Seroprevalence of ToRCH Pathogens among Children Admitted to a Tertiary Care Hospital in Eastern India for Cataract Surgery and Cochlear Transplantation.

AIMS: The study aims to investigate the presence of TORCH infections in a child with bilateral cataracts and deafness and report the ToRCH-serology screening profile (Toxoplasma gondii (TOX), rubella (RV), cytomegalovirus (CMV), and herpes simplex virus (HSV-I/II)) in pediatric cataract and deafness. METHODS: Cases that had a clear clinical history of congenital cataracts and congenital deafness were included in the study. The study population consisted of 18 bilateral cataracts and 12 bilateral deafness child who was admitted to AIIMS Bhubaneswar for cataract surgery and cochlear implantation, respectively. Sera of all children were tested qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner. RESULTS: Anti-IgG antibodies against the torch panel were detected in all cataract and deafness patients. Anti-CMV IgG was detected in 17 of 18 bilateral cataract children and 11 of 12 bilateral deaf children. The rates of anti-CMV IgG antibody positivity were significantly higher. In the cataract group, 94.44% and in the deafness group, 91.66% of the patient was Anti-CMV IgG positive. Besides this, 77.7 % of the patient from the cataract group and 75% from the deafness group was anti- RV IgG antibody positive. In bilateral cataract patients, IgG-alone seropositive cases were mostly attributed to CMV (94.44%; 17/18), followed by RV (77.70%; 14/18), HSV-I (27.70%; 5/18), TOX (27.70%; 5/18), and HSV-II (16.60%; 3/18). In bilateral deafness patients, the spectrum of IgG alone seropositive cases was almost the same except for TOX (0/12). CONCLUSION: The current study recommends interpreting ToRCH-screening in pediatric cataracts and deafness with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize diagnostic errors. The sero-clinical-positivity needs to be tested in older children who might pose a threat to the spread of infection.

A study on knowledge, attitude, and practice about eye donation among medical students and healthcare professionals at a tertiary hospital in Eastern India.

Purpose: To assess and analyze the rate of knowledge, attitude, and practice patterns about eye donation among medical and healthcare professionals in a tertiary care hospital in eastern India. Methods: This was a cross-sectional, descriptive study conducted on medical students, resident doctors, and nursing and paramedical staff at a tertiary institute in the year 2020. A pretested, structured questionnaire consisting of 28 questions in the three subsections based on knowledge and awareness, attitudes and beliefs, and practice patterns mainly willingness to donate eyes by pledging, was noted. All the responses were individually scored, and the total scores were calculated. Univariate analysis was done to find out the factors that had a positive or negative influence on the knowledge and willingness about eye donation. Results: Around 270 participants responded to this survey. The majority of the respondents (206, 76.3%) were below 30 years and 64.4% were males. Awareness about eye donation was 95.6% but a willingness to pledge was observed in 51.5% of participants. The total practice score was lower among nonmedicos compared with medicos (3.33 ± 1.22 vs 3.74 ± 0.64), (P < 0.001). On univariate analysis, the Crude Odds Ratio with a 95% confidence interval was 25.787 (5.18-128.33) in the occupational category (P < 0.001). Conclusion: The study reported an adequate knowledge level among doctors and healthcare workers. The practice pattern among the nursing staff and paramedical workers needs to be improved as they can play a pivotal role in strengthening the hospital corneal retrieval program. They can also be the key messengers during public awareness campaigns for eye donations in our country.

