Abstracts 2012 - KOSC

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Inflammation / Uvea
Chairman Co-Chairman Convenor Moderator : : : : Dr. Sunitha B. L. Dr. Sujatha Rathod Dr. Vasudhendra Dr. Narendra Datti Time 2:30 PM 3:25 PM HALL B

DATE 3 Nov 2012

1(57) Persistent postoperative inflammation- an analysis. Chief Author: Dr.Namita Anagol, Presenting Author: Dr.Deepthi Bhat, Dr.SriGanesh Dr.Sathish Prabhu Dr.Vivek Kedia Dr.Kalpesh Jain Aim: To evaluate the etiology of prolonged post operative uveitis and the occurrence of the HLA B 27 haplotype in patients with persistent post operative uveitis. Methods: A retrospective analysis of 31 eyes of 23 patients with prolonged post operative inflammati on following uneventful topical clear corneal phacoemulsification was done from October 2010 to December 2011. A detailed history and relevant investigations were done. Results: 9 out of 23 patients were HLA B 27 positive, of which 2 patients showed signs of sacroilitis on X ray. 5 of the HLA B27 positive patients (55.5%) underwent immunosuppressive therapy. TB Gold was positive in 3 patients and they were started on AKT4 as per the advice of the pulmonologist. Most of the patients needed a prolonged course of steroids topically. Conclusions: The post operative inflammation was related to HLA B27 in (39.1%) patients. The most important observation in this study was the occurrence of HLA B 27 uveitis in the 6th decade for the first time.Though not routinely advised, HLA B 27 tests should be included in our investigations for prolonged postoperative uveitis. 2(64) Clinical Features, Investigations, Management and Outcome Of Uveitis In Neonates and Infants In South Indian Chief Author: Dr. Padmamalini Mahendra Das, Presenting Author: Dr. Naren Shetty, Dr.Pandu Aim: To study the etiology, clinical features, management and outcome of uveitis in neonates and infants Methods: Retrospective interventional cases series of 30 eyes of 15 children with uveitis in infantile age group studied from January 2008 to June 2012. All these children underwent detailed eye evaluation with hand held slit lamp, Retcam imaging, laboratory investigations in all cases with fluorescein angiography, opti cal coherence tomography in selected cases. Results: There were 10 males with age group ranging from 15 days to 4 months. 10 patients had bilateral disease. Anatomical diagnosis 13 cases had posterior uveitis and two cases had panuveitis. Etiological diagnosis included 6 toxoplasmosis, 1 rubella, 1 tuberculosis, 2 fungal infections, 1 mixed
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rubella and CMV infection, 3 bacterial endophthalmitis and one case of varicella infection. All the cases were of infective etiology. Patients were managed with topical, intravitreal and systemic antimicrobial agents with topical and systemic steroids in selected patients. At final visit, there was complete resolution of inflammation in 10 cases. Conclusions: Posterior uveitis with infective etiology was the commonest presentation in our study. Early recognition and aggressive therapy help to preserve the vision in neonates and infants. 3(113) Prevalence of ocular manifestations in patients hospitalized with dengue fever Chief Author: Dr Narendra P. Datti, Presenting Author:Dr Mithila R, Dr B.N Raghavendra Prasad, Dr Beregowda, Dr Trupti Gowda Aim: To study the prevalence of ocular manifestations in seropositive dengue patients Methods: Cross sectional observational study in which consecutive patients hospitalized with dengue fever during a dengue epidemic were enrolled over a 4- week period between June-Jzuly 2012 at R.L.J hospital kolar. Patients with positive IgM were enrolled and underwent ocular examination which included visual acuity and dilated fundoscopy Results: A total of 71 patients were examined in which 40 were males and 31 females. Age of patients ranged from 3 to 60 years (mean-24 years). 142 eyes were examined. 40 eyes (28.5%) of 21 patients had ocular manifestations. 19 eyes (47.5%) had posterior segment findings like ,cotton wool spots, dot and blot hemorrhages, hyperemic disc and optic neuritis. 21 eyes (52.5%) had anterior segment in form of petechial and subconjunctival hemorrhages. 17 patients with platelet count of Conclusions: Ocular manifestations are commonly seen in patients with Dengue. Hence, its advisable to subject these patients for a detailed ocular examination to avoid any residual impairment of vision. 4(188) Features, Diagnosis, Management and outcome of Ocular Inflammatory CNVM Chief Author: Dr. Padmamalini Mahendran, Presenting Author: Dr Vandhana Suren, Dr Kavitha Avadhani Dr K Bhujang Shetty Aim: To study the clinical features, diagnosis, management and outcome of ocular inflammatory choroidal neovascularisation (CNVM) Methods: It is a retrospective interventional case series of ocular inflammatory CNVM. 9 patients (10 eyes) who received single or multiple intravitreal anti-VEGF injections (either bevacizumab or ranibizumab) were analysed. Patients age, sex, site of inflammation, inflammatory activity, etiology, presenting visual acuity, FFA and OCT were analysed. Results:Posterior uveitis with CNVM was secondary to tuberculosis in 60% cases and toxoplasmosis in 20% and the remaining 20% of cases were idiopathic. 70% of them were treated with intravitreal bevacizumab, 10% with intravitreal ranibizumab and 30% received both. With an average of 2 injections of anti VEGF, 1 eye showed improvement in Snellens visual acuity by 3 lines, 4 eyes by 2
