Publications by authors named "Usha Kim"

61 Publications

Relationship between cooking fuel and lens opacities in South India: a 15-year prospective cohort study.

Am J Ophthalmol 2022 Jul 8. Epub 2022 Jul 8.

Francis I Proctor Foundation, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.

Purpose: Unclean cooking fuels such as wood and kerosene have been associated with cataract in cross-sectional studies. This study sought to determine whether exposure to unclean cooking fuels was associated with subsequent cataract progression.

Design: Prospective cohort study.

Methods: This is a secondary observational analysis of the community-based Antioxidants in Prevention of Cataracts trial (ClinicalTrials.gov ID NCT01664819). The exposure of interest was cooking fuel type, measured at baseline. Main outcome measures were baseline cataract severity and self-reported cataract surgery at a 15-year visit.

Results: Baseline and 15-year follow-up data were available for 798 and 579 participants, respectively. Wood or kerosene was used by 711/798 (89.1%) baseline participants, including 539/579 (93.1%) participants with complete follow-up. Cooking fuel type was not associated with cataract severity at baseline (p=0.443). Out of 8,334 person-years of follow up, 90 cataract surgeries were observed over 15 years (1.08 surgeries per 100 person-years; 95%CI 0.87-1.32). Use of wood or kerosene was not associated with 15-year incidence of cataract surgery relative to individuals using propane (adjusted p=0.154). Cataract surgery was more common in older individuals (HR 1.1 per year, 95%CI 1.1-1.2, p<0.001), those with baseline myopia (HR 2.1, 95%CI 1.2-3.5, p=0.009) and women (HR 3.5, 95%CI 1.2 to 10.1, p=0.019).

Conclusions: This study found no association between unclean cooking fuels and cataract progression over a 15-year period. No other modifiable risk factors were associated with incident self-reported cataract surgery.
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http://dx.doi.org/10.1016/j.ajo.2022.06.021DOI Listing
July 2022

Commentary : Combating COVID-19-associated mucormycosis with limited resources.

Indian J Ophthalmol 2022 Jun;70(6):2169

Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthesis, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_1250_22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359250PMC
June 2022

Orbital tooth - not always a teratoma : a case report.

Orbit 2022 May 17:1-4. Epub 2022 May 17.

Department of Orbit, Oculoplasty, Ocular Oncology and Ocular Prosthetics, Aravind Eye Hospital, Madurai, India.

A 7-year-old girl presented with a painless firm to cystic mass in the infero-temporal quadrant of her right orbit since birth. The mass had recurred with a cutaneous sinus after initial surgery. Right eye vision was affected by mass induced astigmatism. The anterior and posterior segments were normal. Magnetic Resonance Imaging of the orbit suggested a mature teratoma within the orbital bone. Mass excision showed a fully developed molar tooth within a cyst associated with a cutaneous sinus. Histopathological examination reported odontogenic choriostoma. We report this unique case of orbital odontogenic choristoma in an unusual location, associated with a cutaneous sinus, emphasizing the need for complete excision to prevent recurrence.
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http://dx.doi.org/10.1080/01676830.2022.2072900DOI Listing
May 2022

Re: "Improved Eyelid Muscle Tension Balance with Refined Frontalis Muscle Flap Suspension in the Treatment of Severe Ptosis".

Ophthalmic Plast Reconstr Surg 2022 May-Jun 01;38(3):306-307. Epub 2022 May 11.

Department of Orbit and Oculoplasty, Aravind Eye Hospital, Madurai, Tamil NaduIndia.

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http://dx.doi.org/10.1097/IOP.0000000000002198DOI Listing
May 2022

Combined treatment modality including topical 20% fluorescein dye in the management of phthiriasis palpebrarum - A case series.

Indian J Ophthalmol 2022 Apr;70(4):1327-1330

Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Purpose: To study the clinical presentations and outcomes of phthiriasis palpebrarum (PP) managed with combined treatment modality comprising of 20% fluorescein dye, mechanical removal of the ectoparasites, and topical application of antibiotic eye ointment with paraffin base.

