Retinoblastoma in adults. Report of three cases and review of the literature.

Retinoblastoma usually presents in children younger than 5 years. To our knowledge, 20 cases of retinoblastoma in adults (older than 20 years) have been reported in the literature. Of 173 patients with histopathologically proven retinoblastoma seen in our institute, three were adults. All the patients had endophytic tumors with vitreous seeds. Ultrasonography did not reveal calcification in two cases. Immunohistochemistry with neuron-specific enolase was used to confirm the diagnosis in two cases. All three patients ultimately required enucleation. None of the patients had been referred with a diagnosis of retinoblastoma. The diagnosis of retinoblastoma should be considered in cases of whitish mass lesion in the fundus of an adult.

Efficacy and safety of apraclonidine in patients undergoing anterior segment laser surgery.

The efficacy of 1.0% apraclonidine (para-aminoclonidine) in preventing the rise of intraocular pressure following anterior segment, laser surgery was evaluated in a randomised double-masked study. Ninety-nine consecutive patients requiring laser treatment of the anterior segment were included in the study. They were randomised into two groups, one receiving 1.0% para-aminoclonidine and the other placebo (vehicle of para-aminoclonidine). The drug caused a statistically significant reduction in pressure after the laser treatment without causing clinically significant side effects such as bradycardia or hypotension.

Tumor necrosis factor allelic polymorphism with diabetic retinopathy in India.

The association of tumor necrosis factor (TNF) with diabetic retinopathy (DR) has been described previously. A total of 207 Asian Indian patients of 15-year duration of type 2 diabetes were identified. This group included (i) 100 patients with DR and (ii) 107 patients without retinopathy (DNR). In this study, we correlated the length of the (GT)n microsatellite di-nucleotide repeat upstream to the promoter region of TNF gene with susceptibility for the development of retinopathy. The microsatellite was polymerase chain reaction amplified and electrophoresed on polyacrylamide gel and silver stained. In our study population, there were 18 alleles ranging from 97 to 131 base pairs (bp). Allele 4 (103 bp) had a higher prevalence (9.81%) in the DNR group compared to that (2.5%) in the DR group (P=0.002). Patients with retinopathy and allele 8 (111 bp) had a tendency to develop proliferative diabetic retinopathy (PDR). In this study of Indian subjects, it is suggested that allele 4 is a low risk allele for developing retinopathy and allele 8 (111 bp) shows an association with PDR.

Corneal endothelial cell density and morphology in normal Indian eyes.

PURPOSE: To describe corneal endothelial cell density and morphology in the Indian population and to compare endothelial cell characteristics in the Indian population with data available in literature for American and Japanese populations. METHODS: Specular microscopy and corneal pachymetry were performed in both eyes of 537 normal Indian volunteers, aged 20-87 years. Parameters studied included endothelial cell density, cell area, coefficient of variation (CV) in cell area and hexagonality. RESULTS: Mean endothelial cell density in the study population was 2,525 +/- 337 cells/mm2. There was a statistically significant decrease in endothelial cell density with age (p < 0.001, correlation -0.387) and the rate of cell loss was 0.3% per year. There was also a statistically significant increase in mean cell area (p < 0.001, correlation 0.362) and CV (p = 0.02, correlation 0.096), and decrease in percentage of hexagonal cells (p = 0.01, correlation -0.127) with increasing age. There was no significant difference in these parameters between fellow eyes of subjects. In all age groups, the mean endothelial cell density was significantly lower than values reported previously in the Japanese population. The values were less than those described in the American population, but the differences were statistically significant only in the 20-30 and 41-50 year age groups. CONCLUSION: Normative data for the endothelium in the Indian population are reported. Endothelial cell density in Indian eyes is less than the values described in the Japanese and American populations.

Management of giant retinal breaks.

A retrospective study involving 40 eyes of 40 patients with giant retinal break is presented. A comparison is attempted between cases where silicone oil is used and in cases where it was not used. The final success rate was found to be same in the two groups on long term follow-up.

Ocular lesions in AIDS: a report of first two cases in India.

