Cobbler's Technique for Iridodialysis Repair

We describe a novel “Cobbler's technique” for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The “Cobbler's technique” allows a maximally functional and cosmetic result for iridodialysis.

Comparison of multiplex RT-PCR with virus isolation for detection, typing and sub-typing of influenza virus from influenza-like illness cases

PURPOSE

Influenza epidemics and periodic pandemics occur worldwide resulting in significant mortality, morbidity and economic loss. There is need for a sensitive, rapid and cost-effective assay to detect, type and sub-type influenza viruses, as cell culture has a long turnaround time.

MATERIALS AND METHODS

Nasopharyngeal swabs were collected from patients presenting with influenza-like illness (ILI) at AIIMS OPD and Primary Health Centre Ballabhgarh (Haryana). From June 2007 to January 2009 and then from September to November 2009, of 1567 specimens collected, 544 were randomly selected and were tested by virus culture using Madin-Darby Canine Kidney (MDCK) cells and by reverse transcription polymerase chain reaction (RT-PCR) for influenza A using primers for matrix gene and for influenza B using non-structural gene (NS) primers. All influenza A positives were sub-typed using primers for HA and NA genes of A/H1, A/H3. A separate multiplex RT-PCR having primers from matrix and HA genes of pandemic A (H1N1) pdm09 viruses was carried out on samples collected after September 2009.

RESULTS

Of the 544 samples, 136 (25%) were positive for influenza by RT-PCR. Further typing analysis revealed 86 (63.2%) were typed as influenza A and 47 (34.5%) as influenza B viruses and 3 (2%) samples showed dual infection with influenza A and B. Of the 86 influenza A positive samples 48 (55.8%) were identified as seasonal influenza A/H1N1, 22 (25.6%) as A (H1N1) pdm09 and 16 (18.6%) as A/H3N2. Comparison of influenza positivity using virus culture revealed that only 97/136 (71.3%) were influenza positive. Sensitivity of viral detection was lowest for seasonal A/H1 (26/48; 54%), followed by H3N2 (11/16; 68.7%) and influenza B (38/47; 80.8%); all influenza A/H1N1pdm09 viruses were detected by both methods.

CONCLUSION

RT-PCR is a sensitive, low cost and rapid screening test for diagnosing influenza infection during epidemics and pandemics. mRT-PCR increased the detection rates for influenza by 28.6% as compared with virus isolation and thus is a useful assay in both diagnostic and epidemiological settings in resource poor countries.

Optic nerve involvement in childhood onset systemic lupus erythematosus: Three cases and a review of the literature

The ocular system can be affected in systemic lupus erythematosus (SLE) in one third of patients. However, optic nerve involvement is relatively uncommon, but is more so in pediatric SLE patients, where it can occur in 1% of cases. We report three children with SLE who presented with optic nerve involvement. Two children had optic neuritis, with optic neuritis being the first manifestation in one child. The third child had ischaemic optic neuropathy secondary to antiphospholipid syndrome. A careful work up for SLE should be performed in every child with optic nerve disease. Prompt diagnosis and early treatment results in a better prognosis.

Postural and diurnal fluctuations in intraocular pressure across the spectrum of glaucoma

AIMS

To evaluate postural fluctuations (PFs) and diurnal variation (DV) of intraocular pressure (IOP) in patients with untreated glaucoma, glaucoma suspects and healthy volunteers, and study their relationship, if any, to the extent of glaucomatous damage.

METHODS

This prospective, observational cross-sectional study was carried out in a tertiary care referral institution. The patient population included five groups of patients comprising the following: 19 with ocular hypertension (OHT), 26 with optic discs suspicious for glaucoma (DS), 18 with normal tension glaucoma (NTG), 19 with primary open angle glaucoma (POAG) and 20 normal subjects. The IOP was measured at four time periods using Perkins tonometer, in sitting and supine positions. The main outcome measures were change in IOP with posture, the DV in both postures and the relationship between PF, DV and the extent of visual field damage.

RESULTS

The supine IOP was significantly higher than the sitting IOP, at all time points of the day, in all groups (p<0.001). The PF at 04:30 was significantly higher in POAG, OHT and NTG. The PF at 09:00 correlated significantly with the mean deviation (MD) on visual fields in the NTG group (r=0.735; p=0.001). The DV did not correlate with the MD in any of the five groups studied.

CONCLUSIONS

The significantly higher supine IOP is frequently missed in routine glaucoma practice. An early morning supine IOP measurement may reveal a peak IOP hitherto not picked up during routine office IOP measurements, and may be a useful measurement in unexplained progressive glaucoma.

