Biomedical subjects
Publications and source records attributed to N Pushker.
Human cysticercosis and tuberculosis are endemic diseases in developing countries. Both these diseases have certain common factors of origin. We would like to present the co-existence of these infections in a 20-year-old female. She was a known case of pulmonary and ocular tuberculosis and she acquired cysticercosis of the eye and brain.
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Fungal infections of the skin and deeper tissues of the periorbital region are quite rare. We report a case of a localized, deep periorbital necrotizing Fusarium infection in an otherwise healthy, elderly lady. Since the clinical features and histopathological findings of Fusarium infection are by no means characteristic, the definitive diagnosis was achieved with the help of microbiological examination of cultured organisms. A combined medical and surgical therapy led to adequate control of infection. To conclude, localized, deep periorbital necrotizing soft tissue infection by Fusarium in an immunocompetent lady is not reported in literature. One should have a high index of suspicion for emerging fungal pathogens in the differential diagnosis of necrotizing orbital or adnexal conditions, even in an immunocompetent patient. The histologic findings of septate, branching hyphae and vascular invasion cannot distinguish Fusarium species from various other moulds such as Aspergillus species; microbiologic studies are essential for confirming the diagnosis.
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PURPOSE: To study the demographic factors, clinical diagnosis, results of investigation, modalities of treatment and their outcome in ocular and extraocular cysticercosis. METHOD: A total of 20 patients were recruited for the study. Ultrasonography and computed tomography were done for all the patients. Serial ultrasound was obtained in patients receiving medical treatment. Therapy was individualized according to the location of the cyst. RESULTS: The commonest clinical presentation was proptosis (9 of 20) with restriction of ocular movements, followed by subconjunctival cyst, subretinal cyst, papilloedema, atypical optic neuritis, lid nodule and intraretinal cyst. Ultrasonography was comparable with computed tomographic scan for detection of scolex. Two of the twenty patients had associated cysts in the brain parenchyma. Medical or surgical therapy as indicated, had a satisfactory outcome. CONCLUSION: Cysticerci can lodge themselves in any part of the ocular and extra ocular tissue. Associated brain parenchyma involvement is quite rare. The clinical presentation, treatment and outcome mainly depends on the location of the cyst.
PURPOSE: To review the causes, clinical features, course, histopathological and biochemical changes, diagnosis, andtreatmentof neurotrophic keratopathy. METHODS: We reviewed the literature on neurotrophic keratopathy. RESULTS AND CONCLUSIONS: Neurotrophic keratopathy is a clinical entity which involves all degrees of degenerative corneal and conjunctival changes secondary to loss of sensory function in the nasociliary branch of the trigeminal nerve with or without decreased tear production. One of the commonest causes of loss of corneal sensation is herpes virus infection. The clinical course of neurotrophic keratopathy varies considerably. The corneal epithelium becomes diseased and breakdown occurs even in the absence of dessication, infection, and trauma. This stage, if not treated aggressively with ocular lubricants, tarsorrhaphy, or a bandage soft contact lens, will result in stromal lysis with or without perforation. Depending on the size and location of corneal perforation, procedures like the application of cyanoacrylate glue, penetrating keratoplasty, or conjunctival flap may be required.
We conducted a study to analyse the presentation, risk factors, ocular manifestations and ophthalmic management results of Stevens-Johnson syndrome (SJS) in Indian patients. A total of 20 patients with SJS with ocular involvement were studied. Female predominance (70%) was observed. The age ranged from 10 to 30 years (mean +/- SD: 16.85 +/- 5.96). The commonest precipitating risk factor was oral drug intake (80%), sulphonamide (30%; sulphamethoxazole-trimethoprim) being the commonest. One patient had reaction to ciprofloxacin which has not been reported previously. Four patients (20%) had spontaneous onset with no identifiable risk factor. None of the patients had specific infection per se as a risk factor. Conjunctival involvement and its sequelae were the major ocular manifestations. At presentation, the majority of the eyes (68%) had visual acuity less than 3/60. Despite appropriate medical treatment and surgical interventions (11 eyes; 28%) vision continued to deteriorate. In 1 eye, the vision improved after stem cell transplantation. Therapeutic penetrating keratoplasty could preserve ocular integrity in 1 patient.
PURPOSE: To review the diagnosis, microbial and pathological features, pathogenesis, and treatment of infectious crystalline keratopathy (ICK). METHODS: We reviewed the literature on infectious crystalline keratopathy. RESULTS AND CONCLUSIONS: ICK is an indolent corneal infection in which needle-like, branching crystalline opacities are seen within the corneal stroma, in the absence of appreciable corneal or anterior segment inflammation. In most cases it occurs as a complication of corneal surgery and keratitis, with an alpha-hemolytic Streptococcus being the cause of infection. Discontinuation of topical steroids with aggressive antibiotic therapy may suffice, but continued infection, vascularization, or scar formation may affect visual acuity and require penetrating keratoplasty.
There is an increasing demand for refractive surgery stemming from a heightened awareness among patients wearing spectacles or contact lenses. Cosmetic or occupational reasons prompt patients to seek the alternative option of refractive surgery.
PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.
PURPOSE: To report an unusual organism causing infection following lamellar keratoplasty. METHOD: Case report. RESULT: Both gram stain smear and culture from the interlamellar bed revealed Rhodotorula sp., a red yeast as a causative agent. CONCLUSION: Rhodotorula sp. can cause corneal lamellar graft infection.
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PURPOSE: To evaluate the visual outcome after optical sector iridectomy in cases of corneal opacities. METHODS: Seventeen eyes of 17 patients with preoperative visual acuity of <6/60 in the affected eye underwent sector iridectomy in a prospective clinical study at a tertiary eye care center. Of 17 cases, 11 had corneal opacities after healed keratitis, four after trauma, and one each due to alkali burns or trachoma. The sector iridectomy was undertaken in cases in which one sector of the cornea and lens was fairly clear. Success was defined as attainment of ambulatory visual acuity of 6/60 or better. RESULTS: Mean age of the patients was 32+/-2.3 years. Most eyes had deep vascularized corneal scars (13 eyes). Optical sector iridectomy was performed most frequently in the lower nasal quadrant (11 eyes) followed by the lower temporal quadrant (four eyes). Of 17 eyes, 16 achieved a visual acuity of 6/60 or better. No intra-or postoperative complications were encountered. CONCLUSION: Optical sector iridectomy in cases of corneal opacities is a simple and safe procedure that can improve visual outcome and provide ambulatory vision to patients. It is a valuable alternative to penetrating keratoplasty if penetrating keratoplasty is not possible or not promising for various reasons.