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Gangwe A, Barwar G. A 28-mm intraocular foreign body removal: The vitreoretinal surgeon's dilemma. Indian J Ophthalmol 2022; 70:2778. [PMID: 35791256 PMCID: PMC9426066 DOI: 10.4103/ijo.ijo_1432_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Intraocular foreign body (IOFB) removal becomes tricky if its large and impacted in the ocular coats. When confronted with such a combination, the vitreoretinal surgeon will need to modify the surgical plan. This surgical video describes one of such situation encountered during removal of a long wooden IOFB impacted in the ocular coats. Purpose The video describes a scenario when the surgeon becomes aware that injury to ocular structure is inevitable due to inherent length of the IOFB. However, a careful assessment of the situation helps the surgeon to identify how he could minimize the damage to the eye and not put vision at risk. Synopsis A young boy presented with painful loss of vision in left eye since 15 days. Examination showed BCVA of 20/32 and limitation movement in up gaze. Fundus showed hazy media and an IOFB in superior quadrant. It was noted that IOFB was moving with eye movement. The impaction in sclera and extraocular extension was suspected. After pars plana vitrectomy, it was observed that IOFB was longer than what was measured by the scan and it was impacted in the coats. Removal using IOFB forceps further pulled the IOFB into vitreous cavity. A rectangular scleral window was created, IOFB was pushed towards opposite pars plana region to avoid injury to macula, optic nerve, lens and peripheral retina. The IOFB was then removed.The retinal tears were lasered. Three months following the surgery, he developed cataract, which needed surgery. His BCVA at the last follow up visit was 20/25 with attached retina. Highlights 1. Limitation of movement in presence of linear IOFB shall raise a suspicion of IOFB being impacted in coats and possibility of its extraocular extension; 2.An oblique IOFB posterior to limbus, can have length more in transverse diameter of the eyeball. Though rarely used, an ab-externo approach can be a viable option in such a case to minimise injury to vital structure of the eye, particularly if the IOFB is severely impacted in sclera. Online Video Link https://youtu.be/2bF3WLd812o.
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Affiliation(s)
- Anil Gangwe
- Vitreo Retina Services, MGMEI, Raipur, Chhattisgarh, India
| | - Gulshan Barwar
- Vitreo Retina Services, MGMEI, Raipur, Chhattisgarh, India
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Parchand S, Agrawal D, Ayyadurai N, Agarwal A, Gangwe A, Behera S, Bhatia P, Mulkutkar S, Barwar G, Singh R, Sen A, Agarwal M. Sympathetic ophthalmia: A comprehensive update. Indian J Ophthalmol 2022; 70:1931-1944. [PMID: 35647958 PMCID: PMC9359263 DOI: 10.4103/ijo.ijo_2363_21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Sympathetic ophthalmia is a rare, bilateral, granulomatous, panuveitis following penetrating trauma or surgery to one eye. Clinical presentation commonly occurs within the first year of trauma occurrence but can be delayed by several years. It manifests as acute/chronic granulomatous uveitis with yellowish-white choroidal lesions or Dalen-Fuchs nodules. Initially, patients respond rapidly to corticosteroid therapy, but a majority require long-term use of corticosteroid-sparing agents to prevent recurrences. The purpose of this review is to elaborate on the current understanding of the pathophysiology, the importance of multimodal imaging in early diagnosis, and the role of newer immunomodulatory and biological agents in recalcitrant cases.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Deepshikha Agrawal
- Department of Cornea and Anterior segment Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Nikitha Ayyadurai
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic, Abu Dhabi (CCAD), Abu Dhabi, United Arab Emirates (UAE)
| | - Anil Gangwe
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Shashwat Behera
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Priyavat Bhatia
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Samyak Mulkutkar
- Department of Ophthalmology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Gulshan Barwar
- Department of Vitreo-retina and Uvea Services, MGM Eye Institute, Raipur, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Center, PGIMER, Chandigarh, India
| | - Alok Sen
- Department of Retina and Uvea Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Manisha Agarwal
