Intraocular tissue migration of silicone oil after silicone oil tamponade: a histopathological study of enucleated silicone oil-filled eyes

Retrospective clinical and histopathological review of eight silicone oil-filled enucleated eyeballs using light microscopy was carried out in our department of ocular pathology during a period of six years. In all cases, silicone oil vacuoles, both free and incorporated within macrophages were seen in all the retinal layers. Silicone oil vacuoles were seen in the optic nerve, choroid, retinal pigment epithelium, corneal stroma, iris and ciliary body stroma, preretinal and subretinal membranes and retro-corneal membranes. Silicone oil migration could be seen in intraocular tissues as early as two months post surgery. There was no definite histopathological correlation between duration of tamponade and distribution of silicone oil vacuoles. Silicone oil vacuoles were seen in the optic nerve in eyes with neovascular glaucoma. Chronic inflammatory reaction was observed in the retinal tissue in the vicinity of silicone oil vacuoles.     

Direct aspiration of capsular bag material in a case of sequestered endophthalmitis

Chronic recurrent endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens implantation secondary to organisms sequestered in the capsular bag. There is a need to identify these sequestered organisms to facilitate appropriate management. Frequently, specimens from the anterior chamber and vitreous cavity could be unyielding, especially in the early cases in which the vitreous is still uninvolved. This article highlights the technique of directly sampling the capsular bag material in the effective diagnosis of the organism, which facilitates the total cure by irrigation with appropriate antibiotics into the capsular bag.     

Malaria persistence in Kumaon foothills of District Nainital, Uttarakhand, India

Clinic data depicted a high incidence of malaria in a forest ecotype in the Kumaon foothills of District Nainital, Uttarakhand, India. A study was therefore conducted to determine the risk factors associated with the transmission of malaria from 2002 to 2004. The man-hour densities of Anopheles culicifacies and An. fluviatilis varied from 2 to 139 and 1 to 69, respectively. The sporozoite rate of 0.24% was recorded in An. culicifacies. Sibling species investigation revealed prevalence of species B (53.8%) and C (46.2%) of An. culicifacies and of species T (100%) of An. fluviatilis complexes. The slide positivity rate and slide falciparum rate were 50.4% and 28.3%, respectively. The infant parasite rate was 42.9% and the enlarged spleen rate among the children was 25.95%. The findings revealed the persistence of malaria in the area mainly due to indigenous transmission through the malaria vector An. culicifacies and the inadequacy of intervention measures. Transmission could be curtailed by indoor residual application of malathion.     

Cupped disc with normal intraocular pressure: the long road to avoid misdiagnosis

We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important differential diagnosis of NTG. Diagnosis of NTG should be by exclusion. Here the possible causes of misdiagnosis are discussed. We present an approach to distinguish glaucomatous from nonglaucomatous optic neuropathy. The article also emphasizes how important it is for the clinicians to consider the total clinical picture, and not merely the optic disc morphology, to avoid the mismanagement of glaucoma, especially the NTG.     

Dyslipidemia management in primary prevention of cardiovascular disease:Current guidelines and strategies

Cardiovascular disease is the leading cause of death in the United States. In 2010, the Centers for Disease Control and Prevention estimated that $444 billion was spent on cardiovascular diseases alone, about $1 of every $6 spent on health care. As life expectancy continues to increase, this annual cost will also increase, making costeffective primary prevention of cardiovascular disease highly desirable. Because of its role in development of atherosclerosis and clinical events, dyslipidemia management is a high priority in cardiovascular prevention. Multiple major dyslipidemia guidelines have been published around the world recently, four of them by independent organizations in the United States alone. They share the goal of providing clinical guidance on optimal dyslipidemia management, but guidelines differ in their emphasis on pharmacotherapy, stratification of groups, emphasis on lifestyle modification, and use of a fixed target or percentage reduction in low density lipoprotein cholesterol. This review summarizes eight major guidelines for dyslipidemia management and considers the basis for their recommendations. Our primary aim is to enhance understanding of dyslipidemia management guidelines in patient care for primary prevention of future cardiovascular risk.