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Rishita Nutheti

Publications and source records attributed to Rishita Nutheti.

At least 19 recordsLinked to original sources
PubMed2006

Pilot study on in vivo evaluation of retinal vascular maturity in newborn infants in the context of retinopathy of prematurity.

PURPOSE: To study the extent of retinal vascularization at birth. DESIGN: Prospective masked observational case series. METHODS: One hundred ten neonates, at different weeks of gestation and birth weights (BWs), had dilated fundus evaluation for zone of retinal vascularization by a masked observer. Maternal and neonatal factors were ascertained by a masked pediatrician. RESULTS: Irrespective of risk factors, eight of nine babies who were born at <30 weeks of gestation and at <1500 g BW had immature retina. Those babies who were born at >34 weeks of gestational age and at >1700 g BW had mature retina. Babies who were born between 31 to 34 weeks of gestation and at 1501 to 1700 g BW had variable extent of retinal vascularization at birth. Vascularization was affected by maternal anemia and the need for oxygen for >48 hours. CONCLUSION: There exists considerable variability in the extent of retinal vascularization in infants who are born between 31 to 34 weeks of gestation. Modifiable maternal and fetal factors could influence extent of this vascularization birth.

Birth Weight↗
PubMed2006

Consanguinity and eye diseases with a potential genetic etiology. Data from a prevalence study in Andhra Pradesh, India.

PURPOSE: To determine the prevalence of consanguinity and its potential associations with eye diseases in Andhra Pradesh state of south India. METHODS: As part of a demographic interview schedule, prior to clinical examinations, trained investigators collected information regarding consanguinity of the parents from subjects randomly chosen for a population-based cross-sectional epidemiological study. Each subject underwent a detailed ocular examination including visual acuity measurements, anterior segment examinations with slit-lamp biomicroscopy, and posterior segment examinations. Adjusted odds ratios (OR), attributable risks (AR) and population attributable risks (PAR) were estimated. RESULTS: We obtained details regarding consanguinity of the parents from 10,290 of the 10,293 subjects who were enumerated and examined in the study. Parental consanguinity was reported by 1822 (24.7%) rural subjects and 782 (32.9%) urban subjects. Eighty (0.008%, 95% CI: 0.006, 0.010) of the 9757 subjects had an ocular disease with a potential genetic basis. We found microcornea to be significantly associated with both an uncle-niece relationship (adjusted OR: 7.32, 95% CI: 1.73, 30.97, AR = 86.34%, PAR = 42.11%) and a first-cousin relationship between the parents (adjusted OR 4.51, 95% CI: 1.05, 19.40, AR = 77.83%, PAR = 29.02%). Retinitis pigmentosa was significantly associated with a first-cousin relationship between the parents (adjusted OR: 5.31, 95% CI: 1.00, 28.25, AR = 81.17%, PAR = 33.43%). CONCLUSIONS: The high prevalence of consanguinity in this population does not appear to translate into a high prevalence of ocular malformations; however, studies with larger sample sizes are required to further explore the strength of these associations.

Adolescent↗
PubMed2006

Analysis of CFH, TLR4, and APOE polymorphism in India suggests the Tyr402His variant of CFH to be a global marker for age-related macular degeneration.

PURPOSE: To screen polymorphisms in complement factor-H (CFH), toll-like receptor 4 (TLR4), and APOE genes as potential risk factors for age-related macular degeneration (AMD) in Indian patients. METHODS: One hundred patients with AMD and 120 normal control subjects were screened for the polymorphisms by restriction digestion and resequencing. Five intragenic SNPs in CFH were screened to generate haplotype data in cases and controls. The data were analyzed in conjunction with data from other populations based on genotype and haplotype frequencies, and odds ratios were computed to estimate the risk of AMD in the different genotypes. RESULTS: Significant association was noted with the CFH variant (Tyr402His) among AMD cases (P = 1.19 x 10(-7)). Individuals homozygous for the mutant genotype CC had a significantly higher risk (P < 0.0001) of AMD (OR = 11.52; 95% CI 5.05-26.28) than those carrying a single copy of the C allele (OR = 1.51; 95% CI 0.82-2.80), after adjusting for age, gender, and diabetes. Linkage disequilibrium and haplotype analysis at the CFH locus indicated the C-G-T-C-A-G to be a risk haplotype (P = 0.0003). No significant differences were observed in the genotype frequencies of APOE polymorphisms among patients and control subjects (P = 0.76). The carriers of epsilon4 allele had a reduced risk (P = 0.03) of AMD (OR = 0.42, 95% CI 0.19-0.91). TLR4 did not exhibit any association with AMD. CONCLUSIONS: The CFH polymorphism Tyr402His appears indicative of AMD pathogenesis. Diabetes, age, and gender in the presence of the homozygous "CC" genotype in CFH carry an increased risk of AMD. Hence this polymorphism could be used as a potential marker for predictive testing across continents.

