Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 8 Articles
Background: To identify the genetic defect associated with autosomal recessive congenital cataract (ARCC),\r\nmental retardation (MR) and ARCC, MR and microcephaly present in most patients in four Tunisian consanguineous\r\nfamilies.\r\nMethods: We screened four genes implicated in congenital cataract by direct sequencing in two groups of\r\npatients; those affected by ARCC associated to MR and those who presented also microcephaly. Among its three\r\ngenes PAX6, PITX3 and HSF4 are expressed in human brain and one gene LIM2 encodes for the protein MP20 that\r\ninteract with the protein galectin-3 expressed in human brain and plays a crucial role in its development. All genes\r\nwere screened by direct sequencing in two groups of patients; those affected by ARCC associated to MR and\r\nthose who presented also microcephaly.\r\nResults: We report no mutation in the four genes of congenital cataract and its flanking regions. Only variations\r\nthat did not segregate with the studied phenotypes (ARCC associated to MR, ARCC associated with MR and\r\nmicrocephaly) are reported. We detected three intronic variations in PAX6 gene: IVS4 -274insG (intron 4), IVS12\r\n-174G>A (intron12) in the four studied families and IVS4 -195G>A (intron 4) in two families. Two substitutions\r\npolymorphisms in PITX3 gene: c.439 C>T (exon 3) and c.930 C>A (exon4) in one family. One intronic variation in\r\nHSF4 gene: IVS7 +93C>T (intron 7) identified in one family. And three intronic substitutions in LIM2 gene identified\r\nin all four studied families: IVS2 -24A>G (intron 2), IVS4 +32C>T (intron 4) and c.*15A>C (3�-downstream sequence).\r\nConclusion: Although the role of the four studied genes: PAX6, PITX3, HSF4 and LIM2 in both ocular and central\r\nnervous system development, we report the absence of mutations in all studied genes in four families with\r\nphenotypes associating cataract, MR and microcephaly....
Background: Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical\r\nlocation and climate are known to influence the profile of fungal diseases. While there are several reports on\r\nmycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The\r\nreported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and\r\nnorthern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and\r\ntreatment outcome of mycotic keratitis at a tertiary eye care center in eastern India.\r\nMethods: A retrospective review of medical and microbiology records was done for all patients with laboratory\r\nproven fungal keratitis.\r\nResults: Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While\r\nno organisms were found in 25.4% (253/997) corneal samples, 23.4% (233/997) were bacterial, 26.4% (264/997)\r\nwere fungal (45 cases mixed with bacteria), 1.4% (14/997) were Acanthamoeba with or without bacteria and 23.4%\r\n(233/997) were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264) samples grew\r\nfungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical\r\ndiagnosis of fungal keratitis was made in 186 of 264 (70.5%) cases. The microscopic detection of fungal elements\r\nwas achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251) cases. Aspergillus\r\nspecies (27.9%, 60/215) and Fusarium species (23.2%, 50/215) were the major fungal isolates. Concomitant bacterial\r\ninfection was seen in 45 (17.1%, 45/264) cases of mycotic keratitis. Clinical outcome of healed scar was achieved in\r\n94 (35.6%, 94/264) cases. Fifty two patients (19.7%, 52/264) required therapeutic PK, 9 (3.4%, 9/264) went for\r\nevisceration, 18.9% (50/264) received glue application with bandage contact lens (BCL) for impending perforation,\r\n6.1% (16/264) were unchanged and 16.3% (43/264) were lost to follow up. Poor prognosis like PK (40/52, 75.9%,\r\np < 0.001) and BCL (30/50, 60%, p < 0.001) was seen in significantly larger number of patients with late\r\npresentation (> 10 days).\r\nConclusions: The relative prevalence of mycotic keratitis in eastern India is lower than southern, western and\r\nnorth-eastern India but higher than northern India, however, Aspergillus and Fusarium are the predominant genera\r\nassociated with fungal keratitis across India. The response to medical treatment is poor in patients with late\r\npresentation....
