Asymptomatic Intracorneal Graphite Deposits following Graphite Pencil Injury

Reports of graphite pencil lead injuries to the eye are rare. Although graphite is considered to remain inert in the eye, it has been known to cause severe inflammation and damage to ocular structures. We report a case of a 12-year-old girl with intracorneal graphite foreign bodies following a graphite pencil injury

Missed diagnosis of a wooden intra-orbital foreign body

Intraorbital foreign bodies often present a confusing clinical picture. Wooden foreign bodies are notorious for remaining quiescent for a long time, before presenting with a variety of complications. The wound of entry may often be small and self-sealing. Wooden foreign bodies also show a propensity to break during attempted removal. Intraorbital wood is often not detected by standard diagnostic tests like the computed tomography scan, adding to the diagnostic dilemma. The presence of an intraorbital mass with a discharging sinus should evoke suspicion of a retained organic foreign body, regardless of the time interval between the trauma and current presentation. It is imperative to maintain a high index of suspicion in such cases to avoid misdiagnosis. We report an unusual case of a missed wooden intraorbital foreign body, which spontaneously extruded after five years

Role of hyperhomocysteinemia in proliferative diabetic retinopathy: A case–control study

Purpose: Hyperhomocysteinemia has been postulated as a potential risk factor for the development and progression of diabetic retinopathy. The aim of this study was to determine the association of hyperhomocysteinemia with proliferative diabetic retinopathy (PDR). Methods: This was a hospital-based, case–control study, conducted at a tertiary care ophthalmic center in South India. Thirty-nine patients with proliferative diabetic retinopathy were enrolled as cases, and 39 age- and gender-matched patients with no diabetic retinopathy (No DR) were enrolled as controls. Fasting serum homocysteine estimation, as well as baseline investigations, were done in all participants. Data regarding demographic profile and risk factors were documented. Data were analyzed using Chi-square test and independent t-test, as appropriate. Results: The prevalence of hyperhomocysteinemia was higher in PDR (59%) compared to “No DR” (48.7%); however, this difference was not statistically significant (P = 0.36). Similarly, the mean serum homocysteine level in cases was higher than in controls, but this was not statistically significant (17.98 + 6.26 μmol/L vs. 17.71 + 8.17 μmol/L; P = 0.87). Longer duration of diabetes, hypertension, anemia, and renal dysfunction were found to be significantly associated with PDR. Conclusion: The prevalence of hyperhomocysteinemia as well as the mean serum levels of homocysteine were found to be higher in the cases with PDR, compared to the controls with No DR, although the difference was not statistically significant. Longer duration of diabetes, hypertension, anemia, and renal dysfunction were significantly associated with PDR

A study on accuracy of sentinel lymph Node biopsy using methylene blue in clinically No. breast carcinoma

Background: Lymphatic mapping of breast has the potential of changing the standard of surgical care in carcinoma breast patients. The continued interest in less extensive surgery , the need for faster recovery and the increasing demand for early discharge have brought the value of axillary lymph node dissection (ALND) into close scrutiny and led to the emergence of less invasive procedures like sentinel lymph node biopsy as an accepted means of staging the axillary lymph nodes. Our study aims at bringing this method more accessible at affordable cost at suburban areas by using methylene blue dye in place of costlier dyes. Methods: We injected 3ml of methylene blue subareolarly in three places depending on the quadrant in which tumour is situated, before putting incision for Modified Radical Mastectomy and thorough massaging was done for 5-7 minutes in clockwise manner. After the procedure the pathologist segregated the stained lymph nodes and studied and reported them separately along with all the dissected axillary lymph nodes. Once the histopathology report was obtained, we studied the incidence of positive lymph nodes in stained nodes and also incidence of positive nodes in unstained nodes. Then we calculated sensitivity, specificity, false negativity, positive predictive value, negative predictive value and accuracy of sentinel lymph node biopsy with methylene blue staining. Results: Of the 40 patients, Sentinel Lymph node was identified in 34 patients (85%). Among the 6 unidentified patients 5 were T1 disease. i.e. <2cm and had lump in the inner quadrants. Average time for detection of sentinel lymph identification after injecting dye was 41.5 minutes (20-75 min). False Negative rate, defined as proportion actually positive among those test negative was 4.34% in this study. In 1 of the 23 patients the sentinel node was negative for metastasis but axilla was positive. Total number of cases with positive axillary nodes was 22, i.e. both SLN and rest of the axilla also being positive for metastases, and SLN was negative for metastases in 1 cases (false negative rate of 4.34%). Total number of cases with negative axillary nodes was 17 i.e. with no evidence of metastasis of which 5 were unstained. With above mentioned results, the overall Sensitivity, Specificity, Positive Predictive Valve (PPV) And Negative Predictive Valve (NPV) of SLNB in predicting axillary node status was 95.65%, 29.41%, 64.71% and 83.34% respectively. The overall accuracy was 67.50% .None of the 40 patients in this study had any kind of adverse reactions like anaphylaxis or eczema due to the Methylene blue dye. Conclusion: SLNB with methylene blue is effective in Indian set of patient population especially in resource scarce regions, thus reducing the cost of the procedure and avoiding all the morbidity associated with unnecessary axillary lymphadenectomy, that too at a lower cost

Missed diagnosis of a wooden intra-orbital foreign body

Intraorbital foreign bodies often present a confusing clinical picture. Wooden foreign bodies are notorious for remaining quiescent for a long time, before presenting with a variety of complications. The wound of entry may often be small and self-sealing. Wooden foreign bodies also show a propensity to break during attempted removal. Intraorbital wood is often not detected by standard diagnostic tests like the computed tomography scan, adding to the diagnostic dilemma. The presence of an intraorbital mass with a discharging sinus should evoke suspicion of a retained organic foreign body, regardless of the time interval between the trauma and current presentation. It is imperative to maintain a high index of suspicion in such cases to avoid misdiagnosis. We report an unusual case of a missed wooden intraorbital foreign body, which spontaneously extruded after five years

Unusual case of a graphite foreign body in the anterior chamber

Retained intraocular graphite foreign bodies are uncommon. Although they are generally inert, they have been reported to cause severe inflammatory reaction and progressive damage to intraocular structures. We report a case of a six-year-old girl with a retained intraocular graphite pencil lead foreign body in the anterior chamber of the eye and discuss the various considerations in the management of such cases

Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India

Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study. Results: Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2-13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of  protective eyewear should be considered