Aged↗
PubMed2006

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh.

PURPOSE: To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. METHODS: The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined. RESULTS: Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model. CONCLUSIONS: Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.

Adult↗
PubMed2006

Microsporidial keratitis in India: 16S rRNA gene-based PCR assay for diagnosis and species identification of microsporidia in clinical samples.

PURPOSE: To evaluate 16S rRNA-based polymerase chain reactions for the detection and species identification of the microsporidia that cause keratitis. METHODS: Of the 5892 cases of microbial keratitis seen between September 2002 and December 2005, 31 (0.5%) microscopically diagnosed cases of microsporidial keratitis were included in the test group; 103 patients with nonmicrosporidial keratitis constituted the control group. A 16S rRNA-based pan-microsporidian PCR was chosen for the detection of microsporidian DNA. Species level identification was made using species-specific primer sets of Encephalitozoon spp (E. cuniculi, E. hellem, and E. intestinalis). Sequencing and BLAST analysis of amplicons obtained with pan-microsporidian primers were performed for validation. RESULTS: The corneal scrapings from 26 of 31 cases in the test group and 2 of 103 cases in the control group showed a 250- to 280-bp amplicon in PCR by pan-microsporidian primers (sensitivity of 83% and specificity of 98%). The amplicons of 13 of 26 test group samples were identified by species-specific PCR: E. cuniculi, n = 7 (549 bp); E. hellem; n = 3 (549 bp); E. intestinalis; n = 1 (520 bp). The two cases in the control group were identified to be E. cuniculi. The remaining 15 cases (test group) were confirmed to be Vittaforma corneae by sequencing and BLAST analysis. All species were confirmed by sequencing and database homology comparison. CONCLUSIONS: This study is the first to validate PCR-based assays for detection of microsporidial DNA in corneal scrapings. Pan microsporidian PCR can be a useful adjunct with smear examination in the diagnosis of microsporidial keratitis.

Adolescent↗
PubMed2006

Clinical outcome of autologous cultivated limbal epithelium transplantation.

PURPOSE: To report the clinical outcome of autologous cultivated limbal epithelial transplantation. METHODS: Eighty-six patients' records and their clinical photographs were reviewed for demographics, primary etiology, type of limbal transplantation, ocular surface stability, visual acuity, final outcome and possible factors affecting outcome and complications. RESULTS: Eighty-eight eyes of 86 patients with limbal stem cell deficiency (LSCD) underwent autologous cultivated limbal epithelium transplantation between March 2001 and May 2003, with a mean follow-up of 18.3 months. The etiology of LSCD was alkali burns in 64% patients. Sixty-one eyes had total LSCD. Thirty-two of the 88 eyes had undergone amniotic membrane transplantation and 10 eyes had previously undergone limbal transplantation with unfavorable outcome. Nineteen eyes underwent penetrating keratoplasty, of which 11 grafts survived at the final follow-up. Finally, 57 eyes (73.1%, 95% CI: 63.3-82.9) had a successful outcome with a stable ocular surface without conjunctivalization, 21 eyes (26.9%, 95%CI: 17.1-36.7) were considered failures and 10 patients were lost to follow-up. CONCLUSION: LSCD can be successfully treated by autologous cultivated limbal epithelium transplantation in majority of the cases.

Adolescent↗
PubMed2005

Retinal detachment in south India-presentation and treatment outcomes.

