Population based assessment of uveitis in an urban population in southern India

AIM: To assess the prevalence of active and inactive uveitis unrelated to previous surgery or trauma in an urban population in southern India. METHODS: As part of the Andhra Pradesh Eye Disease Study, 2522 subjects (85.4% of those eligible), a sample representative of the population of Hyderabad city in southern India, underwent interview and detailed dilated eye examination. Presence of sequelae of uveitis without current active inflammation was defined as inactive uveitis. RESULTS: Unequivocal evidence of active or inactive uveitis unrelated to previous surgery or trauma was present in 21 subjects, an age-sex adjusted prevalence of 0.73% (95% confidence interval (CI) 0.44-1.14%). Active uveitis was present in eight subjects, an age-sex adjusted prevalence of 0.37% (95% CI 0. 19-0.70), of which 0.06% was anterior, 0.25% intermediate, and 0.06% posterior. The 0.36% (95% CI 0.17-0.68%) prevalence of inactive uveitis included macular chorioretinitis scars (0.26%), anterior (0. 07%) and previous vasculitis involving the whole eye (0.03%). The prevalence of visual impairment due to uveitis of less than 6/18 in at least one eye was 0.27%, less than 6/60 in at least one eye was 0. 16%, and less than 6/60 in both eyes was 0.03%. CONCLUSION: These population based cross sectional data give an estimate of the prevalence of various types of uveitis in this urban population in India. Active or past uveitis that might need treatment at some stage was present in one of every 140 people in this population.     

Patient characteristics, diagnosis, and treatment of non-contact lens related Acanthamoeba keratitis

AIM: To review the clinical characteristics, diagnosis, and visual outcome in patients with non-contact lens related Acanthamoeba keratitis and compare the findings with reported series of contact lens associated Acanthamoeba keratitis. METHODS: Medical and microbiology records of 39 consecutive patients with a diagnosis of Acanthamoeba keratitis, at a tertiary eyecare centre in India between January 1996 and June 1998, were analysed retrospectively. RESULTS: A majority of the patients presented with poor visual acuity and large corneal stromal infiltrates (mean size 38.20 (SD 26. 18) mm). A predisposing factor was elicited in 19/39 (48.7%) patients (trauma 15, dirty water splash three, leaf juice one). None of the patients had worn contact lenses. Most patients (26/39 (66. 6%)) came from a low socioeconomic background. Complaint of severe pain was not a significant feature and radial keratoneuritis was seen in 1/39 (2.5%) patients. A ring infiltrate was present in 41.1% of cases. A clinical diagnosis of fungal keratitis was made in 45% of the patients before they were seen by us. However, all patients were diagnosed microbiologically at our institute based on demonstration of Acanthamoeba cysts in corneal scrapings (34/39) and/or culture of Acanthamoeba (34/39). Treatment with biguanides (PHMB, 15/38 (39.4%), PHMB with CHx, 23/38 (60.5%), one patient did not return for treatment) resulted in healing with scar formation in 27 out of 31(87.0%) followed up patients (mean time to healing 106.9 days). Overall visual outcome was poor with no statistical difference between cases diagnosed within 30 days (early) or 30 days after (late) start of symptoms. The visual outcome in cases requiring tissue adhesive (five) and keratoplasty (three) was also poor. CONCLUSIONS: This is thought to be the largest series of cases of Acanthamoeba keratitis in non-contact lens wearers. In such cases, the disease is advanced at presentation in most patients, pathognomonic clinical features are often not seen, disease progression is rapid, and visual outcome is usually poor. Possible existence of Acanthamoeba pathotypes specifically associated with non-contact lens keratitis and unique to certain geographical areas is suggested.     

Synthesis and analgesic activity of some novel 2-substituted 1,3,4-thiadiazolo

An ecofriendly synthesis for 1,2,3,4,5,6,8-octahydro- 3-amino-2-thioxo-benzothieno[2,3-d]pyrimidin-4-one (7A, B) has been developed. A series of hitherto unreported compounds (2a-i, 3a-c) have been synthesized by treating 3-Amino-2-mercaptopyrimidinones (7A, B) with one carbon donors like chloroacetyl chloride or chloroacetic acid and subsequently replacing the chloro group by various nucleophiles. Compound 2f was successfully synthesized by an alternate route. All the new compounds were characterized by elemental and spectral analyses. They were screened for analgesic activity in mice. Compounds 2a, b, 3a, b, and 2e, showed very good activity.     

Bronchodilation and structure-activity relationship studies on new 6-substituted benzimidazo[1,2-c]quinazolines

Two series of 6-substituted benzimidazo[1,2-c]quinazolines (Ia-p and IIa-l) have been synthesized and characterized. The compounds were evaluated for their bronchodilator activity, in vitro and in vivo. All the test compounds exhibited good activity both in vivo and in vitro methods. The structure-activity relationships based on the results obtained for these series have also been studied. In the 6-alkyl substituted compounds II, a longer alkyl chain and a 4-substitution by an electron-withdrawing group in compounds I, showed more activity. The presence of halogens altered the biological activity in both series. Among the compounds tested, 10-iodo-6-(n-propyl)-benzimidazol[1,2-c]quinazoline (II) was found to be the most potent (% protection = 75%; relative activity = 1.1).     

