Keratoconus in Asian eyes at a tertiary eye care facility

BACKGROUND

The purpose of this study was to assess the demographic variables, age at diagnosis, keratometry and slitlamp signs in keratoconus.

METHODS

Thirty-one patients with 61 keratoconic eyes were selected provided they met one of two criteria: 1. They had an irregular corneal surface, Vogt's striae, Fleischer's ring or apical sub-epithelial corneal scarring characteristic of keratoconus; 2. Corneal topography revealed an average simulated keratometry of more than 45.2 D, central corneal power higher than 47.2 D or infero-superior asymmetry greater than 1.4 D. The main outcome measures were demographic variables, age at diagnosis, disease severity on keratometry and biomicroscopic signs.

RESULTS

The patients' mean age at presentation was 20.2 +/- 6.4 years. Based on average keratometry values, 67.2 per cent of eyes had severe and 32.8 per cent had moderate keratoconus. Eyes with severe keratoconus presented at a younger average age (18.8 +/- 5.35 years) than moderate keratoconus (23.69 +/- 8.07 years). Thirty-eight eyes (92.5 per cent) with severe and 13 eyes (65 per cent) with moderate keratoconus demonstrated biomicroscopic signs of keratoconus. Twenty eyes (32.7 per cent) demonstrated apical sub-epithelial cornea scarring and 95 per cent of these eyes had severe keratoconus.

CONCLUSIONS

The majority of keratoconic eyes in Asian-Indian patients demonstrate the severe stage of the disease by the second decade.

Association of novel SNPs in the candidate genes affecting caprine milk fatty acids related to human health

In the present investigation, 618 milk samples of Sirohi breed of goat were collected, and analyzed for conjugated linoleic acid (CLA, C18:2) and other fatty acids. The CLA in studied goat milk samples was 4.87 mg/g of milk fat and C18:2 cis-9, trans-11 contributes 2.9 mg/g of milk fat and trans10 cis12 contributes 0.82 mg/g of milk fat. The saturated fatty acids in the milk accounted for 69.55% and unsaturated fatty acid accounted for 28.50%. The unsaturated fatty acid was constituted by monounsaturated fatty acid (24.57%) and polyunsaturated fatty acids (3.96%.). The major contribution (45.56%) in total fatty acid was of C12:0, C14:0 and C16:0. C18:0 and short chain ones (C4:0, C6:0, C8:0, and C10:0) have a neutral or cholesterol-decreasing effect. The DNA sequence analysis of the genes (DGAT1, SCAP, PPARG, OLR, FABP3 and PRL) in a random panel of 8 Sirohi goats revealed 38 SNPs across the targeted regions. Out of the studied SNPs (38) across these genes, 22 SNPs had significant effect on one or a group of fatty acids including CLA. The genotypes at these loci showed significant differences in the least square means of a particular fatty acid or a group of fatty acids including CLA and its isomers.

Thyroid function at diagnosis of type I diabetes

BACKGROUND

National guidelines recommend that thyroid function is assessed at diagnosis of type I diabetes (TIDM) and annually thereafter. This paper reports an audit of thyroid surveillance in accordance with this guideline.

PATIENTS

110 patients (66 males), median age 11.3 (1.2-15.7) years at diagnosis of TIDM, were monitored for 2.3 (0.7-4.2) years.

RESULTS

21/110 (19.0%) patients had abnormal thyroid function at diagnosis of TIDM. Of these, 16 had normal thyroid function on reassessment after 45 (3-540) days. Abnormalities of thyroid function occurred more commonly in children with diabetic ketoacidosis (DKA) than those who did not have DKA (9/29, 31.0% vs 12/81, 14.8%, p<0.025). At the end of the observation period, five (4.5%) patients had minor abnormalities of thyroid function not requiring treatment and three (2.7%) were treated.

CONCLUSIONS

Transient abnormalities of thyroid function are common at diagnosis of TIDM, and therefore, thyroid hormones should not be measured at this time.

Femoral pseudoaneurysm in drug addicts: Hunterian ligation still a gold standard

Pseudoaneurysm formation in the site of Intravenous drug abuser had been reported in literature. The repeated puncture of femoral vessels leads to abscess formation and epithelisation of the wall which leads to pseudoaneurysm formation. A case of lacking pseudoaneurysm presenting as reptured groin abscess in a drug addict is reported, which was managed successfully by Hunterian ligation with salvage of lower limb.

