Raised intraocular pressure and orbital inflammation: a rare IgE-mediated allergic reaction to sub-Tenon's hyaluronidase.
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Biomedical subjects
Publications and source records attributed to Sathish Srinivasan.
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We report a case of severe bilateral simultaneous Achromobacter xylosoxidans keratitis following penetrating keratoplasty (PKP) in a patient with graft-versus-host disease. The predisposing factors, clinical features, treatment options, and final visual outcome are reviewed. To our knowledge, this is the first report of bilateral A xylosoxidans keratitis following PKP.
PURPOSE: To characterize the corneal topographic features in a family with nanophthalmos. METHODS: Two observational case reports and a review of the literature. Corneal shape was analyzed using a topographic modeling system (TMS) and an Orbscan topographic system, with further analysis based on Fourier series and Zernicke polynomials. A control group was used for comparison. RESULTS: Two female family members with nanophthalmos belonging to the same generation showed significant irregular corneal astigmatism and corneal steepening. CONCLUSION: Topographic corneal steepening and irregular astigmatism seems to be associated in 1 family with inherited nanophthalmos. Higher degrees of irregular astigmatism, which were not evident without a topographic analysis, may account, in part, for the unexplained visual reduction.
PURPOSE: To report spontaneous corneal perforation as a presenting sign of unilateral Terrien marginal degeneration in a young adult. METHODS: A 19-year-old woman presented with sudden loss of vision in her left eye of 1-day duration. Examination revealed superior corneal thinning with superficial vascularization and secondary lipid keratopathy. There was an area of corneal perforation at the 11 o'clock position, leading to a shallow anterior chamber, ocular hypotony, and a hypotonic maculopathy. The right eye was normal on biomicroscopy. RESULTS: The area of perforation was confirmed by a positive Seidel test. A 22-mm-diameter bandage contact lens was fitted, which led to closure of the perforation and reformation of the anterior chamber. Orbscan corneal topography confirmed superior corneal thinning, 2.3 D of against-the-rule astigmatism, and 3.4 D of irregular astigmatism in the central 3-mm zone. Topography of the right showed no apparent abnormality. CONCLUSION: Terrien marginal degeneration is an unusual cause for a spontaneous corneal perforation. Patients with this disorder should be warned about this possibility.
BACKGROUND: To show that a pledget soaked in mydriatics and placed in the lower conjunctival fornix is as effective as drops in providing mydriasis for cataract surgery. METHODS: A randomized, masked, controlled trial of 56 patients assigned to either a pledget group (n=25) or a control eye drops group (n=31) was carried out. Controls had the routine practice of repeated topical mydriatic drops: tropicamide, phenylepherine and atropine. The trial group had a 3-mm pledget trimmed, soaked in mydriatics and placed in the inferior fornix for 20 min. Pupil diameter was measured using a photographic technique with a standard scale shown in each picture. Two masked observers measured the pupils using the scale of the ruler in the developed photograph. All patients completed a 0-10 stinging score prior to surgery. RESULTS: There were no complications. The mean pupil diameter in the control group was 7.23 (6.91-7.94 95% confidence intervals [CI]) and 7.44 (6.96-7.92 95% CI) in the pledget group. There was no statistically significant difference in pupil diameter between the two groups: difference between means 0.21 (-0.32 to 0.75 95% CI) and Student's t-test of the difference between means (t=0.8 and two-tailed) probability P=0.43. There was no significant difference in the stinging scores: Mann-Whitney test P=0.69. CONCLUSION: The use of a pledget cellulose sponge to deliver mydriatics prior to cataract surgery is as effective as the conventional method of repeated drop administration and was not associated with any adverse effects.
