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Biomedical subjects

M S Sridhar

Publications and source records attributed to M S Sridhar.

At least 19 recordsLinked to original sources
PubMed2006

Pseudodentritic keratitis associated with meibomitis in young healthy males.

PURPOSE: To report unusual corneal manifestations of pseudodendritic keratitis in cases of coexisting meibomian gland dysfunction (MGD). METHODS: Retrospective chart review of five cases of MGD with associated atypical corneal lesions was carried out. Information including patient's age, symptoms and their duration, clinical features, methods of diagnosis, treatment, and outcome were abstracted from the medical records. Pseudodendritic keratitis and MGD was defined before the data collection. RESULTS: All five patients were males within the age range of 6-24 years. Common symptoms were irritation and watering. MGD, which was defined as stenosis of meibomian gland orifices and/or turbid meibomian secretions, was seen in all the patients. Corneal lesions were epithelial, raised and dendritic in morphology. Blood investigations carried out to rule out tyrosinemia in three of the patients were negative. Bandage contact lens facilitated disappearance of these lesions in five eyes. CONCLUSIONS: Corneal involvement in the form of pseudodendritic keratitis may be associated with MGD. Application of bandage contact lens facilitated prompt resolution, suggesting mechanical factor with or without other etiological factors may be at interplay in producing these innocuous corneal lesions.

Adolescent↗
PubMed2005

Acute corneal hydrops treated by intracameral injection of perfluoropropane (C3F8) gas.

PURPOSE: To report a case of acute hydrops with intrastromal cleft in a patient of keratoconus with associated Marfan's syndrome, treated with intracameral injection of perfluoropropane (C(3)F(8)) gas. DESIGN: Interventional case report. METHODS: A nonexpansile concentration of perfluoropropane gas (0.2 ml) was injected intracamerally in the operating room under aseptic precautions. RESULTS: There was complete and rapid resolution of corneal edema. CONCLUSION: Intracameral perfluoropropane gas in nonexpansile concentration may be a useful modality for treatment of corneal edema in acute corneal hydrops.

Acute Disease↗
PubMed2005

Outcome of pterygium surgery: analysis over 14 years.

AIM: To report the outcome of pterygium surgery performed at a tertiary eye care centre in South India. METHODS: Retrospective analysis of medical records of 920 patients (989 eyes) with primary and recurrent pterygia operated between January 1988 and December 2001. The demographic variables, surgical technique (bare sclera, primary closure, amniotic membrane transplantation (AMT), conjunctival autograft (CAG), conjunctival-limbal autograft (CLAG), or surgical adjuvants), recurrences and postoperative complications were analysed. RESULTS: A total of 496 (53.9%) were male and 69 (7.5%) had bilateral pterygia. Bare sclera technique was performed in 267 (27.0%) eyes, primary conjunctival closure in 32 (3.2%), AMG in 123 (12.4%), CAG in 429 (43.4%), and CLAG in 70 (7.1%). Adjuvant mitomycin C was used in 44 (4.4%) cases. The mean duration of follow-up was 8.9+/-17.0 and 5.9+/-8.8 months for unilateral primary and recurrent pterygia, respectively. The overall recurrence rate was 178 (18.0%). Following primary and recurrent unilateral pterygium excision respectively, recurrences were noted in 46 (19.4%) and 1 (33.3%) eyes after bare sclera technique, five (16.7%) and 0 after primary closure, 28 (26.7%) and 0 with AMG, 42 (12.2%) and five (31.3%) with CAG, and nine (17.3%) and two (40%) with CLAG. Recurrences were significantly more in males with primary (23.3 vs 10.7%, P<0.0001) and recurrent (26.7 vs 0%, P=0.034) pterygia, and in those below 40 years (25.2 vs 14.8%, P=0.003). CONCLUSION: CAG appears to be an effective modality for primary and recurrent pterygia. Males and patients below 40 years face greater risk of recurrence. Bare sclera technique has an unacceptably high recurrence. Prospective studies comparing CAG, CLAG, and AMG for primary and recurrent pterygia are needed.