BACKGROUND: Although the presentation and treatment outcomes of retinal detachments in wealthy countries are well known, much less is known about retinal detachment in the developing world. This study reports the presentation and outcomes of 433 rhegmatogenous retinal detachments in South India. METHODS: Retrospective analysis was undertaken of all operated cases of retinal detachment in a tertiary care centre, from 1 January 2000 to 31 December 2000. RESULTS: Retinal detachments were treated in 433 eyes of 417 patients; 67 (16.1%) patients were children below 16 years and 60 (14.4%) patients were blind (visual acuity <6/60). The duration of symptoms was over 1 month in 192 (46.6%) eyes and, in 376 (86.8%), the macula was detached at presentation. Referral diagnosis was incorrect in 69 (22.4%) eyes. Cataract surgery was the predisposing factor in 152 (35.1%) eyes. Primary surgery included pars plana vitrectomy procedures in 235 eyes (53.9%) and scleral buckling in 197 (45.8%). The retina was re-attached with one operation in 281 eyes (71%) and with one or more operations in 333 (87%). Visual acuity of 6/60 or better was achieved in 260 (67.7%) eyes. CONCLUSIONS: The profile of retinal detachments in a tertiary eye care centre in south India includes many paediatric cases, late presentations and macula-off detachments, commonly related to cataract surgery. Despite complex pathology, two thirds of eyes regain useful vision after one or more surgical interventions.

Adolescent↗
PubMed2005

Comparison of mean macular thickness using optical coherence tomography and visual acuity in diabetic retinopathy.

BACKGROUND: The purpose of the present study was to quantitatively assess the mean macular thickness in diabetic patients using optical coherence tomography and its correlation with visual acuity. METHODS: A prospective case series study was undertaken of consecutive diabetic patients referred to a tertiary eye care centre for an eye check up from January 2003 to June 2003. One hundred and five eyes from 55 patients with varying degree of diabetes underwent optical coherence tomography examination. The study patients were divided into four groups: group I, non-proliferative diabetic retinopathy (NPDR); group II, NPDR with clinically significant macular oedema (CSME); group III, proliferative diabetic retinopathy (PDR); and group IV, PDR with CSME. RESULTS: The mean macular thickness of the entire group was 256.0 +/- 129.7 microm. A positive correlation (r = 0.424, P < 0.0001) was evident between mean macular thickness and visual acuity. CONCLUSION: Optical coherence tomography is a useful tool for objectively monitoring macular thickness in patients with diabetic retinopathy. Mean macular thickness correlates with visual acuity.

Adult↗
PubMed2005

Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India.

PURPOSE: To assess prevalence, potential risk factors, and population attributable risk percentage (PAR%) for age-related macular degeneration (AMD) in the Indian state of Andhra Pradesh. METHODS: A population-based study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India from 1996 to 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. In this report, the authors present the prevalence estimates of AMD and examine the association of AMD with potential risk factors in persons aged 40 to 102 years (n = 3723). AMD was defined according to the international classification and grading system. Standard bivariate and multivariate analyses were performed to identify the potential risk factors for AMD. PAR% was calculated by Levin's formula. RESULTS: AMD was present in 71 subjects--an age-gender-area-adjusted prevalence of 1.82% (95% confidence interval [CI], 1.39%-2.25%). Risk factors that were significant in bivariate analyses were considered for multivariate logistic regression analysis. Multivariate analysis showed that the adjusted prevalence of AMD was significantly higher in those 60 years of age or older (odds ratio [OR], 3.55; 95% CI, 1.61-7.82) and history of prior cigar smoking (OR, 3.29; 95%CI, 1.42-7.57). Presence of cortical cataract and prior cataract surgery were significantly associated with increased prevalence of AMD (adjusted OR, 2.87; 95% CI, 1.57-5.26 and 3.79; 95% CI, 2.1-6.78), respectively. The prevalence of AMD was significantly lower in light alcohol drinkers (adjusted OR, 0.38; 95% CI, 0.19-0.76) compared with nondrinkers. The PAR% for hypertension and heavy cigar smoking was 10% and 14%, respectively, in this population. CONCLUSIONS: The prevalence of AMD in this south Indian population is similar to those reported in other developed countries. Abstinence from smoking may reduce the risk of AMD in this population.

Adult↗
PubMed2004

Long-term surgical and visual outcomes in Indian children with developmental glaucoma operated on within 6 months of birth.