- Department of Uvea Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
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Parchand S, Shenoy P, Muralidhar A, Kohli G, Gangwe A, Agrawal D, Varshney A, Mittal R, Saha I, Madharia A, Singh S, Sen A, Trehan H, Agarwal M. Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium. Indian J Ophthalmol 2021; 69:2828-2835. [PMID: 34571643 PMCID: PMC8597502 DOI: 10.4103/ijo.ijo_1395_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess changes in the presentation patterns of posterior segment trauma during the COVID-19 pandemic from six tertiary eye care institutes of North and Central India. Methods A multicenter, hospital-based, retrospective comparative analysis of patients presenting with posterior segment trauma was done during the COVID-19 (Group A) (March 25, 2020 - September 30, 2020) period and the pre-COVID-19 (Group B) (March 25, 2019 - September 30, 2019) period. Results A total of 405 patients were diagnosed with posterior segment trauma (Group A: 206, Group B: 199). The time interval between onset of trauma and presentation was higher in Group A (16.59 ± 29.87 days) as compared to Group B (9.41 ± 19.19 days) (P = 0.004). A majority of patients in Group A had a history of prior consultation before presentation (P = 0.049). In Group A, 120 (58.2%) patients sustained ocular trauma at home as compared to 80 (40.2%) patients in Group B (P < 0.0001). Patients presenting with light perception were significantly more in Group A (43.7%) as compared to Group B (30.2%) (P = 0.004). In Group B, 37.6% patients had presenting visual acuity of counting finger or better as compared to 27.6% patients in Group A (P = 0.07). Patients in Group A had a significantly higher proportion of post-traumatic endophthalmitis with delayed presentation (P = 0.011) and retinal detachment (P = 0.041). Patients undergoing surgery for foreign-body removal were significantly fewer in Group A (P = 0.05). Conclusion Although the number of patients presenting with posterior segment trauma was comparable in Groups A and B, a greater number of patients sustained home injuries during the COVID-19 pandemic. A majority of these patients had delayed presentation with poor presenting visual acuity and a higher tendency of retinal detachment.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Pratik Shenoy
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Alankrita Muralidhar
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
| | - Gaurav Kohli
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Anil Gangwe
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Deepanshu Agrawal
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Abhishek Varshney
- Department of Vitreo-retina Services, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
- The Bodhya Eye Consortium
| | - Ruchi Mittal
- Department of Vitreo-retina Services, LJ Eye Institute, Ambala, Haryana, India
- The Bodhya Eye Consortium
| | - Indranil Saha
- Department of Vitreo-retina Services, Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
- The Bodhya Eye Consortium
| | - Aishwarya Madharia
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Shalini Singh
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
| | - Alok Sen
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Hemant Trehan
- Department of Vitreo-retina Services, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Manisha Agarwal
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
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Vinekar A, Gangwe A, Agarwal S, Kulkarni S, Azad R. Improving Retinopathy of Prematurity Care: A Medico-Legal Perspective. Asia Pac J Ophthalmol (Phila) 2021; 10:437-441. [PMID: 34456232 DOI: 10.1097/apo.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world. India leads all nations with the highest number of premature infants born each year. Asia has the highest estimated incidence, where visual loss from ROP is over twice as high per million live births compared to established market economies. The problems of ROP management in these countries are compounded by a large cohort of babies who require screening, relatively few ROP specialists, and more recently medico-legal challenges. The authors share the Indian jurisprudence literature from the past decade relating to ROP, summarizing key clinical lessons learned from these legal judgments. The authors endeavor to enlist good clinical practices for various key steps involved in ROP care to help mitigate future litigations as well as protect the clinical interest of the infants who require ROP screening and treatment.
