Leucocoria as the presenting sign of a ciliary body melanoma in a child.
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Cataract↗
Biomedical subjects
S G Honavar
Publications and source records attributed to S G Honavar.
Primary ophthalmic rhabdomyosarcoma in 33 patients.
PURPOSE: To review the findings, management, and outcome in 33 cases of primary ophthalmic rhabdomyosarcoma. METHODS: The records of 33 consecutive patients from a single ocular oncology center were analyzed retrospectively for outcomes of final visual acuity, local recurrence, and distant metastasis. RESULTS: Rhabdomyosarcoma was primarily located in the orbit m 25 cases (76%), conjunctiva in 4 (12%), eyelid in 1 (3%), and uveal tract in 3 (9%). Findings had been present for a mean of 5 weeks and included proptosis in 10 patients (30%), eyelid swelling in 7 (21%), and blepharoptosis in 6 (18%). The initial diagnoses before referral to us included primarily rhabdomyosarcoma in 8 cases (24%), conjunctivitis in 5 (15%), cellulitis in 5 (15%), and pseudotumor in 4 (12%). Tumors were classified according to the Intergroup Rhabdomyosarcoma Study Group staging and treatment protocols as group I in 4 cases (12%), group II in 12 (36%), group III in 16 (48%), and group IV in 1 case (3%). Treatment included surgical debulking, chemotherapy, and radiotherapy. Local tumor recurrence was detected in 6 patients (18%), lymph node spread in 2 (6%), and distant metastasis in 2 (6%). Long-term visual outcome of the 28 patients who maintained their globe was 20/20 to 20/40 in 11 patients (39%), 20/50 to 20/100 in 5 (18%), and 20/200 or worse in 12 (43%). Mean follow-up was 8.3 years; tumor-related death occurred in 1 patients (3%). CONCLUSIONS: Rhabdomyosarcoma can present in the orbit, eyelid, conjunctiva, and uveal tract. Following treatment, local tumor recurrence occurs in 18% of cases, metastasis in 6%, and death in 3%.
Adolescent↗
Long-term follow-up of giant nodular posterior scleritis simulating choroidal melanoma.
A 41-year-old asymptomatic woman was referred for enucleation of a 7. 5-mm-thick intraocular tumor suspected to be choroidal melanoma. The clinical findings combined with imaging studies suggested instead a diagnosis of giant nodular posterior scleritis. A scleral biopsy was performed to confirm the diagnosis. After 12 years of observation, the lesion has remained stable and visual acuity has been preserved. Nodular posterior scleritis can present with no symptoms of pain, redness, or visual disturbance and can remain quiet for many years. It must be clinically differentiated from choroidal melanoma. Arch Ophthalmol. 2000;118:1290-1292
Adult↗
Outcome of probing for congenital nasolacrimal duct obstruction in older children.
PURPOSE: To evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome. METHODS: The study was a single-center, prospective, interventional case series. Sixty patients with congenital nasolacrimal duct obstruction aged 24 months or older (range, 24 to 186 months; median, 33 months) presenting consecutively to the authors' institutional referral practice were studied. Probing of the nasolacrimal system under general anesthesia was the surgical intervention. Success of probing was the main outcome measure. Success was predefined as complete resolution of symptoms and signs (tearing, crusting, discharge, regurgitation on pressure over the lacrimal sac) of congenital nasolacrimal duct obstruction within 3 weeks of the procedure and continued remission at 6 months. Two attempts at probing were necessary before the procedure was declared a failure. RESULTS: One attempt at probing resulted in resolution in 73.3% (44 of 60) patients. Sixteen patients needed a repeat procedure. The overall success rate was 80% (48 of 60). Two specific types of obstructions of the nasolacrimal duct were recognized on probing: membranous and firm. Factors predictive of failure of probing were age older than 36 months (P <.0001); bilateral affection (P =.012); failed conservative therapy (P =.015); failed earlier probing (P <.0001); dilated lacrimal sac (P <.0001); and firm obstruction (P <.0001). CONCLUSION: Results indicate that probing is a viable primary surgical option for congenital nasolacrimal duct obstruction in children who present between 2 and 3 years of age, and identify factors predictive of poor prognosis.
Adolescent↗
Conjunctival intraepithelial neoplasia presenting as corneal ulcer.