Extraocular muscle cysticercosis: clinical presentations and outcome of treatment

PURPOSE

To report various clinical presentations and treatment outcomes in a series of patients with extraocular muscle cysticercosis.

METHODS

This retrospective study reviewed the charts of 43 patients diagnosed with extraocular muscle cysticercosis with computed tomography and orbital B-scan ultrasonography between January 1991 and December 2002. Clinical presentation, results of investigations, treatment, and outcome were recorded.

RESULTS

The superior rectus was the most commonly affected extraocular muscle. Restricted ocular motility was present in 88% of patients, and inflammatory signs were noted in the involved quadrant in 70% of patients. Eleven patients were treated with oral albendazole alone and 31 patients were treated with oral albendazole and prednisolone. Four extraocular muscle cysts were excised surgically, and five extruded spontaneously. Inflammatory signs subsided in all patients, and residual restriction of ocular motility was seen in 16 (50%) of 32 patients at a mean follow-up of 5 months. Type of treatment made no significant difference in the ocular motility outcome.

CONCLUSIONS

Extraocular muscle cysticercosis should be considered in patients who present with restricted ocular motility and inflammatory signs. The direction of motility restriction does not indicate the muscle involved. Residual restriction of ocular motility is common despite the addition of corticosteroids to albendazole therapy.

Congenital unilateral adduction associated with jaw movement: a rare variant of trigemino-oculomotor synkinesis

A 21-year-old man had abnormal adducting movements of his left eye on mastication. This suggested an anomalous innervation of the medial rectus muscle from the motor branch of the trigeminal nerve that innervated the external pterygoid muscle.

Successful occlusion therapy for amblyopia in 11- to 15-year-old children

PURPOSE

To investigate the effectiveness of full-time occlusion therapy in treating amblyopia in 11- to 15-year-old children and to determine its lasting results.

PATIENTS AND METHODS

Fifty-five compliant children 11 to 15 years old who had amblyopia were treated with full-time (during all waking hours) occlusion of their good eye until no further improvement in the visual acuity of their amblyopic eye was observed on 3 consecutive monthly follow-up examinations. After this, part-time (4 hours per day) occlusion therapy was used randomly in 24 of 55 patients for 3 to 6 months for maintenance of the final visual acuity. Snellen visual acuity and its logMAR equivalent were recorded before treatment, at the cessation of full-time occlusion therapy, and on the most recent examination.

RESULTS

All 55 of the patients had improved visual acuity after treatment. The mean improvement was 0.46 logMAR unit (4.6 Snellen lines). Thirty-two of the patients had a mean follow-up of 17.6 months after the cessation of full-time and maintenance occlusion therapy. Twenty-nine (91%) of the 32 patients maintained improved visual acuity, whereas 3 (9%) exhibited a regression in visual acuity. Maintenance occlusion therapy did not have a significant stabilizing effect on the improved visual acuity.

CONCLUSION

Compliant, full-time occlusion effectively improves acuity in children 11 to 15 years old who have amblyopia due to strabismus, anisometropia, or both. Most older patients have lasting improvement with or without maintenance patching.

Cyclic "V" esotropia

A young girl had cyclic esotropia with cyclic inferior oblique overaction and "V" pattern. A recession-resection surgery of the horizontal rectus muscles and recession of the inferior oblique muscles cured the cyclic esotropia as well as the inferior oblique overaction and V pattern.

Anterior and posterior capsulorhexis in pediatric cataract surgery with or without trypan blue dye: randomized prospective clinical study

PURPOSE

To evaluate the clinical efficacy of trypan blue 0.1% dye (Blurhex) in creating a complete anterior and posterior capsulorhexis during pediatric cataract surgery.

SETTING

Tertiary eyecare center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

METHODS

In a prospective randomized study, an anterior (ACCC) and posterior (PCCC) continuous curvilinear capsulorhexis were performed in pediatric patients. In Group 1 (n = 19), the ACCC and PCCC were created without use of trypan blue dye. In Group 2 (n = 23), intracameral trypan blue dye was used to stain the anterior and posterior capsules.

RESULTS

In Group 1, 14 eyes (73.6%) had a complete ACCC and 10 (52.6%) had a complete PCCC. In Group 2, 21 eyes (91.3%) had a complete ACCC and 19 (82.6%) had a complete PCCC.

