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Biomedical subjects

Vishali Gupta

Publications and source records attributed to Vishali Gupta.

At least 19 recordsLinked to original sources
PubMed2006

Successful management of tubercular subretinal granulomas.

PURPOSE: To report the successful management of 12 eyes of 11 patients with tubercular subretinal granulomas. METHODS: Eleven consecutive patients with a presumed or confirmed diagnosis of tubercular subretinal granulomas were treated with four-drug anti-tuberculosis chemotherapy with concomitant oral corticosteroids. Two patients underwent pars plana vitrectomy. RESULTS: The study included seven males and four women with a median age of 30.5 years. Ten eyes responded well to medical management and a final visual acuity of 20/80 or better was achieved in eight of them. The eyes subjected to pars plana vitrectomy had a relatively worse outcome. CONCLUSIONS: Tubercular subretinal granulomas are amenable to medical management provided an early diagnosis is made and treatment is initiated promptly. Once the diagnosis of presumed or confirmed tuberculosis is established, surgical intervention should be avoided.

Adult↗
PubMed2005

Simultaneous choroidal tuberculoma and epididymo-orchitis caused by Mycobacterium tuberculosis.

PURPOSE: To report positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis from the vitreous and epididymal fluid in a patient of choroidal tuberculoma and epididymitis. DESIGN: Interventional case report. METHODS SETTING: Institutional setting. intervention: Vitreous and epididymal fluid tap subjected to PCR for primer IS 6110 sequence specific for M. tuberculosis. Purification of DNA product and sequencing on an automated DNA sequencer. Institution of antitubercular therapy. MAIN OUTCOME MEASURE: Matching of sequence with NCBI's data bank response to antitubercular therapy. RESULTS: DNA products from vitreous and epidiymal fluid matched with IS 6110 sequence of M. tuberculosis. Choroidal granuloma and epididymitis responded to antitubercular therapy. CONCLUSIONS: Simultaneous choroidal tuberculoma and epididymitis resulted from an infection by M. tuberculosis, and both matched with IS 6110 sequence of M. tuberculosis.

Adult↗
PubMed2005

Disseminated metastasis following periampullary cancer resection masquerading as uveitis.

The Uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic intraocular inflammation, but are in fact neoplastic in nature. We report a patient with disseminated malignancy who presented with uveitis 5 years after an apparently successful resection of periampullary adenocarcinoma. The Masquerade Syndrome was detected by cytological examination of the vitreous.

Adenocarcinoma↗
PubMed2005

Retinal arterial occlusion in Takayasu's arteritis.

Takayasu's arteritis is an auto-immune disorder of the large and medium-sized arteries, commonly involving the heart and its main vessels. It is now recognised that the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, suggesting that primary small vessel involvement may contribute to the development of the clinico-pathological features of Takayasu aorto-arteritis. Classical ophthalmic features of the disease result from reduced ocular perfusion, which manifests as hypoxic retinal changes such as microaneurysms, arterio-venous anastomosis and non-perfused areas. Branch retinal artery occlusion has not been previously described in this condition. This case illustrates retinal arterial occlusion as the presenting feature of Takayasu's arteritis.

Adult↗
PubMed2004

Intractable glaucoma following intravitreal triamcinolone in central retinal vein occlusion.

PURPOSE: To document secondary glaucoma observed after intravitreal injection of triamcinolone for cystoid macular edema in central retinal vein occlusion. DESIGN: An interventional case series. METHODS: Retrospective study. The setting was a tertiary care referral institute. Nine patients with central retinal vein occlusion and cystoid macular edema received 4.0 mg/0.1 ml of intravitreal triamcinolone acetate injected through the inferior pars plana under topical anesthesia. Baseline intraocular pressures were normal in all, and no patients had glaucoma. RESULTS: Seven of the nine patients had a post-injection rise in intraocular pressures, of which one had intractable secondary glaucoma requiring removal of the depot corticosteroid by pars plana vitrectomy combined with trabeculectomy. Two patients were controlled only by maximal medical therapy. CONCLUSIONS: The occurrence of intractable glaucoma after intravitreal triamcinolone in central retinal vein occlusion is a serious concern and warrants caution in the use of this modality for these patients.

Adult↗
PubMed2004

Lipid-lowering drug atorvastatin as an adjunct in the management of diabetic macular edema.