Adolescent↗
PubMed2005

Allelic heterogeneity of the carbohydrate sulfotransferase-6 gene in patients with macular corneal dystrophy.

Allelic heterogeneity of the carbohydrate sulfotransferase-6 gene in patients with macular corneal dystrophy. Macular corneal dystrophy (MCD) is an autosomal recessive disorder characterized by grayish white opacities in the cornea. It is caused by mutations in the carbohydrate sulfotransferase-6 (CHST6) gene, which codes for the enzyme corneal N-acetylglucosamine-6-sulfotransferase. This enzyme catalyzes the sulfation of keratan sulfate, an important component of corneal proteoglycans. We screened 31 patients from 26 families with MCD for mutations in the coding region of the CHST6 gene. Twenty-six different mutations were identified, of which 14 mutations are novel. The novel mutations are one nonsense mutation found in one patient (Trp2Ter), one frameshift (insertion plus deletion) mutation in two patients (His335fs), and 12 missense mutations (Leu3Met, Ser54Phe, Val56Arg, Ala73Thr, Ser98Leu, Cys165Trp, Ser167Phe, Phe178Cys, Leu193Pro, Pro204Arg, Arg272Ser, and Arg334Cys) in 11 patients. These data demonstrate a high degree of allelic heterogeneity of the CHST6 gene in patient populations with MCD from Southern India, where this disease may have a relatively higher prevalence than in outbred communities.

Adolescent↗
PubMed2004

Pellucid marginal corneal degeneration.

OBJECTIVE: To report the clinical features and outcome of patients with pellucid marginal corneal degeneration (PMCD). DESIGN: Retrospective noncomparative case series. METHODS: Retrospective chart review of 116 eyes of 58 patients with PMCD seen between 1990 and 2002 at the Cornea Service at L.V. Prasad Eye Institute, Hyderabad, India. The diagnosis of PMCD was based on the presence of corneal thinning with ectasia of the normal cornea above or below the area of thinning with no evidence of scarring, vascularization, or lipid deposition and typical topographic features whenever topography was performed. A detailed history including the age of presentation, onset of symptoms, systemic diseases, atopy, and relevant family history was reviewed. The visual acuity (VA) at presentation; the location, extent, and degree of thinning; presence of concurrent keratoconus and keratoglobus; and complications, if any, were noted. The mode of visual rehabilitation; surgical procedure, if any; and the final VA achieved were analyzed. MAIN OUTCOME MEASURES: Clinical features, associations, complications, and outcome of treatment. RESULTS: There were 45 males (77.6%) and 13 females (22.4%). All cases were bilateral. In one eye, no clinical features of PMCD were seen, but the diagnosis was made based on topographic features of typical PMCD. The age of the patients ranged from 8 to 66 years, with a mean of 34.0+/-14.8. One patient (1.7%) had associated vernal keratoconjunctivitis (VKC), 1 (1.7%) had Marfan's syndrome, and 1 (1.7%) had ocular hypertension. The degree of astigmatism was <5.0 diopters (D) in 19 eyes (19.2%), 5 to 10 D in 36 (36.4%), 10 to 15 D in 23 (23.2%), 15 to 20 D in 15 (15.2%), and >20 D in 6 (6.1%). Typical inferior PMCD was seen in 99 eyes (85.3%), and superior PMCD was seen in 17 (14.7%). The thinning was commonly seen between the 5-o'clock and 7-o'clock positions. In 12 eyes (10.3%), PMCD was associated with keratoconus, and in 15 eyes (12.9%), keratoglobus was associated. Seven eyes (6.0%) had hydrops. Visual acuity improved in 52 eyes (55.3%) with correction, in 40 eyes (42.6%) it remained the same as that of the initial presentation, and in 2 eyes (2.1%) it worsened relative to the initial presentation. Forty-one eyes (35.3%) received spectacles, and 31 eyes (26.7%) were fitted with rigid gas-permeable contact lenses. Five eyes (4.3%) underwent surgery. Lamellar keratoplasty was performed in 3 eyes, and a crescentic lamellar graft was done in 2 eyes. Visual acuity improved in 4 eyes after surgery with a follow-up of 2 to 37 months. The final astigmatism in the operated eyes at the last follow-up ranged from 4 to 11 D. CONCLUSIONS: Pellucid marginal corneal degeneration was seen predominantly in males in this series, and was not strongly associated with VKC. Keratoconus was seen in approximately 10% of the eyes, and keratoglobus in approximately 13%. Superior PMCD was seen in approximately 15% of the eyes. In our study, patients presented with severe astigmatism, and hydrops was a common complication. The majority of patients were treated with spectacles or contact lens. Surgery for PMCD-lamellar keratoplasty and crescentic lamellar keratoplasty, if indicated-usually results in significant residual astigmatism.