PURPOSE: To report a case of conjunctival intraepithelial neoplasia presenting as corneal ulcer. METHOD: Case report of a 28-year-old man who presented with sudden onset of pain, redness, and watering in the right eye. Examination of right cornea revealed deep stromal infiltrate inferonasally. Adjacent to the infiltrate and straddling the inferonasal limbus, a reddish well-defined sessible lesion with prominent blood vessels was seen. After corneal scraping for microbiological evaluation, the patient was treated with frequent instillation of ciprofloxacin hydrochloride 0.3% eyedrops. RESULTS: Corneal scraping revealed no microorganisms. Infiltrate resolved promptly after excision of the lesion. Histopathologic evaluation of the excised lesion revealed conjunctival intraepithelial neoplasia. CONCLUSIONS: This case highlights the fact that conjunctival intraepithelial neoplasia at the limbus may present as corneal ulcer. This ulcer could have occurred secondary to a dellen formation and epithelial breakdown predisposing to a corneal ulcer.
Adult↗
Amniotic membrane transplantation for ocular surface reconstruction in Stevens-Johnson syndrome.
PURPOSE: To evaluate amniotic membrane transplantation (AMT) for ocular surface reconstruction in Stevens-Johnson syndrome (SJS). DESIGN: Prospective interventional case series. PARTICIPANTS: Ten consecutive patients (10 eyes) with SJS that underwent AMT as the first step in staged ocular surface reconstruction were included. METHODS: Amniotic membrane was processed under sterile conditions from a fresh placenta obtained from cesarean section in a seronegative pregnant woman and stored at -700 degrees C. Symblepharon release, excision of epibulbar fibrous tissue, and clearing of the fibrovascular membrane over the cornea was performed in all cases. Amniotic membrane covered the entire bulbar surface up to the fornices in five eyes; cornea and the perilimbal area in two eyes; cornea, the inferior bulbar surface, and the lower fornix in two eyes; and cornea and the superior bulbar surface in one eye. Obliterated fornices were deepened by use of fornix-formation sutures in all eyes. Symblepharon ring was placed postoperatively for 3 weeks to 2 months. Mean postoperative follow-up was 13.5 months (SD, +3.8 months; range, 9-30 months). MAIN OUTCOME MEASURES: Restoration of adequate bulbar surface free of symblepharon and good fornix depth were the main outcome measures. RESULTS: Complete corneal reepithelization occurred in all eyes between 1 and 6 weeks. Adequate bulbar surface and fornix depth were achieved in nine eyes, all of which were free of symblepharon at the final follow-up visit. Cicatricial entropion resolved in four of five lower eyelids and one of two upper eyelids after AMT. One patient had a central corneal melt that required or necessitated a penetrating keratoplasty. CONCLUSIONS: AMT restores adequate bulbar surface and fornix depth and prevents recurrence of symblepharon in severe cases of SJS.
Adolescent↗
Sensitivity of Swedish interactive threshold algorithm compared with standard full threshold algorithm in Humphrey visual field testing.
OBJECTIVE: To compare the sensitivity of Swedish interactive threshold algorithm (SITA) strategies with the standard full threshold algorithm in the Humphrey Field Analyzer. DESIGN: Observational case series. PARTICIPANTS: Forty-eight glaucoma patients who were experienced in automated perimetry. TESTING: Central field testing was performed with the 30-2 program using standard full threshold (SFT), SITA standard (SS), and SITA fast (SF) strategies. All three tests were carried out on each of four different days in a span of 4 weeks. MAIN OUTCOME MEASURES: Sensitivity, repeatability, time saved, and the extent of defect in the SITA strategies were compared with those of the SFT. RESULTS: The sensitivity of SS and SF were 95.12% and 92.68%, respectively. The time saved in SS and SF was 53.12+/-9.51% and 70.69+/-8.81%, respectively. The repeatability as assessed by intraclass correlation showed excellent repeatability for the SFT and SS strategies and excellent to poor repeatability with the SF strategy. With increasing mean deviation, the defects (significant at P<0.5%) in the pattern deviation plots tended to be more in the SITA strategies as compared with SFT. CONCLUSIONS: Swedish interactive threshold algorithm strategies have good sensitivity and are significantly faster as compared with the standard threshold algorithm. The repeatability of the SFT and SS strategies are excellent, whereas that of the SF strategy is variable.
