DIRECT LASER PHOTOCOAGULATION TO THE DILATED RIGHT-ANGLED VESSEL IN THE MANAGEMENT OF PROLIFERATIVE TYPE 2 MACULAR TELANGIECTASIA

PURPOSE

To report a case of proliferative Type 2 macular telangiectasia treated successfully with direct laser photocoagulation to the right-angled vessel.

METHODS

Descriptive case report.

CASE DESCRIPTION

A 61-year-old man, with no past medical history, was diagnosed and treated previously elsewhere for bilateral proliferative Type 2 macular telangiectasia. He complained of recent onset decrease in vision in his right eye for last 2 months. Right eye visual acuity was counting fingers at 3 m and left eye was 6/18. Fundus examination showed proliferative Type 2 macular telangiectasia in both eyes with active neovascular complex in the right eye. Direct thermal laser photocoagulation to the tips of the right-angled vessels with single-spot PASCAL Synthesis (Topcon Medical Laser System) at 532 nm wavelength was done. After laser, reduction in the hyporeflective space height was noted on optical coherence tomography. No additional intravitreal anti-vascular endothelial growth factor injections were required. At the last 6-months follow-up visit, visual acuity improved to 6/36, N18 in the right eye.

CONCLUSION

Direct laser photocoagulation to the right-angled vessel can be considered as possible treatment option for proliferative Type 2 macular telangiectasia, especially in patients nonresponsive to anti-vascular endothelial growth factor therapy. However, long-term follow-ups are required to see whether it is possible to maintain the efficacy.

Recommendations for management of peripheral retinal degenerations

Some degenerations involving the peripheral retina can result in a rhegmatogenous retinal detachment. Currently, there are no clear guidelines for retinal screening and/or management of these peripheral retinal degenerations in patients with or without recent onset posterior vitreous detachment or in those prior to refractive surgery or intraocular procedures. This article aims to provide a set of recommendations for the screening and management of peripheral retinal degenerations based on a common consensus obtained from an expert panel of retinal specialists.

Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases

Background Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, particularly in developing countries. Early diagnosis with the best diagnostic marker is highly desired for the prevention and timely treatment of CVDs. However, there is still a dearth of an ideal marker for the detection of CVDs. Objective To explore the diagnostic potential of liver aminotransferases (AST and ALT), and alkaline phosphatase for the diagnosis of CVDs without liver involvement. Method This was a cross-sectional study conducted among 200 adult patients with CVDs, who visited the cardiology and emergency units of Manipal Teaching Hospital, Pokhara, Nepal. The study was conducted from January 2018 to December 2020. The baseline data on family history, anthropometry, baseline biochemical parameters, liver enzymes, and cardiac biomarkers were collected using standard and validated methods. The data were analyzed using SPSS version 21 and MedCalc software 2021. Result The diagnostic sensitivity of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were 53.7%, 52.6%, and 33.7% and specificity were 99%, 90%, and 90% respectively. The area under the curve (AUC) of AST, ALT, and ALP were 0.78, 0.73, and 0.52 respectively. ROC curve indicated that serum AST and ALT activity was a better reliable marker than the serum ALP activities. Conclusion Our study suggests that serum aspartate aminotransferase and alanine aminotransferase but not alkaline phosphatase could have some diagnostic potential to diagnose the risk of CVDs. However, they could not replace the currently adopted cardiac biomarkers such as cTnI and CK-MB.