Adolescent↗
PubMed2004

Superior pellucid marginal corneal degeneration.

PURPOSE: To report the clinical features and topographic findings of superior pellucid marginal corneal degeneration (PMCD). METHODS: Retrospective chart review of 15 eyes of eight patients of superior PMCD. Detailed history, visual acuity at presentation, degree of astigmatism, slit-lamp examination findings, topographic features, and Orbscan findings were noted where available. Improvement in visual acuity with spectacles or contact lens correction, surgical procedure if any, and final visual acuity were analysed. RESULTS: In all, six patients were males and two were females. All cases except one were bilateral. The patients ranged in age from 18 to 48 years. All cases had isolated superior PMCD. One patient was a diagnosed case of vernal keratoconjunctivitis. The visual acuity at presentation ranged from hand motions to 20/25. The degree of thinning varied from 30 to 90%. The extent of thinning was commonly seen between the 10 and 2 o'clock positions. Ectasia was seen below the site of thinning in all the cases of superior PMCD. Topographic features including vertical corridor of reduced power, against-the-rule astigmatism and superior loop cylinder were seen in 10 eyes. Orbscan was carried out in two eyes of one patient and revealed an area of increased elevation in relation to the best-fit sphere superiorly corresponding to the area of ectasia in both the eyes. The visual acuity improved with rigid gas-permeable contact lens in six eyes and the final visual acuity ranged from 20/400 to 20/30. Two eyes were subjected to surgical intervention (peripheral annular graft=1 and lamellar graft=1). CONCLUSIONS: PMCD can occur superiorly. It should be considered in the differential diagnosis of superior ectatic disorders. The topographic findings, of reduced power in the vertical meridian and superior loop cylinder, are typical of superior pellucid marginal degeneration. Visual rehabilitation is usually possible with contact lenses, with surgical management required in selected cases.

Adolescent↗
PubMed2004

Cataract and glaucoma after wear of contact lens soaked in steroid solution: a rare complication.

PURPOSE: To report an unusual case of steroid-induced cataract and glaucoma after wearing soft contact lens soaked in steroid solution. METHODS: Case report of a 28-year-old man who presented with progressive decrease in vision of both the eyes of 2 years' duration. He was wearing conventional soft contact lens from the past 3 years. He used to buy the lenses from an optician and started storing the lenses in steroid solution overnight for the last 2 years. RESULTS: His best-corrected visual acuity was 20/40 in both the eyes. Anterior segment evaluation revealed posterior subcapsular cataract in both the eyes. IOP was 12 mm of Hg in the right eye and 22 mm of Hg in the left eye. Fundus examination showed a cup disc ratio 0.9:1 in the right eye and 0.8:1 in the left eye. Humphrey visual fields revealed incomplete biarcuate scotoma in both the eyes. CONCLUSIONS: Steroid-induced cataract and glaucoma in a contact lens wearer is an extremely rare complication. To our knowledge, there is no previous case of steroid-induced cataract and glaucoma in a conventional soft contact lens wearer. This case emphasizes the role of optometrists and ophthalmologists in patient education while dispensing contact lenses, especially in developing countries.

Adult↗
PubMed2003

Microsporidial keratoconjunctivitis in a HIV-seronegative patient treated with debridement and oral itraconazole.