Algorithms↗
Ultrasound biomicroscopy in the diagnosis of a foreign body simulating iris melanoma.
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Aged↗
Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments.
OBJECTIVE: To determine the incidence and associations of glaucoma after pars plana vitrectomy (PPV) and silicone oil injection (SOI) for complicated retinal detachments and the response to treatment. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 150 eyes of 150 patients who had completed a minimum of 6 months of follow-up were included in this study. Analysis included clinical records of all consecutive cases of complicated retinal detachment that underwent PPV with SOI between July 1991 and February 1996. INTERVENTION: Surgical intervention for vitreoretinal pathology included standard three-port PPV and additional procedures as appropriate for the retinal pathology, and SOI. Procedures for the control of glaucoma were silicone oil removal (SOR), trabeculectomy with mitomycin C, cyclocryotherapy, semiconductor diode laser contact transscleral cyclophotocoagulation (TSCPC) and anterior chamber tube shunt to encircling band (ACTSEB). MAIN OUTCOME MEASURES: Presence of glaucoma (predefined as intraocular pressure [IOP] > or = 24 mmHg, which also was > or = 10 mmHg over the preoperative level, sustained for > or = 6 weeks) and the result of medical and surgical management were the main outcome measures. Demographic, preoperative, intraoperative, and postoperative parameters including the age of the patient, etiology of retinal detachment, refractive status, pre-existing glaucoma, aphakia, diabetes mellitus, presence of silicone oil (SO) in the anterior chamber, emulsification of SO, rubeosis iridis, and anatomic success were evaluated by univariate and multivariate logistic regression analyses to assess their predictive value in the causation of glaucoma and to determine factors prognosticating response to treatment. RESULTS: The main indications for PPV+SOI were proliferative vitreoretinopathy (57%; 85 of 150), proliferative diabetic retinopathy (15%; 23 of 150), and trauma (14%, 21 of 150). Glaucoma occurred in 60 eyes (40%) at 14 days median (range, 1 day-18 months). Elevation of IOP could be attributed directly to SO in 42 (70%) eyes. Glaucoma was controlled in 43 (72%) of 60 eyes on treatment (with medicines alone in 30%; SOR and medicines in 25%; trabeculectomy with mitomycin C/ACTSEB/cyclocryotherapy or TSCPC in 17%); 28% (17 of 60) remained refractory. Independent predictive factors for glaucoma on multivariate analysis were rubeosis iridis (odds ratio, 10.76), aphakia (odds ratio, 9.83), diabetes (odds ratio, 6.03), SO in anterior chamber (odds ratio, 4.74), and anatomic failure (negative risk factor; odds ratio, 0.11). Poor prognostic factors for the control of glaucoma were SO emulsification (odds ratio, 15.34) and diabetes (odds ratio, 6.03). CONCLUSION: Glaucoma is a frequent and often a refractory complication of PPV with SOI and has a multifactorial etiology. Aggressive medical and surgical management with SOR, trabeculectomy with mitomycin C, glaucoma shunts, and cyclodestructive procedures shows modest success in controlling IOP.
Adolescent↗
Myocysticercosis: experience with imaging and therapy.
OBJECTIVE: To compare computed tomography (CT) and B-scan ultrasonography (USG) in the diagnosis and to study the efficacy of a combination of oral albendazole and prednisolone in the management of myocysticercosis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-six consecutive patients with myocysticercosis. INTERVENTION: Diagnostic imaging was performed by CT scan and USG in 24 and 22 patients, respectively; serial USG was obtained in 7 patients receiving treatment. All patients received oral albendazole (15 mg/kg body weight per day) and prednisolone (1.5 mg/kg body weight per day) for 4 weeks. MAIN OUTCOME MEASURES: Presence of scolex on CT scan compared to USG and clinical response to medical therapy were the main outcome measures. Recovery was defined as complete resolution of the scolex or of the main presenting clinical feature. RESULTS: Presence of scolex on CT scan (11 of 24) and USG (11 of 22) was not different (P = 1.0; chi-square test). Recovery was seen in 24 (92%) of 26 patients receiving medical treatment. On serial USG of patients receiving treatment (n = 7), cysts with scolex were seen to progress to a cyst without scolex before final resolution. Time to recovery on treatment (0.5-35 months) correlated with the duration of symptoms at presentation (correlation coefficient r = 0.56, P = 0.003, linear regression analysis), but not with positive serum enzyme-linked immunosorbent assay for anticysticercal antibodies (P = 0.57, log-rank test) or the presence of scolex (P = 0.52, log-rank test). CONCLUSIONS: Treatment with a combination of oral albendazole and prednisolone is effective in the management of myocysticercosis. Imaging methods CT and USG are equally effective in identifying the cyst and the scolex; serial USG is useful in studying the temporal sequence of therapeutic response. The longer recovery time correlating with the duration of symptoms may indicate the chronicity of the inflammatory changes requiring longer time for recovery.