Role of clusterin gene 3'-UTR polymorphisms and promoter hypomethylation in the pathogenesis of pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Pseudoexfoliation (PEX) is a multifactorial age-related disease characterized by the deposition of extracellular fibrillar aggregates in the anterior ocular tissues. This study aims to identify the genetic and epigenetic contribution of clusterin (CLU) in PEX pathology. CLU is a molecular chaperone upregulated in PEX and genetically associated with the disease. Sequencing of a 2.9 kb region encompassing the previously associated rs2279590 in 250 control and 313 PEX [(207 pseudoexfoliation syndrome (PEXS) and 106 pseudoexfoliation glaucoma (PEXG)] individuals identified three single nucleotide polymorphisms (SNPs), rs9331942, rs9331949 and rs9331950, in the 3'-UTR of CLU of which rs9331942 and rs9331949 were found to be significantly associated with PEXS and PEXG as risk factors. Following in silico analysis, in vitro luciferase reporter assays in human embryonic kidney cells revealed that risk alleles at rs9331942 and rs9331949 bind to miR-223 and miR-1283, respectively, suggesting differential regulation of clusterin in the presence of risk alleles at the SNPs. Further, through bisulfite sequencing, we also identified that CLU promoter is hypomethylated in DNA from blood and lens capsules of PEX patients compared to controls that correlated with decreased expression of DNA methyltransferase 1 (DNMT1). Promoter demethylation of CLU using DNMT inhibitor, 5'-aza-dC, in human lens epithelial cells increased CLU expression. Chromatin immunoprecipitation assays showed that the demethylated CLU promoter provides increased access to the transcription factor, Sp1, which might lead to enhanced expression of CLU. In conclusion, this study highlights the different molecular mechanisms of clusterin regulation in pseudoexfoliation pathology.

A study on the clinical profile and visual outcome of pediatric ocular trauma in Eastern India.

PURPOSE: Ocular trauma in children is the leading cause of ocular morbidity and unilateral blindness. This study aims to analyze the clinical profile and predictors of final visual outcomes of ocular injuries in the pediatric age group presenting to a tertiary care institute in Eastern India. METHODS: This is a retrospective, observational study conducted on 114 cases of pediatric ocular injuries over 4 years (between 2016 and 2020) at a tertiary care academic hospital in Eastern India. All the data were analyzed based on the demography, nature of the injury, location of the injury, ocular trauma score (OTS), the initial and final visual acuity, and management protocol. The ocular trauma classification was based on the Birmingham Eye Trauma Terminology and the Ocular Trauma Classification System. RESULTS: Majority of the injuries (n = 51, 44.7%) occurred in children between 6 and 10 years and in males from the rural areas (60.75%). The mean age of children was 9 ± 3.47 years (range: 3-16 years). Most of the injuries occurred during outdoor activities (57.9%). Majority of ocular injuries were caused by sharp objects (34, 30%), followed by blunt objects (24, 21%). Open globe injuries (OGIs) were more common (85, 48.3%) as compared to closed globe injuries (CGIs) (71, 40.3%) and nonglobe injuries (20, 11.4%). Mean OTS was 2.8 in 11-16 years indicating a good final visual outcome. Final visual outcome on multivariate analysis showed that the odds of blindness in CGI were 82% less as compared to OGI (odds ratio [OR] 0.18 [confidence interval (CI) 0.03-0.88]; P < 0.03) and that in late presenting (>6 h) group was 47% more (OR 1.47 [0.13-16.47]; P < 0.75) compared to early reporting group. CONCLUSION: Children with ocular trauma commonly present as emergency cases, especially during the festivals in India. Our study reported OGIs to be more common with high risk for blindness. OTS is a useful tool for predicting the visual outcome of OGIs in children. Hence, strategic planning is needed with a focus on the early detection and intervention and also on creating the awareness activities for its prevention. The primary treatment is the key to a successful visual outcome.

Eyewash with balanced salt solution after intravitreal methotrexate injection in a case of vitreoretinal lymphoma: a simple but effective way to prevent ocular surface toxicity.

Intravitreal methotrexate injection (400 µg/0.1 mL) is the current mainstay for managing vitreoretinal lymphoma. Various complications associated with intravitreal methotrexate are cataract, keratopathy, maculopathy, sterile endophthalmitis, optic atrophy, vitreous haemorrhage, etc. The most common adverse effect of intravitreal methotrexate is keratopathy occurring in more than half of cases. The severity may range from diffuse punctate keratopathy to severe epitheliopathy leading to photophobia, pain, visual blurring, epiphora, etc. This may become a reason for reduced compliance with treatment. The management of these complications includes oral folic acid, topical folinic acid supplementations and reduced frequency or cessation of methotrexate intravitreal injections. Here, we report a simple method of eyewash in a large amount of balanced salt solution after the intravitreal injection procedure to reduce the severity of keratopathy, which helped the patient tolerate the treatment.

Sixth cranial nerve palsy and dense cerebral venous sinus thrombosis in a child with nephrotic syndrome.

