Human papillomavirus in retinoblastoma: A tertiary eye care center study from South India

Purpose:This study is aimed to investigate the presence of Human papillomavirus (HPV) DNA in tumors obtained from sporadic retinoblastoma patients.Methods:One hundred six tumor tissues obtained from sporadic RB patients were analyzed for HPV infection by use of both seminested PCR and real-time quantitative PCR.Results:Of 106 RB patients, 55 were male and 51 were female. The mean age at diagnosis was 26.77 ± 15.36 (mean ± Std. dev) months. Almost all patients presented with leukocoria. Molecular investigation by different methods revealed no HPV positivity in any tumor genome.Conclusion:Our study demonstrates no association between HPV and RB, postulating HPV may not be a major risk factor in the etiology of RB.     

Orbital and adnexal amyloidosis: Thirty years experience at a tertiary eye care center

Purpose:The aim of this work was to study the clinical presentation, management and outcomes of orbital and adnexal amyloidosis.Methods:This retrospective analysis included all the patients diagnosed with orbital and adnexal amyloidosis between January 1990 and December 2019. Positive staining with Congo Red and apple-green birefringence on polarized light microscopy established the diagnosis. Data analyzed included demographic profile, varied presentations, management, and outcome.Results:Thirty-three eyes of 26 patients were included. The male:female ratio was 1:1. The mean age of the study population was 42.6 ± 16 years. The median duration of symptoms was two years. Unilateral involvement was seen in 19 eyes (right = 11, left = 8). The most common presenting feature was acquired ptosis. Eyelid was the most commonly affected site followed by orbit and conjunctiva. Two patients had systemic involvement in the form of multiple myeloma and lymphoplasmacytic lymphoma. Complete excision was done in seven (26.9%) cases while 19 (73.1%) cases underwent debulking. Three patients underwent ptosis surgery. The median duration of follow-up was 1.5 years. Three cases had recurrence and underwent repeat surgery.Conclusion:Orbit and adnexa is a rare site for amyloidosis. It is usually localized; however it can occur as a part of systemic amyloidosis. Eyelid is the most common site of involvement and patients usually present as eyelid mass or ptosis. Complete excision is difficult and most of the patients usually undergo debulking surgery. All patients should undergo screening for systemic amyloidosis     

The economic burden of diabetic retinopathy care at a tertiary eye care center in South India

Purpose:The aim of this study was to analyze the cost and factors affecting diabetic retinopathy (DR) care in a tertiary eye care facility in South India.Methods:In a retrospective, observational study, we evaluated the costs incurred in DR management in each stage of retinopathy from electronic medical records. Both medical and indirect costs (transportation and boarding) were calculated.Results:The study evaluated 1000 consecutive patients (2000 eyes) with DR, from January to June 2019. One-third (32%; n = 321) patients were females. The median cost per patient was INR 8,214 (IQR 2,812-29,748). Cost of care was higher in patients with sight-threatening DR (STDR) compared to non-STDR (INR 31,820 vs INR 14,356, P < 0.001). Among 57.3% (n = 573;1137 eyes) of subjects who completed treatment, there was a statistically significant reduction in visual impairment (427 to 355 eyes) and blindness (<3/60) (132 to 103 eyes) from baseline (P < 0.001). The number of follow-up visits had a negative association with travel distance and socioeconomic status (P < 0.001); the positive association was seen with DR severity (P = 0.002) and total cost (P < 0.001) on regression analysis. There was a nearly 3-fold difference in the average medical cost per eye for subjects with severe visual loss (<3/60) (INR 26,270) compared to those with good vision (≥6/12) (INR 8,510).Conclusion:Treatment of DR benefits, but the cost of care increases with disease severity and visual impairment. Compliance to care was related to DR severity and treatment cost. Some of the barriers could be reduced with greater advocacy and reduced travel distance.     

Outcomes of levator resection at tertiary eye care center in Iran: a 10-year experience

Purpose

To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation.

Methods

In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed.

Results

Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD₁) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD₁, lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection.

Conclusions

Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.     

Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India

Purpose:

To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India.

Materials and Methods:

Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006.