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Affiliation(s)
| | | | | | | | - Rajvardhan Azad
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, India
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Parchand SM, Agrawal D, Gangwe A, Saraogi T, Agrawal D. Combined intravitreal ranibizumab and zone I sparing laser ablation in infants with posterior zone I retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2164-2170. [PMID: 34304202 PMCID: PMC8482907 DOI: 10.4103/ijo.ijo_2581_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the efficacy of combined intravitreal ranibizumab (IVR) and zone I sparing laser ablation in infants with posterior zone I Retinopathy of Prematurity (ROP). Methods This was a retrospective, interventional case series including premature infants diagnosed with posterior zone I ROP (n = 24) on ROP screening. Charts and RetCam images of preterm infants with posterior zone I ROP treated with immediate IVR and zone I sparing laser ablation at 4 weeks between April 2016 and September 2019 were reviewed. Data were analyzed and tabulated using frequency and descriptive statistics to describe the demography, morphology, and treatment outcomes. Primary outcome measure was structural outcome at 6 months. It was further categorized as favorable and unfavorable. Results Twenty-four infants (48 eyes) with a mean gestational age of 28.54 ± 1.98 weeks and birth weight of 1180.33 ± 280.65 grams were analyzed. Thirty-six (75%) eyes had persistent tunica vasculosa lentis and twenty-six (54.1%) eyes had iris neovascularization. All eyes had features of aggressive posterior retinopathy of prematurity (APROP) limited to posterior zone I. The mean duration between IVR and zone I sparing laser ablation was 29.62 ± 6.36 (range: 24-34) days. One infant (2 eyes) received a second IVR treatment for recurrence of plus disease and persistent new vessels close to the fovea. Laser augmentation was done in 13 (27.1%) eyes. A favorable structural outcome was seen in 45 (93.7%) eyes. Conclusion Posterior zone I ROP presents as APROP. Combined IVR and zone I sparing laser ablation appears effective treatment option in these eyes.
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Affiliation(s)
| | | | - Anil Gangwe
- Consultant, Vitreo-Retina Services, Raipur, Chhattisgarh, India
| | - Tripti Saraogi
- Fellow, Vitreo-Retinal Services, Raipur, Chhattisgarh, India
| | - Deepshikha Agrawal
- Consultant, Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Parchand SM, Gangwe A, Agrawal D. Commentary: Retinopathy of prematurity: Where do we stand? Indian J Ophthalmol 2021; 69:2132-2133. [PMID: 34304193 PMCID: PMC8482945 DOI: 10.4103/ijo.ijo_1288_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Swapnil M Parchand
- Consultant, Vitreoretina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Anil Gangwe
- Consultant, Vitreoretina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Gangwe A, Agrawal D, Vinekar A, Azad RV, Parchand SM, Agrawal D. Anti-vascular endothelial growth factor in the management of retinopathy of prematurity: A survey among the members of Indian Retinopathy of Prematurity Society. Indian J Ophthalmol 2021; 69:2158-2163. [PMID: 34304201 PMCID: PMC8482903 DOI: 10.4103/ijo.ijo_200_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To report the results of the survey for the role of anti-VEGF in the management of retinopathy of prematurity (ROP) among the members of Indian ROP (iROP) society. Methods: A questionnaire was designed in English using Google forms and its link was circulated to the members of the iROP society on their mobile numbers. The survey included questions pertaining to demographics, anti-VEGF agents, injection technique, post-injection follow-up, and documentation pertaining to their ROP practice. Anonymous responses were obtained and analyzed for individual questions. Results: 226 members of the society were contacted and 157 responded (69.4%) to the survey. 137 (87.2%) respondents used anti-VEGF in the management of ROP. Aggressive posterior ROP (APROP) was the most common indication (78, 52.7%). The procedure was carried out in the main operation room (102, 70.3%) simultaneously for both the eyes (97; 68%) under topical anesthesia (134; 86.4%) by most of the respondents. One-hundred thirteen (77.9%) respondents used half of the adult dose, irrespective of the agent used; however, more than half of them preferred bevacizumab (85, 54%). 53 (36.3%) respondents followed up infants as per disease severity rather than a fixed schedule while only 33 (23%) performed photo documentation. 151 (96.2%) respondents felt the need for guidelines regarding the usage of anti-VEGF in ROP. Conclusion: There is an increase in the trend towards the use of anti-VEGF in the management of severe ROP, particularly APROP. However, there are considerable variations among the ROP practitioners regarding the agent, dosage, follow-up schedule, and documentation, suggesting the need for uniform guidelines.