PURPOSE: To determine the long-term surgical and visual outcomes in Indian children with developmental glaucoma operated within 6 months of birth. DESIGN: Retrospective consecutive, noncomparative case series. PARTICIPANTS: All children with developmental glaucoma who underwent surgery within 6 months of birth over a 12-year period were included. METHODS: Two hundred ninety-nine eyes of 157 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy for developmental glaucoma from January 1990 through December 2001 by a single surgeon were studied. However, for the purpose of statistical analysis, only 1 randomly chosen eye of patients with a bilateral affliction (142, 90.4%) was considered. MAIN OUTCOME MEASURES: The main outcome measures were preoperative and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, refractive errors, success rate, time of surgical failure, and complications. RESULTS: The series consisted of 299 primary combined trabeculotomy-trabeculectomy surgeries during 157 anesthesias. The intraocular pressure was reduced from 26.6+/-6.2 mmHg to 14.4+/-4.9 mmHg, with a mean percentage reduction of 41.1+/-28.8 (P<0.0001). The probability of success (IOP<21 mmHg) was 94.4%, 92.1%, 86.7%, 79.4%, 72.9%, and 63.1% at first, second, third, fourth, fifth, and sixth year, respectively (Kaplan-Meier analysis). The mean follow-up period was 26.5+/-25.1 months. Preoperatively, 133 eyes (84.7%) had significant corneal edema. Postoperatively, normal corneal clarity was achieved in 83 of 133 eyes (62.4%) with corneal edema. There were no major intraoperative complications. Postoperatively, 17 eyes (10.8%) had a shallow anterior chamber develop; 3 of these eyes (17.6%) required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on visual acuity were available in 49 patients (31.2%). At the final follow-up visit, 20 patients (40.8%) had normal visual acuity (best-corrected visual acuity of >/=20/60 in the better eye). CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma when performed within 6 months of birth. It leads to excellent IOP control and moderate visual outcome.

Cornea↗
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

Perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh.

PURPOSE: To determine the distribution of perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh. METHODS: As part of a population-based epidemiologic study, the Andhra Pradesh Eye Disease Study (APEDS), a 16-item visual function questionnaire was designed and applied to 7363 persons older than 15 years, to record the levels of difficulty perceived by the subjects. Of these, 123 persons were found to have low vision. Rasch analysis was used to convert the ordinal difficulty ratings of these 123 persons into interval measures of perceived visual ability for functional vision. RESULTS: Content validity of the questionnaire was demonstrated by good separation indices (3.17 and 5.44) and high reliability scores (0.91 and 0.97) for person and item parameters. Construct validity was shown with model fit statistics. Criterion validity of the questionnaire was shown by good discrimination among the general vision ratings. The functional situation that required the least visual ability was "reaching an object farther or closer than you thought"; the situation requiring the most visual ability was "recognizing small objects." Bivariate regression analysis determined that for every unit of logMAR visual acuity, perceived visual ability for functional vision decreased by 2.9 logit, which could explain 32% of the variability in the person measure. CONCLUSIONS: The described assessment, across a range of visual problems, is a valid way to measure perceived ability for functional vision in persons with low vision. Perceived visual ability varies with every unit of logarithm of the minimum angle of resolution (logMAR) visual acuity.

Adolescent↗
PubMed2004

Awareness of eye donation in the rural population of India.

PURPOSE: To determine the "awareness of eye donation" and "willingness to pledge eyes for donation" in the rural population of Andhra Pradesh, southern India. METHODS: A total of 7,775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study (APEDS). Subjects older than 15 years were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. RESULTS: Age-gender adjusted prevalence of awareness of eye donation in this population was 30.7% (95% CI: 29.5-31.9) but only 0.1% (age-gender adjusted prevalence) (95% CI: 0.05-0.25) had pledged eyes. On multivariate analysis the awareness of eye donation was significantly less in those subjects > or = 70 years old (OR 0.7; 95% CI: 0.6-0.8), illiterates (OR 0.2; 95% CI: 0.1-0.2), females (OR 0.8; 95% CI: 0.7-0.9), lower socioeconomic status group (OR 0.4; 95% CI: 0.4-0.5) and Christians (OR 0.2; 95% CI: 0.1-0.6). Media comprised the major source of information about eye donation. Of those aware of eye donation, 32.9% were willing to pledge eyes, and 50.6% needed more information to decide whether or not to pledge their eyes. CONCLUSIONS: There needs to be more transfer of knowledge if more eyes are to be pledged. One-third of those aware of eye donation have not pledged their eyes, and an additional 50.6% needed more information to decide. This means only about one-fifth of those aware of eye donations have pledged their eyes.

