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Biomedical subjects

L Gopal

Publications and source records attributed to L Gopal.

At least 19 recordsLinked to original sources
PubMed2001

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.

Alleles↗
PubMed2001

Timing of fornix reconstruction for postoperative conjunctival prolapse.

BACKGROUND AND OBJECTIVE: To describe fornix reconstruction for conjunctival prolapse occurring after ocular surgery. MATERIALS AND METHODS: Two patients with persistent conjunctival prolapse of variable duration following ocular surgery underwent fornix reconstruction using the method described by Barrett. The two patients underwent different surgical methods. In the second patient, no attempt was made to include the malar periosteum. RESULTS: Case 1 with longer duration of prolapse needed further surgery to excise residual prolapsing conjunctiva that had hyperplastic squamous epithelium. Case 2 in which fornix reconstruction was done 2 months after prolapse showed a good result after only one surgical operation. CONCLUSION: Forniceal reconstruction is recommended for persistent postoperative conjunctival prolapse. Early surgery appears to have better results.

Adolescent↗
PubMed2000

Ultrasound biomicroscopy in the diagnosis and management of pars planitis caused by caterpillar hairs.

PURPOSE: To report the use of ultrasound biomicroscopy in the detection of caterpillar hairs in the pars plana in a patient with unilateral pars planitis. METHOD: Ultrasound biomicroscopic imaging of the anterior segment of the eye. RESULTS: Ultrasound biomicroscopy located a hair in the posterior chamber at the first visit and five more in the pars plana 1 month later. This finding was confirmed intraoperatively. CONCLUSION: Ultrasound biomicroscopy is useful in the diagnosis and management of unilateral pars planitis of uncertain cause.

Animals↗
PubMed2000

Postoperative endophthalmitis caused by sequestered Acinetobacter calcoaceticus.

PURPOSE: To describe postoperative endophthalmitis caused by sequestered Acinetobacter calcoaceticus. METHOD: Case report. A 40-year-old woman developed recurrence of inflammation after extracapsular cataract extraction with intraocular lens (IOL) implantation. At last recurrence, the capsular bag was studded with white deposits. Intraocular lens was removed along with capsular bag during pars plana vitrectomy. RESULTS: The capsular bag, when cultured, grew A calcoaceticus. The media remained clear with no evidence of recurrence of infection over a 3-month follow-up. CONCLUSION: Postoperative endophthalmitis similar to that caused by sequestered Propionibacterium acnes can be caused by A calcoaceticus.

Acinetobacter Infections↗
PubMed2000

Postoperative Mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation.

OBJECTIVE: To describe a case of postoperative endophthalmitis caused by Mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. METHODS: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.

Abscess↗
PubMed2000

Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage.

OBJECTIVE: This study was aimed at assessing changes at the sclerotomy site using the ultrasound biomicroscope (UBM) in eyes that underwent primary pars plana vitrectomy for complications of proliferative diabetic retinopathy. DESIGN: Prospective, observational case series. PARTICIPANTS: Eighty-six eyes of 84 patients with vitreous hemorrhage caused by proliferative diabetic retinopathy. INTERVENTION: Three-port pars plana vitrectomy followed by UBM evaluation of all sclerotomy sites between 6 and 8 weeks after surgery. Correlation with intraoperative findings done in case of reoperations. Forty-one eyes had repeat UBM at 6 months. MAIN OUTCOME MEASURES: The changes at the sclerotomy site were classified into six groups: well healed, gape, plaque, vitreous incarceration, fibrovascular proliferation, and anterior hyaloidal fibrovascular proliferation (AHFVP). The UBM characteristics of each of the groups were defined. The findings at 6 months were compared with those at 6 to 8 weeks. RESULTS: At 6 to 8 weeks after surgery, most sclerotomies were well healed or had either moderate to high reflective plaques bridging the site. Wound gape was seen in 22.1% of active ports, 32.6% of light ports, and 25.6% of infusion ports. Vitreous incarceration was seen most often at the infusion port (18. 6% of eyes). Fibrovascular proliferation was seen in 9.3% of active ports, 12.8% of light ports, and 15.1% of infusion ports. Thirteen eyes had recurrent vitreous hemorrhage 6 to 8 weeks after surgery. Cases with rebleeding and no fibrovascular proliferation at the sclerotomy on UBM did well with outpatient fluid-air exchange (two eyes) or observation only (three eyes). Those with fibrovascular proliferation on UBM (eight eyes) required more extensive surgery. CONCLUSIONS: UBM is helpful in detecting complications at the sclerotomy sites after pars plana vitrectomy and is an invaluable tool in the assessment of the patient before reoperation.

Diabetic Retinopathy↗
PubMed2000

Conjunctival rhinosporidiosis associated with scleral melting and staphyloma formation: diagnosis and management.

PURPOSE: Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation. METHODS: Retrospective review of case records of three patients with conjunctival rhinosporidiosis. RESULTS: Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey-white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma. CONCLUSION: Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

Adolescent↗
PubMed2000

Endolaser around macular hole in the management of associated retinal detachment in highly myopic eyes.

PURPOSE: To analyze the role of endolaser around macular hole in managing associated retinal detachment in patients with high myopia. METHODS: Review of medical records of 25 consecutive eyes of 25 patients with at least 5.00 diopters of myopia who underwent primary pars plana vitrectomy and fluid-gas exchange. In the first half of the study period, one row of contiguous argon green endolaser was routinely applied over the retinal edge of the macular hole (EL group). In the second half of the study period, endolaser was not applied around any macular hole (NEL group). Demographic information, intraoperative and postoperative complications, and final visual acuities and retinal reattachment rates were studied. RESULTS: The mean (+/-SD) refractive error was -11.8 +/- -3.5 diopters (D) for the EL group and -11.6 +/- -5.4 D for the NEL group. The mean axial length was 29.0 +/- 1.8 mm for the EL group and 28.3 +/- 1.7 mm for the NEL group. The primary anatomic success was 62.5% (10/16) and 77.8% (7/9) in the EL and NEL groups, respectively. No statistically significant difference was found in preoperative, postoperative, or change in best-corrected visual acuities between the two groups. CONCLUSION: Endolaser around the macular hole after pars plana vitrectomy and internal gas tamponade may not affect the anatomic or visual outcome in primary retinal detachment secondary to a highly myopic macular hole.