In this study we report that deletion of E6-associated protein (E6-AP) in mice results in a smaller prostate gland compared with that in normal wild-type animals. To investigate the mechanism(s) by which E6-AP affects prostate gland growth and development, we carried out both in vitro and in vivo experiments. In this study we show that E6-AP interacts with androgen receptor (AR) in a hormone-dependent manner and enhances the transactivation function of AR. Our in vivo data from E6-AP-null prostate glands show that the level of AR protein is elevated while the level of the AR target protein, probasin, is decreased. In contrast, the level of AR protein is decreased, and its target protein is increased in an E6-AP-overexpressing stable cell line, suggesting that E6-AP modulates both the protein level and the activity of AR. In addition, we show that the levels of phosphatidylinositol 3-kinase, total Akt, and phosphorylated Akt are decreased in E6-AP-null prostate, suggesting that E6-AP deletion down-regulates the signaling of the phosphatidylinositol 3-kinase-Akt pathway. We also show that RhoA negatively regulates AR function, and RhoA levels are increased in E6-AP-null prostate. Furthermore, expression levels of p53, Bax, active caspases, and apoptotic index are increased in E6-AP-null prostate. Collectively, our data suggest that E6-AP deletion attenuates the growth and development of the prostate gland by interfering with AR function as well as by stimulating p53-mediated apoptosis.
PURPOSE: To describe bilateral corneal endothelial abnormalities associated with thalidomide toxicity. METHODS: Observational case report. RESULTS: A 30-year-old man, born with bilateral hypoplastic upper limb defects (phocomelia) caused by thalidomide toxicity, presented with bilateral symmetrical corneal endothelial changes resembling guttata without corneal edema. Pachymetry, specular microscopy, and confocal microscopy were performed. Biomicroscopy findings over a 10-year follow-up showed no changes. CONCLUSIONS: Nonprogressive bilateral corneal endothelial changes resembling cornea guttata should possibly be included in the ocular manifestations of thalidomide toxicity. We postulate that thalidomide may have affected the migration and development of the mesenchymal neural crest cells, which are the developmental precursors of the corneal endothelium and stroma.
PURPOSE: To report a case of localized conjunctival necrosis following intravitreal injection of triamcinolone acetonide (TA). DESIGN: Single observational case report. METHODS: A 63-year- old man presented with inferotemporal branch retinal vein occlusion and macular edema in his left eye (OS). He underwent pars plana vitrectomy combined with arteriovenous sheathotomy. Postoperatively, as the macular edema persisted, he underwent an uneventful intravitreal injection of TA. RESULTS: Ten days following the intravitreal injection, he presented with an area of localized conjunctival necrosis overlying the scleral entry site. Gram stain showed a few white blood cells and no organisms. The conjunctival swab showed no growth on culture. The area of conjunctival necrosis responded well to intense topical antibiotic therapy. CONCLUSIONS: Conjunctival necrosis is a rare anterior segment complication of intravitreal injection of TA. With the increased usage of intravitreal TA for various posterior segment disorders, the treating physician should be aware of this complication.
PURPOSE: To report a case of localized bullous keratopathy and total corneal decompensation secondary to iridocorneal touch in iridoschisis. DESIGN: Single interventional case report with pathologic correlation. METHODS: An 80-year-old man with bilateral iridoschisis presented with loss of vision in the left eye (OS). Examination of the OS showed shallow anterior chamber (AC), cortical cataract, and free-floating iris fibers causing iridocorneal touch, leading to localized bullous keratopathy and total corneal decompensation. Ultrasound biomicroscopy (UBM) confirmed the area of iridocorneal contact. RESULTS: Penetrating keratoplasty combined with cataract extraction and posterior chamber lens implantation was performed in the OS. Histopathology of the corneal button showed features of corneal edema and endothelial cell loss with evidence of iridocorneal contact. CONCLUSIONS: Iridoschisis is an uncommon cause of bullous keratopathy and corneal decompensation. Patients with iridoschisis may need specular microscopy to determine the status of the corneal endothelium.
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PURPOSE: To report two patients with lipid granulomas of the episclera complicating vitrectomy and silicone oil tamponade. DESIGN: Two observational case reports. INTERVENTION: Patient 1, a 41-year-old woman, underwent vitrectomy with silicone oil tamponade for proliferative diabetic retinopathy. Four weeks later, she sought treatment for inflamed episcleral nodules adjacent to one of the sclerostomy sites. The oil was removed and the episcleral nodules were excised. Patient 2, a 33-year-old man, underwent vitrectomy and silicone oil tamponade for tractional retinal detachment. He experienced a painful blind eye with episcleral nodule that required enucleation. MAIN OUTCOME MEASURES: On histopathological analysis, both specimens demonstrated episcleral granulomas caused by silicone oil. CONCLUSIONS: Episcleral nodules adjacent to vitrectomy entry sites with silicone oil tamponade may represent lipid granulomas, probably caused by silicone oil leakage from scleral entry ports.
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