Methods: This is a prospective interventional noncomparative hospital-based series of 13 patients of PP. All the patients underwent local application of 20% fluorescein dye over the eyelashes and eyebrows of both the eyes followed by the mechanical removal of all the ectoparasites and trimming of the eyelashes from the base followed by application of ophthalmic ointment.

Results: Mean age of the patients was 28 ± 22 years (range 3-60 Years). Out of the total of 13 patients, 11 patients (85%) were having bilateral involvement. The mean duration of symptoms in 11 patients (rest 2 were accidental findings) was 4 ± 3 weeks (range 1-10 weeks). Three patients (23%) had a history of sexual contact with possible parasite-infested partners. Four patients (31%) had additional parasites in the pubic area or torso. All the patients were completely parasite free at the end of 1 month. There was no infestation of the treating medical personnel from the patient. The average follow-up was 8 ± 5 months (range 3-21 months).

Conclusion: Itching and irritation of the eyes were the most common presentations of PP. Combined treatment modality comprising of 20% fluorescein dye, mechanical removal of ectoparasites, and topical application of antibiotic eye ointment with paraffin base is effective in the management of PP.
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http://dx.doi.org/10.4103/ijo.IJO_1954_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240500PMC
April 2022

Searching beyond nevi - A rare case of neurocutaneous ocular syndrome.

Orbit 2022 Mar 17:1-5. Epub 2022 Mar 17.

Department of Orbit and Oculoplasty, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, India.

Epidermal nevus syndrome is a rare congenital disorder affecting only a few hundred people in the world. It has ophthalmic, dermatological, and neurological manifestations, with varied presentation. Here, we report a case of two-year-old child who presented with epibulbar mass in left eye, pigmented nevi over left side of the body and alopecia over left side of parieto-temporal scalp. Imaging confirmed epibulbar mass and presence of calcification of choroid on ipsilateral side with presence of arachnoid cyst of brain with underlying pachygyria. Neurological examination was normal and dermatologist confirmed presence of verrucous nevi over skin. Excisional biopsy of epibulbar mass revealed a complex choristoma with presence of lacrimal gland tissue. Underlying ocular findings were near normal with normal posterior segment. It is a rare form of epidermal nevus syndrome with near normal ocular findings in the presence of anterior and posterior choristoma, which has not been reported.
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http://dx.doi.org/10.1080/01676830.2022.2049609DOI Listing
March 2022

Parental age and retinoblastoma-a retrospective study of demographic data and genetic analysis.

Eye (Lond) 2022 01 19;36(1):57-63. Epub 2021 Nov 19.

Aravind Eye Hospital & PG Institute of Ophthalmology, Madurai, India.

Objective: To determine the association between the parental age gap and the absolute parental age with the risk of retinoblastoma (RB) development in an offspring.

Methods: RB individuals diagnosed between March 2013 and December 2019 in a single tertiary eye care centre were included. We recorded the demographic data, parental age and RB1 gene mutation status in the patient's tumour, blood and the parental blood. We categorised RB1 mutation inheritance as sporadic RB with somatic mutations (only present in tumour), heritable RB with de novo (present in patient's blood) and familial (present in patient and parents' blood) germline mutations. The statistical significance was confirmed by Fisher's exact/Chi-square test.

Results: Out of 259 RB patients, 247 were included in our study. Heritable RB with de novo germline mutations was significantly less common (p value: 0.0387; 95% CI: 0.2676-0.9329) and sporadic RB with somatic mutations was more common (p value: 0.0545; 95% CI: 1.025-3.39), if the parental age gap was <10 years. There were increased odds of a heritable RB with de novo germline mutation with an increase in paternal age and this was more intensified when combined with parental age gap of more than ≥10 years. The heritable RB with de novo germline mutations significantly increased as maternal age progressed, only when it was adjusted to ≥10 years parental age gap (p value: 0.0262; 95% CI: 1.26-17.91).

