Ophthalmomyiasis externa -- report of two cases.

Ocular myiasis in humans is a rare phenomenon. Here two cases are reported who came to a tertiary care centre with features of unilateral acute catarrhal conjunctivitis. Fly larvae were detected on slit lamp examination and removed after immobilising it with topical 4% lignocaine. Topical antibiotics and steroid drops were prescribed for 2 weeks. The samples were identified as Oestrous ovis by the entomology department of the Institute of Tropical Medicine, Kolkata. The signs and symptoms regressed within 48 hours. The cases are being reported to create awareness among the ophthalmologists regarding larval conjunctivitis especially in developing countries like India, where the general standard of hygiene is low and fly infestation is common.

Evaluation of visual outcome following cataract surgery in a tertiary eye care hospital.

A retrospective study was conducted at the Regional Institute of Ophthalmology (RIO), Kolkata to assess the visual outcome in senile cataract after surgery in the age group of 45-65 years. A total number of 1837 operated eyes (1826 patients) were included in the study during the period of January, 2000 to December, 2000. Patients with low vision unrelated to cataract surgery were excluded. The mean age at cataract extraction was 56 +/- 9 years. Patients were followed for 6 months. Of 1837 operated eyes, 26 (1.4%) were blind (visual acuity < 3/60), 122 (6.6%) had low visual acuity (3/60-6/18) and 1689 eyes (92.2%) gained good vision (visual acuity > 6/18). Of 148 visually compromised eyes posterior capsular opacity (41.2%) was the commonest complication followed by corneal oedema (36.5%) and glaucoma (12.8%). Other posterior segment causes accounted for the remaining cases. The study emphasises the need for proper selection, good pre-operative check-up, skilled surgery and regular follow-up to improve the qualitative aspect of cataract surgery.

Epidermal naevus syndrome--a case report.

A case of epidermal naevus syndrome in a 25-year-old male presenting with maldevelopment of the lid margin in the left eye, pigmentation of the left half of the body and alopecia is presented here along with a brief discussion of literature.

Conjunctival rhinosporidiosis.

Conjunctival rhinosporidiosis is usually a surprise diagnosis in histological section of an excised conjunctival mass. The condition is rarely encountered outside the endemic coastal areas of South India. Accurate diagnosis of this rare condition is infrequent in clinical practice; tumour, neoplasm, papilloma being the common misdiagnoses. Herein, a report of a case of an 18-year-old otherwise healthy male who attended outpatient department of Regional Institute of Ophthalmology, Medical College, Kolkata with a red fleshy papillomatous growth about 7 mm x 4 mm in size, in the palpebral conjunctiva just behind the intermarginal strip of his right upper lid. His routine blood examination was within normal limits. The growth was excised under local anaesthesia and histopathological examination revealed rhinosporidiosis. There was no recurrence of the growth within one month of follow-up.

Mutations in MYOC gene of Indian primary open angle glaucoma patients.

PURPOSE: Glaucoma is the second leading cause of blindness worldwide after cataract. Defects in the myocilin gene (MYOC) have been shown to be associated with Primary Open Angle Glaucoma (POAG), the most common form of the disease, especially in its juvenile form. Most of the reported mutations in MYOC are in POAG patients of Caucasian origin. A few studies have been reported on Asian patients (such as Chinese, Japanese, and Koreans) but none from the Indian subcontinent. The purpose of this study was to investigate the molecular basis of POAG among Indians, using MYOC as the candidate gene, and broaden our understanding on the pathogenesis caused by MYOC. METHODS: Fifty-six unrelated POAG patients, comprising 39 sporadic cases and 17 patients having familial history for POAG were enrolled in this study. The coding sequence of the gene was amplified by polymerase chain reaction (PCR) using genomic DNA from 30 POAG patients, followed by sequencing of the PCR products. Nucleotide changes were detected by identifying double peaks in the chromatogram due to heterozygosity and pairwise BLAST analysis of the sequence output data against the normal copy of the MYOC cDNA. Alteration of restriction sites due to nucleotide changes was identified. Twenty-six patients (not sequenced) and controls were screened for nucleotide changes by allele specific restriction digestion of the PCR products followed by separation of the digested DNA fragments by polyacrylamide gel electrophoresis. RESULTS: From a pool of 56 unrelated POAG patients two mutations were identified. A putative novel mutation (144 G->T; Gln48His) of a conserved amino acid was detected in the exon 1 of MYOC from three unrelated patients but none in the 51 control samples examined. The other mutation (1109 C->T; Pro370Leu), located in exon 3 and detected in a family affected with POAG, cosegregated with the disease and was not present in control samples. Two single nucleotide polymorphisms (SNPs) were identified; one in the promoter region (-83 G->A) and the other in the coding sequence (227 G->A; Arg76Lys). These two SNPs were found to be highly heterozygous both in the control (0.480) and the patient (0.477) populations, and were observed to be in linkage disequilibrium. CONCLUSIONS: The presence of a novel non-conservative change in codon 48 of MYOC in 3 POAG patients, but none in the healthy controls, suggests a causal association of the mutation with the disease, either singly or in combination with other genetic loci. The other point mutation (Pro370Leu) detected in the members of an affected POAG family represents a hotspot of mutation in the gene. Two identified SNPs (-83 G->A and 227 G->A) are not associated with the disease phenotype but could be used as highly informative markers in POAG affected families to determine any causal association of MYOC with the disease, and for identification of presymptomatic carriers in the family, where applicable. A comparison of our data with other studies revealed that these two polymorphisms are in complete linkage disequilibrium among Asians, but not among other ethnic groups studied so far.