PURPOSE: To determine the efficacy of the lipid-lowering drug atorvastatin in reducing retinal hard exudates and subfoveal lipid migration after focal/grid laser photocoagulation in clinically significant macular edema in patients with diabetes with elevated serum lipids. DESIGN: Randomized case trial. METHODS: Thirty patients with type 2 diabetes with clinically significant macular edema, dyslipidemia, and hard exudates of grade 4 and above were assessed in an institutional setting. All patients were subjected to strict metabolic control within 4 to 6 weeks of enrollment. In addition, 15 patients in group A received atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A inhibitor; 15 members of group B did not receive any lipid-lowering therapy. All received laser photocoagulation after a metabolic control period and were followed up for a minimum of 18 weeks. The outcome measures were reduction in hard exudates, subfoveal lipid migration, status of macular edema, and visual acuity. RESULTS: The study included 21 men and nine women with noninsulin-dependent diabetes mellitus who could achieve good metabolic control within 4 to 6 weeks of inclusion in the study. All patients had elevated serum lipids at baseline. Ten (66.6%) of 15 patients in treatment group A and two (13.3%) of 15 patients in control group B showed reduction in hard exudates (P =.007). None of the patients in group A and five (33.3%) of 15 in group B showed subfoveal lipid migration after laser photocoagulation (P =.04). Regression of macular edema was seen in nine eyes in group A and five in group B (P =.27). None of the eyes in group A and three eyes in group B showed worsening of visual acuity (P =.22). CONCLUSION: Oral atorvastatin therapy in patients with type 2 diabetes with dyslipidemia reduces the severity of hard exudates and subfoveal lipid migration in clinically significant macular edema and could be an important adjunct in the management of clinically significant macular edema.

Administration, Oral↗
PubMed2004

Paediatric open globe injuries. Visual outcome and risk factors for endophthalmitis.

PURPOSE: To study the incidence of open globe injuries and the outcome in children, and to study the risk factors for post-traumatic endophthalmitis. METHODS: Paediatric patient population. Retrospective analysis of 72 consecutive cases of open globe injury over 3 years (January 1998 to December 2000). RESULTS: The cause of trauma was sports related (n = 18), home-made bow and arrow (n = 16), household kitchen injuries (n = 10), cracker injuries (n = 7) and other miscellaneous outdoor activities (n = 16). In 5 children the cause could not be ascertained. Visual acuity of > or = 3/60 in the injured eye at the last follow-up examination was recorded in 37 of 70 patients (52.86%) whose visual acuity could be tested. The final visual acuity was significantly poorer in eyes where primary repair was delayed beyond 24 hours of injury (P < 0.05). Post- traumatic endophthalmitis developed in 39 of 72 (54.16%) eyes. Bow and arrow and household injuries (P < 0.5) and eyes in which primary repair was delayed beyond 24 hours of injury (P < 0.01) had a higher risk of endophthalmitis in univariate analysis. In multivariate analysis delayed repair was the only significant risk factor for the occurrence of endophthalmitis (P = 0.014). CONCLUSION: Delayed repair, bow and arrow injuries and household injuries were associated with significantly higher risk of endophthalmitis. The incidence of endophthalmitis can be reduced by early referral of trauma cases and parental supervision.

Adolescent↗
PubMed2004

Pattern of uveitis in a referral eye clinic in north India.

PURPOSE: To report the pattern of uveitis in a north Indian tertiary eye center. METHODS: A retrospective study was done to identify the pattern of uveitis in a uveitis clinic population of a major referral center in north India from January 1996 to June 2001. A standard clinical protocol, the "naming and meshing" approach with tailored laboratory investigations, was used for the final diagnosis. RESULTS: 1233 patients were included in the study; 641 (51.98%) were males and 592 (48.01%) females ranging in age from 1.5 to 75 years. The anterior uveitis was seen in 607 patients (49.23%) followed by posterior uveitis (247 patients, 20.23 %), intermediate uveitis (198 patients, 16.06%) and panuveitis (181 patients, 14.68%). A specific diagnosis could be established in 602 patients (48.82%). The infective aetiology was seen in 179 patients, of which tuberculosis was the commonest cause in 125 patients followed by toxoplasmosis (21 patients, 11.7%). Non-infectious aetiology was seen in 423 patients, of which ankylosing spondylitis was the commonest cause in 80 patients followed by sepigionous choroidopathy (62 patients, 14.65%). CONCLUSION: Tuberculosis and toxoplasmosis were the commonest form of infective uveitis, while ankylosing spondylitis and serpiginous choroidopathy were commonly seen as the non-infective causes of uveitis in North India.

Adolescent↗
PubMed2003

Presumed tubercular serpiginouslike choroiditis: clinical presentations and management.

