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Biomedical subjects

V Vinod Mootha

Publications and source records attributed to V Vinod Mootha.

9 recordsLinked to original sources
PubMed2006

Mucous membrane pemphigoid with fatal bronchial involvement in a seventeen-year-old girl.

PURPOSE: This study was designed to report a case of biopsy-proven mucous membrane pemphigoid with severe bronchial involvement in a young woman. METHODS: Case report of a 17-year-old girl who presented with worsening dyspnea, skin rash, and bilateral ocular injection, symblepharon, and fornix foreshortening. Conjunctival, skin, and bronchial biopsies were performed along with imaging and serological tests in an effort to establish a diagnosis for this unusual constellation of findings. The surprising occurrence of a cerebrovascular accident during her hospitalization also prompted a search for a concurrent coagulation disorder. RESULTS: Immunofluorescence studies of conjunctival, skin, and bronchial tissue specimens revealed deposition of multiple antibody classes at the basement membrane zone. The patient also possessed circulating basement membrane zone antibodies in her serum and a significant titer of antiphospholipid antibodies. She underwent dilation and stent placement for subglottic tracheal and left bronchial stenosis and was treated with immunosuppressive agents. After a favorable initial response, the patient experienced progressive bronchial stenosis and respiratory compromise, culminating in her death from bronchospasm and cardiopulmonary arrest. CONCLUSION: To our knowledge, this is the first report of mucous membrane pemphigoid involving the lower airways that was confirmed by immunofluorescence analysis. It highlights the potentially lethal, systemic nature of mucous membrane pemphigoid and underscores the need to question patients about symptoms of respiratory dysfunction.

Adolescent↗
PubMed2004

Slitlamp, specular, and light microscopic findings of human donor corneas after laser-assisted in situ keratomileusis.

OBJECTIVE: To examine slitlamp, specular, and light microscopic features of human donor corneas known to have undergone laser-assisted in situ keratomileusis (LASIK). METHODS: Twenty-six donor corneas known to have undergone LASIK prospectively underwent slitlamp examination with particular attention to the presence of a flap edge, as well as specular microscopy with particular attention to the presence of highly reflective particles in the stroma corresponding to the LASIK interface. Central endothelial cell density and pachymetery were obtained. They were compared with 26 control donor corneas without LASIK. Eleven LASIK donor corneas were processed for histology. Twenty-six donor corneas with no known prior keratorefractive surgery also underwent similar slitlamp examination and specular microscopy to serve as controls. RESULTS: Twelve (46%) of 26 LASIK donor corneas had an obvious flap edge, and 10 (39%) had a subtle flap edge by slitlamp examination. Four (15%) had infiltrates by slitlamp examination, of which 3 were confirmed by histopathologic examination. Highly reflective particles were seen by specular microscopy in the stroma of 23 (88%) of 26 LASIK donor corneas, but only 1 (4%) of 26 control donor corneas had a single highly reflective particle in the stroma (P<.001). The mean central endothelial cell counts were similar: 2138 cells/mm(2) in the LASIK group compared with 2250 cells/mm(2) in the controls (P =.39). Vacuolization and pyknosis of keratocytes was a consistent histopathologic finding after LASIK. Metallic particles at the interface were not detected by histology. CONCLUSIONS: Detection of a flap edge by slitlamp examination may detect at least half of the donor corneas that may have undergone LASIK. The detection of highly reflective stromal particles may form an effective basis for screening for LASIK donor corneas using specular microscopy and requires further study.

Adult↗
PubMed2004

Incidence of and risk factors for residual posterior capsule opacification after cataract surgery.