Although 444 cases of AIDS have been officially registered till July 1993 from various parts of India, ocular lesions in these cases have not been reported. Till May 1994, ELISA test for HIV 1 and HIV 2 had been done in 12 cases of suspicious ocular lesions which include viral retinitis, endogenous endopthalmitis and active chorioretinitis. Two patients had seropositivity for HIV 1. Ocular lesions include subretinal yellow mass in the first case and cytomegalovirus retinitis and cotton-wool spots in the second case. These two patients also had several systemic infections which include tuberculosis in both and nocardia in one. To the best of our knowledge, these two cases are the first report of ocular lesions in AIDS from India.

A case control study of senile cataract in a hospital based population.

A case-control study (244 cases and 264 controls) was done during 1986-89 on a hospital based population to evaluate the risk factors associated with the etiology of senile cataract. Patient with age between 40-60 years, visual acuity of 6/9 or less, and presence of lenticular opacity of senile origin were included as cases. Age matched individuals with absence of lenticular opacity made up the controls. Multivariate logistic regression analysis revealed that higher systolic BP and number of meals were significantly (P < or = 0.05) associated with presence of senile cataract; whereas higher weight, education and income, and utilization of cooking water had a significant protective effect against senile cataract. The present study helps the clinician to understand the possible risk factors associated with the development of senile cataract and could be helpful in designing a intervention strategy in future.

Retinal detachment secondary to ocular perforation during retrobulbar anaesthesia.

The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At the last follow-up, all eyes had attached retina. One eye did not recover useful vision due to possible concurrent optic nerve damage.

Clinical features and virologic studies in viral retinitis.

Viral retinitis is an important infectious disease of the retina which can occur in both healthy and immunocompromized or immunodeficient individuals. The clinical picture and the role of laboratory studies in diagnosis of viral retinitis are still not well-defined. We correlated the clinical picture and virologic study in the serum and vitreous specimens by Enzyme-linked Immunosorbent Assay (ELISA), rapid immunofluorescence technique and culture in five clinically suspected patients of viral retinitis. None of the patients had any evidence of systemic viral infections. In four patients, the virus was detected by immunofluorescence, ELISA or culture from the vitreous sample. Paired serum samples showed elevation of antiviral IgG titre in two cases and high antiviral IgM titre in all cases. Our study evaluated the role of virological investigations of vitreous aspirate and rising antibody titre in the paired serum samples in the diagnosis of active viral retinitis.

Surgery for stage 5 retinopathy of prematurity: the learning curve and evolving technique.

PURPOSE: To describe our experience with management of eyes with stage 5 retinopathy of prematurity (ROP). METHODS: Closed vitreoretinal surgery was done on 96 eyes of patients with stage 5 ROP. Lens was sacrificed in all but one eye. Surgery involved an attempt to clear all preretinal tissue and open the peripheral trough all round. In most instances bimanual surgery under viscoelastic was performed. RESULTS: At last follow up, anatomical success (defined as attached posterior pole) was achieved in 22.5% cases. Significant postoperative problems included reproliferation and secondary glaucoma. Only two infants obtained mobile vision. CONCLUSION: Late identification of disease, lack of prior treatment such as laser or cryo, and higher incidence of narrow-narrow funnel configuration were responsible for the poor surgical results noted in this series. The poor surgical and functional results reemphasize the need for prompt screening and management of infants at risk.

Endophthalmitis caused by anaerobic bacteria.

A retrospective analysis of 22 patients who underwent pars plana vitrectomy for endophthalmitis and had culture-proven anaerobic bacteria, was done. Elimination of infection with attached retina and recovery of ambulatory vision > or = 2/60 were considered as anatomic success and functional success, respectively. Mean follow-up period was 12.7 months (range, 2 to 48 months). Anatomic success was attained in 14 (63.6%) eyes and functional success in 12 (54.6%) eyes. A poor preoperative visual acuity was found to be associated with poor functional outcome (p < 0.046). In endophthalmitis, a routine anaerobic culture of intraocular specimen is recommended.

Subconjunctival cysts following silicone oil injection: a clinicopathological study of five cases.