Results:

Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively.

Conclusion:

Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.     

印度中部某三级眼科护理中心的角膜屈光手术实践

目的：研究印度中部患者的特征和角膜屈光手术(KRS)实践。方法：回顾性研究2017-06/2022-04在印度中部某三级眼科护理中心行KRS的患者410例。记录患者的人口统计学资料,如年龄、性别、居住地(城市或农村)、屈光不正、手术原因、最佳矫正视力、手术类型、术后随访和并发症。结果：410例患者中,324例接受KRS(79.0%)。其中,200例(61.7%)行激光辅助原位角膜磨镶术(LASIK),124例(38.3%)行屈光性角膜切除术(PRK)。研究组最终由179名女性和145名男性组成。患者平均年龄为(25±3.5)岁。大多数患者来自城市地区(n=250,77.2%)。右眼和左眼的平均术前显性屈光度分别为-4.5±2.1和-4.9±2.0。LASIK患者双眼平均手术时间为(15±2)min,PRK患者双眼平均手术时间为(17±3)min。未出现上皮内向生长、皮瓣愈合并发症或感染,且无患者需行增强手术。角膜厚度不理想(n=28,32.6%)是排斥手术最常见的原因。随访1a,3名接受LASIK手术的患者出现回退(-0.5D±1D),屈光度校正分别为-6.75D,-8.5D,-7.0D。结论：LASIK是印度中部人群矫正屈光不正的主要手术。虽然PRK手术的数量很少,但LASIK和PRK都具有良好的视力预后。高度近视选择LASIK时应考虑近视消退。     

Profile of retinal vasculitis in a tertiary eye care center in Eastern India

Aims:

To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India.

Materials and Methods:

Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009.

Results:

One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7%) patients were male (mean age 33± 11.1 years) and 10 (14.3%) were female (mean age 32.4 ± 13.6 years). Vasculitis was bilateral in 43 (61.4%) and unilateral in 27 (38.6%) patients. Commonest symptoms were dimness of vision (73; 64.6%) and floaters (36; 31.9%). Vascular sheathing (82; 72.6%) and vitritis (51; 45.1%) were commonest signs. Mantoux test was positive in 21 (30%) patients but tuberculosis was confirmed in only four (5.71%) patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71%) patients each. Human leukocyte antigen B5 (HLA B5) marker was present in one (1.4%) patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7%) was the mainstay of treatment. Forty-eight (42.5%) eyes maintained their initial visual acuity and 43 (38%) gained one or more line at mean follow-up of 16.6± 6.3 months.

Conclusion:

Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.     

The spectrum and clinicopathological correlation of eyelid lesions: Twenty years’ experience at a tertiary eye care center in South India

Purpose:To study the epidemiological pattern and diagnostic accuracy of histopathologically proven eyelid lesions over a period of two decades.Methods:A retrospective study of all histopathologically proven eyelid lesions from April 1996 to March 2016 was conducted. The lesions were broadly categorized as benign or malignant. Inflammatory and infectious lesions were included under the benign category. The percentage and diagnostic accuracy of each lesion was calculated.Results:There were a total of 994 (M = 551, F = 443) cases. The mean age of the patients was 43.5 ± 19.9 years. There were 809 (81.4%) benign and 185 (18.6%) malignant lesions. Benign lesions were commonly seen in the fourth decade, while the malignant ones in the late fifth decade. The upper lid was the most common site in both groups (n = 481, 48.4%). The commonest benign lesion was chalazion (n = 484, 59.8%). Dermal nevus (n = 94, 11.6%) was the most common benign neoplasm, while Molluscum contagiosum (n = 25, 3.09%) was the most common infectious lesion. Sebaceous gland carcinoma (SGC) (n = 103, 55.7%) was the leading malignant lesion followed by basal cell carcinoma (n = 39, 21.1%). Eleven malignant cases were misdiagnosed as benign (5.9%). Chalazion (99.1%) and SGC (65%) had the highest diagnostic accuracy, while Molluscum (40%) and squamous cell carcinoma (40%) were the most misdiagnosed lesions in the respective groups.Conclusion:Benign eyelid lesions are far more common than malignant ones. Atypical and rare presentations may lead to misdiagnosis. Knowledge of epidemiological patterns and clinical features can help in achieving higher diagnostic accuracy.     

