Retinal break adjacent to the optic disc causing retinal detachment in a pathological myopia

Retinal detachment is one of the common complications of pathological myopia due to presence of retinal break. However, retinal break commonly occurs in the peripheral retina. This case report illustrates the rare incidence of retinal break adjacent to the optic disc, highlights the possible causes of poor visual outcome following surgical repair as well as the possible measures to treat the complications

Recurrent orbital cellulitis secondary to the ‘forgotten’ scleral buckle: a case report

Scleral buckle placement is a well-established technique for the treatment of primary rhegmatogenous retinal detachment. Complications associated with scleral buckle are uncommon and its presentations can be vary. We report a case of recurrent orbital cellulitis with anterior segment ischemia following a forgotten episode of previous scleral buckling surgery, presenting with blurring of vision, redness and swelling of the lids. The presence of scleral buckle was detected by detailed examination and confirmed by orbital imaging. Orbital infection and rubeosis iridis were successfully treated with scleral buckle removal, intravenous antibiotics and intracameral ranibizumab. However, the retinal detachment recurred and the visual acuity deteriorated to light perception. There was no further intervention as the family declined in view of her old age. In cases of recurrent orbital infection, detailed clinical examination is important to look for evidence of ocular prostheses as a source of infection. Orbital imaging is an adjunct for making the diagnosis especially in cases where history is unreliable. Anterior segment ischemia due to scleral buckle responds well to buckle removal with ranibizumab injection

Exudative retinal detachment and macular hole as a rare sequelae of central vein occlusion

Central retinal vein occlusion (CRVO) is uncommon among young patients. Among the young adults, CRVO tends to be more benign with good visual prognosis. Macular oedema secondary to retinal vein occlusion is a relatively common complication that is currently being treated with intravitreal anti vascular endothelial growth factor with good outcomes. Other complications include lamellar hole,vitreous hemorrhage and neovascular glaucoma. We report a case of central retinal vein occlusion in a young female who presented to us with the complaint of blurring of vision in the left eye for four months. Fundus examination showed hyperemic optic disc, dilated tortuous vein, extensive retinal hemorrhages with macular oedema and an inferior shallow exudative retinal detachment. One month later, intravitreal ranibizumab injection for her macular oedema, a full thickness macular hole developed with reduction of macular oedema. Four months later, the hole spontaneously closed but her macular oedema persisted. The possibility of rare complications like exudative retinal detachment and full thickness macular hole must be kept in mind to ensure early detection and effective management is provided to preserve vision

‘Boating’ out migrated dexamethasone implant; surgical management of removal of anterior chamber migrated dexamethasone intravitreal implant : a case report

It is rare for anterior chamber migration of an Ozurdex® implant from vitreous cavity, but it is seen more frequently in aphakic eyes or in pseudophakic cases with zonular dehiscense. We describe a case of a middle-aged gentleman who had persistent diabetic macular oedema not responding to anti-VEGF (vascular endothelium growth factor), who was treated with intravitreal Ozurdex® in his post vitrectomized eye and developed anterior migration of the implant to the anterior chamber. Anterior dislocation of an intravitreal implant of dexamethasone can be managed by repositioning it to the vitreous cavity or removing it through a corneal limbal incision. Ozurdex® is a friable implant, especially after a few weeks of implantation. Therefore, removal of the implant by grasping or aspiration may lead to its fracture or dispersion of the implant material. This is a report of a simple,fast and effective technique to remove a migrated Ozurdex® from the anterior chamber using a modified silicone tip

Comparison of non-mydriatic fundus photography and optical coherence tomography with dilated fundus examination for detecting diabetic retinopathy including diabetic macular edema

Given increasing diabetes rates worldwide, better screening tools for diabetic retinopathy (DR) and macular edema (DME) are needed. The study aim was to compare reliability and predictive values between non-mydriatic fundus photography (NMFP) and spectral-domain optical coherence tomography (OCT) for detection of DR and DME with dilated fundus examination (DFE). This was a non-interventional, comparative study. Diabetics underwent both NMFP and macula OCT, followed by DFE. Images were interpreted by two masked ophthalmologists. The DFE result was considered gold standard. One hundred and fifty-four eyes of 83 patients were recruited. Sensitivity of NMFP for DR was 77.3% and 80.3% for OCT. Specificity for NMFP was 81.8% and 55.7% for OCT. Area under Receiver Operating Characteristics Curve (AROC) for DR was 0.80 for NMFP and 0.68 for OCT. The sensitivity of NMFP for DME was 63.2% and 82.5% for OCT. Specificity for DME was 90.1% by NMFP and 61.5% for OCT. Positive predictive value (PPV) of NMFP and OCT for DR was 76.1% (95% CI: 63.9-85.3%) and 57.6% (46.8-67.7%), respectively. Negative predictive value (NPV) of NMFP and OCT was 82.7% (95% CI: 72.8-89.7%) and 79.0% (66.4-87.9%) respectively. Positive predictive value of NMFP and OCT for DME was 80.0% (95% CI: 67.6- 88.5%) and 57.3% (45.9-68.0%), respectively. Negative predictive value of NMFP and OCT was 79.6% (95% CI:70.3 - 86.7%) and 84.8% (95% CI:73.4 - 92.1%), respectively. Eyes with normal OCT miss 21% of DR. In conclusion, NMFP is better than OCT for DR screening, while OCT is better than NMFP and DFE for detection of DME. Both modalities should be for better DR screening

