Open Access Case study

Immune Reconstitution Inflammatory Syndrome (IRIS) Presenting as Bilateral Severe Granulomatous Sclerouveitis in a HIV-Infected Patient with Mycobacterium Tuberculosis Infection: A Case Report

Ee-Ling Tan, Shelina Oli Mohamed, Hanizasurana Hashim, Norfariza Ngah, Liza- Sharmini Ahmad Tajudin

Ophthalmology Research: An International Journal, Page 33-39
DOI: 10.9734/OR/2015/12474

Aim: To report a case of tuberculosis (TB) associated immune reconstitution inflammatory syndrome (IRIS) presenting as rapid progressive bilateral severe granulomatous sclerouveitis.

Presentation of Case: A 26-year-old Human Immunodeficiency Virus (HIV) -infected male who was on antiretroviral therapy (ART) 3 months prior to presentation complained of left acute painful red eye with blurring of vision and floaters. There was severe granulomatous uveitis in both eyes with necrotizing scleritis in the left eye. There was also cervical lymph node that was positive for Mycobacterium tuberculosis. He initially responded well to antituberculosis therapy together with topical steroids and antibiotics, oral non-steroidal anti-inflammatory drugs (NSAIDS) and ART. His vision deteriorated after 6 weeks of treatment. He developed bilateral severe sclerouveitis and marked sclera thinning with self-sealed scleral perforation of the left eye. A diagnosis of IRIS was made and systemic steroid was added. Ocular inflammation was controlled, but his left vision remained poor due to perforated extensive necrotizing scleritis, seclusiopupillae and cataract.

Discussion: Intraocular TB may be presented with aggressive, rapid progression of the disease in HIV –infected patients. ART-associated TB is seen in HIV patients who developed TB after initiation of ART. Subset of ART-associated TB could be due to unmasking IRIS. Patients who were treated for opportunistic infection after ART may develop paradoxical IRIS.

Conclusion: Bilateral severe granulomatous uveitis with necrotizing scleritis is a rare manifestation of TB-related IRIS in an HIV patient. It is a potential sight threatening condition. A close monitoring for the development of IRIS during treatment of HIV is essential to minimize the morbidity.


Open Access Case study

Third Ventricular Ependymoma Mimicking Foster Kennedy Syndrome- A Case Report

Ee- Ling Tan, Regunath Kandasamy, Wan- Hitam Wan-Hazabbah, Thavaratnam Lakana-Kumar, Liza- Sharmini Ahmad Tajudin

Ophthalmology Research: An International Journal, Page 43-48
DOI: 10.9734/OR/2015/13780

Aims: To report a case of a third ventricular tumour mimicking Foster Kennedy Syndrome in a young adult.

Presentation of Case: A 21-year-old female presented with bilateral blurring of vision with preceded by generalized headache, nausea and vomiting. Fundoscopy revealed optic nerve atrophy of the right eye and a swollen optic disc on the left in keeping with features of Foster Kennedy Syndrome. MRI of the brain revealed a third ventricular tumor extending into the suprasellar region with hydrocephalus. Surgical excision of the tumour was done and the subsequent histopathological report confirmed it to be a clear cell ependymoma.

Discussion: Foster Kennedy syndrome is a rare clinical constellation describing a pattern of ocular findings typically related to extraaxial tumours involving the anterior skull base. It is characterized by the triad of unilateral optic disc swelling, contralateral optic atrophy and ipsilateral anosmia. The clinical signs of Foster Kennedy syndrome are a result of direct compression of the mass on the optic nerve and an indirect effect from raised intracranial pressure.

Conclusions: We conclude from this report that intraventricular or intraaxial lesions in the vicinity of the optic apparatus may also produce features mimicking Foster Kennedy syndrome in clinical practice.


