 14 patients (28%) showed progression of DR and 36 (72%) did not show progression of DR. There was no significant association with progression of retinopathy and CDI findings. (p=>0.05). CONCLUSION: The retrobulbar arterial circulation seems to be affected in all diabetics with DR. The changes appear to be progressive. The CDI findings in arterial circulation however lack predictive power for progression of diabetic retinopathy in non proliferative DR.

Safety and efficacy of low-molecular-weight heparins in prophylaxis of deep vein thrombosis in postoperative/ICU patients: A comparative study.

BACKGROUND: Venous thromboembolism (VTE), although a very common problem in everyday clinical practice, remains asymptomatic in most cases. Clinical diagnosis helps identify those who are going to have thromboembolic episode. A combination of clinical scoring systems like Wells' score and D-dimer assay provide a useful diagnostic tool. Trauma (surgical or accidental) and critically ill patients are found to have greatest risk. Enoxaparin and dalteparin are amongst the most common low-molecular-weight heparins (LMWHs) used for deep venous thrombosis (DVT) prophylaxis in such patients. AIM: The present study is designed to compare their role in preventing DVT in postoperative or critically ill patients and to determine their relative safety profiles. MATERIALS AND METHODS: The study included 36 critically ill adult patients. All the patients were allocated into three groups of 12 patients each. Group I patients received no prophylaxis, group II received inj. enoxaparin s/c 0.6-0.8 mg/kg twice daily, and group III received inj. dalteparin s/c 125-250 units/kg once daily. Routine investigations and coagulation profile were recorded on admission to intensive care unit (ICU) and at every third day thereafter. Patients were daily assessed for pretest probability of DVT using Wells' scoring, and D-dimer test was done on the 7(th) day. Occurrence of any bleeding (visible or occult) was noted, and incidence of DVT was determined in each group using positive results of D-dimer test and the clinical assessment with Wells' score. RESULTS: A significant difference in Wells' score (P < 0.05) was found between groups I and III on day 5 and day 7. A lower, but insignificant difference in the incidence of DVT was found between the study and control groups. No significant difference in major bleeding or other side effects was found. Better hemodynamic status and arterial blood gases in the study groups may indirectly refer to absence of asymptomatic DVT or silent pulmonary embolism in this group. CONCLUSION: The present study suggests that LMWHs, namely, enoxaparin and dalteparin, provide effective means of preventing DVT in high-risk, critically ill or postoperative patients, without causing any significant increase in the risk of bleeding or other side effects. Dalteparin appears to be unaffected by low creatinine clearance as explained by its clearance by a non-saturable mechanism. Still, a more extensive study with larger population is needed to make the outcomes worthwhile.

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.

Retinal nerve fiber layer thickness in Indian eyes with optical coherence tomography.

INTRODUCTION: Measuring the thickness of the retinal nerve fiber layer is a potential method of recognizing axon loss prior to the visual field abnormality. OBJECTIVE: To study normal individuals to quantify peripapillary retinal nerve fiber layer (RNFL) thickness in Asian Indian subjects. MATERIALS AND METHODS: This was a prospective study of 150 normal subjects. Peripapillary RNFL was imaged with Optical Coherence Tomography (OCT3) and the thickness of the RNFL around the disc was determined in four quadrants with a 3.4 mm circle OCT scan. The influence of age and gender was evaluated on various parameters using unpaired t test, Pearson's correlation coefficient and ANOVA. RESULTS: The sample included 66 males and 84 females. The mean age of the study sample was 42.64 +/-13.63 years. The average RNFL thickness was 101.07 +/- 10.13µm with the maximum thickness in the inferior quadrant (127.47±15.57) followed by the superior, nasal and temporal quadrants. The difference between the inferior and superior quadrants was statistically significant (p less than 0.001). There was no significant difference in RNFL thickness between males and females. Negative correlation was found between age and average RNFL thickness, superior and temporal average (Pearson's correlation value = -0.262, - 0.209, - 0.294 respectively and p = 0.02, 0.04, 0.001 respectively). CONCLUSION: The present study provides additional data on the existing database of RNFL thickness in Asian Indians. It is also evident that RNFL thickness decreases with age but there is no relationship with gender.