Background: Diabetic macular oedema is the leading causes of blindness. Laser photocoagulation reduces the risk\r\nof visual loss. However recurrences are common and despite laser treatment, patients with diabetic macular\r\noedema experienced progressive loss of vision. Stabilization of the blood retinal barrier introduces a rationale for\r\nintravitreal triamcinolone treatment in diabetic macular oedema. This study is intended to compare the best\r\ncorrected visual acuity (BCVA) and the macular oedema index (MEI) at 3 month of primary treatment for diabetic\r\nmacular oedema between intravitreal triamcinolone acetonide (IVTA) and laser photocoagulation.\r\nMethods: This comparative pilot study consists of 40 diabetic patients with diabetic macular oedema. The patients\r\nwere randomized into two groups using envelope technique sampling procedure. Treatment for diabetic macular\r\noedema was based on the printed envelope technique selected for every patient. Twenty patients were assigned\r\nfor IVTA group (one injection of IVTA) and another 20 patients for LASER group (one laser session). Main outcome\r\nmeasures were mean BCVA and mean MEI at three months post treatment. The MEI was quantified using\r\nHeidelberg Retinal Tomography II.\r\nResults: The mean difference for BCVA at baseline [IVTA: 0.935 (0.223), LASER: 0.795 (0.315)] and at three months\r\npost treatment [IVTA: 0.405 (0.224), LASER: 0.525 (0.289)] between IVTA and LASER group was not statistically\r\nsignificant (p = 0.113 and p = 0.151 respectively). The mean difference for MEI at baseline [IVTA: 2.539 (0.914),\r\nLASER: 2.139 (0.577)] and at three months post treatment [IVTA: 1.753 (0.614), LASER: 1.711 (0.472)] between IVTA\r\nand LASER group was also not statistically significant (p = 0.106 and p = 0.811 respectively).\r\nConclusions: IVTA demonstrates good outcome comparable to laser photocoagulation as a primary treatment for\r\ndiabetic macular oedema at three months post treatment....
Background: the purpose of this study was to report a binocular photic retinal injury induced by plasma arc\r\nwelding and the follow-up after treatment with vitamin supplements for a month. In our study, we used different\r\ndiagnostic tools such as fluorescein angiography (FA), optical coherence tomography (OCT) and multifocal\r\nelectroretinogram (mfERG).\r\nCase presentation: in the first visit after five days from arc welding injury in the left eye (LE) the visual acuity was\r\n0.9 and 1.0 in the right eye (RE). FA was normal in both eyes. OCT in the left eye showed normal profile and\r\nnormal reflectivity and one month later, a hyperreflectivity appeared in the external limiting membrane (ELM). The\r\nmfERG signal in the LE was 102.30 nV/deg2 five days after the injury and 112.62 nV/deg2 after one month and in\r\nthe RE respectively 142.70 nV/deg2 and 159.46 nV/deg2.\r\nConclusions: in cases of retinal photo injury it is important for the ophthalmologist to evaluate tests such as OCT\r\nand the mfERG in the diagnosis and follow-up of the patient because the recovery of visual acuity cannot exclude\r\nthe persistence of phototoxic damage charged to the complex inner-outer segment of photoreceptors....
Background: The human lens is continuously exposed to high levels of light. Ultraviolet radiation is believed to\r\nplay a causative role in the development of cataract. In vivo, however, the lens is mainly exposed to visible light\r\nand the ageing lens absorbs a great part of the short wavelength region of incoming visible light. The aim of the\r\npresent study was to examine the optical effects on human lenses of short wavelength visible light and ultraviolet\r\nradiation.\r\nMethods: Naturally aged human donor lenses were irradiated with UVA (355 nm), violet (400 and 405 nm) and\r\ngreen (532 nm) lasers. The effect of irradiation was evaluated qualitatively by photography and quantitatively by\r\nmeasuring the direct transmission before and after irradiation. Furthermore, the effect of pulsed and continuous\r\nlaser systems was compared as was the effect of short, intermediate and prolonged exposures.\r\nResults: Irradiation with high intensity lasers caused scattering lesions in the human lenses. These effects were\r\nmore likely to be seen when using pulsed lasers because of the high pulse intensity. Prolonged irradiation with\r\nUVA led to photodarkening whereas no detrimental effects were observed after irradiation with visible light.\r\nConclusions: Irradiation with visible light does not seem to be harmful to the human lens except if the lens is\r\nexposed to laser irradiances that are high enough to warrant thermal protein denaturation that is more readily\r\nseen using pulsed laser systems....
