Clinical experience in treatment of diffuse unilateral subretinal neuroretinitis

Nidhi Relhan,1,2 Avinash Pathengay,2,3 Vishal Raval,2 Sameera Nayak,2 Himadri Choudhury,3 Harry W Flynn Jr11Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Kode Venkatadri Chowdry Campus, Vijayawada, Andhra Pradesh, India; 3Retina and Uveitis Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh, India Purpose: To describe the clinical features, management, and outcomes of patients with diffuse unilateral subacute neuroretinitis (DUSN). Methods: A noncomparative, consecutive analysis of case series from two tertiary care campuses of LV Prasad Eye Institute, India, between January 2011 and April 2014 was performed. Medical records of the patients presenting with DUSN (early or late stage) were reviewed. Results: The current study included 13 patients. The majority (10/13, 76.92%) of the patients were aged 20 years or less. All patients had unilateral eye involvement. Visual acuity at presentation was 20/200 or worse in 9/13 (69.23%) patients. A delay in diagnosis occurred in 6/13 patients, and initial diagnosis in these patients included retinitis pigmentosa (4 patients) and posterior uveitis (2 patients). Clinical features included early presentation (prominent vitritis, localized retinitis, and vasculitis) in 7/13 (53.85%) patients and late presentation (attenuation of vessels, retinal pigment epithelium atrophic changes, and optic atrophy) in 6/13 (46.15%) patients. Worm could not be identified in any of the cases. All the patients received laser photocoagulation of retina and oral albendazole treatment for a period of 30 days. With treatment, visual acuity improved in seven patients (six early stage, one late stage) and remained unchanged in six patients. Mean follow-up period was 8.69 months (range, 1–21 months). The mean central foveal thickness in the affected eye, done by optical coherence tomography, during the late stage of the disease was 188.20±40 µm (range, 111–242 µm), which was significantly thinner than the fellow eye, 238.70±36.90 µm (range, 186–319 µm), P=0.008. Conclusion: DUSN is a serious vision threatening disease, which may progress to profound vision loss in the later stage of the disease. Visualization of subretinal worm is usually not possible. Treatment with high-dose albendazole therapy and laser photocoagulation may alter the blood–retinal barrier and may be useful in achieving visual recovery. Keywords: diffuse unilateral subacute neuroretinitis, retinitis pigmentosa, OCT, albendazole therapy, central macular thicknes

Broad-band ultraviolet B phototherapy is associated with elevated serum thiobarbituric acid reactive substance and nitrite-nitrate levels in psoriatic patients

WOS: 000241502800009PubMed ID: 17062036Background Although the local anti-inflammatory, immunosuppressive and oxidative activity of UVB is known, the systemic effect of UVB phototherapy in dermatological patients has not been investigated. Objective We aimed to investigate the lipid peroxidation status (as represented by thiobarbituric acid reactive substance, TBARS) and nitrite-nitrate levels in psoriatic patients under broad-band ultraviolet B (BB-UVB) phototherapy in order to determine the systemic effects of UVB. Subjects and methods Thirty-two psoriatic patients and 20 healthy controls were included. Blood samples were obtained at the beginning, after 6-10 exposures to BB UVB phototherapy (mean 5 weeks) and at the end of the therapy period (mean 21 weeks). Serum TBARS and nitrite-nitrate levels were evaluated. Results There was no statistically significant difference in serum TBARS and nitrite-nitrate levels between psoriatic patients (basal) and healthy volunteers. There was no statistically significant correlation between disease duration, disease severity, or the total cumulative dose of UVB and serum levels of TBARS and nitrite-nitrate in psoriatic patients. Total nitrite levels in samples obtained during and at the end of therapy were significantly higher than basal levels (P = 0.033 and P = 0.005, respectively). TBARS levels in samples obtained during and at the end of therapy were significantly higher than basal levels (P = 0 and P = 0.026, respectively). There was a negative correlation (r = -0.576, P = 0.039) between the total nitrite and TBARS levels in psoriatic patients at the end of therapy. Conclusion Our study showed that chronic exposure to UV irradiation may lead to a systemic effect on lipid peroxidation and NO levels, which are shown by a significant elevation in TBARS and nitrite-nitrate levels in serum

Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin B and voriconazole

Kopal Mithal,1 Avinash Pathengay,1 Abhishek Bawdekar,1 Animesh Jindal,1 Divya Vira,2 Nidhi Relhan,3 Himadri Choudhury,1 Namrata Gupta,1 Varun Gupta,1 Nagendra K Koday,4 Harry W Flynn Jr3 1Retina and Uveitis Services, 2Cornea Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India; 3Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 4Ocular Microbiology Service, LV Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India Purpose: To report outcomes of exogenous fungal endophthalmitis treated with combination of intravitreal antifungal agents. Design: Retrospective, non-randomized, interventional, consecutive case series. Methods: Twelve eyes of twelve consecutive cases of filamentous fungal endophthalmitis were treated with a combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy at a single center. Clinical characteristics, microbiology results, treatment strategy, visual, and anatomical outcomes were analyzed. Results: Ten cases out of the twelve were postoperative endophthalmitis of which nine were part of a post cataract surgery cluster. The remaining included endophthalmitis following keratitis post pterygium excision (1) and following open globe injury (2). The most common fungus was Aspergillus terreus, which was isolated in 8/12, followed by A. flavus in 2/12 and Fusarium solani in 1/12. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow-up was 20/400 or better in 7/12 eyes (58.33%) and 20/60 in 2/12 eyes (range 20/60 to LP). All eyes with corneal involvement had final visual acuity 20/400 or worse. Globe salvage was achieved in all cases. Conclusion: Combining intravitreal amphotericin-B and voriconazole could be a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with corneal involvement had poor visual outcome either with or without therapeutic penetrating keratoplasty. Keywords: fungal, endophthalmitis, Aspergillus, intravitreal, voriconazole, amphotericin

Role of Oxidative Stress in Various Stages of Psoriasis

Psoriasis is a chronic inflammatory, proliferative skin disease characterized by pathological skin lesions due to various exogenous and endogenous factors. It is associated with a number of biochemical and immunological disturbances. Recently, it has been suggested that increased reactive oxygen species (ROS) production and compromised function of antioxidant system may be involved in the pathogenesis of this disease. In the present study, 90 psoriasis patients were selected. Disease severity was assessed by psoriasis area severity index score and grouped as mild, moderate and severe (each group consists of 30 subjects) and compared with 30 healthy controls. Serum levels of malondialdehyde, nitric oxide end products and the activities of antioxidant enzymes such as erythrocyte-superoxide dismutase, catalase and total antioxidant status were investigated in these groups/subjects. As compared to controls, we found severitywise significantly increased serum malondialdehyde, nitric oxide end products with decrease in erythrocyte-superoxide dismutase activity, catalase activity and total antioxidant status in patients with psoriasis suggesting worsening of the disease. It seems to be linked with the enhancement of Reactive Oxygen Species production and decreased antioxidant potential in psoriasis