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    Penetrating keratoplasty in xeroderma pigmentosum: Case reports and review of the literature
    ( 1994-01-01) Jalali, S. ; Boghani, S. ; Vemuganti, G. K. ; Ratnakar, K. S. ; Rao, G. N.
    Xeroderma pigmentosum is an uncommon inherited disorder characterized by hypersensitivity to ultraviolet radiation, with defective repair of DNA damage caused by short-wavelength radiation. Corneal complications of this disorder may require penetrating keratoplasty for visual rehabilitation. Surgery is rarely undertaken in these eyes due to multiple associated problems involving the ocular surface and the lids. We report three cases of successful penetrating keratoplasty in xeroderma pigmentosum and review nine cases reported earlier. Successful grafts were achieved in all 12 eyes initially. Persistent superficial punctate keratopathy was observed in one eye and graft rejection episodes in five eyes. However, graft failure occurred due to an untreated rejection episode in only one eye. Another eye was treated by exenteration for recurrent ocular malignancies. This report highlights the encouraging results of penetrating keratoplasty in carefully selected patients of xeroderma pigmentosum with corneal pathology.
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    Economic consequences of HIV/AIDS in India
    ( 1997-01-01) Pandav, C. S. ; Anand, K. ; Shamanna, B. R. ; Chowdhury, S. ; Nath, L. M.
    Background. HIV/AIDS is one of the pressing public health problems in India. Available information indicates a rising trend of infection. The impact of HIV/AIDS on the economic front is important as it affects mainly the young, who are in the reproductive age group. We estimated the cost of productivity losses in a lifetime attributable to HIV-related mortality in India in the population of the year 1991 at current HIV infection rates. Methods. The analysis was done from the societal viewpoint, adopting a discount rate of 5%. To estimate the loss in person-years due to HIV/AIDS, two scenarios were considered. Firstly, the population without HIV/AIDS, and secondly, the population with HIV/AIDS. The difference in person-years lived by the cohort in both populations would provide the person-years lost due to HIV/AIDS. To calculate the person-years lived in each, the life table approach was used. The demographic data from the 1991 Census were used. The population was divided into 15 five-year cohorts and the current age-specific death rates were used. Assumptions regarding HIV incidence rates in urban and rural areas in different age groups were made based on the available data and consensus of experts. The estimate was first done for a cohort of 100 000 population for rural and urban areas and then extrapolated to the population in the different age groups. To convert the person-years lost into monetary terms, minimum wages were estimated to be Rs 14 460 per annum. Results. The total undiscounted life-years lost due to HIV/ AIDS by the present population of India will be 238.4 million years-123.7 million years for urban and 114.7 million years for rural areas. On an average this is 0.4 years lost per person. The life-years lost per case of HIV was 44.4 years. Assuming minimum wages of Rs 14 460 as the value of one year, the total economic loss is Rs 3447 billion. The productivity loss percase is Rs 642 024 (US$ 20 710). For an estimated national per capita income of Rs 4252.4 the total economic loss is Rs 1014 billion. If a discount rate of 5% is applied for future losses then the total potential years of life lost will be 23 million - 11.3 million for urban and 11.7 million for rural areas. In monetary terms this will be Rs 332.6 billion by minimum wages assumption, and 97.8 billion if the national per capita income is assumed to be the cost of one year. Conclusion. HIV/AIDS imposes a significant burden on the economic front. The productivity losses are likely to be an underestimate as the costs of treatment of HIV/AIDS patients, prevention programmes and labour costs have not been taken into account. To decide whether HIV/AIDS needs a high priority in the Indian context, it is necessary to have similar estimates for other important diseases such as tuberculosis and cancer.
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    Ethanol-induced changes in hepatic chromatin and nonhistone nuclear protein composition in the rat
    ( 1998-04-01) Mahadev, Kalyankar ; Vemuri, Mohan C.
    Excessive ethanol consumption has been shown to affect hepatic nucleic acid and protein synthesis. This study was undertaken to identify the changes in hepatic chromatin and nonhistone nuclear proteins as a consequence of chronic ethanol treatment, because these changes could be contributory to alcoholic cirrhosis. Chromatin conformation was monitored by circular dichroism spectrophotometry. The chromatin from alcoholic rat liver showed decreased molar ellipticity (Θ). This change in chromatin conformation influences chromatin functions such as replication and transcription through the regulatory pool of nonhistone nuclear (NHN) proteins. The NHN proteins were analysed by ultrasensitive two-dimensional gel electrophoresis. Specific changes in nuclear proteins were documented in the liver of chronic alcohol- fed rats. This study shows chronic ethanol-induced changes in chromatin conformation and nuclear proteins, which might be critical in the mechanism of alcoholic cirrhosis.