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Affiliation(s)
- Anil Gangwe
- Vitreoretina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Deepanshu Agrawal
- Vitreoretina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India
| | - Raj V Azad
- Raj Retina Eye Care Hospital, Patna, Bihar, India
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Parchand SM, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Agrawal D. Post-cataract surgery cluster endophthalmitis due to multidrug-resistant Pseudomonas aeruginosa: A retrospective cohort study of six clusters. Indian J Ophthalmol 2021; 68:1424-1431. [PMID: 32587182 PMCID: PMC7574127 DOI: 10.4103/ijo.ijo_1612_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To analyze clinical presentations, antibiotic susceptibility, and visual outcomes in six clusters of post cataract surgery endophthalmitis caused due to multidrug-resistant Pseudomonas aeruginosa (MDR-PA). This was a hospital-based retrospective cohort study. Methods: Our study comprised sixty-two patients from six nonconsecutive clusters of post cataract surgery endophthalmitis caused by MDR-PA referred to our tertiary eye care institute. Demographic details, best-corrected visual acuity (BCVA), clinical features, microbiological findings, and patient management were reviewed. Results: The interval between onset of symptoms and presentation ranged from 1 to 7 (mean: 4.61 and median: 5) days. The presenting BCVA was no light perception in 17 (27.4%) eyes, light perception in 35 (56.4%) eyes, and hand movement or better in 10 (16.1%) eyes. All patients had hypopyon and vitreous exudates. Corneal infiltrates were noted in 40 (64.5%) eyes. Panophthalmitis was diagnosed in 20 (32.2%) eyes. The surgical intervention included intraocular antibiotics (IOAB) in 8 (12.9%) eyes, pars plana vitrectomy with IOAB in 26 (41.9%) eyes, and evisceration in 23 (37.09%) eyes. At 6 weeks, BCVA of 20/200 or better was achieved in 9 (14.5%) eyes. Pseudomonas aeruginosa was least resistant to colistin (8.3%), piperacillin (31.8%), and imipenem (36.1%). Ceftriaxone and ceftazidime resistance was seen in 80.5% and 70% isolates, respectively. Conclusion: Cluster endophthalmitis due to MDR-PA has poor visual outcomes with high rates of evisceration. In the setting of cluster endophthalmitis where MDR-PA is the most common etiology, piperacillin or imipenem can be the first drug of choice for empirical intravitreal injection for gram-negative coverage while awaiting the drug susceptibility report.
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Affiliation(s)
- Swapnil M Parchand
- Consultant, Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | - Samrat Chatterjee
- Consultant, Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Anil Gangwe
- Consultant, Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Mihir Mishra
- Consultant, Orbit, Oculoplasty and Ocular Oncology Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Deepshikha Agrawal
- Consultant, Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Agrawal D, Parchand S, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Sahu A. Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute. Indian J Ophthalmol 2021; 69:709-713. [PMID: 33595506 PMCID: PMC7942066 DOI: 10.4103/ijo.ijo_3200_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma. Methods: In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019). Results: Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034). Conclusion: During the COVID-19 period, there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.
