Surgical Management of Bilateral Abductor Palsy: Comparative Study Between Posterior Cordotomy and Partial Arytenoidectomy

The aim of this study is to analyse outcome of patients with bilateral abductor palsy undergoing unilateral partial arytenoidectomy and unilateral posterior cordotomy in terms of respiration, phonation and risk of aspiration. Initially tracheostomy was only treatment available to relieve respiratory distress. Now various methods are described e.g. endoscopic posterior cordotomy, arytenoidectomy, suture lateralization of vocal cords, laryngeal reinnervation and muscle transfer procedures. In our study, review of management of 21 cases of bilateral abductor palsy were carried out. Patient assessment included fibre optic laryngoscopy and radiology. Unilateral partial arytenoidectomy was carried out in 9 patients and unilateral posterior cordotomy was carried out in 12 patients. All the 21 cases in our study were tracheotomised. Among the 21 surgically treated patients 90.5% patients were decannulated. The mean increase in VHI 10 score after surgery was of 4.8. The mean increase was 4 in the partial arytenoidectomy group, whereas the mean increase in the posterior cordotomy group was 5. There was no history of aspiration following surgery. The percentage of cases requiring revision surgery was 33% in patients undergoing partial arytenoidectomy and was 25% in patients undergoing posterior cordotomy. Analysis of results after 12 months revealed that both unilateral posterior cordotomy and unilateral partial arytenoidectomy are effective and satisfactory procedures in treatment of bilateral abductor palsy.     

First contact diagnosis and management of contact lens-related complications

To describe the spectrum of contact lens-related problems in cases presenting to a tertiary referral eye hospital. A retrospective case record analysis of 111 eyes of 97 consecutive patients was undertaken over a period of five months at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Contact lens-related complications (CLRC) were classified into microbial keratitis, sterile corneal infiltrates, corneal epitheliopathy and contact lens-related red eye (CLARE). Main parameters examined were nature of the first contact, clinical diagnosis, and management pattern. Forty-two percent of the initial presentations were to health care practitioners (HCPs) other than ophthalmologists. Mean duration from the onset of symptoms to presentation was 6.3 ± 10.9 days. Forty-nine percent (n = 54) of patients had an associated risk factor, most commonly overnight use of contact lenses (n = 14, 13 %). Most common diagnosis at presentation was corneal epitheliopathy (68 %) followed by sterile infiltrates (10 %), CLARE (8 %) and microbial keratitis (6 %). No significant differences were found in the pattern of treatment modalities administered by ophthalmologists and other HCPs. HCPs other than ophthalmologists are the first contact for contact lens-related problems in a significant proportion of patients. These HCPs manage the majority of CLRC by direct treatment or immediate referral.     

Ocular allergy and keratoconus

Keratoconus is the most common corneal ectatic disorder, the cause of which is largely unknown. Many factors have been implicated, and the ocular allergy is being one of them. The commonly proposed pathogenesis includes the release of inflammatory mediators due to eye rubbing which may alter the corneal collagen and lead to corneal ectasias. The onset of keratoconus is often early in cases associated with allergy and routine corneal topography may detect subtle forms of keratoconus. These cases may require early keratoplasty and are at an increased risk of having acute corneal hydrops. Surgical outcomes are similar to primary keratoconus cases. However, post-operative epithelial breakdown may be a problem in these cases. Control of allergy and eye rubbing is the best measure to prevent corneal ectasias in cases of ocular allergy.     

Evaluation of 0.3% Gatifloxacin Hydrochloride in Decontamination of Donor Corneas

PURPOSE:: To evaluate demographic, clinical, and microbiological profile of eye donors and efficacy of 0.3% gatifloxacin hydrochloride in microbial decontamination of donor corneas. METHODS:: About 513 donors and 1,026 corneas received at National Eye Bank of a tertiary care hospital during 1-year period were analyzed prospectively in this randomized clinical trial. The donor eyes were graded and treated with 5% povidone-iodine, 0.4% amikacin sulphate, and 0.3% gatifloxacin hydrochloride. The parameters evaluated were death enucleation time (DET), grading of donor corneas, microbiological profile of culture organisms, and their sensitivity to various antibiotics. RESULTS:: Mean DET was 6.29±5.7 hours. Forty one percent eyes were optical grade corneas and the majority of donors (38.5%) had accidental deaths. Good grade eyes were maximum with DET of <1 hour and were comparable between 0-6 hours and 6-12 hours. About 57.6% (591/1026) eyes were culture positive; most common organisms were Pseudomonas spp (53%) and Coagulase-negative Staphylococci (24%). Culture positivity reduced significantly after treatment with povidone iodine and amikacin (P=0.002, right eye; P=0.004; left eye) and decreased further with use of gatifloxacin (P=0.001). Pseudomonas (93%), Coagulase-negative Staphylococci (96.3%), Staphylococcus aureus (90.5%), enterococci and gram-negative bacilli were sensitive to gatifloxacin. Pseudomonas spp which were multidrug-resistant were sensitive to polymyxin-B. CONCLUSIONS:: Gatifloxacin hydrochloride in addition to amikacin sulphate is beneficial for donor eye decontamination. Polymyxin-B may be used for multidrug-resistant Pseudomonas spp.