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    Selective changes in protein kinase C isoforms and phosphorylation of endogenous substrate proteins in rat cerebral cortex during pre-and postnatal ethanol exposure
    ( 1998-08-15) Mahadev, Kalyankar ; Vemuri, Mohan C.
    The effect of pre- and postnatal ethanol exposure on protein kinase C (PKC) activity, immunochemical analysis of PKC α, βI, βII, γ, δ, ε, η, and ζ by isoform-specific antibodies, and in vitro phosphoryLation of endogenous substrate proteins was investigated in rat cerebral cortex. The PKC activity was increased throughout the development. However, the activity at the age of 8 days was significantly high in cytosolic and membrane fractions from ethanol-treated rats. Immunochemical analysis showed increased levels of PKC βI and βII at the age of 8 days, and a decrease in isoform at 8, 30, and 90 days of age. PKC isoforms α, γ, ε, and η showed no appreciable change in ethanol-treated rats. PKC ζ levels were high in the cytosolic fraction from ethanol-treated samples of 90 days age. In vitro phosphorylation of endogenous substrate proteins in the presence of Ca2+/phospholipid showed increased phosphorylation of selective membrane and cytosolic proteins with 87, 65,50, 43, 36, and 29 kDa in ethanol-treated rats. The phosphorylation of these proteins decreased in the presence of staurosporine, which also supported PKC-mediated phosphorylation. Increased PKC activity, activation of βI and βII isoforms, decreased levels of δ isoform, and phosphorylation of selective substrate proteins in cerebral cortex due to alcohol exposure might be relevant in ethanol-induced central nervous system dysfunction and fetal alcohol syndrome.
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    Effect of ethanol on chromatin and nonhistone nuclear proteins in rat brain
    ( 1998-08-17) Mahadev, Kalyankar ; Vemuri, Mohan C.
    Changes in chromatin conformation and nonhistone nuclear protein composition were analyzed in various classes of nuclei from the brain of control and chronic ethanol fed rats. Conformational studies of chromatin by circular dichroism spectrophotometry showed an increased molar ellipticity [Θ] of chromatin in neuronal, astrocyte and oligodendroglial nuclei due to ethanol treatment. The increased molar ellipticity directly indicates relaxed state of chromatin in these nuclei, which facilitates ready state of transcription and replication. Further, the circular dichroism spectrum, due to a change over point at ~260 nm also indicated the possibility of DNA- protein interactions governing chromatin conformation. In microglial nuclei, the circular dichroism spectrum showed a decrease in molar ellipticity due to ethanol treatment, indicating the existence of chromatin in a condensed state. This type of circular dichroism change points towards the possibility of closed conformation, which renders the gene sequences not accessible due to conformational constrains of the chromatin. Since circular dichroism changes indicated the involvement of DNA-protein interactions, changes in nonhistone nuclear proteins were analyzed in these classes of nuclei by two- dimensional gel electrophoresis. In astrocytes and oligodendrocytes two new proteins appeared in each type of nuclei while in neurons and microglial nuclei four different proteins were either completely missing or showed a decrease. These changes indicate the presence of dynamic flux of nonhistone nuclear proteins in chromatin. Taken together, the changes in chromatin conformation, associated with specific changes in non histone nuclear protein composition suggest the modulation of chromatin as a response to ethanol evoked stimulus and has relevance in the regulation of cellular responses to ethanol crisis in brain.
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    Economic Burden of Blindness in India
    ( 1998-09-01) Shamanna, B. R. ; Dandona, Lalit ; Rao, Gullapalli N.