Adolescent↗
PubMed2003

Outcome of surgery on infants younger than 1 month with congenital glaucoma.

PURPOSE: To determine the visual outcomes and surgical and anesthetic complication rates of patients with newborn glaucoma operated within 1 month of age. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: All children with newborn glaucoma who underwent surgery between January 1990 and December 2000 were included. METHODS: The medical records of 25 consecutive patients (47 eyes) who underwent primary combined trabeculotomy and trabeculectomy either bilaterally in a single session or unilaterally were reviewed retrospectively. Outcomes were evaluated using Kaplan-Meier survival analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included corneal clarity, intraocular pressure (IOP), bleb characteristics, visual acuity, refractive errors, and identification of surgical and anesthetic complications. RESULTS: The mean follow-up was 3.1+/-1.8 years (range, 9.5 months-7.4 years). The mean preoperative IOP was 26.9+/-5.2 mmHg (range, 14-42 mmHg). At the final follow-up visit, the mean IOP was 14.5+/-3.8 mmHg (range, 8-28 mmHg). The percentage reduction in IOP was 43.3+/-21.5 (P<0.0001). Twelve-, 24-, and 36-month survival rates for complete success for IOP control were 89.4%, 83.6%, and 71.7%, respectively, which were maintained for 7 years of follow-up. After surgery, complete clearance of corneal edema was achieved in 66% of the eyes. Data on visual acuity was available for 19 patients. Final best spectacle-corrected visual acuity was 20/40 or better in the better eye in 5 patients (26.3%), 7 patients (36.8%) obtained 20/60 or better in the better eye, 8 patients (42.1%) achieved final visual acuity of less than 20/60 to 20/200 in the better eye (low vision), and four patients obtained less than 20/400 visual acuity in the better eye (blind) according to World Health Organization criteria. However, there was no eye with absent perception of light in the better eye. Myopia (mean spherical equivalent, 4.6+/-3.2 diopters) was the most common refractive error, present in approximately half of the eyes (n = 23; 53.8%). There were no significant intraoperative or postoperative complications in any patient. Anesthesia-related complications developed in 2 patients; however, they were resuscitated successfully. CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy offers a viable surgical option in infants that have cloudy corneas at birth as a result of congenital glaucoma. It is associated with a favorable visual outcome and a low rate of anesthetic complications in an Indian population.

Cornea↗
PubMed2003

Clinical experience with N-butyl cyanoacrylate tissue adhesive in fungal keratitis.

PURPOSE: To evaluate the role of tissue adhesive in the management of corneal thinning or perforation associated with active fungal keratitis. DESIGN: Retrospective noncomparative interventional case series. METHODS: Seventy-three eyes of 73 patients with microbiologically proven keratomycosis associated with thinning or perforation participated in the study. N-Butyl cyanoacrylate tissue adhesive (medical grade) and bandage contact lens were applied in addition to topical and systemic antifungal therapy. Our outcome measures included resolution of the infiltrate and preservation of the structural integrity of the globe. RESULTS: Outcome data were available for 66 eyes. The infiltrate resolved with scar formation in 42 (63.6%) eyes. In an additional eight (12.1%) eyes, tissue adhesive maintained the structural integrity of the globe while the patients awaited penetrating keratoplasty. Sixteen (24.2%) eyes showed progressive worsening or persistence of the infiltrate after application of tissue adhesive. Twenty-five (37.8%) eyes required multiple applications of tissue adhesive. The outcome was better in cases where the infiltrate measured less than 30 mm2 at the time of presentation and application of tissue adhesive (P < 0.01). CONCLUSION: In view of the poor outcome of penetrating keratoplasty in active fungal keratitis, N-butyl cyanoacrylate tissue adhesive is a useful modality for the management of progressive thinning or perforation associated with active fungal keratitis. However, close observation is mandatory to assess the progression of disease.

Antifungal Agents↗