Administration, Oral↗
Automated perimetry and threats to fixation.
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Fixation, Ocular↗
Sterilisation of tonometers and gonioscopes.
Precautions to prevent spread of infection through tonometers and gonioscopes are described in this article. Tonometers and gonioscopes should not be used in the presence of clinically manifest conjunctivitis and keratitis. The Schiotz tonometer should be dipped in a 1:1000 merthiolate solution, and rinsed in saline/distilled water prior to use. The Goldmann applanation prism tip can be wiped with gauze soaked in 70% isopropyl alcohol and then dried before use. Gonioscopes should be cleaned in running water, wiped with gauze soaked in 70% isopropyl alcohol, and then dried before use. Koeppes and goniotomy lenses can be sterilized with ethylene oxide, prior to use in surgery.
Anti-Infective Agents, Local↗
Mitomycin-C in congenital glaucoma.
BACKGROUND AND OBJECTIVE: To evaluate the adjunctive use of mitomycin-C (MMC) during trabeculotomy and trabeculectomy for eyes with high-risk congenital glaucoma. PATIENTS AND METHODS: A prospective, randomized, double-blind study was performed to compare the effect of a single, 4-minute intraoperative exposure to 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC on trabeculotomy with trabeculectomy in 16 high-risk cases (30 eyes) of congenital glaucoma. RESULTS: The preoperative and final postoperative intraocular pressures (IOPs) of the two groups did not differ significantly. At the final follow-up, IOP control (< 21 mm Hg) without medications was achieved in 60% of the eyes in group 1 and in 86.67% of the eyes in group 2 (P = 21). With medication, IOP control was achieved in 86.7% of the eyes of each group. In both groups, the rate of surgical failure was 13.3%. Avascular, thin, sharply demarcated blebs were noted in 33.3% of the eyes from group 1 and in 66.67% of those from group 2 (P = .14). Intraoperative and postoperative hyphema and postoperative hypotony were the complications encountered in both groups, whereas serous choroidal detachment and wound leakage were seen only in group 2. CONCLUSIONS: Intraoperative MMC applied at a concentration of 0.2 mg/ml controlled postoperative IOP as effectively as a 0.4-mg/ml concentration in high-risk cases of congenital glaucoma, but with a lower incidence of complications and thin-walled blebs.
Administration, Topical↗
Evaluation of topical 0.03% flurbiprofen drops in the treatment of herpetic stromal keratitis.
PURPOSE: The management protocol for herpetic stromal keratitis (HSK) is still controversial. We have attempted to compare the relative efficacy of topical dexamethasone 0.01% and flurbiprofen 0.03% in combination with topical acyclovir 3% in HSK. METHODS: In this institutional, prospective, randomized, controlled, double-blind study, 45 clinically diagnosed cases of HSK were randomly distributed into three coded treatment groups--topical placebo, dexamethasone 0.01%, and flurbiprofen 0.03% each in tapering frequency and in combination with acyclovir 3% ointment five times per day for four weeks. Therapeutic response was assessed every third day for four weeks. Decoding of the treatment groups was done at the conclusion of the study and data analysed. RESULTS: Four-week success rate was 93.3% (14 of 15) in the dexamethasone-acyclovir treatment group, 66.7% (10 of 15) in the flurbiprofen-acyclovir treatment group and 20% (3 of 15) in the placebo-acyclovir treatment group. CONCLUSION: While dexamethasone in combination with acyclovir gives the best results in HSK with minimal side-effects, the role of topical flurbiprofen seems promising.