Preserving neural retina through re-emerging herbal interventions

Eye related diseases such as glaucoma, diabetic retinopathy, cataract, conjunctivitis are very common worldwide. With the current scenario India will be among the top five countries in the number of glaucoma cases. Limited discovery of successful drugs for the treatment of such diseases led scientists to look towards the use of conventional sources for treatment. Herbal extracts from Ayurveda have remained an important part of treatment regime in many parts of world even today. For this reason, local herbs possessing curative properties are still being used by local inhabitants due to its anti-inflammatory and antioxidant properties. Because retinal damage involves alterations in oxidative enzymes, blood flow changes and increase in apoptotic signals, herbal extracts are being tested for their ability to moderate antioxidant machinery and trigger neuroprotective pathways. The present review summarizes some of such herbal extracts which have been tested for their neuroprotective role in eye related diseases. The active components that exert neuroprotective effects have also been discussed along with possible mechanisms of action.

Traumatic Glaucoma in Children

Young patients are more prone to ocular trauma but most of the published studies describe complicated cataract as a result of trauma with its treatment modality. As a result, little is known about the different causes, common presenting signs and symptoms, visual outcomes, and most frequent management modalities of traumatic glaucoma in children. This review aims to study the demographical profile, presentation, management and outcome of traumatic glaucoma in children as well as the various factors associated with advanced glaucomatous changes.

How to cite this article: Kaur S, Kaushik S, Pandav SS. Traumatic Glaucoma in Children. J Curr Glaucoma Pract 2014; 8(2):58-62.

Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma

Primary angle closure glaucoma is usually a bilateral disease, though it may be asymmetrical. However, it is unusual to see advanced glaucoma in one eye and no disk damage in the other. We present a case of unilateral angle closure glaucoma complicated by an optic disk pit and iridociliary cysts.

How to cite this article: Kaushik S, Ichhpujani P, Kaur S, Pandav SS. Optic Disk Pit and Iridociliary Cyst Precipitating Angle Closure Glaucoma. J Current Glau Prac 2014;8(1): 33-35.

Intractable glaucoma necessitating dexamethasone implant (Ozurdex) removal and glaucoma surgery in a child with uveitis

Although there are encouraging reports showing the use of dexamethasone implant (Ozurdex) in uveitis in adults, the literature is scanty regarding its benefits and side effects in children. A 12-year-old boy presented with intermediate uveitis with disc oedema. He had 20/20 visual acuity and intraocular pressure (IOP) of 18 mm Hg in both eyes. He was treated with intravitreal Ozurdex in his left eye (LE) due to progressive worsening of uveitis and disc oedema. He developed increased IOP (31 mm Hg) that could not be controlled on maximal antiglaucoma medications and required the removal of the Ozurdex implant at 2.5 months. His IOP remained persistently high leading to increased cup disc ratio necessitating glaucoma filtration surgery (GFS). At 9 months of post-GFS follow-up, IOP was 12 mm Hg in LE without any medication. Though dexamethasone implant is being increasingly used in children with uveitis, its potential risk factors such as intractable glaucoma should be considered.

Unilateral recalcitrant glaucoma associated with cytomegalovirus in an immunocompromised child with Wiskott-Aldrich syndrome

We report a case of anterior uveitis and unilateral recalcitrant glaucoma in an immunocompromised 6-year-old boy diagnosed with Wiskott-Aldrich syndrome who presented with elevated intraocular pressure (IOP), mild anterior uveitis, and unilateral acute glaucoma. Polymerase chain reaction from the aqueous was positive for cytomegalovirus (CMV). After initially responding to ganciclovir, the IOP rose again. With worsening optic nerve status, the patient underwent glaucoma filtration surgery with mitomycin C, and a postoperative regimen for CMV retinitis was initiated.

Pediatric Uveitic Glaucoma

The pediatric glaucomas present some of the greatest clinical challenges. Uveitic glaucoma is a pathology whose causes and treatment are still a great enigma to all glaucoma specialists. We describe the spectrum of pediatric uveitic glaucoma along with its risk factors and the outcome of treatment in this subgroup. Our paper aims to review the existing literature on the subject and throw light on how to manage these cases.

How to cite this article: Kaur S, Kaushik S, Pandav SS. Pediatric Uveitic Glaucoma. J Current Glau Prac 2013;7(3): 115-117.

Use of Electroconvulsive Therapy in the Presence of GLAUCOMA: A Case Report and Review of Literature

Limited data is available with respect to use of Electroconvulsive therapy (ECT) in the presence of glaucoma. We present a case of severe depression with psychotic symptoms who did not respond to various antidepressant trials and required ECT. His medical history showed that he was diagnosed to have open angle glaucoma and cataract in both the eyes. He had undergone bilateral trabeculectomy and cataract surgery for his ophthalmological aliments. He was safely treated with bilateral ECT, with which he achieved remission.