Low vision devices.

A person with low vision has some useful sight. However, low vision usually interferes with the performance of daily activities such as reading or driving. Because low vision cannot be improved by mere traditional methods (i.e., the use of eyeglasses, contact lenses, etc), persons with low vision often rely on the use of a number of different instruments, called low vision devices, and tailored equipment for improved vision. Low vision devices are described in this article.

Role of amniotic membrane transplantation in ocular surface disorders.

UNLABELLED: The advent of amniotic membrane (AM) and limbal stem cell grafts have transformed the treatment of diseases resulting in ocular surface failure. The current success may be attributed to cryopreservation of human AM, which retains its properties and renders the amniotic epithelial cells nonviable and thus nonimmunogenic. Its unique properties have prompted its application in a large number of ocular ailments. The present article reviews the properties of AM and its uses in ophthalmic practice. KEYWORDS: amniotic membrane transplantation; ocular surface disorders; chemical injury; dry eye.

Conjunctival rhinosporidiosis presenting as a cystic mass-an unusual presentation.

Rhinosporidiosis is endemic in India and Sri Lanka and parts of East Africa and South America. Cases of ocular rhinosporidiosis have also been reported from Nepal. Ocular rhinosporidiosis usually involves the conjunctiva and the lacrimal sac. It usually presents as a polypoidal mass. Cystic mode of presentation has not yet been reported in the literature. We herein report an unusual mode of presentation of ocular rhinosporidiosis presenting as a huge conjunctival cystic mass.

Demograhic pattern, clinical features and treatment outcome of patients with infective keratitis in the eastern region of Nepal.

BACKGROUND: corneal ulcer is one of the major causes of monocular blindness in developing countries. OBJECTIVE: to determine demographic pattern, risk factors, microbiological pattern and treatment outcome of infective keratitis. MATERIALS AND METHODS: a retrospective analysis of hospital records of 44 patients with clinically-diagnosed infective keratitis presenting to B.P. Koirala Institute of Health Sciences in the eastern region of Nepal was carried out. OUTCOME MEASURES: the parameters studied were risk factors and organisms responsible for keratitis. RESULTS: the infective keratitis was mostly prevalent among the males between 21-40 years of age (50%). 79.5 % of them were engaged in agricultural work. Ahistory of corneal injury was found in 30 eyes (68.1%). Vegetative matter was the most common agent of trauma in 17 (56.6%). Culture positivity for microorganisms was observed in 20 (45.5%) samples. Of these, 8 (40%) patients had purely bacterial corneal ulcer. Purely fungal growth was seen in 4 (20%) and mixed in 8 (40%). Staphylococcus aureus was the most commonly isolated bacteria (70%). The other bacteria included Pseudomonas species, E. coli and Acinetobactor. Aspergillus species was the most common fungal organism isolated in 8 (40%) samples. 65.9 % of the patients improved with medical treatment alone. Perforation, endophthalmitis and panophthalmitis were the common complications encountered in 11.3%, 4.5% and 4.5% respectively. CONCLUSION: corneal ulcer is prevalent in males, predominantly amongst the farmers. Ocular trauma with vegetative matter is the commonest predisposing factor. Staphylococcus aureus and Aspergillus species are the most commonly isolated organisms in corneal ulcers.

Herpes simplex keratitis -- an unusual clinical presentation.

A case of posterior corneal abscess with extension into the anterior chamber, in the presence of an intact corneal epithelium and clear anterior corneal stroma, occurring in a young patient is described. The patient responded to treatment with systemic and topical acyclovir. The diagnosis of presumed herpes simplex keratitis was made. We report this unusual presentation of ocular herpes manifesting as a posterior corneal and anterior chamber abscess.

Pattern of ocular tumors in the eastern region of Nepal.