Open Access Short Research Article

Solution for Dead Space Problem in Ranibizumab Syringe System

Sinan Bilgin, Ozcan Kayikcioglu, Basak Can, Fatma Taneli

Ophthalmology Research: An International Journal, Page 40-42
DOI: 10.9734/OR/2015/13310

Intravitreal injection of drugs that inhibit the actions of vascular endothelial growth factor bring high economic burden for the health systems. We evaluated the amount of drug volume retained in two different types of syringes with billed and non - billed rubber stopper. Difference between two syringe types is 0.037 g. This indicates a significant amount of volume loss due to dead space between syringe and needle. Consequently, a simple change of design of rubber stopper of the plunger as billed form may reduce significant amount of drug loss due to dead space volume.


Open Access Short Research Article

A Safe, Efficacious and Cost Effective Way of Delivering Sub-Tenon’s Anaesthesia during Cataract Surgery

S. Bansal, K. Jasani, K. Taherian

Ophthalmology Research: An International Journal, Page 49-53
DOI: 10.9734/OR/2015/7213

Aims: There are considerable pressures in various health economies at present to reduce costs whilst maintaining patient safety and clinical efficacy. We report a new simplified regime for the administration of Sub-Tenon’s anaesthesia offering a cost saving of up to 95% whilst maintaining to total safety and efficacy.

Study Design: The study compared usage of 2% Xylocaine (2% Lignocaine with 1:200000 Adrenaline) over the more prevalent regime of 2% Bupivacaine + 2% Lignocaine + Hyaluronidase in terms of cost, patient satisfaction, safety and efficacy prior to phacoemulsification surgery.

Place and Duration of Study Sample: Department of Ophthalmology, Royal Preston Hospital, Preston UK between July and November 2010.

Methodology: Following topical anaesthesia with 3 drops of Proxymetacaine 0.5% drops instilled one minute apart and subsequent administration of a drop of 5% Povidone Iodine aqueous solution into the conjunctival sac, 2ml of 2% Lignocaine with 1:200000 adrenaline was administered as a Sub-Tenon’s injection to 100 eyes of consecutive patients undergoing phacoemulsification. Pain levels during the administration of the injection and during surgery were monitored by measuring Visual Analogue Pain (VAP) scores via a prospective questionnaire immediately after the operation.

Results: There were 100 eyes of patients undergoing cataract surgery included in this study. No patient required top up anaesthesia during the surgery and no serious anaesthetic related intra or post-operative complication was noted in any of the patients. The mean VAP score during delivery of anaesthetic and for the duration of surgery were both 0.

Conclusion: Our results show that this regime for administration of Sub-Tenon’s anaesthesia meets the standards required in terms of both safety and efficacy whilst delivering considerable cost savings. We recommend its routine use for the reasons cited above.


Open Access Original Research Article

Diplopia and Strabismus in Diabetics (Type II) and Non-diabetics in Yazd, Iran

Mitra Dehghan Harati, Mohammad Reza Besharati, Elahe Abbasi Shavazi, Mohammad Afkhami Ardekani, Samira Salimpur, Sajjad Besharati

Ophthalmology Research: An International Journal, Page 54-58
DOI: 10.9734/OR/2015/11816

Purpose: To describe the frequency of diplopia and strabismus in diabetics (Type II) and non-diabetics in Yazd, Iran.

Methods: This is a cross-sectional study on 3000 patients including 1500 diabetics (type II) and 1500 non-diabetics in Yazd from 2011 to 2012.Based on aims, a questionnaire was designed and data including, demographic data, duration of diabetes, presence of diplopia or strabismus, duration of them, and involved cranial nerves were gathered and documented. Data were analyzed by SPSS (ver. 16) using descriptive statistics, chi-square, fisher and T tests.

Results: Diplopia existed in 6(0.4%) diabetic and 13(0.9%) non-diabetic patients, without statistically significant difference (p-value=0.107). Strabismus existed in 6(0.4%) diabetic and 10(0.7%) non-diabetic patients, without statistically significant difference (p-value=0.316).Mean duration of diabetes was 11±7.42 years. There was no statistical difference between the two groups in terms of gender. Sixth nerve palsies were accounted for the majority of patients with strabismus in the two groups.

Conclusion: There was no statistically significant difference in frequency of diplopia and strabismus between diabetics and non-diabetics.