Postoperative fungal endophthalmitis due to Basidiobolus ranarum: Report of a rare case

Postoperative fungal endophthalmitis is a significant cause of visual loss due to the rapid progress and severe inflammation. Management is dictated by the precise identification of fungus subspecies, choice of antifungal agent, and associated systemic features. We report a rare case caused by Basidiobolusranarum, never known to have caused endophthalmitis or any form of ocular infection or inflammation. A 59-year-old, Asian, immunocompetent, agriculturist presented with endophthalmitis on the 3 rd postoperative day. Smear and culture from the aqueous and vitreous samples detected a species of fungus called Basidiobolusranarum. Fungal endophthalmitis should be suspected even in patients who present in the early postoperative period and rare species considered even in immunocompetent individuals. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections

The relationship between blood sugar levels (glycosylated haemoglobin) and the risk of development of diabetic retinopathy

Introduction: Diabetic retinopathy is a major cause of visual impairment and blindness in India and with its early detection and timely treatment, the risk of visual loss can be reduced significantly. Onset and progression of retinopathy is determined by fasting and postprandial blood sugar levels and other risk factors such as duration of diabetes, hypertension, nephropathy, hypercholesterolemia and obesity. This study was done to evaluate the role of glycosylated hemoglobin and its association with the severity of retinopathy. Materials and Methods: A total of 100 patients were included. This was a prospective study conducted over 1 year in Sri Ramachandra University, Chennai, India. Fundus examination was done using slit lamp biomicroscopy and indirect ophthalmoscopy on all patients. Ancillary investigations such as fundus fluorescein angiography and optical coherence tomography were performed. HbA1c was measured along with fasting, postprandial, lipid profile and urine sugars. Results: High and uncontrolled levels of HbA1c were associated with maculopathy. A statistically significant difference (p < 0.01) was found in them. The retinopathy however was not related to HbA1C alone. The most frequent type of maculopathy noted was cystoid macular oedema and the level above which it occurred was 7% of HbA1C. Besides HbA1C, the other important factor that was associated with maculopathy was duration of diabetes mellitus. Conclusion: HbA1c value >7.0% was significantly related with maculopathy. The severity of retinopathy is dependent on the level of blood sugar and duration of diabetes. Control of sugar levels is crucial to prevent diabetic retinopathy and its complications which can lead to irreversible complications in the eye

An analysis of ocular features and vision loss at presentation and after treatment in systemic lupus erythematosus in 60 patients

Introduction: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, multisystem autoimmune disease and ocular involvement occurs in several forms. It may be the first indicator of underlying SLE. Early identification and precise treatment of the disease can reduce blindness. The objective of this study was to analyze the causes of visual loss before and during treatment. Methods: This is a retrospective cohort study on 60 patients over 2 years in multispecialty, tertiary eye care hospital. Ophthalmic examination and routine and ancillary investigations were performed. Patients were followed up for at least one year to assess the progress of ocular features, their response to treatment and development of complications. Case records from a referral practice in patients with systemic lupus erythematosus, with diagnosis of dry eye, peripheral ulcerative keratitis, episcleritis, scleritis, uveitis, retinitis or optic neuropathy were analyzed. Results: In our study, the incidence of episcleritis was most frequent followed by dry eye, retinopathy and keratitis. Age group affected was 34 to 52 years and more in women. Scleritis was associated with decreased vision and maximum complications. Following treatment, cataract was the commonest cause of blindness. Conclusion: Our study showed the presence of simultaneous, multiple ocular complications which make treatment and follow up very crucial to avoid blindness. Ocular signs that occurs in SLE can be vision threatening and requires immediate assessment and management by an ophthalmologist. Drugs used to treat SLE may also cause blindness and coordinated treatment between rheumatologist, physician and ophthalmologist needs to be adopted

Clinical features, visual outcome and association with systemic disease in patients with episleritis and scleritis. A study of 50 eyes

Introduction: Episcleritis and scleritis are inflammatory disorders which can have an acute presentation and are frequently encountered by primary care practitioners.Episcleritis is a benign, self-limited disease that resolves within 2 to 3 weeks. Scleritis is painful, causing visual loss due to uveitis, glaucoma, cataract, and retinal detachment. Both are associated with underlying systemic diseases.We aim to report clinical features, visual outcome and association with systemic disease in patients with visual symptoms. Methods: This is a prospective cohort study conducted on 50 patients over 1 year in a tertiary eye care hospital Complete ophthalmic evaluation was performed. Patients were followed up for one year to look for response to treatment and development of complications. Results: In our study, the incidence of episcleritis was more frequent than scleritis. The age group affected was 34 to 52 years and more in women. Most of our patients with episcleritis showed resolution within 3 weeks. Scleritis was associated with decreased vision and more complications. In both forms of inflammation rheumatoid arthritis, systemic lupus erythematosus and psoriasis were the most common etiology. Conclusion: In rheumatoid arthritis, systemic lupus erythematosus and psoriasis patients, episcleritis and scleritis can be the initial clinical presentation. Clinical features are more severe in scleritis and can be diagnosedwith B scan ultrasound. Visual loss in both can be prevented by early treatment. We found the association with rheumatoid arthritis and SLEto be high in our population. Infections were not as common as autoimmune diseases in the population studied