Conclusions: An increased parental age gap and increased paternal age are independent risk factors for the development of heritable RB with de novo germline mutation.
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http://dx.doi.org/10.1038/s41433-021-01771-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727630PMC
January 2022

Human papillomavirus in retinoblastoma: A tertiary eye care center study from South India.

Indian J Ophthalmol 2021 08;69(8):2111-2115

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai; Department of Molecular Biology, Aravind Medical Research Foundation, Affiliated to Alagappa University, Karaikudi, India.

Purpose: This study is aimed to investigate the presence of Human papillomavirus (HPV) DNA in tumors obtained from sporadic retinoblastoma patients.

Methods: One hundred six tumor tissues obtained from sporadic RB patients were analyzed for HPV infection by use of both seminested PCR and real-time quantitative PCR.

Results: Of 106 RB patients, 55 were male and 51 were female. The mean age at diagnosis was 26.77 ± 15.36 (mean ± Std. dev) months. Almost all patients presented with leukocoria. Molecular investigation by different methods revealed no HPV positivity in any tumor genome.

Conclusion: Our study demonstrates no association between HPV and RB, postulating HPV may not be a major risk factor in the etiology of RB.
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http://dx.doi.org/10.4103/ijo.IJO_106_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482879PMC
August 2021

Emerging role of tumor microenvironment derived exosomes in therapeutic resistance and metastasis through epithelial-to-mesenchymal transition.

Life Sci 2021 Sep 23;280:119750. Epub 2021 Jun 23.

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai, Tamil Nadu 625 020, India. Electronic address:

The tumor microenvironment (TME) constitutes multiple cell types including cancerous and non-cancerous cells. The intercellular communication between these cells through TME derived exosomes may either enhance or suppress the tumorigenic processes. The tumor-derived exosomes could convert an anti-tumor environment into a pro-tumor environment by inducing the differentiation of stromal cells into tumor-associated cells. The exosomes from tumor-associated stromal cells reciprocally trigger epithelial-to-mesenchymal transition (EMT) in tumor cells, which impose therapeutic resistance and metastasis. It is well known that these exosomes contain the signals of EMT, but how these signals execute chemoresistance and metastasis in tumors remains elusive. Understanding the significance and molecular signatures of exosomes transmitting EMT signals would aid in developing appropriate methods of inhibiting them. In this review, we focus on molecular signatures of exosomes that shuttle between cancer cells and their stromal populations in TME to explicate their impact on therapeutic resistance and metastasis through EMT. Especially Wnt signaling is found to be involved in multiple ways of exosomal transport and hence we decipher the biomolecules of Wnt signaling trafficked through exosomes and their potential in serving as therapeutic targets.
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http://dx.doi.org/10.1016/j.lfs.2021.119750DOI Listing
September 2021

Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1.

Indian J Ophthalmol 2021 07;69(7):1670-1692

Department of Ophthalmology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India.

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.

Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.

Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).

Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
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http://dx.doi.org/10.4103/ijo.IJO_1565_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374756PMC
July 2021

Genetic characterization of a patient with an unusual presentation of Waardenburg syndrome Type 4 and retinoblastoma.

Pediatr Blood Cancer 2021 01 16;68(1):e28553. Epub 2020 Jul 16.

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai, India.

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http://dx.doi.org/10.1002/pbc.28553DOI Listing
January 2021

Ocular oncology practice guidelines during COVID-19 pandemic-An expert consensus.

Indian J Ophthalmol 2020 Jul;68(7):1281-1291

Pediatric Oncology, Cytecare Cancer Hospitals, Bangalore, India.