    Economic analysis is one way to determine the allocation of scarce resources for health-care programs. The initial step in this process is to estimate in economic terms the burden of diseases and the benefit from interventions for prevention and treatment of these diseases. In this paper, the direct and indirect economic loss due to blindness in India is calculated on the basis of certain assumptions. The cost of treating cataract blindness in India is estimated at current prices. The economic burden of blindness in India for the year 1997 based on our assumptions is Rs. 159 billion (US$ 4.4 billion), and the cumulative loss over lifetime of the blind is Rs. 2,787 billion (US$ 77.4 billion). Childhood blindness accounts for 28.7% of this lifetime loss. The cost of treating all cases of cataract blindness in India is Rs. 5.3 billion (US$ 0.15 billion). Similar estimates for causes of blindness other than cataract have to be made in order to develop a comprehensive approach to deal with blindness in India.
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    Developing a model to reduce blindness in India: The International Centre for Advancement of Rural Eye Care
    ( 1998-12-01) Dandona, Lalit ; Dandona, Rakhi ; Shamanna, B. R. ; Naduvilath, Thomas J. ; Rao, Gullapalli N.
    With the continuing high magnitude of blindness in India, fresh approaches are needed to effectively deal with this burden on society. The International Centre for Advancement of Rural Eye Care (ICARE) has been established at the L.V. Prasad Eye Institute in Hyderabad to develop such an approach. This paper describes how ICARE functions to meet its objective. The three major functions of ICARE are design and implementation of rural eye-care centres, human resource development for eye care, and community eye-health planning. ICARE works with existing eye-care centres, as well as those being planned, in underserved areas of India and other parts of the developing world. The approach being developed by ICARE, along with its partners, to reduce blindness is that of comprehensive eye care with due emphasis on preventive, curative and rehabilitative aspects. This approach involves the community in which blindness is sought to be reduced by understanding how the people perceive eye health and the barriers to eye care, thereby enabling development of strategies to prevent blindness. Emphasis is placed on providing good-quality eye care with attention to reasonable infrastructure and equipment, developing a resource of adequately trained eye-care professionals of all cadres, developing a professional environment satisfactory for patients as well as eye-care providers, and the concept of good management and financial self-sustainability. Community-based rehabilitation of those with incurable blindness is also part of this approach. ICARE plans to work intensively with its partners and develop these concepts further, thereby effectively bringing into practice the concept of comprehensive eye care for the community in underserved parts of India, and later in other parts of the developing world. In addition, ICARE is involved in assessing the current situation regarding the various aspects of blindness through well-designed epidemiologic studies, and projecting the eye-care needs for the future with the help of reliable information. With balanced attention to infrastructure, manpower, financial self-sustenance, and future planning, ICARE intends to develop a practical model to effectively reduce blindness in India on a long-term basis.
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    Ectopic brain presenting as orbital and conjunctival mass: A case report
    ( 1999-01-01) Vemuganti, G. K. ; Shekar, G. C.
    The presence of brain tissue in the orbit is a rare finding, whether it occurs isolated, in continuity with intracranial contents, or within a tumor. In this paper, the authors report a rare case of ectopic brain in the orbit, presenting as a conjunctival mass, in a 15-day-old female child. The clinical and histological features of the case are presented, together with a review of the literature.
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    Refresher Training and Continuing Education for Para-Medical Ophthalmic Assistants
    ( 1999-03-01) Shamanna, B. R. ; Sujata Rao, R. ; Premarajan, K. C. ; Saravanan, S. ; Thulasiraj, R. D. ; Venkataswamy, G.
    This paper describes a refresher training and continuing education programme in clinical and community ophthalmology for para-medical ophthalmic assistants (PMOAs) conducted by the Lions Aravind Institute of Community Ophthalmology. The course participants included 60 PMOAs working either in district hospitals, primary health centres or mobile units from the districts in Maharashtra. Each training programme was spread over 43 hours in 4 days and included lectures, practical demonstrations, and hands-on training in the outpatient, inpatient, and operation theatre of the training institution. Participants were given exposure to outreach activities in an eye camp and a satellite eye centre resembling a district hospital. The PMOAs found the training to be useful and it was seen that areas like patient counselling, instrument and equipment maintenance, and assistance in the operation theatre for newer surgical procedures which were lacking in the basic training were fulfilled in this training programme. Regional Institutes of Ophthalmology, upgraded medical colleges, and other eye-care institutions which have facilities and manpower could organise similar refresher and continuing education programmes for PMOAs so that they could be utilised more efficiently in the blindness-control activities in the country.