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.     

Cost analysis of pediatric cataract surgery in a tertiary eye care hospital in Western India

Purpose:To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider’s perspective.Methods:Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered.Results:The per-patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76).Conclusion:Pediatric cataract surgeries are cost-intensive. High-volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness-free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.     

Pattern of uveitis in North East India: A tertiary eye care center study

We conducted an institutional-based retrospective study on 308 uveitic patients and analyzed the pattern of uveitis in Northeastern India. Anterior uveitis was the most common type (47.07%) followed by posterior (29.87%), intermediate (12.98%) and panuveitis (10.06%). Toxoplasmosis (40.21%) had the highest incidence among posterior uveitis cases. Harada''s form of Vogt Koyanagi Harada''s disease is a frequent occurrence in this subset of the population.     

Etiology and clinical profile of childhood optic nerve atrophy at a tertiary eye care center in South India

Background:Optic nerve atrophy is an important ophthalmological sign that may be associated with serious systemic conditions having a significant bearing on the overall morbidity of the child. Studies specific to etiology of childhood optic atrophy are scarce, this being the first such study from India to the best of our knowledge.Aim:The aim was to analyze the clinical features and etiology of diagnosed cases of optic nerve atrophy in children <16 years of age.Results:A total of 324 children (583 eyes) were identified. Among these 160 (49%) presented with defective vision, 71 (22%) with strabismus, 18 (6%) with only nystagmus. Rest had a combination of two or three of the above symptoms. Sixty-five patients (20%) had a unilateral affection. Hypoxic ischemic encephalopathy seen in 133 patients (41%) was the most frequent cause of childhood optic atrophy, followed by idiopathic in 98 (30%), hydrocephalus in 24 (7%), compressive etiology in 18 (5%), infective in 19 (6%), congenital in 6 (2%), inflammatory in 5 (2%) patients, respectively.Conclusion:Hypoxic ischemic encephalopathy appears to be the most common cause of optic atrophy in children in this series. The most common presenting complaint was defective vision.     

A study of the spectrum of Acanthamoeba keratitis: a three-year study at a tertiary eye care referral center in South India

PURPOSE: To determine the epidemiological and clinical characteristics of Acanthamoeba keratitis and also to determine the sensitivity and specificity of smears in the detection of Acanthamoeba. MATERIALS AND METHODS: A retrospective review of all culture-positive cases of Acanthamoeba keratitis seen between October 1999 and August 2002 was performed. Corneal scrapes were subjected to culture and microscopy using standard protocols. RESULTS: Out of 3183 consecutive patients with clinically diagnosed corneal ulcers evaluated, 33 (1.04%) were found to be due to Acanthamoeba. Twenty-four out of 33 (72.72%) were less than 51 years of age (P<0.001). All patients were from rural areas (P<0.001) and 26 (78.79%) of them were agricultural workers (P=0.031). All 33 had history of corneal injury (P<0.001) and 28 (84.85%) patients had injury with mud (P<0.001). All 33 (100%) patients had previous medical treatment (P=0.009) and 10 (30.3%) had used traditional eye medicines (P=0.183). A clinical pattern of ring infiltrate was characteristic in 15 (45.45%) patients. The diameter of the corneal ulcer was more than 6 mm in 27 (81.82%) eyes (P<0.001). Twenty-six (78.79%) patients had visual acuity of perception of light on initial presentation (P<0.001) and 24 (72.73%) had the same as their final visual outcome. The sensitivity of 10% potassium hydroxide (KOH) preparation was found to be higher (P<0.001) in the detection of Acanthamoeba cysts. CONCLUSION: The incidence of Acanthamoeba keratitis amongst the corneal ulcer patients was 1% in this setting and it was mainly due to corneal injury by mud. The KOH preparation is a sensitive diagnostic tool for the detection of Acanthamoeba. Delayed diagnosis or misdiagnosis and inappropriate antimicrobial therapy results in poor visual outcome.