The outbreak of rapidly spreading COVID-19 pandemic in December 2019 has witnessed a major transformation in the health care system worldwide. This has led to the re-organization of the specialty services for the effective utilization of available resources and ensuring the safety of patients and healthcare workers. Suspension of oncology services will have major implications on cancer care due to delayed diagnosis and treatment leading to irreversible adverse consequences. Therefore various oncology organizations have called for a continuation of cancer care during this crisis with diligence. The COVID-19 pandemic has forced the clinicians to transform the components of care from screening to outpatient care and primary management. The purpose of this article is to establish guidelines and recommendations for ocular oncology in the management of ocular tumors set by a multidisciplinary team of experts including ocular, medical and radiation oncologists, and pathologists. As the pandemic is evolving fast, it will require constant updates and reformation of health strategies and guidelines for safe and quality health care.
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http://dx.doi.org/10.4103/ijo.IJO_1669_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574098PMC
July 2020

All India Ophthalmological Society - Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic.

Indian J Ophthalmol 2020 06;68(6):974-980

Advanced Eye Care Center, PGIMER, Chandigarh, India.

Oculoplastic surgeries encompass both emergency surgeries for traumatic conditions and infectious disorders as well as elective aesthetic procedures. The COVID-19 pandemic has brought about a drastic change in this practice. Given the highly infectious nature of the disease as well as the global scarcity of medical resources; it is only prudent to treat only emergent conditions during the pandemic as we incorporate evidence-based screening and protective measures into our practices. This manuscript is a compilation of evidence-based guidelines for surgical procedures that oculoplastic surgeons can employ during the COVID-19 pandemic. These guidelines also serve as the basic framework upon which further recommendations may be based on in the future, as elective surgeries start being performed on a regular basis.
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http://dx.doi.org/10.4103/ijo.IJO_1415_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508093PMC
June 2020

Cancer Stem Cells with Overexpression of Neuronal Markers Enhance Chemoresistance and Invasion in Retinoblastoma.

Curr Cancer Drug Targets 2020 ;20(9):710-719

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai, Tamil Nadu, 625 020, India.

Background: Retinoblastoma is a sight and life-threatening embryonal tumor in children. Though chemotherapy is the main mode of therapy, evolving resistance remains a major obstacle in treatment success. The presence of cancer stem cells (CSC) is frequently reported to be responsible for chemoresistance in multiple tumors.

Objective: Our study aims to identify the molecular factors that facilitate the chemoresistance through cancer stem cells in retinoblastoma.

Methods: We developed etoposide and carboplatin resistant retinoblastoma (Y79) cell lines by stepwise drug increment treatment, validated with MTT and TUNEL assays. Colony forming and invasive ability were studied by soft-agar colony forming and transwell assays, respectively. Similar analysis in non-responsive retinoblastoma tumors were carried out by histopathology. Finally, expression of CSC/neuronal markers and ABC transporters were examined by quantitative PCR and protein expression of neuronal stem cell markers was confirmed by Western blot.

Results: Larger colony size of resistant cells in soft-agar assay provided evidence for increased selfrenewability. Histopathology in non-responsive tumors showed poorly differentiated cells predominantly. Besides, both resistant cell lines and non-responsive tumors showed increased invasion with higher expression of neuronal stem cell markers - SOX2, NANOG, OCT4 and ABC transporters - ABCB1 and ABCC3. Increased self-renewal ability and invasion along with overexpression of stemness markers in resistant cells and tumors provide evidence for stemness driving chemoresistance and invasion in retinoblastoma.

Conclusion: We have demonstrated Neuronal stem cell/CSC markers that facilitate the maintenance of cancer stem cells. Developing therapies targeting these factors will help in overcoming resistance and improving retinoblastoma treatment.
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http://dx.doi.org/10.2174/1568009620666200504112711DOI Listing
September 2021

Antioxidant Vitamins for Cataracts: 15-Year Follow-up of a Randomized Trial.

Ophthalmology 2020 07 4;127(7):986-987. Epub 2020 Feb 4.

Francis I Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California. Electronic address:

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http://dx.doi.org/10.1016/j.ophtha.2020.01.050DOI Listing
July 2020

Phthiriasis Palpebrarum in A Psychiatric Patient.

Indian Dermatol Online J 2020 Jan-Feb;11(1):125. Epub 2019 Sep 26.