Distribution of p53 codon 72 polymorphism in Indian primary open angle glaucoma patients.

PURPOSE: Glaucoma is a complex neurodegenerative disorder of the eye. Primary Open Angle Glaucoma (POAG) is the most common type, accounting for over half of the total cases. Recently, a significant difference in the distribution of the codon 72 polymorphism of the tumor suppressor gene p53 between control subjects and POAG patients of Chinese origin (p=0.00782) was demonstrated. The proline residue at codon 72 of the p53 gene was significantly over represented in the POAG patients relative to healthy controls. The purpose of this study was to investigate whether the reported association between the p53 polymorphism and POAG is a common phenomenon irrespective of geographical location or ethnicity of the population. METHODS: Sixty seven unrelated POAG patients, ranging from 10-65 years of age (mean+/-SD of 41.16+/-18.52 years), and 112 control subjects having a similar age range of 18-63 years (mean+/-SD of 36.64+/-14.65 years) were enrolled in this study. A region of the p53 gene encompassing two polymorphic sites, a 16 bp duplication in intron 3 and a BstU I RFLP in exon 4, were amplified by polymerase chain reaction from Indian POAG patients and normal healthy controls. A single base change (G to C) in codon 72 alters the amino acid residue from arginine to proline and removes the polymorphic BstU I site mentioned above. The amplified DNA fragments were digested with the restriction enzyme and the digestion patterns of the fragments were used to identify the alleles for both the polymorphic sites. RESULTS: No significant association between p53 alleles and Indian POAG patients were observed by analyzing either codon 72 polymorphism (p=0.5627) or the intronic 16 bp duplication polymorphism (p=0.059). Haplotype analysis, reported to be a better predictor of association of the p53 gene with different types of cancer, was also performed and no association of any haplotype was detected with POAG (p=0.1831). CONCLUSIONS: Association between the p53 gene encoding for proline at codon 72 and POAG presumably exists in some ethnic populations but cannot be used as a predictor for the role of the gene as a common regulator of cell death of retinal ganglions leading to POAG.

Role of potassium hydroxide mount in rapid diagnosis of fungal corneal ulcers.

The aim of the study was to establish the importance of KOH mount in rapid diagnosis of fungal corneal ulcers. Corneal scrapings were collected from 50 patients with corneal ulcers where clinical features suggested fungal aetiology and ulcers showed no signs of healing on initial treatment. Corneal scrapings were subjected to wet mount with 10% KOH, Gram's stain, and culture on SDA media. Wet mount showed fungal elements in 34 cases (68%) and were classified according to morphology. Gram's stain of corneal scrapings did not provide much help. Fungal culture was positive in 9 (26.4%) out of 34 cases. Specific antifungal treatment was instituted in all cases that showed positive wet mount without waiting for culture reports and on follow-up all these 34 patients showed improvement. Thus wet mount with 10% KOH can be relied upon as the singlemost important screening tool for rapid diagnosis of fungal corneal ulcer and treatment should be dispensed on its basis.