Aditi Agarwal, Venkatavaradan Raghavan, Ramadas Rathnadevi, Pukhraj Rishi
Aditi Agarwal, Venkatavaradan Raghavan, Ramadas Rathnadevi, Pukhraj Rishi
Pradeep Sagar, P Mahesh Shanmugam, Vinaya K Konana, Rajesh Ramanjulu, K C Divyansh Mishra, Sriram Simakurthy
Nandini Bothra, Suryasnata Rath, Ruchi Mittal, Devjyoti TripathyRead More
Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.
Vivek Gupta, Anuj Prabhakar, Mukesh Yadav, Niranjan KhandelwalRead More
Purpose: This study aims to evaluate normal orbital structures with nonenhanced computed tomography (NCCT) and determine normative data for the Indian population. Methods: CT images of the orbits of 100 patients were retrospectively reviewed on a work station to record the normative data of the orbits. Clinical details of all patients were reviewed to ensure that they did not have ocular/orbital diseases. Both axial and coronal images were utilized to record the data. Results: The mean age of the population evaluated was 34.07 years, with male to female ratio of 1.77. The average orbital index for the left orbit was 97 and for the right side was 103. The mean thickness of left inferior rectus, lateral rectus, medial rectus, and the superior rectus was 3.36 mm, 3.14 mm, 3.80 mm, and 3.75 mm, respectively. The right inferior rectus, lateral rectus, medial rectus, and the superior rectus measured 3.46 mm, 3.14 mm, 3.83 mm, and 3.78 mm, respectively. The optic nerve sheath complex diameter varied between 3.05 mm and 7.17 mm for the left eye and 3.05 mm and 7.0 mm for the right eye. Conclusion: The study provides normative data on various orbital structures in an Indian population. This data is likely to be useful for diagnosing various orbital pathologies and in planning surgical orbital procedures.
Paul T FingerRead More
A case of exudative circumscribed choroidal hemangioma successfully treated with CyberKnife® stereotactic radiosurgery is presented in this issue. It was reasonable to assume Cyberknife® would be effective because ionizing radiation causes a progressive, obliterative vasculitis secondary to destruction of vascular endothelial cell and pericytes. At least 15 exudative circumscribed choroidal hemangiomas have been successfully CyberKnife® irradiated.,,,,, In each case, both the tumor and its exudative retinal detachment have regressed. Most reported no significant complications with relatively short follow up. However, this issues’ CyberKnife® report prompted me to abstract what we know about radiation therapy for exudative choroidal hemangioma, compare it to laser therapies and comment on how we may decide which treatment is the “best” treatment…..
Raksha Rao, Santosh G Honavar, Kaustubh Mulay, Vijay Anand P ReddyRead More
An 18-year-old female presented with rapidly progressive proptosis of the left eye for one month and grade II relative afferent pupillary defect. Orbital imaging showed a well-defined homogenous extraconal mass in close relation to the lateral rectus muscle and extending up to the superior orbital fissure, associated with bony erosion. An incisional biopsy was performed, with the histopathology demonstrating stellate to spindle-shaped tumor cells (fibroblasts) embedded in a richly myxoid matrix. A diagnosis of low-grade fibromyxoid sarcoma (LGFS) was made. The patient was treated by stereotactic external beam radiotherapy. Here, we report a case of LGFS which, to the best of our knowledge, is the first at an orbital location.
Ankita Aishwarya, Prabha Gupta, Uma S TiwariRead More
n 19th century, sir Louis-Auguste Desmarres, a French ophthalmologist, introduced Desmarres-curved lid retractor. It is used to retract upper lid during examination of eyeball and for double eversion of upper lid to examine superior fornix. Barraquer eye speculum is used to keep lids apart during any intraocular procedure.
In 2008, a paper clip usage was demonstrated for retraction of edematous lids, but double eversion of lid is not possible with this instrument. In 2012, a case was reported by Canadian dental association wherein a dentist lost total sight in one eye after splashing calcium hydroxide in her left eye due to ineffective removal of calcium hydroxyl apatite from recess of the eye. Chemical burns are characterized by ongoing tissue destruction for as long as the inciting agent is present.,, Thus, the earliest removal of the inciting agent is crucial in management of chemical injuries. We hereby describe an easy and quick technique on how to use wire eye speculum as a wire lid retractor for double eversion of lid……
Puneet Jain, Paul T FingerRead More
Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices. Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used. Results: The mean (±SD) age was 58.3 ± 12.5 years (median 57.5, range 37–81). Patients were 57.7% male and 27% hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16–20/40). Intraocular pressures were 16 mmHg (10–23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75%. A single varix was seen in 64% and 36% appeared multiple. Varix orientation was radial in 57% and circumferential in 21%. Combined radial and circumferential varix orientation was noted in 18%. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36%. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3–129), 96.4% eyes were stable and one (3.6%) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred. Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.
Aloysius Abraham, Kannan Thirumalairaj, Namrata Gaikwad, Veerappan Muthukkaruppan, Alla G Reddy, Kumarasamy Thangaraj, Usha Kim, Ayyasamy VanniarajanRead More
Retinoblastoma has an increased inheritance risk of germline RB1 mutations in offspring and siblings, especially twins. Three families, each having one retinoblastoma-affected twin, were selected for genetic analysis and DNA profiling. Germline RB1 mutations were found in all probands. DNA profiling carried on similar-looking twins of families I and II, proved them to be fraternal. This study demonstrates the importance of genetic analysis of RB1 gene for risk prediction in retinoblastoma families. It also emphasizes that DNA profiling is a mandate for genetic screening of families with twins, thus adding a new dimension in counseling of retinoblastoma.
Jenil Sheth, Suryasnata Rath, Devjyoti TripathyRead More
Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.