Evaluation of visual evoked potential in chronic myeloid leukemias.

BACKGROUND: Visual complaint is not very uncommon in chronic myeloid leukemia (CML) patients. Our study aims to evaluate the visual pathway using visual evoked potential (VEP) in cases of CML at the time of diagnosis and 6 weeks after tyrosine kinase therapy, to find out treatment impact in asymptomatic as well as symptomatic individuals and compare it with the general population. MATERIALS AND METHODS: This is an analytical cross-sectional study. The study group comprised 20 newly diagnosed cases of CML and 20 age- and sex-matched healthy control population. A thorough history and clinical examination with detailed ophthalmological studies, including VEP, were done. Cases who had VEP abnormalities were then followed-up after 6 weeks post-Imatinib therapy and underwent repeat investigations, including VEP. RESULTS: VEP in cases was significantly deranged (P < 0.001), where 15 patients (75%) had abnormalities in VEP compared to 3 (15%) in control. Post 6 weeks chemotherapy, Out of 10 cases that were followed up, 7 patients had achieved hematological remission with normal VEP finding (P = 0.02). Simultaneously, an increase in hemoglobin (P = 0.002) and reduction in total leukocyte count (TLC) (P = 0.004) were observed. CONCLUSION: Considerable evidence appear to support the notion that CML patients have a higher prevalence of ophthalmic manifestations as compared to the general population, which can be screened earlier with objective tests like VEP. Concurrently, hematological parameters and VEP showed derangement at the time of diagnosis. After 6 weeks of Imatinib treatment, the improvement in VEP can then be attributed to a reduction in TLC. Hence it can be deduced that VEP has paramount importance in the early identification of ophthalmic manifestations, which are reversible with timely treatment.

A comparison of sutureless flanged fixation and 4-point Gore-Tex fixation for scleral-fixated intraocular lenses: a pilot study.

Purpose: Scleral-fixation of intraocular lenses (IOLs) provides an option for eyes that lack sufficient capsular support for in-the-bag IOL placement. The latest techniques for lens fixation include use of a novel suture material, Gore-Tex, and a sutureless method, with flanged intrascleral fixation. The purpose of this pilot study was to compare these methods in terms of anatomic and clinical outcomes. Methods: A total of 35 eyes of patients 18-60 years of age who presented with aphakia, subluxated lens, or ectopia lentis were randomized into two groups. Group A (15 eyes) underwent flanged intrascleral IOL fixation using the Yamane technique; group B (20 eyes) underwent 4-point transscleral fixation of IOL using Gore-Tex suture. The following parameters were compared between groups on day 1, week 3, and month 6 postoperatively: logMAR uncorrected and best-corrected visual acuity, retinoscopy, IOL centration on slit-lamp biomicroscopy, and IOL tilt on ultrasound biomicroscopy. Results: Postoperative visual acuity was better in group B: uncorrected, logMAR 0.89 ± 0.22 versus 0.72 ± 0.24 (P = 0.046); best-corrected, logMAR 0.51 ± 0.18 versus 0.37 ± 0.26 (P = 0.016). No significant difference was found in postoperative retinoscopy and astigmatism between groups. IOL tilt (>100 µm) occurred in 8 cases in group A and in 9 cases in group B; 87% in group A and 100% in group B were well centered. Complications in both groups were minimal. Conclusions: In our small study cohort, both sutureless flanged IOL fixation and Gore-Tex sutured scleral IOL fixation resulted in excellent visual rehabilitation of patients with aphakia and subluxated lenses. Patients who underwent Gore-Tex suture fixation experienced better postoperative visual acuity, IOL centration, and stability.

Results of Deep Anterior Lamellar Keratoplasty for Advanced Keratoconus in Children Less Than 18 Years.

PURPOSE: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children with advanced keratoconus. DESIGN: Retrospective noncomparative interventional case series. METHODS: A retrospective analysis was conducted of 20 eyes of 16 patients who underwent deep anterior lamellar keratoplasty at a tertiary eye care center for advanced keratoconus. The main preoperative parameters measured were decimal uncorrected visual acuity (UCVA), decimal best-corrected visual acuity (BCVA), and average keratometry. The average keratometry was taken as an average of the flat and steep keratometric readings. The follow-up ranged from 24 to 105 months. The main outcome measures were UCVA, BCVA, steep and flat simulated keratometry, refraction, graft clarity, and complications. RESULTS: At the final follow-up, 18 patients had clear grafts in the visual axis area. Mean decimal UCVA changed from 0.06 ± 0.08 to 0.24 ± 0.09. Mean decimal BCVA changed from 0.12 ± 0.19 to 0.45 ± 0.24. The average keratometry decreased from 64.15 diopter (D) to 45.7 D after surgery. The complications noted in the patients were graft rejection (1), shield ulcers (2), graft infection (2), and interface vascularization (4). They were managed accordingly and only 1 patient needed penetrating keratoplasty. CONCLUSIONS: DALK is an effective therapeutic modality for the management of advanced keratoconus in children.