PURPOSE: To evaluate the incidence of and determine the risk factors for residual posterior capsule opacification (PCO). SETTING: University of New Mexico Health Sciences Center and the Veterans Administration Medical Center, Albuquerque, New Mexico, USA. METHODS: This study evaluated 194 uneventful cataract surgeries. Immature cataracts were graded for nuclear sclerosis (NS), posterior subcapsular cataract (PSC), and anterior cortical spokes on a 1 to 4 scale. Preoperative Snellen best corrected visual acuity was converted to the logMAR scale. The posterior capsule was examined after polishing and was classified as clear or as having residual opacity. Those with residual capsule opacity were evaluated 6 weeks postoperatively for the presence of visually significant PCO. RESULTS: The incidence of residual capsule opacity was 23% (44 eyes). Seven (54%) of 13 eyes with white mature cataract had residual capsule opacity. In contrast, 37 (20%) of 181 eyes with immature cataract had residual capsule opacity (P = .01). In eyes with immature cataract, the mean preoperative logMAR acuity was +1.14 +/- 0.60 (SD) in the residual capsule opacity group and +0.73 +/- 0.46 in the clear group (P<.001). In eyes with immature cataract, the adjusted odds ratio for each increasing grade of NS was 2.3 and of PSC, 1.8 (P = .002 and P<.001, respectively). Eleven percent (5 eyes) of residual capsule opacities resulted in visually significant PCO 6 weeks postoperatively. All 5 opacities were centrally located at surgery. CONCLUSIONS: Results indicate that aggressive polishing of peripheral or adherent residual capsule opacities is not advisable as only 5 eyes with central residual capsule opacities developed visually significant PCO.

Aged↗
PubMed2004

Bilateral keratoconjunctivitis associated with lichen planus.

PURPOSE: To describe a case of bilateral keratoconjunctivitis in a patient with lichen planus. METHODS: Case report and review of the English literature. RESULTS: To our knowledge, this is the fourth reported case of keratoconjunctivitis associated with lichen planus. A 33-year-old Navajo man with lichen planus had recurrent and progressive keratoconjunctivitis that failed to improve on multiple topical medications. Tapered oral prednisone, 2% topical cyclosporin, and amniotic membrane transplantation pacified the acute exacerbation. CONCLUSIONS: Our patient with lichen planus developed an ocular surface disease with cicatricial conjunctivitis, keratouveitis, keratoconjunctivitis sicca, punctate epithelial erosions, and persistent epithelial defects leading to noninfectious or infectious corneal ulceration. Amniotic membrane transplantation may play an adjunctive role in refractory cases of lichen planus-related keratoconjunctivitis. Topical cyclosporin may stabilize the ocular surface when combined with systemic immunosuppression in severe cases.

Administration, Oral↗
PubMed2004

Pterygia with deep corneal changes.

PURPOSE: To report a series of patients with pterygia associated with deep corneal marks at the level of the endothelium and Descemet membrane previously unreported. METHODS: Clinical presentations of 7 patients (11 eyes) with pterygia and underlying deep corneal changes were reviewed for age, duration of pterygium, size of pterygium, and location of pterygium. Slit-lamp photos were obtained. Specular microscopy was performed on both eyes of 6 of these patients to evaluate the central endothelium and measure central corneal pachymetry. RESULTS: All patients were elderly (mean age 75 years, range 64-91) with long-standing nasal pterygia (average duration 43 years). The average size of the pterygium was 2.3 mm (range 0.75-4.25 mm). All patients had significant ultraviolet-B exposure based on outdoor employment or hobbies. None of the patients had a family history of pterygia. Slit-lamp photos document marks at the level of the endothelium and Descemet membrane. All the deep corneal changes were underlying or directly adjacent to the pterygium. Pachymetry measurements of the central involved corneas averaged 531 +/- 41 microm. Central endothelial cell counts of the 9 eyes with endothelial changes averaged 1580 +/- 412 cells/mm2. CONCLUSIONS: Long-standing nasal pterygia in elderly patients may rarely induce deep corneal changes at the level of the endothelium and Descemet membrane. Endothelial cell density may be lower in eyes with pterygia with deep corneal changes.

Aged↗