Background: To evaluate results after seven years using prophylactic intracameral cefazolin for the prevention of\r\nendophthalmitis in cataract surgery.\r\nMethods: A prospective, observational study of all patients submitted to cataract surgery over the period January\r\n1996 to December 2009. All cases of postoperative endophthalmitis over that period were reviewed. The patients\r\nwere classified in two groups: Group 1 (11,696 patients) operated on between January 1996 and December 2002,\r\nGroup 2 (13,305 patients) between January 2003 and December 2009 (in whom a 1 mg/0.1 bolus of intracameral\r\ncefazolin was instilled).\r\nResults: During the study period, 76 cases of endophthalmitis were observed in Group 1, and seven in Group 2.\r\nThe rate of postoperative endophthalmitis reduced from 0.63% to 0.05% with a cefazolin injection. The relative risk\r\n(RR) for endophthalmitis in Group 1 against group 2 was 11.45 [95% CI 5.72-22.84, p < 0.001].\r\nConclusions: An intracameral bolus injection of cefazolin (1 mg in 0.1 ml solution) at the conclusion of the\r\ncataract surgery significantly reduced the rate of postoperative endophthalmitis....
Background: The purpose of this study was to investigate current patterns of management and outcomes of\r\nintermittent distance exotropia [X(T)] in the UK.\r\nMethods: This was an observational cohort study which recruited 460 children aged < 12 years with previously\r\nuntreated X(T). Eligible subjects were enrolled from 26 UK hospital ophthalmology clinics between May 2005 and\r\nDecember 2006. Over a 2-year period of follow-up, clinical data were prospectively recorded at standard intervals\r\nfrom enrolment. Data collected included angle, near stereoacuity, visual acuity, control of X(T) measured with the\r\nNewcastle Control Score (NCS), and treatment. The main outcome measures were change in clinical outcomes\r\n(angle, stereoacuity, visual acuity and NCS) in treated and untreated X(T), 2 years from enrolment (or, where\r\napplicable, 6 months after surgery). Change over time was tested using the chi-square test for categorical,\r\nWilcoxon test for non-parametric and paired-samples t-test for parametric data.\r\nResults: At follow-up, data were available for 371 children (81% of the original cohort). Of these: 53% (195) had no\r\ntreatment; 17% (63) had treatment for reduced visual acuity only (pure refractive error and amblyopia); 13% (50)\r\nhad non surgical treatment for control (spectacle lenses, occlusion, prisms, exercises) and 17% (63) had surgery.\r\nOnly 0.5% (2/371) children developed constant exotropia. The surgically treated group was the only group with\r\nclinically significant improvements in angle or NCS. However, 8% (5) of those treated surgically required second\r\nprocedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% (13) were\r\novercorrected.\r\nConclusions: Many children in the UK with X(T) receive active monitoring only. Deterioration to constant\r\nexotropia, with or without treatment, is rare. Surgery appears effective in improving angle of X(T) and NCS, but\r\nrates of overcorrection are high....
Background: Descemet�s Stripping with Automated Endothelial Keratoplasty (DSAEK) is constantly gaining\r\npopularity in the management of endothelial dysfunctions such as bullous keratopathy or Fuchs� dystrophy.\r\nCase Presentation: A 36 year - old man with Fuchs� dystrophy underwent combined phacoemulsification and\r\nDSAEK of the right eye. Immediately postoperatively, corneal graft displacement and peripheral corneal edema\r\nwhich remained stable during the first postoperative month were evident on slit lamp examination. Three months\r\nafter the procedure the peripheral edema had completely resolved and the patients� subjective symptoms were\r\nimproved.\r\nConclusions: The purpose of this case presentation is to demonstrate that corneal graft displacement after DSAEK\r\ncan lead to peripheral corneal edema that can resolve without further intervention such as graft repositioning or\r\nreplacement....
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