Association of Anthropometric Parameters with Lipid Profile among Adult Population of Kaski District, Nepal

Background Anthropometric parameters of individuals are good at predicting functional impairment, mortality, and future cardiometabolic diseases. The relationship between anthropometric parameters and lipid profiles have been studied in different parts of the world. But to date, no such studies have been conducted in Nepal. Objective To investigate the association between anthropometric parameters and lipid profile in the adult population of Kaski district, Nepal. Method This study was carried out at Manipal Teaching Hospital, Pokhara, Kaski, Nepal. The fasting lipid profiles were analyzed in a total of 400 subjects aged > 18 years with an automated OCD Vitros 350 dry chemistry analyzer. The Kolmogorov-Smirnov test was used to test the normality of the data. The mean values of fasting lipids were compared within the subjects with different body mass index groups using ANOVA and waist circumference, waist-hip ratios, waist-height ratios, and neck circumference using independent samples t-test. The anthropometric indices evaluated were body mass index, waist circumference, waist-hip ratio, waist-height ratio, head circumference, neck circumference, and mid-upper arm circumference. Pearson's correlation coefficients and multiple regression analysis were performed to identify the association between the lipid profile and anthropometric parameters. The difference was considered statistically significant when p values (two-tailed) were < 0.050. Result The mean values of the serum lipid parameters other than high-density lipoprotein cholesterol were found to be higher in the subjects with an above than normal BMI, waist circumference, waist-hip ratio, waist-height ratio, and neck circumference. Pearson's correlation coefficient and multiple regression analysis showed that waistheight ratio best predicts serum triglycerides (β=0.622, p < 0.001) and high-density lipoprotein cholesterol (β=-0.711, p < 0.001) among all measured anthropometric parameters. Conclusion Among all the studied anthropometric parameters, the WHtR was found to be the most powerful predictor of serum triglycerides and high-density lipoprotein cholesterol.

PHARMACOTHERAPEUTIC CLOSURE OF A PERSISTING TRAUMATIC MACULAR HOLE WITH INTRAOCULAR STEROIDS

PURPOSE

To report a case of successful closure of traumatic macular hole after treatment with intraocular steroids in a nonvitrectomized eye.

METHODS

Retrospective observational case report.

CASE DESCRIPTION

A 34-year-old man developed a full-thickness macular hole and submacular bleed after injury with firecracker in the left eye. Visual acuity in the left eye was counting fingers close to face. Intraocular gas, 0.3 cc of 100% SF6, was injected for displacement of submacular bleed. At 2 months after presentation, macular hole persisted with signs of intraocular inflammation. A trial of intraocular triamcinolone injection (2 mg in 0.05 ml) was given, which resulted in complete closure of macular hole and improvement in visual acuity to 6/36 and thereby avoiding the need for ocular surgery.

CONCLUSION

Ocular steroids could play an important role in successful closure of persisting macular holes in a setting of blunt trauma, especially in a background of uveitis.

Morphological features of focal choroidal excavation and its association with macular pathology in Asian Indian eyes

Purpose

To study the characteristics of focal choroidal excavation (FCE) in Indian eyes based on spectral-domain optical coherence tomography (SD-OCT) findings and their association with macular pathologies.

Methods

Retrospective study of 26 patients diagnosed with FCE. All patients' clinical and imaging data were reviewed.

Results

There were eight females and 18 males aged between 24 and 85 years. FCE was noted in 31 eyes of 26 patients - unilateral in 21 and bilateral in 5. The conforming type was noted in 13 and nonconforming in 19 eyes. The location was extrafoveal in 16 and subfoveal in 15 eyes. The morphology was bowl-shaped in 24, cone-shaped in six eyes, and mixed type in one eye. Associated pathologies were central serous chorioretinopathy in nine eyes, choroidal neovascular membrane in seven eyes, Stargardt's disease in three eyes, Best disease in four eyes, other retinal dystrophies in two eyes, polypoidal choroidal vasculopathy and moderate non-proliferative diabetic retinopathy, each in one eye. The mean FCE width was 1667.2 ± 817.7 μ, mean depth was 95.7 ± 46.4 μ, and the mean choroidal thickness under the FCE was 234.8 ± 85.9 μ. No abnormal choroidal tissue was found under any FCE.

Conclusion

FCE is a relatively common entity and frequently associated with macular pathologies. The presence of an FCE did not alter the course or management of these conditions.