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Affiliation(s)
- Deepanshu Agrawal
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Swapnil Parchand
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | | | - Anil Gangwe
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Mihir Mishra
- Orbit, Oculoplasty and Ocular Oncology Services, Raipur, Chhattisgarh, India
| | - Anupam Sahu
- Pediatric, Squint and Community Ophthalmology Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Gangrade A, Parchand SM, Chatterjee S, Gangwe A, Agrawal D. Fulminant scleral abscess secondary to infected scleral buckle with Moraxella species. Indian J Ophthalmol 2019; 67:1214-1216. [PMID: 31238471 PMCID: PMC6611322 DOI: 10.4103/ijo.ijo_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We here report a case of scleral buckle infection with fulminant scleral abscess secondary to Moraxella species. A 54-year-old chronic alcoholic male with a history of retinal detachment repair, with scleral buckle 8 years prior, presented with complaints of severe pain, redness, and swelling in the right eye since 2 weeks. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed Moraxella species. The postoperative course included fulminant scleral abscess treated with dual antibiotic therapy that included ceftriaxone and moxifloxacin. All systemic antibiotics were discontinued after 3 weeks, retina remained attached, and no recurrence occurred over a 1-year follow-up. Moraxella, though commonly associated with bacterial keratitis, can also lead to buckle infection, especially in chronic alcoholic and immunocompromised patients. In buckle infection, infected buckle along with sutures should be immediately removed without damaging underlying compromised sclera. Lastly, culture and drug sensitivity play a very important role in buckle infections.
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Affiliation(s)
| | | | - Samrat Chatterjee
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, India
| | - Anil Gangwe
- Vitreo Retina Services, MGM Eye Institute, Raipur, India
| | - Deepshika Agrawal
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, India
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Azad R, Chandra P, Gangwe A, Kumar V. Lack of Screening Underlies Most Stage-5 Retinopathy of Prematurity among Cases Presenting to a Tertiary Eye Center in India. Indian Pediatr 2016; 53 Suppl 2:S103-S106. [PMID: 27915316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the barriers to effective screening, early detection and treatment of Retinopathy of Prematurity leading to advanced disease. DESIGN Cross-sectional study. SETTING Tertiary eye care hospital in northern India. PARTICIPANTS 115 babies with bilateral stage 5 ROP identified amongst 354 preterm infants examined over a one year period. METHODS Information regarding gestational age, birthweight, duration of stay in nursery, duration of supplemental oxygen therapy and treatment details were obtained from discharge summary when available, and by interviewing carers.28 stage 5 ROP eyes underwent pars plana lensectomy and vitrectomy. RESULTS Among the 354 infants (708 eyes) examined, 115 had stage 5 ROP in both eyes. The mean post conceptional age (PCA) at first visit to an ophthalmologist was 54.6 (7.6) weeks (Median 52.9 ± 4.2). The mean overall delay in first examination for Retinopathy of Prematurity was 24.7 (3.9) weeks. Most common risk factor was oxygen therapy in 103 babies (89.6%). 109 (89.8%) babies had never been screened for ROP; four babies fell outside the NNF guidelines (i.e. they had a birth weight of 1750 gms or more and were born at 34 weeks gestational age or more). Another important finding is that only 4.3% of babies were given the correct diagnosis. While 99 babies (86.1%) were referred by ophthalmologists, only 10 babies (8.7%) were referred by pediatricians. A large number were from the capital city of Delhi (21 babies, 18.2%). 28 stage 5 ROP eyes (12.1%) underwent surgery, and at 6 months follow up, only 20 operated eyes had visible attached posterior pole. 210 (91.3%) stage 5 eyes were irreversibly blind. CONCLUSION ROP is an increasingly important cause of leucocoria. There were notable gaps in timely ROP screening, referral and treatment and much needs to be done to improve awareness amongst ophthalmologists about ROP. Measures are needed to improve the coverage of initiatives for the detection and timely treatment of sight threatening ROP in India as well as improving neonatal care to reduce sight threatening ROP in bigger, more mature infants.
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Affiliation(s)
- Rajvardhan Azad
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Parijat Chandra, Additional Professor of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Abstract
A 34-year-old female presented with firecracker injury with curved metallic foreign body embedded in the left orbit and protruding out through the upper eyelid. The report highlights notable aspects in diagnosis, decision-making, and successful removal of this unusual case of retro-orbital foreign body.
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Affiliation(s)
- Maya Hada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Gangwe
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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