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    Effect of pre- and postnatal ethanol exposure on protein tyrosine kinase activity and its endogenous substrates in rat cerebral cortex
    ( 1999-04-01) Mahadev, Kalyankar ; Vemuri, Mohan C.
    The rat brain contains high levels of tyrosine-specific protein kinases (PTKs) that specifically phosphorylate the tyrosine-containing synthetic peptide poly(Glu4Tyr1). Using this peptide as a substrate, we have measured the protein tyrosine kinase activity in membrane and cytosolic fractions from the cerebral cortices of pre- and postnatal ethanol-exposed rats at time intervals of 8, 30, and 90 days. During the course of development of the cerebral cortex, PTK activity decreased both in the membrane and cytosolic fractions from 8 and 90 days of age. Maximum activity was associated at the age of 8 days and gradually declined in the later ages (30 and 90 days) of postnatal development. However, PTK activity in the ethanol exposed rat cerebral cortex was further decreased when compared to controls in all the ages of postnatal development in membrane as well as in cytosolic fractions. In the presence of vanadate, a specific inhibitor of protein tyrosine phosphatases (PTPs), the PTK activity increased, indicating that the balance between protein tyrosine kinase and protein tyrosine phosphatase might be lost during ethanol exposure. In addition, when using an antibody specific for phosphotyrosine, endogenous substrates for protein tyrosine kinases were identified on an immunoblot of membrane and cytosolic fractions from the ethanol-exposed rat cerebral cortex. The immunoblot showed several phosphotyrosine-containing proteins with molecular weights of 114, 70, 36, 34, 32, 20, and 14 kDa that were present in the cerebral cortex. However, higher levels of immunoreactivity of these proteins were found in the ethanol-exposed membrane fractions when compared to control fractions- particularly at the age of 30 and 90 days. Two phosphotyrosine proteins with molecular weights of 38 and 40 kDa showed decreased immunoreactivity at the age of 90 days in the cytosolic fraction of an ethanol-exposed rat's cerebral cortex. The differences in tyrosine-specific protein kinase activity and in phosphotyrosine-containing proteins observed during pre- and postnatal ethanol exposure may reflect specific functional defects in the cerebral cortex which could possibly underlie the mechanism contributing to fetal alcohol syndrome (FAS).
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    Conjunctival intraepithelial neoplasia presenting as corneal ulcer
    ( 2000-01-01) Sridhar, Mittanamalli S. ; Honavar, Santosh G. ; Vemuganti, Geeta ; Rao, Gullapalli N.
    PURPOSE: To report a case of conjunctival intraepithelial neoplasia presenting as corneal ulcer. METHOD: Case report of a 28-year-old man who presented with sudden onset of pain, redness, and watering in the right eye. Examination of right cornea revealed deep stromal infiltrate inferonasally. Adjacent to the infiltrate and straddling the inferonasal limbus, a reddish well-defined sessible lesion with prominent blood vessels was seen. After corneal scraping for microbiological evaluation, the patient was treated with frequent instillation of ciprofloxacin hydrochloride 0.3% eyedrops. RESULTS: Corneal scraping revealed no microorganisms. Infiltrate resolved promptly after excision of the lesion. Histopathologic evaluation of the excised lesion revealed conjunctival intraepithelial neoplasia. CONCLUSIONS: This case highlights the fact that conjunctival intraepithelial neoplasia at the limbus may present as corneal ulcer. This ulcer could have occurred secondary to a dellen formation and epithelial breakdown predisposing to a corneal ulcer. Copyright (C) 2000 Elsevier Science Inc.
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    Infectious keratitis in climatic droplet keratopathy
    ( 2000-07-01) Sridhar, M. S. ; Garg, Prashant ; Das, Sujatha ; Vemuganti, Geeta ; Gopinathan, Usha ; Rao, Gullapalli N.