Multimodal imaging of an idiopathic florid vascularised epiretinal membrane: Course, treatment, and outcome

Idiopathic vascular epiretinal membrane is an extremely rare entity and the pathogenesis and clinical course is not clearly understood. A 53-year-old hypertensive female patient presented with complaints of altered vision in the right eye. On examination, her vision was 20/30 and fundoscopy showed a vascularized epiretinal membrane (ERM), which was confirmed on spectral-domain optical coherence tomography. No primary cause was found after investigations. The symptoms and ERM showed slow progression over the next three years with a visual acuity of 20/60. She underwent surgery for removal of the ERM, which was subjected to histopathological evaluation. This is a unique case of a florid proliferative vascularisation of an ERM in the absence of any identifiable cause, which had a good visual outcome following surgery.

Morphometric analysis of retinal arterioles in control and hypertensive population using adaptive optics imaging

Purpose:

To measure the wall-to-lumen ratio (WLR) and the vascular wall cross-sectional area (WCSA) of retinal arterioles by an Adaptive Optics (AO) retinal camera using semi-automated software and comparing them between control and hypertensive population.

Methods:

This was a cross-sectional observational study including a hypertensive group and a control group. Subjects were examined and their medical history recorded. Retinal arteriolar morphometry was assessed by rtx1 AO retinal camera using AOdetect Artery semiautomated software. Main Outcome Measures: WLR and WCSA were measured on the basis of retinal arteriolar wall thickness (W1, W2), lumen diameter (LD) and vessel diameter (VD). Influence of age and arterial hypertension on the WLR and WCSA were examined.

Results:

A total of 150 human subjects were included out of which 110 were controls and 40 were hypertensives under treatment. There was statistically significant difference in the age, systolic and diastolic blood pressures between the control and hypertensive groups (P < 0.01). We found no significant correlation between age and WLR (R² = 0.049, P > 0.05) or age and WCSA (R² = 0.045, P > 0.05). We observed a significant difference in WLR and WCSA measurements between control and hypertensive groups (P < 0.01). On measuring intra-observer variability (IOV) we found excellent consistency.

Conclusion:

AO retinal imaging allows a direct measurement of the retinal vessel wall and LD with excellent IOV. WLR and WCSA reflect the remodelling process and can be used to further aid the early detection and monitoring of systemic hypertension.

Structural-functional correlation using adaptive optics, visual fields, optical coherence tomography and multifocal electroretinogram in a case of torpedo maculopathy

We present a case of a 37-year-old gentleman with a rare diagnosis of Torpedo maculopathy (TM). We describe the multimodal imaging features of torpedo maculopathy using adaptive optics, visual fields, OCT and multifocal ERG, and understand the clinical and structural-functional correlation in TM. According to us, this is the first case report to describe the adaptive optics imaging findings in Torpedo maculopathy in English Medical literature.

Distribution of peripheral lesions identified by mydriatic ultra-wide field fundus imaging in diabetic retinopathy

PURPOSE

To analyze the distribution of diabetic retinopathy (DR) lesions in an Indian population using ultra-wide field (UWF) fundus imaging.

METHODS

Seven hundred fifteen subjects (1406 eyes) with diabetic retinopathy in India were enrolled in this multicenter, prospective, observational study using UWF pseudocolor imaging with Optos Daytona Plus (Optos plc, Dunfermline, Scotland, UK). Images were transmitted to Doheny Image Reading Center, Los Angeles, CA, for grading. The ETDRS grid was overlaid on stereographic projections of UWF images, and images were graded independently by 2 masked graders. Lesion distribution was graded as predominantly central (PCL) or predominantly peripheral (PPL) according to previous criteria, considering both lesion number and area. An image was graded as PPL if > 50% of the lesion area was seen in at least one peripheral field as compared with the corresponding ETDRS field. Diabetic retinopathy severity was also assessed based on the International Classification of Diabetic Retinopathy (ICDR) grading scale. The main outcome measures were lesion distribution (PPL versus PCL): overall and within specific fields in eyes with various grades of DR.