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lines and 3 eyes by 1 line. OCT showed an average decrease in the sub foveal thickness from 251 microns to 165 microns. Conclusions: Intravitreal anti VEGFs cause regression in ocular neovascularisation in various ocular inflammatory diseases leading to significant visual improvement. In our case series, tuberculous uveitis was found to be the most common cause of inflammatory CNVM. 5(189) Endophthalmitis following intravitreal avastin for various indications Chief Author & Presenting Author: Dr K.S.KUMAR, Aim: To report the occurrence of endophthalmitis post intravitreal avastin injections Methods: This was an analysis of all cases undergoing intravitreal avastin injection in the OT ( 0.05mg/0.1ml , Roche) for various indications viz. CNVM, vein occlusions, diabetic macular oedema etc . All patients who underwent injections from Jan 2010 to mar 2012 were evaluated. Out of a total of 403, 2 patients developed post injection re action suspected to be endophthalmitis . Both were treated with intravitreal antibiotics but one needed vitrectomy. Results: One patients who responded to intravitreal antibiotics had persistent vitreous debris but declined further treatment. Another patient needed vitrectomy & later developed RD that needed revit + silicone injection. Conclusions: Endophthalmitis post avastin injection is a serious potential risk inherent in the procedure. In view of direct inoculation of organisms into the vitreous cavity, visual consequences can be devastating. Though a simple procedure all aseptic precautions must be taken. Possible risk factors & steps to minimize risks will be highlighted in this paper. 6(217) A CASE SERIES OF NEURORETINITIS Chief Author:Dr. Ganesh Sathyamurthy, Presenting Author:Dr. Amey Uttam Tamhane, Dr. M. S. Usha, Dr. Brinda Prasad, Dr. Jagannath Shetty, Dr. J. Deepthi, Dr. Gayathri B., Dr.Satish P. K., Dr. Richa Aim: To evaluate the efficacy of posterior subtenon triamcinolone injection in treatment of neuroretinitis. Methods: Five patients of neuroretinitis who have attended Mysore Race Club Eye Hospital, Mysore Out patient department over a period of 1 year, were evaluated clinically & with blood investigations including TLC, DLC, ESR, CRP, VDRL, HIV 1 & 2 , ANA, cANCA, pANCA, Sr. ACE levels and chest X ray, mantoux test. All patients received posterior subtenon triamcinolone after reviewing the report of blood test & they were followed up for a minimum period of 6 months. Results: The blood investigations of all these patients turned out to be normal. There was a significant improvement in Visual Acuity in 4 out of 5 patients. One patient lost for follow up. Conclusions: Single injection of Posterior subtenon triamcinolone acetonide is effective in treating probable post viral URTI related neuroretinitis.
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7(242) Ocular sarcoidosis and its systemic associations Chief Author: Dr.Kavitha Avadhani, Presenting Author : Dr.Neethu Vishwanath Lokapur, Dr.Padmamalini Mahendradas, And Dr. Bhujang K Shetty Aim: To report the systemic associations of ocular sarcoidosis presenting to a tertiary referral center in south India Methods: Retrospective interventional case series.Records of 42 patients with diagnosis of definite, presumed or probable ocular sarcoidosis seen over a period of 2 years was retrieved. A complete ophthalmic evaluation and systemic examination by a physician with appropriate laboratory investigations were done in all patients. Results: Of the 42 cases included, female patients were slightly more than male.Presumed, probable and definite sarcoidosis was seen in 46,38 and 16% of the patients.Five of the patients with definite sarcoidosis had non pulmonary sarcoidosis (i.e ocular signs with no lung involvement); 3 patients had mucosal/dermatological sarcoid while there was one each of hepatic and renal sarcoidosis. Conclusions: Sarcoidosis is more commonly seen in India than previously reported in literature. Ocular manifestations may often be the heralding sign of sarcoidosis. Hence a thorough systemic evaluation is mandatory in all patients of ocular sarcoidosis to recognize involvement of other organ syst ems such as lung, liver etc. 8(274) The clinical features and treatment outcome of patients with infectious scleritis in a tertiary care Chief Author :Dr Padmamalini Mahendradas, Presenting Author :PARVATHI T HARI, Dr Kavitha Avadhani, Dr Thungappa K.S, Dr K Bhujang Shetty Aim: To describe the clinical profile of patients with infectious scleritis. Methods: We reviewed the clinical findings, microbiology findings, therapeutic interventions, and visual outcomes of 14 patients with infective scleritis Results: In the series we reviewed 16 eyes of 14 patients who were diagnosed with infective scleritis. Two cases were bilateral, with 5 males and 9 female patients. There were 6(42%) cases of tuberculous scleritis,2(14%)cases with leprosy, 4 (28%)cases with bacterial scleritis which included 1 case of pseudomonas and 3 cases positive for the eubacterium genome on PCR, 1 (7%)case of herpes zoster, 1(7%) case of fungal infection. Two of the patients had Wegeners granulomatoses with superadded infection and 2 had history of trauma. All patients received intensive systemic medical and topical therapy based on the etiology and 5(35%) patients required surgical management, incision and drainage(3) and scleral patch graft(2). Seven cases (50%) out of the 14 resolved completely without any structural changes.Five (35%) of them resolved with scleral thinning and 2 patients had stable scleral patch grafts. In all cases there was an improvement in the visual acuity with treatment Conclusions: Infective scleritis is a rare entity but an early clinical suspicion of infectious origin, identification of infecting organism, knowledge of antibiotic susceptibility, and institution of appropriate medical and/or surgical therapy can improve outcome
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