    Purpose. To report the ulcer characteristics, microbiologic data, and outcome of infectious keratitis associated with climatic droplet keratopathy (CDK), suggesting that CDK is a predisposing factor for infectious keratitis. Methods. Medical records of 32 patients (34 eyes) in whom infectious keratitis was seen in association with CDK were retrospectively reviewed. Data were collected regarding the nature of CDK lesions, infiltrate characteristics, organisms isolated, and outcome. Results. CDK was peripheral in 16 (47.1%) eyes, central in 8 (23.5%), and diffuse in 10 (29.4%). The CDK lesions were nodular and elevated in all eyes. The infiltrate was adjacent to the CDK lesions in 28 eyes (82.4%). The infiltrate size (widest dimension) ranged 2-6 mm in 18 eyes (52.9%) and was > 6 mm in 7 (20.5%). The infiltrate was full thickness in 15 eyes (44.1%) and was involving up to the middle third of the corneal stroma in another 18 (52.8%). Hypopyon was seen in all. Bacteria were commonly isolated. Staphylococcus epidermidis (six eyes) and Streptococcus pneumoniae (five eyes) were the common bacteria isolated. Resolution with medical treatment was seen in 20 (58.8%) eyes. Conclusions. CDK is a predisposing factor for infectious keratitis. Treatment should be considered for advanced and nodular lesions, even if they are peripheral, to prevent infectious keratitis.
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    Keratocyte loss in Acanthamoeba keratitis: Phagocytosis, necrosis or apoptosis ?
    ( 2000-12-01) Vemuganti, Geeta K. ; Sharma, Savitri ; Athmanathan, Sreedharan ; Garg, Prashant
    Purpose: Pathogenesis of Acanthamoeba keratitis involves breakdown of epithelial barrier, stromal invasion by Acanthamoeba, loss of keratocytes, inflammatory response and finally stromal necrosis. The loss of keratocytes, believed to be due to the phagocytic activity of the parasite, occurs disproportionate to and independent of the parasite load, thereby suggesting additional modes of cell loss. To test our hypothesis that the loss of keratocytes in Acanthamoeba keratitis is due to apoptosis, we did both histology and histochemistry on the corneal tissues. Methods: Routine Haematoxylin and Eosin, Gomori's Methenamine Silver and Periodic acid Schiff stained sections of five corneal tissues from penetrating keratoplasty and eviscerated eyes were reviewed. TUNEL staining was done for morphological detection of apoptosis in three cases, using formalin-fixed, paraffin-processed tissues. Results: Histological changes were epithelial ulceration, loss of keratocytes in all layers, inflammation in anterior two-thirds of the stroma with necrosis, and deeper quiet stroma. Acanthamoeba trophozoites were found in the anterior stroma while the cysts were more in the deeper stroma, with minimal or no inflammatory response. TUNEI staining was positive in keratocytic nuclei in all layers. Conclusions: This study demonstrates that one of the modes of keratocyte loss in Acanthamoeba keratitis is by apoptosis, possibly in addition to the necrotic process and phagocytic activity of the parasite. The death of inflammatory cells also appears to be mediated by apoptosis.
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    Use of an anaerobic environment to preserve the endogenous activity of protein-tyrosine phosphatases isolated from intact cells.
    ( 2001-01-01) Zhu, L. ; Zilbering, A. ; Wu, X. ; Mahadev, K. ; Joseph, J. I. ; Jabbour, S. ; Deeb, W. ; Goldstein, B. J.
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    Enzymatic, clinical and histologic evaluation of corneal tissues in experimental fungal keratitis in rabbits
    ( 2001-01-01) Gopinathan, Usha ; Ramakrishna, T. ; Willcox, Mark ; Rao, Ch Mohan ; Balasubramanian, D. ; Kulkarni, Ajay ; Vemuganti, Geeta Kashyap ; Rao, Gullapalli N.