RESULTS

Lesion distribution was rated to be PPL in 37% of eyes and PCL in 63% of eyes (P < 0.003). The frequency of a PPL distribution varied significantly across all ICDR severity levels, with frequencies of mild non-proliferative DR (NPDR) (30.9%), moderate NPDR (40.3%), severe NPDR (38.5%) and PDR (34.9%), P = 0.005. When assessing which individual fields were rated to show a PPL distribution, the frequency was greatest in field 4 and least in field 7. For any grade of DR, temporal fields showed the greatest PPL frequency, followed in order by the superior, inferior, and nasal fields (P < 0.001). Only 3.5% of eyes showed PPL distribution in all five peripheral fields.

CONCLUSIONS

One-third of the UWF images showed a PPL distribution in this cohort with the temporal quadrant having the widest distribution of PPL. As the PPL distribution varied significantly between various grades of DR, UWF imaging may prove to be important for screening of referral warranted retinopathy.

A least-squares method for the design of two-reflector optical systems

The purpose of this paper is to present a method for the design of two-reflector optical systems that transfer a given energy density of the source to a desired energy density at the target. It is known that the two-reflector design problem gives rise to a Monge–Ampère (MA) equation with transport boundary condition. We solve this boundary value problem using a recently developed least-squares algorithm (Prins et al 2015 J. Sci. Comput. 37 B937–61). It is one of the few numerical algorithms capable to solve these type of problems efficiently. The least-squares algorithm can provide two solutions of the MA problem, one is concave and the other one is convex. The reflectors are validated for several numerical examples by a ray-tracer based on Monte-Carlo simulation.

Multicolor imaging findings in torpedo maculopathy

We describe the multicolor imaging findings in two cases of Torpedo maculopathy (TM). Multicolor imaging can be a useful tool in identifying the level of retinal and choroidal layer involvement in TM. This imaging modality further confirms the hypothesis that TM is a localized congenital abnormality of retinal pigment epithelium pigmentation which leads to outer retinal and inner choroidal degeneration.

Correlation between systemic S100A8 and S100A9 levels and severity of diabetic retinopathy in patients with type 2 diabetes mellitus

AIMS

S100A8 and S100A9 are myeloid-related damage-associated molecular patterns (DAMPs) primarily involved in the modulation of innate immune response to cellular injury. This study evaluated the correlation between circulating concentrations of S100A8 and S100A9 proteins with the severity of diabetic retinopathy (DR) in patients with type 2 diabetes (T2DM).

METHODS

T2DM patients with HbA1c levels >7%, fasting blood glucose >126 mg/dl and history of diabetes were included in this study. DR severity was graded based on ETDRS and Gloucestershire classifications. Plasma samples were evaluated for S100A8 and S100A9 levels using ELISA.

RESULTS

In this comparative study, DR patients (n = 89) had increased plasma S100A8 and S100A9 proteins compared to age-matched T2DM controls (n = 28), which was directly related to the severity of DR. Female DR subjects had increased S100A8 expression compared to their male counterparts. Substantial retention of S100A8 and S100A9 production was seen in DR patients above 50 years of age. Duration of T2DM was not found to affect protein levels, however T2DM onset at >50 years old significantly increased S100A8 and S100A9 concentrations.

CONCLUSIONS

Our findings suggest that systemic circulation levels of S100A8 and S100A9 are correlated with the progression of DR in T2DM patients, indicating their potential role in DR pathogenesis.