PURPOSE: Choroiditis, choroidal tubercles, and tuberculomas are well known ocular manifestations of systemic tuberculosis. The present series aimed to report the occurrence of serpiginouslike choroiditis of presumed tubercular origin. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Eleven eyes in seven consecutive patients with a diagnosis of choroidal tuberculosis simulating serpiginous choroiditis were studied between 1997 and 2000. TESTING AND INTERVENTION: All patients had their fundus photographs taken at the time of initial presentation as well as during follow-up. All patients underwent a Mantoux skin test and chest radiography. In addition, five patients had their aqueous or vitreous humor subjected to polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Sputum examination, biopsy, or both were carried out whenever recommended by the pulmonologist. Systemic antituberculosis chemotherapy was instituted in combination with treatment for ocular inflammation. MAIN OUTCOME MEASURE: Therapeutic response and visual improvement. RESULTS: There were five men and two women ranging in age from 17 to 32 years. Clinical presentations included three morphologic variants; multifocal progressive choroiditis showing wavelike progression to confluent, diffuse lesions resembling serpiginous choroiditis (three eyes); diffuse choroiditis characterized by diffuse plaquelike choroiditis with an amoeboid pattern suggestive of serpiginous choroiditis at initial presentation (four eyes); and mixed variety where opposite eyes had mixed features (four eyes). All patients had strongly positive Mantoux skin test results and positive chest radiograph results. The PCR results from aqueous and vitreous humor in four samples was positive for Mycobacterium tuberculosis; one had sputum positive for acid-fast bacilli, whereas two had histopathologic evidence of tuberculosis from cervical or parahilar lymph nodes. Treatment was associated with resolution of choroidal lesions and visual improvement. Final visual acuity of 20/30 or better was achieved in five eyes. CONCLUSIONS: Choroidal tuberculosis may present as multifocal progressive or diffuse choroiditis resembling serpiginous choroiditis. It is important to recognize these presentations because these eyes show good response to systemic antituberculosis chemotherapy.

Adolescent↗
PubMed2003

Role of prophylactic intravitreal antibiotics in open globe injuries.

PURPOSE: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. METHODS: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. RESULTS: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. CONCLUSIONS: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.

Adolescent↗
PubMed2003

Spectrum and clinical profile of post cataract surgery endophthalmitis in north India.

PURPOSE: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. METHODS: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. RESULTS: The mean age of the patients was 59.50 +/- 13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81 +/- 24.01) and the medium symptom-presentation interval 7.5 days (mean 14.19 +/- 19.13). Corneal infiltrates were seen in 29%, hypopyon in 62 (50%). Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%), bacterial 12 (10%), fungal 27 (21.5%), polymicrobial 8 (6.5%) and negative 55 (44%). 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. CONCLUSION: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.

Aged↗
PubMed2003

Posterior scleritis associated with systemic tuberculosis.

Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

Antitubercular Agents↗
PubMed2002

Clinical characteristics of serpiginous choroidopathy in North India.

PURPOSE: To describe clinical characteristics of serpiginous choroidopathy in the North Indian population. DESIGN: Retrospective cohort-based study. METHODS: Records of 86 patients who obtained a diagnosis of serpiginous choroidopathy at presentation or after a minimal follow-up of 2 years were retrieved. Group I included 62 patients who were diagnosed as having serpiginous choroidopathy at the initial presentation. Group II included 20 patients who initially presented as having multifocal placoid pigment epitheliopathy resembling acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and had progressed over years to serpiginous choroidopathy, while group III had 4 patients with mixed presentations. Statistical analysis was done using the chi-square and Mann-Whitney U test. A review of the clinical, historical, fundus photographic, and fluorescein angiographic features was performed. The demographic and clinical features, number of recurrences, final visual acuity, and final description of healed lesions were documented. RESULTS: The median age at presentation was 30 years in group I, 29 years in group II, and 31 years in group III. The disease was bilateral in five (15%) patients in group I, 12 (60%) in group II, and all four in group III. All the affected eyes in groups II and III and 58 eyes (87%) in group I had recurrences over 2 to 8 years of follow up. Compared with group I, group II was characterized by more bilaterality (P =.001), less central foveal involvement (P =.001), better final visual acuity (P =.001), the presence of healed multifocal scars (P =.001), and less subretinal fibrosis (P =.02). Four patients in group III showed mixed features. CONCLUSIONS: Serpiginous choroidopathy in our population was seen in young patients and had three distinct presentations that seemed to affect the choriocapillaris primarily. Our patients appeared to have a variation of serpiginous choroidopathy, typical of the Asian-Indian population, that had some important differences from that reported in Caucasians.

Adolescent↗