Biomedical subjects
Publications and source records attributed to R B Vajpayee.
We report a rare case of bilateral congenital posterior-capsular defects and its successful management by the dry-aspiration technique. To our knowledge, this is the first documented case of a posterior-capsular rupture with no demonstrable cause.
We studied 16 children, ranging in age between 3 and 8 years, who had posterior chamber intraocular lens implantation and developed inflammatory pupillary-block glaucoma. Prophylactic peripheral iridectomy had not been performed in any of the eyes. The patients were treated medically, and YAG laser iridotomy was performed successfully one week after initial control of intraocular pressure. Of 16 eyes in which intraocular pressure remained uncontrolled, trabeculectomy was necessary in three eyes and irreversible glaucomatous visual loss occurred in two eyes. Our data demonstrate the need for stringent and more frequent postoperative follow-up of children after intraocular lens implantation, especially during the first four postoperative weeks. Careful long-term follow-up for treatment after cataract is mandatory to prevent development of amblyopia.
We treated 12 eyes with Pseudomonas ulcerative keratitis with topical 0.3% Norfloxacin drops (Ranbaxy Laboratories). Excellent response was achieved in all eyes, resulting in complete ulcer resolution. The healing time varied from 12 to 20 days. There was a marked improvement over the pretreatment visual acuity in 11 of the 12 eyes. No systemic or ocular side effects were observed during the study period. The present study strongly suggests that topical norfloxacin is a potent and effective drug in the treatment of Pseudomonas ulcerative keratitis.
Therapeutic keratoplasty was done in 123 neglected cases of fungal ulcers that did not respond to maximal medical therapy. It is recommended that, if the surgery is contemplated, it should be done before the ulcer perforates. A 0.5mm larger donor graft than recipient bed is better than a similar-sized graft. Various complications and final results are discussed.
We report a pseudophakic malignant glaucoma attack in the early postoperative period in the normal eye of an 8-year-old child who had undergone extracapsular cataract extraction with posterior chamber (modified Sinskey type) intraocular lens implantation for congenital zonular cataract. Intensive antiglaucoma medical therapy did not resolve the glaucoma, but vitreous aspiration and anterior chamber reformation proved successful.
The records of 59 patients (66 eyes) with contact thermal burns of the cornea (unilateral in 52 cases and bilateral in 7) were reviewed to determine the causes, clinical presentation, management and complications of such injuries. Most of the injuries (90%) occurred at home. The commonest cause was splashing of boiling fluids (42% of cases), followed by contact with red-hot firecracker particles (18%) and lit match heads (17%). In 59 eyes (89%) the burn was limited to the corneal epithelium, in 5 (8%) the superficial stroma was also involved, and in 2 (3%) there was associated corneal perforation caused by mechanical impact of foreign bodies. Débridement of the coagulated epithelium with patching was the most successful treatment, healing 48 (73%) of the eyes. Postburn complications were rare, the most common being development of inferior symblepharon, in three eyes (4%).
We studied the pathogenesis, clinical features, and management of posterior capsular breaks in 28 cataract patients during planned extracapsular cataract extraction and intraocular lens implantation surgery. In the age-related cataract group (17 cases), the posterior capsular breaks were fresh, caused by the irrigation-aspiration cannula. Located in the upper part of the posterior capsule, they had thin margins and tended to enlarge with continued irrigation. Nine (52.9%) of these breaks could be plugged with viscoelastic, and after dry aspiration, a posterior chamber lens was implanted successfully. Posterior capsular breaks in traumatic cataracts (11 cases) were preexisting but were detected only during surgery. Centrally located, they had thick fibrosed margins and remained the same size during irrigation- aspiration. The minimal vitreous herniation seen in four (35.3%) of these cases was managed by automated partial anterior vitrectomy through the break. A posterior chamber intraocular lens was implanted in all these cases.
In a retrospective analysis, we studied the association between ocular atopy and keratomycosis. Forty-one (26.3%) of 156 patients with fungal corneal ulcers were found to have preexisting allergic conjunctivitis. All patients had been using a combination of antibiotics and corticosteroids before developing the corneal ulcer. Fungus isolation on Sabouraud's agar medium was obtained in 74.8% (31/42) ulcers. The most common fungi isolated were Fusarium (32.3%) and Aspergillus (29%). One percent silver sulfadiazine was used as an antifungal agent in these patients. Overall efficacy of this drug was found to be 77.8%, with Fusarium being the most sensitive (87.5%).
In a hospital-based case-control study of 1441 patients with age-related cataracts and 549 controls, we studied associations between types of cataract--nuclear, cortical, posterior subcapsular, and mixed--and a number of physiologic, behavioral, environmental, and biochemical variables. Using polychotomous logistic regression analysis, we found an increased risk of cataract with lower educational achievement (all types of cataract), decreased cloud cover at place of residence (all types), use of aspirin less than once a month (posterior subcapsular and mixed), diets low in selected nutrients (posterior subcapsular, nuclear, and mixed), higher blood pressure (nuclear and mixed), lower body mass index (nuclear and mixed), use of cheaper cooking fuels (cortical, nuclear, and mixed), and lower levels of an antioxidant index based on red blood cell levels of glutathione peroxidase and glucose-6-phosphate dehydrogenase and plasma levels of ascorbic acid and vitamin E (posterior subcapsular and mixed). All risks cited were significantly different from those for the other cataract types, a finding that emphasizes the need to investigate the epidemiology of specific types of cataract.
We undertook a prospective study to test Simoons' hypothesis that in certain susceptible races milk exerts a cataractogenic effect. Overall milk intake in low lactase deficiency areas did not correlate with cataract occurrence. Subgrouping of cataract patients revealed that greater milk intake did show positive correlation with cortical cataracts. Cortical cataracts were also markedly more common in females. Analysis of data from three different regions showed greater milk intake in cortical cataract patients only. Our data indicate the importance of specifying cataract type in cataract studies and highlight the problem this approach brings forth. We noted no different trends in subjects from northwest and southeast India, although the number of subjects from the southeast was considerably less. Patients with early cortical cataracts may be advised to restrict milk intake.
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The efficacy of silver sulphadiazine in human keratomycosis has not been evaluated so far. Encouraged by the success of an earlier experimental trial, a prospective, controlled, randomised double masked clinical study was designed to evaluate the efficacy of 1% silver sulphadiazine ophthalmic ointment in 20 eyes of mycotic keratitis. Miconazole 1% was used for comparative evaluation in another 20 eyes. Silver sulphadiazine had a higher success rate (80% vs 55%) than miconazole. It had broad antifungal activity and was found to be effective in fusarium keratitis. Absence of side effects, economy, and its efficacy in deeper and extensive lesions were additional advantages. It is concluded from this study that silver sulphadiazine is a safe and effective broad spectrum antifungal agent which can be used for the treatment of human keratomycosis.
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The efficacy of topical sodium cromoglycate and medrysone was evaluated in 38 patients suffering from atopic keratoconjunctivitis. It was found that medrysone (1%) significantly improved the symptoms of itching, watering, photophobia and hyperaemia, while sodium cromoglycate (2%) was found to be ineffective. Tear prostaglandin E2 and histamine levels did not decrease significantly after sodium cromoglycate therapy. The findings of the present study reveal that sodium cromoglycate has no significant role in the management of atopic keratoconjunctivitis.
Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large.