PURPOSE: To study the occurrence, risk factors and management of subconjunctival cysts formed following the use of intraocular silicone oil as a tamponade. METHODS: We analyzed 5 cases of single and multioculated subconjunctival oil cysts between 1986 and 1996. RESULTS: Cysts were observed 15 days to 4 months following silicone oil injection. Clinically they showed minimal inflammatory signs but histopathology of removed cysts showed emulsified silicone oil globules with chronic inflammatory cellular infiltration. CONCLUSION: Though silicone oil is considered to be nontoxic, it can cause chronic inflammation when spilled into the subconjunctival space.

pH-adjusted periocular anaesthesia for primary vitreoretinal surgery.

PURPOSE: To evaluate the efficacy of pH-adjusted bupivacaine in conjunction with medial orbital periconal block (periocular anaesthesia). METHODS: Sixty consecutive patients undergoing primary vitreoretinal surgery were enrolled prospectively. RESULTS: Adequate anaesthesia and akinesia with no intraoperative supplementation was achieved in 53 eyes (88.3%). Factors influencing intraoperative supplementation were combined vitrectomy with scleral buckling (p = 0.005) and duration of surgery of more than 2 hours (p = 0.001). No ocular or systemic complication resulted. CONCLUSION: pH-adjusted periocular anaesthesia is safe and effective in patients undergoing primary vitreoretinal surgery.

A case-control study of suprachoroidal hemorrhage during pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To investigate the risk factors associated with suprachoroidal hemorrhage (SCH) during vitrectomy. PATIENTS AND METHODS: Of 6971 pars plana vitrectomies performed between May 1988 and December 1994, SCH occurred intraoperatively in 12 (0.17%) cases. Forty-two age- and sex-matched control subjects were selected by computer-generated random numbers. Preoperative and intraoperative variables were subjected to univariate and conditional logistic regression analysis. RESULTS: Statistically significant risk factors for SCH after univariate analysis included myopia (P = .048), aphakia or pseudophakia (P = .024), rhegmatogenous retinal detachment (P = .044), scleral buckling and/or encirclage at vitrectomy (P = .029), and longer duration of surgery (P = .044). Multivariate analysis revealed independent risks associated with the absence of a lens and longer duration of the surgery. CONCLUSION: A knowledge of the risk factors involved with SCH helps the physician to identify patients who are at a greater risk for this complication.

Removal of silicone oil and epimacular proliferation from eyes following vitrectomy.

BACKGROUND AND OBJECTIVES: Epimacular proliferation (EMP) represents a localized form of reproliferation at the macula. The significance of EMP in eyes that have undergone vitrectomy is still not clear. This study investigated the redetachment rate following silicone oil removal when combined with removal of EMP. PATIENTS AND METHODS: Twenty-two consecutive eyes underwent removal of silicone oil and EMP These eyes had attached retinas following silicone oil injection used as an adjunct to complex vitreoretinal surgery. RESULTS: The retina remained attached in 19 (86.4%) of the eyes, with functional improvement it vision in 81.8% of the eyes. Visual acuity of 6/60 (20/200) or better was obtained in 12 (54.5%*) of the eyes. The mean follow-up time was 6.3 months. CONCLUSION: These results suggest that removal of EMP and silicone oil does not increase the risk of redetachment.

Mortality and morbidity associated with ophthalmic surgery.

BACKGROUND AND OBJECTIVES: To study the mortality and morbidity among the patients undergoing ophthalmic surgery under local or general anesthesia. MATERIALS AND METHODS: A retrospective analysis of all patients who underwent ophthalmic surgery at Sankara Nethralaya, Madras, India, between 1979 and 1988, was performed. Relevant details included the preoperative medical status of the patients (ASA status), type of surgical procedure, type of anesthesia, and intraoperative and postoperative complications. RESULTS: The overall mortality rate was 1.15 per 1000. There was a decrease in the mortality rate from 2.09 per 1000 in the first 5-year period to 0.37 per 1000 in the second 5-year period. The factors significantly associated with mortality were hypertension, presence of cardiac pacemaker, renal disease, duration of surgery, type of surgery, and physical status (American Society of Anaesthesiologists classification). CONCLUSION: Identifying the risk factors can help reduce the mortality in ophthalmic surgery.