    Mycotic keratitis, being frequently refractive to most of the currently available antifungal therapy, continues to pose a therapeutic challenge to the clinician. In keratitis of infectious etiology stromal dissolution may be brought about by a combination of agent and host factors. An understanding of the source and nature of corneal tissue damage is essential for evolving more effective therapeutic modalities in the treatment of fungal keratitis. In the present study, we have characterized the extracellular proteases produced in vitro by corneal fungal pathogens namely the Aspergillus flavus and Fusarium solani when collagen was provided as the sole nitrogen source. In addition, fungal infected rabbit corneas were investigated for proteolytic activities and nature of inflammatory reaction. Gelatin zymography detected protease bands with molecular mass ranging from 100 to 200 kDa in the culture extracts of A. flavors, and a single major band of molecular mass approximately 200 kDa in the culture extracts of F. solani. A basal proteolytic activity of mass 65 kDa was visualized in all uninfected and infected rabbit corneal extracts. Infected corneas in addition revealed the presence of additional proteolytic species of mass 92 and 200 kDa. The enzyme inhibitory profile suggested that fungal cultures in vitro contained predominantly serine protease activity and to a lesser extent metalloprotease activity. However, fungal infected corneal homogenates showed the presence of metalloproteinase activity alone, the enzymatic activities entirely being sensitive to ethylene diamine tetra acetate (EDTA). a metalloprotease inhibitor. Interestingly, the serine proteolytic activity detected in fungal cultures in vitro was not present in the fungal infected corneas in vivo. However, the possible role of fungal serine proteases in the activation of corneal matrix metalloproteinases (MMPs) cannot be ruled out. Based on the criteria of molecular mass, proteolytic activity in the presence of calcium at neutral pH, and sensitivity to inhibition by a metalloprotease inhibitor, the 65 and 92 kDa gelatinases were identified as MMP 2 and MMP 9, respectively. The expression of 92 and 200 kDa gelatinases correlated positively with the amount of polymorphonuclear cells present in the infected tissues. Activated resident corneal cells or inflammatory cells may largely contribute to the increased proteolytic activities in fungal infected corneas resulting in tissue matrix degradation in fungal keratitis. © 2001 Academic Press.
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    Does silicone oil penetrate the lens capsule?
    ( 2001-01-01) Batra, Anjli ; Vemuganti, Geeta K. ; Das, Taraprasad ; Singh, Shashi ; Jalali, Subhadra
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    Enucleation in a tertiary eye care centre in India: Prevalence, current indications and clinicopathological correlation
    ( 2001-01-01) Vemuganti, Geeta K. ; Jalali, Subhadra ; Honavar, Santosh G. ; Shekar, G. Chandra
    Purpose. Enucleation is a standard surgical treatment modality for many end-stage eye diseases. Indications for enucleation vary with changing trends in disease management. Few studies have addressed the issue of the frequency and indications of enucleation of eyes in India. We aimed to determine the frequency and the current clinical indications for enucleation in patients at a tertiary eye care centre in India, and attempted a clinico-pathological correlation. Methods. Medical records of patients undergoing enucleation at a tertiary eye care centre over a period of 31/2 years (January 1995 to July 1998) were reviewed to obtain patients' demographic data and socio-economic status. The clinical indications and predisposing factors were assessed. The formalin-fixed, paraffin-embedded sections of all enucleated eyes were re-evaluated and histopathological findings were correlated with the clinical diagnosis. The prevalence of enucleation was calculated, and age adjustments were done using the Indian population data from 1998 mid-year statistics. Results. Enucleation of the eye was performed in 150 patients (151 eyes) out of 88 991 new ophthalmic cases, constituting 0.17% of the cases seen in the hospital, and amounting to a prevalence of 0.33% (95% CI, 0.27-0.40). Males outnumbered females in a ratio of 1.85:1 (98 males, 53 females). The median age was 8 years (mean 16.8 ± 18.3 years). Children below 15 years of age constituted 85.2% (95% CI, 81.2-89.21%) of cases that underwent enucleation. Clinical indications for enucleation included tumours in 74 (49%); staphyloma in 38 (25%); acute injury in 20 (13%); absolute glaucoma in 9 (6%); painful blind eye in 5 (3%); phthisis bulbi in 1 (1%); and others in 4 (3%). Of the 74 cases with a clinical diagnosis of tumour, histopathology revealed retinoblastoma in 55 (74%) cases, melanoma in 6 (8%) and ocular surface tumours in 4 (6%). Clinico-pathological correlation was 100% in cases with a definite clinical diagnosis of retinoblastoma and melanoma. Nine blind eyes (6%) in which an intraocular tumour was one of the differential diagnoses, were negative for a tumour on histopathology. Staphyloma was more prevalent in the low socio-economic group (p = 0.0004), with a history of childhood trauma in 34% cases. Conclusions. The prevalence of enucleation in the population reporting to this tertiary eye care centre was 33 per 10 000 population over the study period of 31/2 years. Major indications for enucleation were tumours, staphyloma and trauma (88% of all cases). Increased frequency in the young was due to the high proportion of retinoblastoma and staphyloma. Childhood trauma, inflammation and malnutrition may together play a role in the pathogenesis of staphyloma. Awareness at the level of primary health care providers, paediatricians and general practitioners should be promoted to identify the disease process at an early stage and facilitate early intervention measures that could result in eye and vision salvage.