An automated framework to quantify areas of regional ischemia in retinal vascular diseases with OCT angiography

In this observational and cross-sectional study, capillary nonperfusion (CNP) and vascular changes in branch retinal vein occlusion (BRVO, sample size [n] = 26) and choroidal neovascularization (CNV, n = 29) were evaluated. Subjects underwent imaging using Optical coherence tomography angiography (Angiovue OCTA, RTVue XR, Optovue Inc., Fremont, California). Local fractal analysis was applied to the OCTA images of superficial, deep and choriocapillaris layer. CNP area (BRVO eyes) and vascular parameters were computed using local fractal-based method. Sensitivity and specificity of vascular parameters were assessed with receiver operating characteristics curve. Automated CNP area showed excellent agreement with manually quantified CNP areas in both superficial (intraclass coefficient [ICC] = 0.96) and deep (ICC = 0.96) layers. BRVO eyes showed significantly altered (P < .05) vascular parameters in both superficial and deep layer as compared to normal eyes (n = 30). CNVM eyes had significantly higher capillary free zones (P < .001) as compared to normal eyes. In normal vs BRVO eyes, vessel density and spacing between the large vessels had similar area under the curve (AUC) (P > .05) in both superficial (0.97 and 0.97, respectively) and deep layer (0.99 and 0.98, respectively). Further, capillary free zones showed high AUC (0.92) in differentiating CNV eyes from normal eyes.

Axial length and cone density as assessed with adaptive optics in myopia

Aim:

To assess the variations in cone mosaic in myopia and its correlation with axial length (AL).

Subjects and Methods:

Twenty-five healthy myopic volunteers underwent assessment of photoreceptors using adaptive optics retinal camera at 2° and 3° from the foveal center in four quadrants superior, inferior, temporal and nasal. Data was analyzed using SPSS version 17 (IBM). Multivariable regression analysis was conducted to study the relation between cone density and AL, quadrant around the fovea and eccentricity from the fovea.

Results:

The mean cone density was significantly lower as the eccentricity increased from 2° from the fovea to 3° (18,560 ± 5455–16,404 ± 4494/mm² respectively). There was also a statistically significant difference between four quadrants around the fovea. The correlation of cone density and spacing with AL showed that there was a significant inverse relation of AL with the cone density.

Conclusion:

In myopic patients with good visual acuity cone density around the fovea depends on the quadrant, distance from the fovea as well as the AL. The strength of the relation of AL with cone density depends on the quadrant and distance.

Unilateral anterior persistent fetal vasculature in a child with blepharophimosis-ptosis-epicanthus inversus syndrome: A surgical challenge

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare autosomal dominant genetic disease. It is clinically characterized by four major features; blepharophimosis, ptosis, epicanthus inversus, and telecanthus. We report a case of a 1-year-old female with BPES with unilateral anterior persistent fetal vasculature (PFV). On examination, she was found to have all the clinical features of BPES, along with calcified and partially absorbed cataract with elongated ciliary processes in her left eye. B-scan of left eye showed attached retina with no evidence of posterior PFV. Systemic examination was normal. She underwent cataract surgery with primary posterior capsulotomy with intraocular lens implantation under general anesthesia. Literature search did not reveal any previous reports of unilateral anterior PFV and BPES. The clinical features, other associations, and the difficulties in the surgical management of this condition are discussed.

Control of Aedes aegypti and Ae. albopictus, the vectors of dengue and chikungunya, by using pheromone C21 with an insect growth regulator: Results of multicentric trials from 2007-12 in India

BACKGROUND & OBJECTIVES

Aedes mosquito control has gained much importance nowadays in view of rise in number of reported cases of dengue and chikungunya in India and other countries. In the present study, C21 attracticide (containing a pheromone and an insect growth regulator—IGR, developed by Defence Research and Development Establishment (DRDE), Gwalior, India was tested for its feasibility for surveillance and control of Aedes mosquito in a multicentric mode from October 2007 to June 2012 in urban (Delhi, and Bengaluru district, Karnataka) and suburban (Alappuzha district, Kerala) settings of the country in three phases.

METHODS

Across the randomly selected households in each study area, two to four containers treated with attracticide (experimental) and untreated (control) were placed and monitored by trained surveillance workers on weekly/ fortnightly basis for determining the presence of eggs, larvae and pupae. Container positivity, percent larvae, egg and pupae collected were determined during different phases and analyzed statistically using SPSS 18.0.