Nephrotic syndrome (NS) is a common glomerular disease characterised by massive proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. Cerebral venous sinus thrombosis (CVST) is a rare complication in children with NS. Here, we report a case of relapsing NS on steroid therapy, in a male in early childhood who presented with symptoms of headache, vomiting and double vision. On prism cover test there was 25 PD esotropia with abduction restriction in the left eye. Fundus examination showed bilateral papilloedema. He was diagnosed as sixth cranial nerve palsy of left eye. Neuroimaging reported dense CVST. He was managed with subcutaneous low molecular weight heparin and steroids. After 2 months of treatment, there was a complete resolution of esotropia and optic disc oedema. This case highlights the importance of early diagnosis of acute onset esotropia and sagittal sinus thrombosis in a case of NS.

Rare Presentation of Apocrine Hidrocystoma Along the Nasolacrimal Duct.

Hidrocystomas are rare benign cystic tumors of the sweat glands, with no cases of hidrocystoma of nasolacrimal duct previously reported. We present a case of a 28-year-old female with no prior significant medical history presenting with an enlarging mass medial to her right lower eyelid for 2 years. Computed tomography scan showed nodular soft tissue in the middle part of the right nasolacrimal duct. Following complete excision of the cyst, histopathology reported an apocrine hidrocystoma, which is very rare.

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy.

Context: Diabetic retinopathy, a form of microvasculopathy, is the leading cause of the visual abnormality. However, there is no conclusive evidence of the relationship of systemic vascular dysfunction with retinal microvasculopathy. In addition, diabetes-associated cardiac autonomic neuropathy may also compromise vascular function. Aims: The present study intends to correlate arterial stiffness, endothelial function, and heart rate variability (HRV) as a standardized measure of cardiac autonomic neuropathy with diabetic retinopathy. Settings and Design: The present cross-sectional, observational study was conducted in the Department of Physiology. Materials and Methods: Twenty subjects were recruited in group 1 (T2DM, type 2 diabetes mellitus patients, without retinopathy) and group 2 (T2DM with retinopathy). The vascular parameters such as heart rate, peripheral and central blood pressure, augmentation index [AIx (%)], brachial -ankle pulse wave velocity (baPWV), and reactive hyperaemia index (RHI) were recorded. Statistical Analysis Used: Independent sample t-test (for parametric data) and Mann-Whitney U test (for non-parametric data) were employed to compare the variables of two groups. Spearman correlation was used to examine the relationship among the parameters. Linear regression analysis was performed to examine the important vascular predictor for diabetic retinopathy. Results: baPWV was significantly higher in group 2 than in group 1 and positively associated with group 2. RHI was significantly less in group 2 than group 1 and negatively associated with group 2. Among HRV metrics, standard deviation of successive differences (SDSD), root mean square of successive differences between normal heartbeats (RMSSD), and high frequency (HF) power were significantly decreased in group 2 than in group 1. SDSD, RMSSD, and HF power were negatively associated with group 2. RHI emerged as a significant predictor of diabetic retinopathy following linear regression. Conclusions: Overall, the result of the present study indicates that metabolic dysregulation of glucose may affect the normal functioning of the autonomic nervous system and vascular function. Therefore, screening of vascular function and cardiac autonomic tone may be advocated in diabetic patients in routine clinics to examine the existence of any comorbid condition, such as diabetic retinopathy, as systemic vascular changes may also affect ophthalmic vasculature.

Ophthalmology as a career choice among medical students in Eastern India - A cross-sectional study.

Purpose: Several factors influence medical students to choose a specialty branch for post-graduate training, and it is important to understand them so that strategies can be made to make it more attractive and hence the shortage in the workforce can be addressed. This study aimed to identify the factors that influenced under-graduate medical students to choose ophthalmology as their specialty for post-graduate training. Methods: It was a descriptive, cross-sectional, questionnaire-based study, carried out among medical students at a tertiary academic institute in eastern India. In this survey tool, 25 questions were divided into different sections: demographic data, factors influencing the choice and perceptions about ophthalmology as a career option, and the impact of rotatory internship posting on the choice of subject. The various factors were then scored and indexed appropriately. Results: There were 515 participants. The median age was 23 years. The major influencing factor for choosing ophthalmology was "adequate time" (52.04%), and the discouraging factor was "steep learning curve" (58.64%). Age had an odds ratio of 0.781, showing that the lower the age, the higher the chances of being positively inclined toward ophthalmology as a career choice. Similarly, major deciding factors, perceptions, and experiences in ophthalmology had odds ratios of 1.841, 1.725, and 2.057, respectively, showing a positive inclination. Conclusion: The study states that a steep learning curve, personal attitudes, and misconceptions may dissuade the students from taking this subject, but adequate clinical exposure and experience, as well as role models during the internship, can create a positive impact on career choice.