CONCLUSION

In cases of pediatric cataract, staining the anterior and posterior capsules with trypan blue 0.1% allowed recognition of capsule flaps and facilitated the creation of complete ACCCs and PCCCs.

Factors predicting upshoots and downshoots in Duane's retraction syndrome

PURPOSE

Factors predicting mechanical and innervational types of upshoots and downshoots in Duane's retraction syndrome were evaluated.

METHODS

This retrospective study evaluated upshoots and downshoots in 196 patients (222 eyes) with Duane's retraction syndrome seen between January 1990 and July 2001. On the basis of the clinical characteristics, upshoots and downshoots were classified as mechanical type, innervational type, or both. Factors potentially predicting the upshoot-downshoot phenomenon that were studied included patient age, type of Duane's retraction syndrome, horizontal strabismus, and vertical tropia in the primary position of gaze.

RESULTS

Upshoots and downshoots were present in 39% of the eyes. The mechanical type was more common than the innervational type (26% vs 12%). Overall, upshoots and downshoots were statistically significantly more common in type III Duane's retraction syndrome, with exotropia, and with vertical tropia in primary position. Patient age had no correlation with upshoots or downshoots. Both types of upshoots and downshoots were significantly more common in type III Duane's retraction syndrome. A statistically significant association was found between exotropia and the mechanical type, and between vertical tropia in primary position and the innervational type.

CONCLUSIONS

All patients with type III Duane's retraction syndrome, exotropia, and vertical tropia in the primary position of gaze should be examined for upshoots and downshoots. One should look specifically for the mechanical type when there is exotropia and for the innervational type when there is a large vertical tropia in the primary position of gaze.

Indications and outcome of optical partial thickness lamellar keratoplasty

PURPOSE

To review the indications and outcome of optical partial thickness lamellar keratoplasty (LKP) over a 22-year period.

METHODS

The study is a retrospective review of 138 eyes of 126 patients. Snellen visual acuity, preoperative clinical condition, and postoperative clinical status were assessed.

RESULTS

Postoperative follow-up ranged from 1 month to 174 months (average, 34.5). In descending order of frequency, climatic droplet keratopathy, infectious keratitis scar, and band-shaped keratopathy were the most common indications for surgery. Follow-up records were available for 130 eyes; 93% of grafts remained transparent. One hundred eyes (80%) preoperative measured Snellen acuity of 6/60 or less. Postoperatively, only 20 eyes (13.4%) were assessed as worse than 6/60. Mean best-corrected visual acuity postoperative was 0.58 +/- 0.24. Twenty-two eyes (16.9%) demonstrated postoperative visual acuity of better than 6/12. Complications included presumed rejection in two eyes, nonhealing epithelial defect in two eyes, and graft infection in seven eyes.

CONCLUSION

Vision gain following LKP is generally moderate (visual acuity, 6/18-6/12) in the majority of eyes (61.5%). Vision-threatening complications are low (6.9%). There is scope for reducing complications like postoperative infections and improving visual gain through deep lamellar keratoplasty.

Vertical rectus recession for the innervational upshoot and downshoot in Duane's retraction syndrome

PURPOSE

To report the results of recession of the vertical rectus muscle for the innervational upshoot and downshoot in Duane's retraction syndrome.

METHODS

Ten patients who had Duane's retraction syndrome with innervational upshoot or downshoot underwent recession of the superior and inferior rectus muscle for the upshoot and downshoot, respectively. This procedure was combined with recession of the lateral rectus muscle(s) for exotropia in 6 patients and for the mechanical upshoot-downshoot in one patient. Postoperatively, the effects of surgery on the upshoot/downshoot, and horizontal and vertical deviation in the primary position were recorded. Average follow-up period was 1.2 years.

RESULTS

Following surgery, the innervational upshoot/downshoot was eliminated in all patients. Mean vertical deviation in the primal position in 6 patients was reduced from 21.2 to 2.5 prism diopters and none of them developed a consecutive vertical imbalance. Four patients did not have a vertical deviation in the primary position preoperatively and one of them developed 10 prism diopters hypotropia following recession of the superior rectus muscle.

CONCLUSIONS

Recession of the superior and inferior rectus muscle is a safe and effective treatment for the innervational upshoot and downshoot, respectively, in Duane's retraction syndrome.