Acyclovir↗
Capsulotomy for phacoemulsification in hypermature cataracts.
We describe a modified surgical technique of anterior capsulotomy and phacoemulsification for use in hypermature cataracts. Surgical steps included inferior linear capsulotomy with aspiration of milky cortex, inflation of the capsular sac with viscoelastic, a reverse triangular anterior capsulotomy with Vannas scissors, and in-the-bag bimanual sculpting of the nucleus. An oval 5 mm x 6 mm posterior chamber intraocular lens was used with single horizontal or no-stitch wound closure. The technique was used successfully in 20 cases of hypermature cataract. The mean time required to perform phacoemulsification was 3.46 minutes (range 1.2 to 6.3 minutes), with a standard deviation of 1.29. Visual acuity on the first postoperative day ranged from 20/20 to 20/60 (median 20/40). At one week, the mean astigmatism was 1.01 diopters (range 0.25 to 2.75 diopters). The mean endothelial cell loss was 13% (range 3.6% to 26.0%). Based on our results, the modified phacoemulsification technique merits consideration for use in hypermature cataracts.
Adult↗
Combined keratoplasty, cataract extraction, and intraocular lens implantation after corneolenticular laceration in children.
Over a period of two years we performed combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation in seven children between the ages of 2 and 12 years old. The interval between trauma and the surgery varied from six weeks to six months (3.5 +/- 1.6 months, mean +/- SD). All of the patients had undergone primary repair of corneal perforation. Fresh corneas preserved in McCarey-Kaufman medium were used. The graft size was 7.5 mm with 0.5 mm disparity. Posterior chamber polymethylmethacrylate C-loop lenses were used in all cases. The surgeon's average postkeratoplasty keratometry was used in the calculation of intraocular lens power. The follow-up period ranged from nine to 36 months (18 +/- 9.1 months, mean +/- SD). Six grafts remained clear at the final follow-up. The visual acuity ranged from 20/40 to 20/200 with final astigmatism ranging from 0.5 diopter to 2.0 diopters. One patient developed a retinal detachment 12 months after surgery, which was successfully reattached. One patient, who had preoperative corneal vascularization, had graft rejection, which was treated medically. Our limited series suggests that the triple ocular procedure is a good choice for the treatment of corneolenticular trauma in children. The proper postoperative treatment includes vigorous antiamblyopia therapy and Nd:YAG laser treatment of after-cataracts.
Amblyopia↗
Pre-existing posterior capsule breaks from perforating ocular injuries.
We analyzed the characteristic features and intraoperative behavior of pre-existing posterior capsule breaks in 12 cases of traumatic cataract caused by perforating ocular trauma. The interval between the occurrence of trauma and cataract surgery ranged from three days to one year. Two distinct types of posterior capsule breaks were found: one had thick, fibrous, opaque margins with associated posterior capsule opacification (type I); the other had thin, transparent margins (type II). Type I breaks did not enlarge intraoperatively, whereas type II breaks behaved as fresh breaks by enlarging during irrigation/aspiration and had to be managed by viscoelastic plugging, dry aspiration, and adequate vitrectomy. Primary posterior capsulectomy was required in all cases with type I breaks because of posterior capsule opacification. The difference in the two types of breaks appeared to be time-dependent: cases with delayed surgical intervention (one month to one year) showed type I breaks with clinical evidence of attempted healing of the defect; cases with early surgical intervention (three days to one week) exhibited type II breaks, which did not differ from fresh intraoperative breaks.
Adult↗
Protection of the iris by lamellar dissection of corneal layers. A technique in penetrating keratoplasty.
Adherent leukomatous corneal opacities constitute the bulk of cases undergoing keratoplasty in developing countries. Surgical trauma to the iris resulting in a large iris coloboma, iridodialysis, and bleeding are the imminent intraoperative complications in such cases. We have evolved a technique of lamellar separation of corneal layers and gentle separation of adherent iris after partial trephination in such cases. We have successfully used this technique in six cases of adherent leukoma. No intra-or postoperative complication related to lamellar separation was encountered, and all the grafts remained clear at the end of 3 months.
Adolescent↗