RESULTS

Container positivity was found statistically significant at Bengaluru and Alappuzha, Kerala while in Delhi, it was found non-significant. Eggs collected from experimental containers were significantly higher in comparison to control at all the locations except Delhi. Also larvae collected from control containers were significantly higher at all the locations except Bengaluru. Pupae collected from control containers remained significantly higher at all the locations as no pupal formation was recorded from experimental containers.

INTERPRETATION & CONCLUSION

The use of C21 attracticide hampered pupal formation, thus inhibiting adult population in the study areas. The study established that C21 attracticide was efficacious in the field conditions and has potential for use in surveillance and management of dengue and chikungunya mosquitoes.

Detection of dengue virus in individual Aedes aegypti mosquitoes in Delhi, India

BACKGROUND & OBJECTIVES

Delhi, the capital city of India, has so far witnessed several outbreaks of dengue fever since 1967 (last one reported in 2013). Improved virological and entomological surveillance are the only tools that can help in prevention of dengue as well as in the development of dengue control programmes. The aim of the study was to conduct a prospective field study to detect dengue virus in adult Aedes aegypti mosquitoes collected from various localities represented by different socioeconomic groups in Delhi.

METHODS

The study areas were selected and categorized into high, medium and low income groups on the basis of socioeconomical characteristics of the resident population, where dengue cases were reported during the past three years by MCD. Dengue viral infection was detected in the head squash of each adult mosquito by immunofluorescent assay (IFA) employing monoclonal antibodies against dengue virus (DENV). A total of 2408 females and 1206 males of Ae. aegypti were collected and tested by IFA.

RESULTS

Out of 2408 Ae. aegypti females, 14 were found positive, with minimum infection rate (MIR) of 5.8 per 1000 mosquitoes. Among the 18 study areas, 11 localities were found positive for dengue virus infection. Low income group (LIG) areas showed highest mosquito infectivity (9.8), followed by medium income group (MIG), i.e. 6.2; while least was observed in high income group (HIG), i.e. 1.3. No vertical transmission of dengue virus could be detected in 1206 Ae. aegypti males collected.

INTERPRETATION & CONCLUSION

The study concludes that there was high MIR in the identified localities of low and medium income groups. Estimation of MIR in a female Aedes mosquito in the existing arsenals for dengue surveillance would be an added advantage for early warning of dengue outbreak. The presence of infected mosquitoes in identified localities of Delhi was alarming and require rigorous vector surveillance so that the severe outbreaks can be prevented.

An overview of data mining algorithms in drug induced toxicity prediction

The growth in chemical diversity has increased the need to adjudicate the toxicity of different chemical compounds raising the burden on the demand of animal testing. The toxicity evaluation requires time consuming and expensive undertaking, leading to the deprivation of the methods employed for screening chemicals pointing towards the need to develop more efficient toxicity assessment systems. Computational approaches have reduced the time as well as the cost for evaluating the toxicity and kinetic behavior of any chemical. The accessibility of a large amount of data and the intense need of turning this data into useful information have attracted the attention towards data mining. Machine Learning, one of the powerful data mining techniques has evolved as the most effective and potent tool for exploring new insights on combinatorial relationships among various experimental data generated. The article accounts on some sophisticated machine learning algorithms like Artificial Neural Networks (ANN), Support Vector Machine (SVM), k-mean clustering and Self Organizing Maps (SOM) with some of the available tools used for classification, sorting and toxicological evaluation of data, clarifying, how data mining and machine learning interact cooperatively to facilitate knowledge discovery. Addressing the association of some commonly used expert systems, we briefly outline some real world applications to consider the crucial role of data set partitioning.