Unusual association of keratoconus with situs inversus and micronystagmus.

Keratoconus is a bilateral non-inflammatory ectasia of the cornea and the presentation is usually as an isolated condition. A few ocular and a number of systemic associations have been described. Situs inversus of retinal vessels is a rare developmental anomaly due to anomalous insertion of optic stalk into the optic vesicle. In this case report, we describe an unusual association of keratoconus with situs inversus and micronystagmus in a young man. An additional feature, a blue dot cataract, was also present. To the best of our knowledge, such a conglomeration of multiple ocular features has not been described previously.

Role of corneal collagen cross-linking in pseudophakic bullous keratopathy: a clinicopathological study.

OBJECTIVE: To evaluate the clinical and histopathologic changes induced by collagen cross-linking (CXL) in pseudophakic bullous keratopathy (PBK). DESIGN: Randomized, prospective, interventional study. PARTICIPANTS: Twenty-four patients with PBK were included in the study. METHODS: Twenty-four patients with PBK underwent CXL followed by keratoplasty at 1 or 3 months. Twelve patients underwent penetrating keratoplasty 1 month after CXL (group A) and the remaining 12 patients underwent penetrating keratoplasty 3 months after CXL (group B). The main outcome measures were assessed at 1 week and 1 month for all patients and at 3 months for 12 patients only. The corneal buttons underwent histopathologic and immunofluorescence evaluation. MAIN OUTCOME MEASURES: Visual acuity, ocular discomfort (tearing, redness, pain), corneal haze, central corneal thickness, histopathologic evaluation, and immunofluorescent microscopy. RESULTS: Mean visual acuity showed a significant improvement after CXL, from 1.925 ± 0.173 before surgery to 1.75±0.296 at 1 month after surgery (P = 0.010), but deteriorated to 1.81 ± 0.23 at 3 months. Symptomatic relief after CXL was at a maximum at 1 month, with a worsening trend at 3 months. Eighteen patients showed a reduction in corneal haze 1 month after CXL. The effect was maintained in 9 of 12 patients at 3 months. The mean central corneal thickness decreased significantly from 846.46 ± 88.741 to 781.0 ± 98.788 µm at 1 month (P<0.01) after CXL, but increased to 805.08±136.06 µm at 3 months. Immunofluorescence microscopy revealed anterior stromal compaction in 7 of 12 patients (58.3%) in group A and in 5 of 12 patients (41.6%) in group B. Staining of keratocyte nuclei with 4',6-diaminido-2-phenylindole dihydrochloride (Molecular Probes, Carlsband, CA) revealed a relative uniform distribution throughout the stroma. CONCLUSIONS: Collagen cross-linking causes symptomatic relief and a decrease in central corneal thickness and anterior stromal compaction in PBK. However, the effect decreases with time and depends on disease severity.

Voriconazole versus natamycin as primary treatment in fungal corneal ulcers.

BACKGROUND: To evaluate the efficacy of topical 1% voriconazole versus 5% natamycin in treatment of fungal corneal ulcers. DESIGN: A prospective, randomized pilot study in a tertiary care hospital. PARTICIPANTS: Thirty patients of microbiologically proven fungal keratitis divided randomly in two groups of 15 patients each. METHODS: Two groups were treated with either 5% natamycin (group A) or 1% voriconazole (group B) topically as a primary treatment for fungal keratitis. The mean size, depth of infiltrate and LogMAR visual acuity at presentation were comparable in both groups (P > 0.05). Patients were followed up for minimum of 10 weeks or till complete resolution of ulcer, whichever was later. Cultures to identify the causative organisms were performed. MAIN OUTCOME MEASURE: Time of resolution of the ulcer. RESULTS: Twenty-nine of the total 30 patients showed complete resolution. Average time of resolution and gain in LogMAR visual acuity was 24.3 days and 1.12 in group A and 27.2 days and 0.77 in group B. These were comparable in the two groups (P > 0.05%). Aspergillus spp. (40%) and Curvularia spp. (30.0%) were found to be most common isolates. CONCLUSION: Topical 1% voriconazole was found to be safe and effective drug in primary management of fungal keratitis, its efficacy matching conventional natamycin. There was no added advantage of using topical 1% voriconazole over topical natamycin as primary treatment in fungal keratitis.