Patterns of mortality after prolonged follow-up of a randomised controlled trial using granulocyte colony-stimulating factor to maintain chemotherapy dose intensity in non-Hodgkin's lymphoma

The effect of utilising granulocyte colony-stimulating factor (G-CSF) to maintain chemotherapy dose intensity in non-Hodgkin's lymphoma (NHL) on long-term mortality patterns has not been formally evaluated. We analysed prolonged follow-up data from the first randomised controlled trial investigating this approach. Data on 10-year overall survival (OS), progression-free survival (PFS), freedom from progression (FFP) and incidence of second malignancies were collected for 80 patients with aggressive subtypes of NHL, who had been randomised to receive either VAPEC-B chemotherapy or VAPEC-B+G-CSF. Median follow-up was 15.7 years for surviving patients. No significant differences were found in PFS or OS. However, 10-year FFP was better in the G-CSF arm (68 vs 47%, P=0.037). Eleven deaths from causes unrelated to NHL or its treatment occurred in the G-CSF arm compared to five in controls. More deaths occurred from second malignancies (4 vs 2) and cardiovascular causes (5 vs 0) in the G-CSF arm. Although this pharmacovigilance study has insufficient statistical power to draw conclusions and is limited by the lack of data on smoking history and other cardiovascular risk factors, these unique long-term outcome data generate hypotheses that warrant further investigation

PlasmoDraft: a database of Plasmodium falciparum gene function predictions based on postgenomic data

<p>Abstract</p> <p>Background</p> <p>Of the 5 484 predicted proteins of <it>Plasmodium falciparum</it>, the main causative agent of malaria, about 60% do not have sufficient sequence similarity with proteins in other organisms to warrant provision of functional assignments. Non-homology methods are thus needed to obtain functional clues for these uncharacterized genes.</p> <p>Results</p> <p>We present PlasmoDraft <url>http://atgc.lirmm.fr/PlasmoDraft/</url>, a database of Gene Ontology (GO) annotation predictions for <it>P. falciparum </it>genes based on postgenomic data. Predictions of PlasmoDraft are achieved with a <it>Guilt By Association </it>method named Gonna. This involves (1) a predictor that proposes GO annotations for a gene based on the similarity of its profile (measured with transcriptome, proteome or interactome data) with genes already annotated by GeneDB; (2) a procedure that estimates the confidence of the predictions achieved with each data source; (3) a procedure that combines all data sources to provide a global summary and confidence estimate of the predictions. Gonna has been applied to all <it>P. falciparum </it>genes using most publicly available transcriptome, proteome and interactome data sources. Gonna provides predictions for numerous genes without any annotations. For example, 2 434 genes without any annotations in the Biological Process ontology are associated with specific GO terms (<it>e.g</it>. Rosetting, Antigenic variation), and among these, 841 have confidence values above 50%. In the Cellular Component and Molecular Function ontologies, 1 905 and 1 540 uncharacterized genes are associated with specific GO terms, respectively (740 and 329 with confidence value above 50%).</p> <p>Conclusion</p> <p>All predictions along with their confidence values have been compiled in PlasmoDraft, which thus provides an extensive database of GO annotation predictions that can be achieved with these data sources. The database can be accessed in different ways. A global view allows for a quick inspection of the GO terms that are predicted with high confidence, depending on the various data sources. A gene view and a GO term view allow for the search of potential GO terms attached to a given gene, and genes that potentially belong to a given GO term.</p

An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital

Pneumocystis jirovecii pneumonia (PCP) is associated with high mortality in immunocompromised patients without human immunodeficiency virus infection. However, chemoprophylaxis is highly effective. In patients with solid tumours or haematologic malignancy, several risk factors for developing PCP have been identified, predominantly corticosteroid therapy. The aims of this study were to identify the potentially preventable cases of PCP in patients receiving corticosteroid therapy at a tertiary care cancer centre and to estimate the frequency of utilisation of chemoprophylaxis in these patients. Two retrospective reviews were performed. Over a 10-year period, 14 cases of PCP were identified: no cases were attributable to failed chemoprophylaxis, drug allergy or intolerance. During a 6-month period, 73 patients received high-dose corticosteroid therapy (⩾25 mg prednisolone or ⩾4 mg dexamethasone daily) for ⩾4 weeks. Of these, 22 (30%) had haematologic malignancy, and 51 (70%) had solid tumours. Fewer patients with solid tumours received prophylaxis compared to patients with haematologic malignancy (3.9 vs 63.6%, P<0.0001). Guidelines for PCP chemoprophylaxis in patients with haematologic malignancy or solid tumours who receive corticosteroid therapy are proposed. Successful primary prevention of PCP in this population will require a multifaceted approach targeting the suboptimal prescribing patterns for chemoprophylaxis