PURPOSE: To report a case of microsporidial keratoconjunctivitis in an HIV-seronegative. METHODS: We report on a 40-year-old woman who presented with acute symptoms of 4 days' duration. Visual acuity was 6/6 in the right eye and 6/6 partial in the left eye. In the left eye, there was diffuse conjunctival congestion with papillary changes. There were multiple raised epithelial lesions in the cornea. RESULTS: Corneal scrapings stained with potassium hydroxide and calcofluor white showed Microsporidium spores in large numbers. These spores with polar staining were also confirmed in Gram stain. One month after initiation of itraconazole, the left eye was quiet. She had a visual acuity of 6/6 in that eye, with faint corneal haze. CONCLUSIONS: We report a rare case of microsporidial keratoconjunctivitis in a HIV-seronegative patient who was treated by debridement and oral itraconazole. Microsporidium should be suspected even in an immunocompetent individual if the corneal examination revealed showed multiple raised epithelial lesions.

Administration, Oral↗
PubMed2003

Fungal keratitis associated with vernal keratoconjunctivitis.

PURPOSE: To report a case of fungal keratitis associated with vernal keratoconjunctivitis. CASE REPORT: A 22-year-old man with a history of vernal keratoconjunctivitis since October 1999 developed a shield ulcer in the left eye in June 2000, which resolved with intensive topical steroid therapy. He presented in August 2001 with onset of acute pain, redness, and decreased vision. The tarsal conjunctiva in the left eye showed large papillae. The cornea showed a white plaque-like lesion with an underlying stromal infiltrate involving the upper half of the cornea. The overlying epithelial defect measured 4.5 x 2.5 mm. The anterior chamber showed 1+ flare and cells and hypopyon measuring about 1 mm. RESULTS: Corneal scrapings were performed for microbiologic investigations. Smears of corneal scrapings revealed septate fungal filaments, and the culture showed a significant growth of Aspergillus flavus. CONCLUSIONS: Fungal keratitis may be associated with vernal keratoconjunctivitis. Though rare, fungal keratitis should be considered in the differential diagnosis of infections associated with vernal keratoconjunctivitis.

Adult↗
PubMed2003

Nomogram for spherical RGP contact lens fitting in patients with pellucid marginal corneal degeneration (PMCD).

PURPOSE: To present a nomogram for spherical rigid gas-permeable (RGP) contact lens fitting in patients with pellucid marginal corneal degeneration (PMCD). METHODS: Retrospective review of the medical records of 24 patients diagnosed with PMCD who underwent an RGP contact lens trial at the Bausch & Lomb contact lens center between April 1995 and March 2002 at L.V. Prasad Eye Institute in Hyderabad, India. Data collected included age and sex of patients, duration of presenting symptoms, associated ocular conditions, presenting visual acuity, and degree of astigmatism. For the purpose of analysis, the astigmatism was classified into four groups: group 1, less than 5.00 diopters (D); group 2, 5.00 to 10.00D; group 3, 10.00 to 15.00D; and group 4, 15.00 to 20.00D. The final lens parameters, the patient's comfort level, and the duration of follow-up were analyzed. RESULTS: Forty eyes of 24 patients were fitted with RGP contact lenses during the study period. Sixteen were male patients and eight were female patients. The age of the patients ranged from 13 to 59 years, with a mean of 35.5 years. Twenty-two (91.7%) patients had typical inferior PMCD, whereas the other two (8.3%) had superior PMCD. The mean corneal curvature was 7.1 mm (range, 5.9-7.8 mm) in group 1, 6.9 mm (range, 6.6-7.9 mm) in group 2, 7.5 mm (range, 6.5-7.8 mm) in group 3, and 7.9 mm (range, 6.8-7.8 mm) in group 4. The mean base curve of the final fitting lens was 6.3 mm (range, 5.7-7.8 mm) in group 1, 6.8 mm (range, 5.9-7.8 mm) in group 2, 7.5 mm (range, 6-8.2 mm) in group 3, and 7.2 mm (range, 6.6-7.8 mm) in group 4. The mean lens diameter of the final fitting lens was 8.7 mm (range, 8.6-10.6 mm) in group 1, 9.5 mm (range, 8.8-10.5 mm) in group 2, 10.2 mm (range, 8.8-11.5 mm) in group 3, and 10.4 mm (range, 8.8-11.3 mm) in group 4. The common fluorescein patterns were central touch with midcentral peripheral pooling in 14 (35%) and dumbbell pattern in seven (17.%). The final visual acuity range with an RGP lens in the four astigmatism groups was 20/40 to 20/20 in group 1, 20/30 to 20/20 in group 2, 20/40 to 20/20 in group 3, and 20/200 to 20/50 in group 4. Twenty-one patients were comfortable with an RGP lens, and the mean duration of follow-up was 13 months. Three patients discontinued lens wear. In one patient, the lens was not stable, and the other two experienced discomfort with their lenses. CONCLUSIONS: Spherical rigid gas-permeable lenses are a good option for patients even with advanced PMCD. In patients with astigmatism of less than 10D, a lens with a base curve of 6.0 to 7.0 mm and a diameter of 8.0 to 9.5 mm seems to be a good initial lens for trial, and for patients with astigmatism of more than 10D, a lens with a base curve of 7.0 to 7.5 mm and a diameter of 10.0 to 10.5 mm seems to be a good initial lens.