Adult↗
PubMed2000

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.

Clinical Competence↗
PubMed2000

Intraocular cilia associated with perforating injury.

PURPOSE: To report a case series of penetrating injury complicated by occurrence of intraocular cilia. METHODS: Retrospective analysis of charts of 11 eyes of 11 patients with penetrating injury and intraocular cilia, presenting between September 1978 and November 1998. Ten eyes underwent surgery for trauma-related problems such as cataract, vitritis, retinal detachment etc., at which time intraocular cilia were removed. One eye did not have surgery and continues to harbour cilia at the posterior perforation site. RESULTS: Metallic wire was responsible for injury in 6 of 11 eyes with intraocular cilia. Five eyes had significant intraocular inflammation. The cilia were located in the anterior segment in 4 eyes; in the posterior segment in 6 eyes and in both in one eye. At the last follow up, 72.7% had 6/18 or better vision. Poor vision in the rest was due to recurrent retinal detachment (2 eyes) and macular scarring (1 eye). CONCLUSION: Intraocular cilia are more commonly associated with injury by a metallic wire. The presentation and management of an injured eye does not seem to be influenced by the presence of cilia in the eye.

Adolescent↗
PubMed2000

Recent developments in vitreoretinal surgery.

In the past three decades, a great improvement has occurred in microsurgical techniques used in the management of various eye diseases involving retina and vitreous. Advances in instrumentation has made the surgery easier and refined. The instruments used are narrated widely in this article. Various vitreous substitutes have been developed and are required in vitreoretinal surgery. These are gases, silicone oil, perfluorocarbon liquids and fluorosilicone oil. Anterior segment indications for vitreous surgery are: Vitreous loss during cataract surgery, thick after cataracts that can't be managed with Nd: YAG capsulotomy, vitreocorneal touch, updrawn pupils, incarcerated vitreous in the wound causing cystoid macular oedema, malignant glaucoma, penetrating keratoplasty in aphakic patients, congenital cataracts and filtering procedures in aphakic eyes. In posterior segment indications, vitrectomy is useful in penetrating trauma, haemorrhage, retinal deetachment, intra-ocular foreign bodies and infection endophthalmitis Macular surgery involves peeling of epimacular membrane or proliferation, treating vitreomacular traction syndrome, idiopathic macular holes, retinal detachment associated with optic pit, evacuation of submacular haemorrhage and excision of choroidal neovascular membranes. Available options to treat retinal detachments are pneumatic retinopexy, scleral buckling and vitreous surgery. Proliferative vitreoretinopathy remains the important cause of failure and occurs in about 8-10% cases after retinal detachment. Vitreous surgery for ocular trauma, vitrectomy for proliferative diabetic retinopathy, macular hole surgery, submacular surgery are also discussed in detail.

Diabetic Retinopathy↗
PubMed1999

Combined surgery for severe eye trauma with extensive iridodialysis, posterior lens dislocation, and intractable glaucoma.

A 44-year-old woman sustained a severe left eye contusion from the explosion of a plastic bottle containing fermented orange juice. This resulted in extensive iridodialysis, posterior crystalline lens dislocation, and intractable glaucoma. Eleven days after the injury, combined surgery of trabeculectomy with mitomycin-C, pars plana vitrectomy, lens removal, iridodialysis repair, and scleral-fixated intraocular lens implantation under general anesthesia was performed. Intraocular pressure (IOP) was under control until 5 weeks postoperatively; glaucoma implant surgery was then performed. At the last follow-up 15 months after the combined surgery, best corrected visual acuity was 20/50 and IOP was 15 mm Hg without medication. Combined surgery can be considered a safe, effective option in the management of severe eye trauma in selected cases.

Adult↗
PubMed1999

Vitreoschisis in Eales' disease: pathogenic role and significance in surgery.

PURPOSE: To report the surgical anatomy of vitreoretinal adhesions as observed intraoperatively in patients undergoing vitreous surgery for complications of Eales' disease. METHODS: Eighteen consecutive male patients (18 eyes) undergoing vitrectomy for Eales' disease were studied prospectively. Intraoperative diagnosis was vitreous hemorrhage (VH) in nine cases, traction retinal detachment (TRD) in four, VH and TRD in three, and combined traction-rhegmatogenous retinal detachment in two. Epiretinal membranes (ERMs) obtained during surgery were studied using light microscopy and immunohistochemistry. RESULTS: An incomplete posterior vitreous detachment was observed in all eyes. Multifocal vitreoretinal adhesions were evident in 83.3% of eyes. The proliferation was fibrovascular in 10 eyes and fibrous in eight. A radial traction fold extending from optic disk to periphery was observed in three eyes. A double-layered membrane, probably the result of vitreoschisis, caused tangential traction. ERMs consisted principally of type II collagen and the cellular element was predominantly composed of lymphocytes, glial cells, and macrophage-like cells (probably hyalocytes). CONCLUSIONS: Fibrous and fibrovascular proliferations have multiple areas of adhesions to the posterior vitreous cortex. The presence of type II collagen in the ERM indicates a possible vitreous collagen component to the double-layered membranes (vitreoschisis). Recognition of the double-layered membranes aids in relief of traction during surgery by delamination.

Adult↗