Ocular manifestations in moderate-to-severe psoriasis in India: A prospective observational study.

Purpose: Ocular manifestations in psoriasis are due to direct eye involvement with psoriatic plaques or psoriasis-related, immune-mediated inflammatory processes. The commonly reported pathologies are blepharitis, conjunctivitis, keratitis, dry eyes, and uveitis. Limited data is available on the ocular findings in psoriasis patients in India. In this study, we evaluated various ocular changes associated with moderate-to-severe psoriasis. Methods: In this prospective cohort study, treatment-naive psoriasis patients with Psoriasis Area Severity Index (PASI) score of more than 10 were included. The Ocular Surface Disease Index (OSDI) score, Schirmer's score, tear film breakup time (TBUT), corneal and conjunctival staining score, and meibomian gland dysfunction score were noted. All these parameters were re-evaluated at 8 weeks of follow-up after systemic treatment. Results: Sixty-eight patients were enrolled in the study. The most common ocular pathologies observed in this study were tarsal hyperemia and anterior blepharitis in 128 (94.1%) and 64 (47%) eyes, respectively. Mild, moderate, and severe dry eyes were seen in 26 (19.1%), 14 (10.2%), and 34 (25%) eyes, respectively. Thirty-nine (57.3%) patients complained of significant difficulty watching television or digital screen. In 21 patients evaluated on follow-up at 8 weeks, cornea and conjunctiva's ocular surface staining score increased and TBUT decreased significantly. Conclusion: The most common ocular pathologies observed in this study were anterior blepharitis and moderate dry eye, which significantly affected most patients' daily routines. Screening patients with greater severity of psoriasis would help in early management of such problems.

Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus?

A 15-year-old female patient presented with complaints of headache, blurring of vision, and redness of both eyes for 15 days and fever for 20 days. Her best-corrected visual acuity (BCVA) was 20/40 in both eyes. Anterior segment examination was normal except for subconjunctival haemorrhage in both eyes. Examination of the posterior segment showed disc oedema in both eyes. Her blood investigations revealed platelet count to be 1.5 lakhs per cubic mm, and leucocyte count to be10,700 per cubic mm. CSF culture showed seven cells per microlitre,76% lymphocytes and CSF samples negative for gram stain, acid-fast bacilli, and culture. Further investigation for IgM titre for scrub typhus was positive. She was treated with oral doxycycline. On follow up after three weeks, both the subconjunctival haemorrhage and bilateral disc oedema resolved with BCVA of 20/20 in both eyes. She was kept on follow up and has not presented with any fresh complaints until six months after the initial presentation."

Firework related ocular injuries in Eastern India - A clinico-epidemiological analysis.

Purpose: :Ocular trauma is one of the major preventable causes of ocular morbidity and blindness in children and young adults. Firework injuries account for 20% of ocular trauma. The purpose of this study was to describe the clinical profile and assess the severity of the ocular injuries sustained from fireworks in Eastern India mainly during the festive season. Methods: :This was a retrospective, hospital-based case study of patients with ocular injuries sustained from fireworks during the year 2017-2020. The study was conducted at a tertiary care hospital in Eastern India. Demographic details, type of injury, duration of injury, visual status, diagnostic tests, and management were recorded. Results: Sixty-five patients were reported to suffer from firework-related ocular injuries. The majority of cases were male (51/78.5%). The mean age was 21.78 ± 16.82 years (range: 0-90 years). Children and young adult males were mostly affected (n = 40, 61.5%). Most common offending agent was the bottle rockets (n = 23, 35.4%), followed by bomb and crackers in (n = 18, 27.7%). Majority of the injuries occurred at home environment (n = 37, 56.9%), followed by street (n = 15, 23.1%). About (n = 39, 60%) of the injuries occurred among bystanders. About 40 cases (61.5%) hailed from rural areas. The majority of the cases (n = 46, 70.8%) suffered from closed globe injuries and surgical intervention was required in (n = 40, 61.5%) of the cases. The mean length of hospital stay of fewer than 5 days was required in (n = 42, 64.6%). The final visual acuity of 6/18 or better was achieved in 41 cases (63.1%). Conclusion: :Ocular injuries from fireworks remain a public health problem. Awareness among the masses, preventive measures, and strict implementation of government legislation may help in bringing down the incidence of firework-related ocular morbidity and blindness.

