Surgical outcome of single site phacotrabeculectomy in management of concurrent glaucoma and cataract

Background:The aim of our study is to evaluate the efficacy and safety of combined procedure of single site phacoemulsification and trabeculectomy in terms of improvement of visual acuity and intraocular pressure control.Methods: Prospective, noncomparative, consecutive, interventional study of 74 eyes (64 patients) of single site phacotrabeculectomy in cases of primary open angle glaucoma with significant operable cataract from April 2014 to March 2015. Out of 64 patients 30 were male and 34 were female with age ranged 48 to 80 (mean 64.5) years. Ten patient required bilateral surgery. The controlled mean preoperative IOP was 20 mmHg ranged (12- 36 mmHg).Postoperative best corrected visual acuity, intraocular pressure and fundus examination were  done one day, one week, one month, three months and one year following surgery. Perimetery was done at third and twelve months.Results: Mean postoperative intraocular pressure after 12 months of follow up was 12 mmHg (range 08 to 20 mmHg) and overall improvement in visual acuity achieved in 90.54% (67) of eyes. Visual acuity of 6/12 and better was achieved in 62.16% (46) eyes. IOP was controlled without any treatment in 83.78% (62) eyes, and rest 16.22% (12) eyes needed antiglaucoma drugs to control IOP. Hyphema and uveitis were common complications noted.Conclusions: Combined phacotrabeculectomy is safe and effective method in restoring vision and lowering intraocular pressure. It helps in early visual rehabilitation and convenient, economical method to manage concurrent glaucoma and cataract.

Prevalence, Antibiotic Susceptibility Testing, Beta-Lactamase Production and mcr-1 Gene Detection in Uropathogenic Klebsiella Pneumoniae Isolated from A Tertiary Care Hospital in Bhopal: A Prospective Study

Introduction: Klebsiella pneumoniae (K pneumoniae) is an inhabitant of the nasopharynx and gastrointestinal tract and it is capable of causing a variety of infections, including urinary tract infection (UTI), pneumonia, liver abscess and septicemia. UTI in humans can be hospital and community-acquired. UTI should initially be treated with Co-trimoxazole, Nitrofurantoin, 1st generation cephalosporins, and Ciprofloxacin. Still, in India, frequent usage of broad-spectrum antibiotics such as cephalosporins, carbapenems and colistin for getting immediate response has led to resistance to these drugs. K pneumoniae possess several different mechanisms of drug resistance for survival. ESBL, MBL and AmpC beta-lactamase production is one of the dominant mechanisms to inactivate the beta-lactam antibiotics. UTI caused by MDR K pneumoniae is often treated with carbapenems and colistin. Inappropriate doses and frequent usage of these antibiotics make bacteria resistant therefore it is important to know about the susceptibility of antibiotics against K pneumoniae before giving broad-spectrum antibiotics in the local community for the better management of UTI. Methods: The present study is a prospective study. All clean-catch, mid-stream urine samples were collected in the sample collection centre from the patients suspecting UTI. Semi-quantitative culture method (SQCM) was used to isolate K pneumoniae. SQCM is a routinely used culture method as a diagnostic criterion for patients having a UTI. SQCM indicates the bacterial count present in the urine sample. Firstly, K pneumoniae was isolated and identified followed by Antimicrobial-susceptibility testing (AST). After the AST, double disc synergy test checked the production of ESBL, MBL and AmpC beta-lactamase. Lastly, colistin resistance in K pneumoniae was determined by the E-strip method and K pneumoniae strains positive by E-strip method were further screened for mcr-1 gene by PCR. Results: A total of 11740 urine samples were received and processed. 2465 (21%) samples showed significant growth of uropathogens. Out of all pathogens, 332 (13%) were identified as K pneumoniae.  Other 2133 (87%) pathogens were identified as Enterobacteriaceae members, Pseudomonas aeruginosa, Burkholderia, Acinetobacter baumannii, Enterococcus, and Staphylococcus. Of all the antibiotics we tested in our study, colistin (87%), carbapenems (78-79%) were the most and penicillin (00-43%) group was the least sensitive. ESBL, AmpC and MBL were 203 (61%), 126 (38%) and 83 (25%) respectively in K pneumonia. Colistin resistance was shown by 43 (13%) K pneumonia strains and out of these 43, only 08 (19%) strains were positive for mcr-1 gene

Clinical presentation and management of anterior capsular contraction

Purpose: Aim of this study is to analyze clinical presentation and predisposing risk factors of anterior capsular contraction following phacoemulsification and to assess challenges encountered in management. Methods: This is retrospective study of anterior capsular contractions of capsulorhexis following phacoemulsification. All patients were analyzed for clinical presentation by detail history and slit lamp examination. YAG laser capsulotomy or surgical excision of phimosis was done and various challenges encountered in management were detailed. Results: Total 20 patients (23 eyes), age between 26 years 72 years,, with 13 male and female 7 were analyzed retrospectively. The predisposing risk factors noted were Uveitis (7 patients), myopia (3 patients), pseudo exfoliation (2 patients), diabetes (3 patients), trauma (1 patient), both diabetes and uveitis (1patient), Status post phacovitrectomy (1 patient) and no accompaniments in (2 patients). We managed 18 patients (21 eyes) by observation in (3 eyes), YAG laser in (7 eyes), simple surgical excisions in (8 eyes), excision with vitrector (1 eye), aspiration of milky fluid behind IOL from bag (1 eye) and phimosed dislocated bag removal from anterior chamber and intraocular lens (IOL) exchange with (SF) scleral fixated IOL (1eye). Conclusions: Anterior capsular contraction is more common with patients with various risk factors and has varied clinical presentations. Simple procedures like YAG and surgical excision will help patients to restore vision