Unusual manifestations of henoch-schonlein purpura

Henoch schonlein syndrome (HSP) represents a diagnostic challenge when gastrointestinal symptoms or other atypical symptoms precede the cutaneous manifestations. We describe two patients whose abdominal symptoms antedated cutaneous manifestations. Six-year-old, black male patient, presented with 1 wk history of vomiting (without diarrhea or urinary symptoms), hypertension (140/90 mmHg), diffuse abdominal pain and hypoactive bowel sounds:. WBC’s 40,000/Cu mm³ with 80 percent hypoproteinemia, (albumin 1.6 G%), high plasma renin and stools positive for occult blood. Renal function and urinalysis was normal. Two weeks later patient developed urticarial purpuric rash over the ankles, gross hematuria and gross edema. Biopsy of the skin lesion was consistent with HSP vasculitis. Second patient 4 yr Brazilian male patient presented with abdominalpain, vomiting, blood in the stools, and pain in the right testis. Three days later, developed purpuric rash over his limbs and trunk. He also had hypoproteinemia, hypoalbuminemia, leukocytosis and normal urine analysis. Abdominal pain, bloody stools, painful testicular swelling and hypoproteinemia abated with steroid therapy. In HSP patients, atypical presentation of abdominal pain, hypertension, hypoproteinemia without proteinuria testicular swelling and leucocytosis in the absence of cutaneous and joint manifestations poses as diagnostic problem. Protein-losing enteropathy should be considered in HSP patients with hypoproteinemia.     

Effect of age on the refractive outcome of myopic photorefractive keratectomy

PURPOSE: To evaluate the effect of age on the outcome of myopic photorefractive keratectomy (PRK). SETTING: University-based refractive surgery practice. METHODS: A retrospective analysis of 197 eyes that had PRK for myopia was performed. Four groups of patients were compared: Group 1, patients < 30 years (n=35); Group 2, patients 31 to 40 years (n=56); Group 3, patients 41 to 50 year s (n=47); Group 4, patients > 50 years (n=59). The percentage of eyes with an uncorrected visual acuity of 20/20 or better and 20/40 or better and the percentage of eyes with spherical correction within +/-0.5 and +/-1.0 diopter (D) of the attempted correction were derived for each age group. The percentage of patients overcorrected and undercorrected by 1.0 D or more in each age group was also calculated.The difference between the percentage of patients who achieved a visual acuity of 20/20 or better in Group 4 and in the younger groups was statistically significant at 3 months (P =.02) but not at 6 months (P =.70) and 12 months (P =.55). The difference between the percentage of patients who achieved an acuity of 20/40 or better was not significant at any time. The difference between the percentage of patients who were within +/-0.5 D of intended correction in Group 4 and in the younger groups was statistically significant at 3 months (P =.001), 6 months (P =.006), and 12 months (P =.008); the difference between the percentage of patients who were within +/-1.0 D of intended correction was not significant at any time. The difference between the percentage of patients overcorrected and undercorrected by 1.0 D or more in Group 4 and in the younger groups was not significant at any time.In the 3 younger groups, age did not significantly affect visual outcome or predictability. However, there was a significant difference between Group 4 and the 3 younger groups in predictability of the refractive outcome at 3, 6, and 12 months. Age may play a role in the outcome of refractive surgery.     

Understanding corneal topography

With the increase in corneal laser refractive surgery, there is a greater need for precise evaluation of the corneal surface. Articles published in the past year have reported possible use of confocal scanning laser technology-based devices to image the cornea. Other studies have compared existing instruments and software in an effort to determine if data from different instruments are comparable. Topographic evaluation also has served to highlight long-term complications of procedures like radial keratotomy and the promise of newer surgical procedures like the intrastromal corneal ring segments. Studies of the corneal surface have helped refine surgical procedures like photorefractive keratectomy, laser in situ keratomileusis, penetrating keratoplasty, and cataract surgery. Topographic measures that serve as direct correlates of ocular visual performance, however, still remain elusive. Studies in the past year have confirmed that corneal topographic evaluation may be a powerful tool in the search for a genetic basis of keratoconus. Important areas for future research include precise determination of the power of the postrefractive surgery cornea to allow precise estimation of intraocular lens power in these eyes. Detecting the presence of past corneal refractive surgery in donor eyes also is likely to be a challenge. Despite the numerous advances in the field of corneal topography in the past year, there is still a need to present the data in a standardized format that is universal to all instruments and technologies.     

Corneal autografting: a systematic approach

OBJECTIVE: To describe a systematic approach to corneal autografting. PATIENTS AND METHODS: Retrospective review of case records of 3 patients who underwent this procedure. RESULTS: All patients achieved satisfactory visual recovery. Oversized grafts of 0.5 mm had less post-operative complications in the recipient eye. A phakic blind eye that received a 0.5 mm undersized graft had a temporary ocular hypertensive phase. CONCLUSIONS: Corneal autografting is a safe and effective technique in selected patients. The preferred surgical technique consists of surgery first on the blind eye, excision of a 0.5 mm oversized donor graft, cataract extraction if the eye is phakic, and use of an appropriate temporary keratoprosthesis to maintain donor eye integrity until autografting is completed in the eye with visual potential.