Clinical outcomes of non-Descemet stripping automated endothelial keratoplasty

To describe the results of non-Descemet stripping automated endothelial keratoplasty (non-DSAEK). Retrospective, interventional, consecutive clinical case series. Twenty-three patients underwent non-DSAEK from January 2010 to February 2011. The various indications were pseudophakic corneal edema, aphakic corneal edema, failed graft, iridocorneal endothelial syndrome and congenital glaucoma. Corneal edema cleared in all patients within 1–4?weeks. Mean follow-up duration was 7.6?months. Post-operative best corrected visual acuity ranged from 20/400 to 20/40. Fourteen patients had co-morbid factors affecting the vision. No patient had interface haze. Immediate post-operative complications were partial graft detachment (1 patient) and secondary angle closure (1 patient). Corneal clarity was restored following secondary interventions. One late post-operative complication was graft rejection at 6?months, leading to graft failure. Non-DSAEK is a safe and viable option in cases of corneal decompensation when the Descemet membrane is non-pathological.     

Wolcott Rallison Syndrome: A Rare Inherited Diabetes Mellitus

A 9-y-old boy was referred to authors’ institute for the management of insulin dependent diabetes mellitus. He was the product of third degree consanguineous marriage and was delivered by full term vaginal delivery with a birth weight of 2.75 kg. At 3 mo of age, he had presented with diabetic ketoacidosis and was on insulin regimen. Patient had delayed milestones and short stature. On follow up, child developed limb deformity and was diagnosed to have skeletal dysplasia. At the age of 9 y, patient was diagnosed to have cirrhosis of liver. Genetic analysis revealed homozygous EIF2AK3 nonsense mutation. It confirmed the diagnosis of Wolcott-Rallison syndrome. Patient’s mother was heterozygous for the same mutation.     

Chronic conjunctivitis due to Mycobacterium tuberculosis

To report the clinical characteristics and treatment outcome in six patients with chronic conjunctivitis due to Mycobacterium tuberculosis. In this retrospective observational case series, all patients with a diagnosis of conjunctival tuberculosis seen in our clinics between January 2000 and January 2010 were reviewed. The clinical presentation, diagnostic investigations and response to medical therapy and outcomes were analyzed. Six patients (age range 15–47 years) were diagnosed with conjunctival tuberculosis. The mean duration from onset of symptoms to diagnosis was 6.5 months (range 1–12 months). Of the six patients, two had ulceration, one had a nodulo-ulcerative lesion, one had bilateral nodular epibulbar masses, and one had a hypertrophied papillary lesion. Systemic signs of tuberculosis were noted in two patients—pleural effusion in one and preauricular and submandibular lymph node involvement in the other. All patients had resolution of symptoms after treatment with four-drug anti-tuberculosis therapy (ATT). None had ocular or systemic recurrences after completion of ATT. Tuberculosis of the conjunctiva can have varied clinical presentation. Although a rare entity, it should be suspected in non-responding chronic conjunctivitis. A high index of suspicion and clinical examination aided by appropriate microbiological and histopathological testing can help in early diagnosis and management.     

Reduction of Radiation Doses in Cardiac Imaging, Part I: Minimally Invasive Cardiovascular Procedures

Fluoroscopically guided minimally invasive diagnostic and therapeutic cardiovascular procedures constitute an essential component of the contemporary practice in medicine. Such procedures are however associated with radiation exposure and its attendant hazards. Given the exponential increase in both the type and number of various cardiovascular procedures over the past few decades, radiation exposure has become a critical parameter mandating periodic evaluation. Although existent data indicate variable but nominal radiation doses associated with cardiovascular interventions, the radiation risk may be significant in certain patient populations and the operators who perform numerous procedures annually. Awareness regarding radiation doses and exposure delivered to both patients as well as operators during interventional procedures is therefore imperative. In this article, we review the current literature regarding radiation exposure, its potential hazards, and the ways to reduce the radiation dose in the current practice of cardiovascular medicine.     

Paradoxic cerebral embolism after cemented knee arthroplasty: a report of 2 cases and prophylactic option for subsequent arthroplasty

Major orthopaedic procedures that involve instrumentation of the medullary canal are well known to produce showers of embolic debris including fat, bone fragments, marrow constituents, and cement. A growing literature has identified paradoxic cerebral embolism as a rare but serious consequence of the passage of these emboli through an intracardiac right-to-left shunt to the cerebral arterial circulation. We report 2 cases of paradoxic cerebral embolism after cemented total knee arthroplasty and propose a novel treatment plan to prevent recurrent stroke during subsequent surgery.