Liver dysfunction in alcoholics in Western Nepal

To estimate liver function tests in patients with alcoholic fatty liver disease, alcoholic hepatitis and alcoholic cirrhosis and to compare the levels of enzymes between the groups. A hospital based case control study was carried out at Nepalgunj Medical College, Nepal from January 2013 to June 2013. A total of 150 alcoholic associated liver disorders patients aged between 20-70 years and 50 sex age matched normal healthy controls were taken to assess liver function tests (LFTs) by measuring Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), Gamma glutamyltranspeptidase (GGT) & Albumin. The mean±SD of liver function tests (LFTs) of patients of alcoholic fatty liver disease is highest followed by alcoholic hepatitis patients. All the 3 groups of alcoholic associated liver disorders patients when compared to normal healthy control subjects showed statistically significant increase in the levels of AST (p<0.000), ALT (p<0.000), ALP (p<0.006), GGT (p<0.000), & Albumin (p<0.000). Liver function tests values for alcoholic associated liver disorders patients when compared to the healthy control subjects was significantly altered.

Endothelial cell study in a case of Werner's syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy

Werner's syndrome (WS) is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG) capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS.

A truly knotless technique for scleral fixation of intraocular lenses: two-year results

Scleral fixated intraocular lens (SFIOL) is a safe and effective option for managing optical aphakia. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. are unique to SFIOL. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. We performed a recently described novel technique which obviates the need for knot and scleral flaps in securing the SFIOL. This novel 2-point Ab externo knotless technique may reduce the knot related problems. Twenty-three eyes undergoing this knotless SFIOL procedure were analyzed for intraoperative and postoperative complications. Twenty-two eyes either maintained or improved on their preoperative vision. All patients had a minimum follow-up of 24 months.

Comparison of lipid profile in type-2 obese diabetics and obese non-diabetic individuals. a hospital based study from Western Nepal

BACKGROUND

Type-2 diabetes mellitus is an independent risk factor for coronary artery disease and risk of coronary disease is three to four fold increased in patients with diabetes compared with non-diabetic population and 60-80% 0f type-2 diabetics are obese.

METHODS

This study was conducted in Nepalgunj Teaching Hospital, Kohalpur, Banke, Nepal, between 1st March, 2011 and 28th February, 2012. A total of 150 samples were taken to assess the lipid profile in type-2 diabetic patients associated with obesity and 25 obese controls for their lipid profile. Venous blood samples were taken from all the subjects in the morning after fasting overnight. Exclusion criteria included pregnancy, chronic infectious disease, heart failure; renal failure and drug allergy were confirmed from the subject's personal physician report and a detailed history. The data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version.

RESULTS

The mean ± SD age of diabetic patients with obesity was 53.76± 6.23 while the mean ± SD age of control was 49.61 ± 4.8. Out of 150 patients 105 (70%) were males and 45 (30%) were females. Among control subjects 16 (64%) were males and 9 (36%) were females. Obese type-2 diabetic patients when compared to obese control subjects showed statistically significant increase in the levels of serum total cholesterol (p < 0.001), serum triglycerides (p < 0.001), serum LDL-cholesterol (p < 0.001) while serum HDL-cholesterol levels did not show statistically significant difference in the two group (p > 0.05).

CONCLUSION

This study showed obese diabetic individuals have dyslipidemia and more prone to develop cardiovascular diseases.

Clinical, anatomic, and electrophysiologic evaluation following intravitreal bevacizumab for macular edema in retinal vein occlusion

PURPOSE

To investigate clinical, anatomic, and electrophysiologic response after single intravitreal injection of bevacizumab for macular edema attributable to retinal vein occlusion.

DESIGN

Prospective nonrandomized, interventional case series.

METHODS

Twenty-one patients with macular edema attributable to vein occlusion received intravitreal injection of bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion (CRVO), and 12 patients had branch retinal vein occlusion (BRVO). Complete ophthalmic examination including optical coherence tomography (OCT) was done at baseline and follow-up visits. Fifteen patients underwent fluorescein angiography at baseline. Selected patients underwent electroretinography (ERG) and visual evoked potential (VEP) at baseline and follow-up. Follow-up was for 12 weeks.