BACKGROUND: ocular tumors are commonly encountered in ophthalmic practice. OBJECTIVE: to study the clinical pattern of ocular tumors in the eastern region of Nepal. MATERIALS AND METHODS: the hospital records of patients with ocular tumors treated at B P Koirala Institute of Health Sciences in the eastern region of Nepal over a period of 5 years (April 2003 - March 2008) were studied retrospectively. RESULTS: of 115 consecutive patients with ocular tumors, 40 (34.75%) were below the age of 21 years, 41 (35.65%) were in the age group of 21-50 years and 34 (29.56%) of age above 50 years. There were 48 (41.73%) and 67 (58.26%) patients with benign and malignant tumors respectively. The common benign tumors were conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma. Among the malignant tumors, basal cell carcinoma was the commonest (22.38%). Retinoblastoma was the most common ocular malignant tumor in the pediatric age group (88.8%). Basal cell carcinoma was the commonest eyelid malignancy (53.57%). CONCLUSION: conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma are common benign ocular tumors, whereas basal cell carcinoma and retinoblastoma are the commonest ocular malignancies in adults and children respectively.

Newborn liver gene transfer by an HIV-2-based lentiviral vector.

Newborn gene therapy, because it can prevent the damage caused by the onset of a disease, deserves specific attention. To evaluate gene transfer in tissues of newborn mice, we used a human immunodeficiency virus (HIV)-2 based lentiviral vector pseudotyped with vesicular stomatitis virus G glycoprotein expressing the green fluorescent protein reporter gene under the control of the cytomegalovirus promoter. We found that very low doses of HIV-2 could infect and be expressed in newborn mice. Under these conditions, the virus was preferentially expressed in the liver and hepatocytes were the predominant target. The treatment was not toxic, the infected liver cells proliferated and the transduced gene was stably expressed. Adult mice could be infected by HIV-2, but the vector was detected in the liver only utilizing the sensitive method of polymerase chain reaction coupled with Southern blot. Direct comparison between newborn and adult recipients demonstrated a much greater efficiency of liver transduction in the newborn mouse. These results indicate that the combination of early intervention and low multiplicity of infection may be a strategy for preferentially and efficiently targeting newborn liver for gene therapy applications.

Induction of potent human immunodeficiency virus type 1-specific T-cell-restricted immunity by genetically modified dendritic cells.

A novel technology combining replication- and integration-defective human immunodeficiency virus type 1 (HIV-1) vectors with genetically modified dendritic cells was developed in order to induce T-cell immunity. We introduced the vector into dendritic cells as a plasmid DNA using polyethylenimine as the gene delivery system, thereby circumventing the problem of obtaining viral vector expression in the absence of integration. Genetically modified dendritic cells (GMDC) presented viral epitopes efficiently, secreted interleukin 12, and primed both CD4(+) and CD8(+) HIV-specific T cells capable of producing gamma interferon and exerting potent HIV-1-specific cytotoxicity in vitro. In nonhuman primates, subcutaneously injected GMDC migrated into the draining lymph node at an unprecedentedly high rate and expressed the plasmid DNA. The animals presented a vigorous HIV-specific effector cytotoxic-T-lymphocyte (CTL) response as early as 3 weeks after a single immunization, which later developed into a memory CTL response. Interestingly, antibodies did not accompany these CTL responses, indicating that GMDC can induce a pure Th1 type of immune response. Successful induction of a broad and long-lasting HIV-specific cellular immunity is expected to control virus replication in infected individuals.

Ocular fireworks injuries. Clinical features and visual outcome.

In a prospective analysis of ocular fireworks injuries over three consecutive years (1997 to 1999) during the Indian festival of Diwali, 42 patients presented with various types of fireworks-related ocular injuries. Twenty two (52%) patients had to be admitted for the management of their ocular injuries.

Cyclodialysis cleft diagnosed by conventional ultrasonography.