Adolescent↗
PubMed2002

Phototherapeutic keratectomy versus diamond burr polishing of Bowman's membrane in the treatment of recurrent corneal erosions associated with anterior basement membrane dystrophy.

PURPOSE: To compare the efficacy of phototherapeutic keratectomy (PTK) to epithelial debridement and polishing of Bowman's membrane using a diamond burr (DB) in the treatment of recurrent corneal erosions associated with anterior basement membrane (ABM) dystrophy. DESIGN: Retrospective nonrandomized comparative trial. METHODS: Medical records of 39 patients (42 eyes) who underwent a PTK or DB procedure for recurrent corneal erosions associated with ABM dystrophy between March 1992 and June 2000 were reviewed. History of injury, prior treatment received, and the corneal slit-lamp findings were noted in all patients. In both procedures, all loose epithelium was completely removed. In PTK patients, 5 microm of Bowman's membrane was ablated with the excimer laser. In patients who underwent DB treatment, a hand-held battery-driven diamond dusted burr was used to gently and uniformly polish Bowman's membrane in the area of the epithelial defect. MAIN OUTCOME MEASURES: Symptomatic improvement, recurrence of painful erosions, development of haze, and change in the visual acuity. Statistical analysis was performed for comparison of data between the two groups. RESULTS: Fifteen eyes of 14 patients underwent PTK, and 27 eyes of 25 patients underwent epithelial debridement and DB treatment. In the PTK group, mild haze was seen in five (35.7%) eyes. Recurrence of painful erosions was seen in four eyes (26.7%). The mean follow-up was 17.6 +/- 5.7 months (range, 0.7-81.9 months). Best-corrected visual acuity was better in five eyes (35.7%) after the procedure and the same in nine eyes (64.3%). In the DB group, mild haze was seen in seven eyes (25.9%). Recurrence of painful erosions was seen in three eyes (11.1%). The mean duration of follow-up was 6.7 months (range, 1-24.2 months). Best-corrected visual acuity was better in 3 eyes (14.3%), the same in 17 eyes (81%), and worse in 1 eye (4.8%) after the procedure. Final visual acuity was not available for one eye in the PTK group and 6 eyes in the DB group. There was no statistically significant difference in haze (Fisher's exact test, P = 0.38), recurrence of erosions (Kaplan-Meier analysis with log rank, P = 0.73), and vision being better or the same (Fisher's exact test, P = 0.6) between the PTK and DB groups. CONCLUSIONS: Both PTK and DB treatment are effective methods of treating recurrent corneal erosions associated with ABM dystrophy. Diamond burr treatment, being a simpler, less expensive office procedure with a tendency toward lesser incidence of haze and recurrence in this study, seems to have advantages over PTK in the treatment of recurrent corneal erosions. Further prospective studies are required to confirm the long-term efficacy of DB treatment in the management of recurrent corneal erosions associated with ABM dystrophy.

Basement Membrane↗