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    Bilateral infectious keratitis after laser in situ keratomileusis: A case report and review of the literature
    ( 2001-01-30) Garg, Prashant ; Bansal, Aashish K. ; Sharma, Savitri ; Vemuganti, Geeta K.
    Objective: To report a case of bilateral infectious keratitis after simultaneous bilateral laser in situ keratomileusis (LASIK) and to explore appropriate preventive, diagnostic, and therapeutic measures. Design: Interventional case report and literature review. Intervention: A 22-year-old woman had bilateral corneal infiltrates after simultaneous bilateral LASIK. The same set of instruments was used for surgery on both eyes. Corneal scrapings from the edge of the infiltrate and underneath the flap were taken for microscopic examination and inoculation on culture media. Treatment consisted of irrigation of stromal bed with amikacin sulphate (2.5%) solution along with half hourly instillation of amikacin (2.5%) and cefazolin (5%) eye drops. Main Outcome Measures: Causative organism and response to medical treatment. Results: Culture revealed a significant growth of Mycobacterium chelonae from the corneal scrapings of both eyes. There was progressive thinning of corneal stroma in the right eye requiring cyanoacrylate tissue adhesive application. The left eye showed progressive worsening after initial response and required penetrating keratoplasty. Conclusions: The risk of bilateral sight-threatening complications must be kept in mind when contemplating bilateral simultaneous LASIK. Nontuberculous mycobacteria should be considered as an etiologic agent in cases of infectious keratitis occurring after LASIK. Microbiology work-up of a specimen collected directly from the site of lesion can help in early diagnosis and institution of appropriate therapy. © 2001 by the American Academy of Ophthalmology.
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    Impression cytology-proven corneal stem cell deficiency in patients after surgeries involving the limbus
    ( 2001-03-06) Sridhar, M. S. ; Vemuganti, Geeta K. ; Bansal, Aashish K. ; Rao, Gullapalli N.
    Purpose. To report three cases of limbal stem cell deficiency (confirmed by impression cytology) that followed multiple pterygium surgeries and therapeutic penetrating keratoplasty. Methods. The first case, after multiple pterygium surgeries, presented with corneal scarring and thickened epithelium with vascularization sparing the central cornea in the right eye and involving the entire cornea in the left eye. The second case presented with superficial scarring and extensive vascularization after failed therapeutic graft performed for a large perforated corneal ulcer. The third case was a clear graft performed for a progressing fungal ulcer with signs of conjunctivalization inferotemporally. Limbal stem cell deficiency was clinically suspected in all of these cases. Results. Goblet cells with mucin globules were found on the corneal surface by impression cytology in all three cases. Conclusions. We report three cases of limbal stem cell deficiency (proven by impression cytology) that followed multiple pterygium surgeries and therapeutic penetrating keratoplasty. Surgical insult to the limbus is the predisposing factor for stem cell damage in these cases. Involvement of the limbus by infection and use of intensive medications are probable contributing factors for stem cell damage in cases of therapeutic penetrating keratoplasty.
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    Atypical herpes simplex keratitis (HSK) presenting as a perforated corneal ulcer with a large infiltrate in a contact lens wearer: Multinucleated giant cells in the Giemsa smear offered a clue to the diagnosis
    ( 2001-04-18) Athmanathan, Sreedharan ; Pranesh, Veenashree M. ; Pasricha, Gunisha ; Garg, Prashant ; Vemuganti, Geeta K. ; Sharma, Savitri
    Purpose: To report a case of atypical herpes simplex keratitis initially diagnosed as bacterial keratitis, in a contact lens wearer. Results: Case report of an 18-year-old woman using contact lenses who presented with pain, redness and gradual decrease in vision in the right eye. Examination revealed a paracentral large stromal infiltrate with a central 2-mm perforation. Corneal and conjunctival scrapings were collected for microbiological investigations. Corneal tissue was obtained following penetrating keratoplasty. Corneal scraping revealed no microorganisms. Giemsa stained smear showed multinucleated giant cells. Conjunctival, corneal scrapings and tissue were positive for herpes simplex virus - 1 (HSV) antigen. Corneal tissue was positive for HSV DNA by PCR. Conclusions: Atypical HSV keratitis can occur in contact lens wearers. A simple investigation like Giemsa stain may offer a clue to the diagnosis.