This case report describes the diagnosis and management of a traumatic cyclodialysis cleft, in the absence of newer investigating modalities like ultrasonic biomicroscopy (UBM). This entity is frequently difficult to recognize clinically owing to the extreme hypotony and media haze that these patients usually present with, which makes gonioscopy particularly taxing. Adding to the diagnostic dilemma is the difficulty in delineating the lesion ultrasonically due to the extreme anterior location of the cleft. In these situations, high frequency ultrasound has been found to be extremely helpful, but the availability of such sophistication is difficult. Presented here is demonstration of the cleft with a microconvex ultrasound probe of 9 MHz frequency. The patient was successfully managed conservatively. This modality could prove to be a valuable adjunct to the diagnosis of such cases even in the situations of nonavailability of high frequency ultrasonography.

Antiviral chemokines: intracellular life of recombinant C-C chemokine RANTES.

OBJECTIVE: Select C-C and C-X-C chemokines can suppress HIV infection. This is because their receptors are the gateways for HIV-1 entry, determinants of viral tropism and sensitivity. C-C chemokines are most effective against macrophage-tropic viruses, and C-X-C chemokines are most effective against T-tropic viruses. The epitopes on the chemokine molecule responsible for virus inhibition and for chemokines' specificities are not known. The objective of this study was to map the functional domains of prototypic antiviral chemokine, namely, RANTES (regulated-on-activation normal T-expressed and secreted). STUDY DESIGN: Optimal folding of the chemokine molecule is thought to be important for its biologic activity. Anticipating that it will provide a native milieu for folding, we expressed recombinant RANTES molecules in an HIV-2-derived lentivirus mammalian expression system. We focused on the structural landmarks of RANTES to determine their role in its life and function. RESULTS: We found that the flexible amino-terminal region of RANTES was not important for its structural integrity or antiviral activity, either positively or negatively. It was also not important for binding to the CCR5 receptor. Modification of all other domains was detrimental, implying a functional role. However, a more careful analysis revealed that these domains were crucial for controlling stability, transport, and secretion of the molecule. Although all recombinant clones contained signal sequence and were transcriptionally active, they presented three different phenotypes: normal synthesis and secretion, normal synthesis but blocked secretion, and presumed normal synthesis but rapid degradation. Structural considerations and preliminary experiments showing a lack of effect of proteasome inhibitors suggested that the signal recognition particle pathway of translocation and proteasomal pathway of destruction may not be the major determinant of the life of the chemokine. CONCLUSIONS: The amino-terminal domain of RANTES was not essential for its antiviral activity or for its binding to the CCR5 receptor. Although the 1-domain of the core and carboxy-terminal domain may contribute to the antiviral activity of RANTES, they were more important for its intracellular life.

In vitro phenotype of SDF1 gene mutant that delays the onset of human immunodeficiency virus disease in vivo.

OBJECTIVE: Inheritance of a mutant allele of the SDF1 gene delays the onset of human immunodeficiency virus type 1 (HIV-1) disease. Because the mutation lies in the 3' untranslated region of the gene, it was suggested that this mutation may upregulate transcription of the gene, resulting in more abundant SDF1, which in turn inhibits T-tropic HIV-1 and delays disease onset. This implies that this segment of SDF1 gene contains a negative regulatory element. We directly tested this hypothesis in vitro. STUDY DESIGN/METHODS: We cloned the wild-type and the mutant SDF1 gene in an HIV-2 gene transfer vector as well as in a baculovirus expression vector. We expressed the cloned genes in human and insect cells in culture and analyzed the abundance of SDF1 RNA by hybridization and protein using antiviral assays. RESULTS: The abundance of SDF1 RNA synthesized by the mutant clone with the mutation in the 3' untranslated region was no different from that synthesized by the wild-type clone in cultured cells. This was the case for both the HIV-2 long terminal repeat (LTR)-directed expression in human cells and baculovirus promoter-directed expression in insect cells. Both clones apparently synthesized SDF1 with equivalent biologic activity. Similar results were obtained for a mutant with the deletion of a GC-rich segment in the 5' untranslated region. CONCLUSIONS: Mutation of the 3' untranslated exon did not affect SDF1 RNA synthesis in vitro. It also did not appear to affect translation of SDF1 RNA. A similar mutational analysis of the 5' noncoding exon suggested that this region also did not regulate SDF1 expression.