RESULTS

At baseline, mean visual acuity was 20/381 (median, 20/400) and showed improvement to mean 20/135 (median, 20/60) after one month, (P = .001). At 12 weeks, mean visual acuity was 20/178 (median, 20/80) (P = .001). The mean central retinal thickness (CRT) was 647.81 microm (median, 609.00 microm) at baseline and decreased to mean 293.43 microm (median, 222.00 microm) at one month (P = .001). At 12 weeks, mean CRT was 320.90 mum (median, 280.00 microm) (P = .001). ERG and VEP showed no worsening of the waveforms. There was no significant difference in the visual outcome between the BRVO and CRVO groups.

CONCLUSION

Intravitreal injection of bevacizumab appears to result in significant short-term improvement of visual acuity and macular edema secondary to vein occlusion. The present report confirms the previous studies. No ocular toxicity or adverse effects were observed. However, prospective, randomized, controlled long-term studies are required with an adequate number of patients.

Influence of cultural conditions on lipid production by mutant strain of Rhodotorula glutinis MTCC 1151

Mutant of Rhodotorula glutinis MTCC 1151 was found to produce high level of lipid (63.6% of biomass) as compared to parent strain (56.7% biomass). The lipid synthesizing capacity of mutant of R. glutinis was evaluated with different glucose concentrations, nitrogen sources, incubation time, and aeration-agitation. Maximum lipid yield (63.6% of biomass) was found with 5% glucose using ammonium sulfate (0.2%) as a nitrogen source under shake-flask conditions (50 ml broth in 250 ml conical flask at 125 rpm) after 4 days of incubation at 28 degrees C. The ability of ammonium sulfate to replace comparatively very costly yeast extract is highly appreciable.

Lipid production by Candida Y-1

Ten oleaginous yeasts were isolated from sources like fruits, flowers, curd whey and soil samples. Lipid production varied from 24 to 71.2% of dry weight of cell biomass. Strain Y-1, which was isolated from curd whey, produced the highest amount of lipid. It was identified belonging to the genus Candida. The optimal cultural conditions for lipid production by Candida Y-1 were found to be glucose (5%) as carbon source, ammonium sulfate (1%) as nitrogen source, pH 4.5, and temperature 28 degrees C under shake-flask conditions (125 rpm).

Influence of growth conditions on the accumulation of ergosterol by Rhodotorula glutinis

Maximum accumulation of ergosterol by Rhodotorula glutinis IIP-30 [4% (w/w) of the biomass] was at pH 4 and 28 to 30°C, wich glucose or sucrose as carbon source and (NH4)2SO4 as N-source. Molasses only gave 1% (w/w) ergosterol content, as did KNO3 or urea when used as sole N source.

Laboratory-scale production of acetoin plus diacetyl by Enterobacter cloacae ATCC 27613

Conditions for the laboratory-scale production of acetoin plus diacetyl by Enterobacter cloacae ATCC 27613 were studied. Thirty-five g acetoin plus diacetyl/50 g sucrose were obtained when fermentation was carried out in 2.5 liter medium containing 12.5 g peptone and 12.5 g yeast extract, at pH 7.0, in a 5 liter conical flask on a shaker (240 rpm) at 28-30 degrees C for 48 hr. Recovery of pure diacetyl was 85% of the total acetoin plus diacetyl.

Effect of substrates on acetoin production by Torulopsis colliculosa and Enterobacter species

Under optimal conditions, Torulopsis colliculosa NRRL 172 and Enterobacter B-87 (ATCC 27613) produced 50 to 500 mg of acetoin per g of substrate. Whereas cane molasses, gur, glucose, and sucrose were suitable substrates for acetoin production, lactose and mannitol supported very good growth but yielded little or no acetoin. Production of acetoin increased with increases in the concentration of glucose, yeast extract, and peptone. Combination of substrates and intermittent feeding of substrate failed to increase the yields.