Management of cataract in a case of retinitis pigmentosa with bilateral pseudoexfoliation syndrome.

Retinitis pigmentosa (RP) patients are at higher risk for macular oedema, anterior capsular phimosis and spontaneous dislocation of the implanted lens after cataract surgery. A 70-year-old hypertensive woman presented with diminution of vision in her left eye since 2 years. She had history of cataract surgery in the right eye 1 year ago. Her visual acuity was 20/200 in right eye and hand movements in left eye. Slit-lamp examination showed anterior capsular phimosis with intraocular lens in the right eye and pseudoexfoliation in both the eyes. Fundus examination revealed features of RP in both the eyes. Optical coherence tomography showed bilateral foveal atrophy. The patient underwent phacoemulsification cataract surgery with intraocular lens implantation in left eye and Nd:YAG laser capsulotomy in right eye. Postoperative best corrected distance visual acuity was 20/125 in right eye and 20/80 in left eye. This case highlights a rare coincidence of pseudoexfoliation syndrome in a patient with RP and the precautions undertaken during cataract surgery for an optimal visual outcome.

Invasive fungal disease misdiagnosed as tumour in association with orbital apex syndrome.

Invasive sino-orbital aspergillosis is a rare cause of orbital apex syndrome (OAS) in immunocompetent patients and often misdiagnosed as tumour because of its aggressive nature and invasive patterns. We report a 23-year-old immunocompetent man presenting with painful progressive loss of vision, ophthalmoplegia and proptosis of the right eye suggestive of OAS. MRI with gadolinium contrast showed an enhancing heterogeneous mass filling the paranasal sinuses, extraconal space and extending up to the right orbital apex. A functional endoscopic biopsy reported as invasive sino-orbital aspergillosis. He was started on intravenous voriconazole and maximal surgical debridement was done. He gradually regained his vision to 20/30 in the right eye. A review of literature reported several such cases which were managed medically or surgically but with poor visual recovery. This case highlights the need for awareness among clinicians for early diagnosis and treatment to prevent vision loss and better survival.

Abduction Deficit Mimicking Sixth Nerve Palsy due to Metastasis in Systemic Malignancy: Rare Case Report.

Lateral rectus palsy presenting as abduction deficit resulting in diplopia is attributed to neurogenic causes. Metastasis as a cause of sixth cranial palsy is an extremely rare entity but cannot be overlooked. Cases of metastasis to lateral rectus secondary to lung and breast carcinoma have been reported. Primary adrenocortical carcinoma (ACC) metastasizing to lateral rectus muscle is extremely rare. Here, we report a case of ACC arising from the left adrenal gland that presented with left-sided abduction deficit in a 58-year-old male with vasculopathic risk factors. The case highlights the importance of neuroimaging in cases of isolated nontraumatic sixth nerve palsy or in cases with isolated ocular symptoms with associated systemic findings. The fact that all cases of muscle palsies may not be neurogenic and rare causes such as metastatic muscle involvement must be included as a differential diagnosis in suspected cases has been emphasized.

Ocular Syphilis Presenting as Acute Necrotizing Retinitis in a Human Immunodeficiency Virus-Positive Patient.

The incidence of ocular syphilis is increasing in the developing world even in the era of effective human immunodeficiency virus (HIV) treatment, as there is a potential increase of high-risk sexual behavior. Ocular involvement in the form of uveitis is seen in all stages of syphilis. Diagnosis begins with ophthalmologic examination, but requires serologic testing for confirmation. Ocular syphilis presents with unusual presentations or mimics other diseases and is identified by serological screening. It is curable with a relatively short course of antibiotic treatment, making its recognition a priority. All ophthalmic manifestations of syphilis should be treated with a Centers for Disease Control and Prevention-approved neurosyphilis regimen. In this report, we present a case of necrotizing retinitis with no response to antiviral treatment. On subsequent serological testing it was proved as syphilis in a HIV-positive patient who responded well to intravenous antibiotics with rapid visual recovery. Hence, awareness of this disease will promote early diagnosis and treatment.