Department of Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/idoj.IDOJ_70_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001411PMC
September 2019

How can we make the most of allied health personnel?

Community Eye Health 2020 31;33(110):S11-S12. Epub 2020 Dec 31.

Senior Faculty, LAICO: Aravind Eye Care System, Madurai, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115715PMC
December 2020

Accuracy of preoperative imaging in predicting optic nerve invasion in retinoblastoma: A retrospective study.

Indian J Ophthalmol 2019 12;67(12):2019-2022

Department of Orbit and Oculoplasty, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Purpose: Optic nerve invasion is an important cause of mortality in retinoblastoma. We aimed correlate preoperative imaging and surgical histopathology findings in enucleated eyes with retinoblastoma to determine the efficacy of preoperative imaging in predicting optic nerve invasion in retinoblastoma.

Methods: A retrospective review of records of all patients undergoing primary enucleation for retinoblastoma at a tertiary eyecare system between March 2013 and December 2017 with all patients having undergone preoperative imaging, either CT scan or MRI. Data was analyzed statistically to determine the correlation between preoperative CT scan/MRI and histopathology.

Results: Totally, 97 eyes of 97 patients were included in the study who underwent primary enucleation for unilateral retinoblastoma. The average age at presentation was 27.8 months with the chief complaint being leukocoria in all the cases. 14 patients (14.43%) had evidence of optic nerve involvement in preoperative imaging. 30 patients had optic nerve invasion on histopathology (laminar and retrolaminar). Spearman's rank correlation test revealed a significant correlation between MRI findings and HP and an insignficant correlation between CT findings and HP. The CT scan had a sensitivity of 20%, specificity of 88.89%, 50% positive predictive value and 66.67% negative predictive value. MRI had a sensitivity of 40%, specificity of 93.55%, positive predictive value of 66.67% and a negative predictive value of 82.86%.

Conclusion: MRI showed significant moderate correlation with surgical histopathology for predicting optic nerve invasion in retinoblastoma whereas CT shows insignificant correlation with HPE. Therefore, we recommend MRI for predicting optic nerve invasion in cases of retinoblastoma.
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http://dx.doi.org/10.4103/ijo.IJO_1611_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896533PMC
December 2019

Combined treatment modality for phthiriasis palpebrarum.

Indian J Med Microbiol 2019 Apr-Jun;37(2):296-297

Department of Post Graduate Ophthalmology, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Phthiriasis palpebrarum (PP) is the infestation of eyelids caused by the ectoparasite Phthirus pubis, frequently misdiagnosed as allergic conjunctivitis, blepharitis or dermatitis. There is no standard treatment of choice although various treatment modalities have been described. A 6-year-old male child with PP was successfully treated with local application of 20% fluorescein solution over the eyelashes and eyebrows of both the eyes, followed by the mechanical removal of all parasites and trimming of the eyelashes from the base and application of ophthalmic ointment.
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http://dx.doi.org/10.4103/ijmm.IJMM_19_251DOI Listing
April 2020

Retinoblastoma discordance in families with twins.

Indian J Ophthalmol 2019 03;67(3):436-439

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai, India.

Retinoblastoma has an increased inheritance risk of germline RB1 mutations in offspring and siblings, especially twins. Three families, each having one retinoblastoma-affected twin, were selected for genetic analysis and DNA profiling. Germline RB1 mutations were found in all probands. DNA profiling carried on similar-looking twins of families I and II, proved them to be fraternal. This study demonstrates the importance of genetic analysis of RB1 gene for risk prediction in retinoblastoma families. It also emphasizes that DNA profiling is a mandate for genetic screening of families with twins, thus adding a new dimension in counseling of retinoblastoma.
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http://dx.doi.org/10.4103/ijo.IJO_1245_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407382PMC
March 2019

Invasive sino-orbital fungal infections in immunocompetent patients: a clinico-pathological study.

Eye (Lond) 2019 06 14;33(6):988-994. Epub 2019 Feb 14.

Department of Orbit, