Cataract surgery in sympathetic ophthalmia

PURPOSE: To analyze the results of cataract surgery in patients with sympathetic ophthalmia. SETTING: Sankara Nethralaya, Medical Research Foundation, Chennai, India. METHODS: This study comprised 66 patients (132 eyes) with sympathetic ophthalmia seen at the uveitis referral clinic between January 1990 and July 2001; 42 eyes (31.8%) had cataract. Cataract surgery was performed in 17 sympathizing eyes and 1 exciting eye (17 patients). The records of these 18 eyes were retrospectively analyzed. Three eyes had extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation, 6 eyes had ECCE without IOL implantation, and 9 eyes had phacoemulsification with IOL implantation. The mean follow-up was 28.7 months (range 3 to 60 months). RESULTS: The causes of sympathetic ophthalmia were penetrating trauma (n = 8 eyes), ocular surgery (n = 6), perforated corneal ulcer (n = 2), and cyclocryotherapy (n = 1). The most common cataract type, present in 7 eyes (38.8%), was mixed (posterior subcapsular and posterior polar). Visual acuity improved after surgery in 13 eyes (72.2%). The main factors impairing visual recovery were submacular scar and optic atrophy, which were sequelae of the sympathetic ophthalmia. Posterior capsule opacification was noted in 14 eyes (77.7%); it was visually significant in 6 eyes. There was no significant difference in postoperative inflammation or disease reactivation between the 3 types of surgery. CONCLUSIONS: Cataract extraction in cases of sympathetic ophthalmia can be safely and successfully performed with vigilant preoperative and postoperative control of inflammation, careful surgical planning, and meticulous surgical technique. The final visual outcome, however, depends on the posterior segment complications of the disease.     

Apolipoprotein E gene polymorphism in Indian patients with Alzheimer's disease and vascular dementia

The association of apolipoprotein E (ApoE) gene polymorphism with Alzheimer's disease (AD) has been reported in several populations including one from a rural community in North India. However, the association of ApoE polymorphism with vascular dementia (VaD) is yet to be established in this population. In a case-control study involving 54 cases of dementia (29 AD and 25 VaD) and 76 age-matched healthy controls, the frequency of epsilon4 allele was significantly higher among cases of AD and VaD compared with controls (p < 0.001). The epsilon3epsilon3 (p < 0.05) and epsilon2epsilon3 (p < 0.001) genotypes were found to be protective. The odds of developing AD or VaD were 4.4 and 3.7 times higher, respectively, in the presence of even a single epsilon4 allele. Our results suggest that the increased risk of developing AD or VaD is similar among Asian Indians with ApoE epsilon4 compared with the Caucasian population.     

Study of serum levels of superoxide dismutase in preeclampsia and eclampsia: role of the test as a predictive tool

AIM: To report serum levels of superoxide dismutase in women with preeclampsia and eclampsia. To document the use of the value as a predictive tool for deciding the time of onset of subsequent convulsions with fulminating eclampsia and use of the value as a marker for obstetric intervention in clinical severe preeclampsia and eclampsia. METHODS: Superoxide dismutase concentration was measured in a consecutive study in sera of women admitted in obstetric ward for preeclampsia and eclampsia, and compared with sera of normotensive, healthy pregnant women in third trimester. Three mL venous blood was subjected to superoxide dismutase estimation by pyrogallol autoxidation method. RESULTS: We found statistically significant difference (P < 0.05) in mean superoxide dismutase levels of normotensive pregnant women; and preeclamptic and eclamptic subjects, no statistically significant difference was found in between value of enzyme in preeclampsia and eclampsia (P > 0.05). Superoxide dismutase levels in two pregnancy outcomes; live births and still births, shows significant difference (P < 0.05), being 1.03 U/mL and 0.52 U/mL, respectively. The comparison of values before delivery and after delivery showed highly statistically significant difference (P < 0.001) in both groups separately. The cut-off value of serum superoxide dismutase 0.52 U/mL has sensitivity 68.5%, specificity 59.5% and negative predictive value of 78.6%, for predicting the fetal death as outcome of pregnancy with severe grade of disease. CONCLUSION: We found low levels of serum superoxide dismutase, less than 0.52 U/mL, being the predecessor of fulminating eclampsia. Our results support this predictive value of serum superoxide dismutase level as important in deciding the time of intervention as termination of pregnancy.     

Eccrine duct carcinoma of the eyelid mimicking meibomian carcinoma: clinicopathological study of a case

Eccrine duct carcinoma belongs to a group of malignant sweat gland tumors showing de novo eccrine differentiation, but without features of benign adnexal counterparts. They are therefore likely to be confused with visceral adenocarcinomas that have metastasized to the lid. These tumors require important diagnostic considerations when adenocarcinoma is encountered in the lid in the absence of a known primary tumor. We present the case of a 60-year-old man with a nodule in the right upper eyelid that was histopathologically diagnosed as eccrine duct carcinoma of the lid. The differential diagnosis of eccrine carcinomas based on light microscopy, enzyme histochemistry, and immunohistochemistry is discussed, and a list of the various malignant eccrine tumors reported in the lid is presented.     

Racial differences in preventive practices of African-American and Hispanic women

OBJECTIVES: To compare the use of preventive practices of Hispanic- and African-American women aged 50 and older. DESIGN: A cross-sectional survey. SETTING: Inpatient and outpatient units of a teaching hospital located in South Central Los Angeles. PARTICIPANTS: Convenience sample of 337 women aged 50 and older. MEASUREMENTS: Demographic and lifestyle characteristics and selected preventive practices. Preventive practices reported were self-breast examination, mammography, Papanicolaou (Pap) smear, digital rectal examination and stool occult blood examination, sigmoidoscopy, chemoprophylaxis, and immunization. Information was obtained in a face-to-face interview. RESULTS: African-American women were more likely to have had a Pap smear ever and to have used aspirin prophylaxis than Hispanic women. CONCLUSION: There were no major differences in the use of preventive services by the two ethnic groups except for Pap smear and aspirin use. Immunization and colorectal cancer screening rates were low in African-American and Hispanic women.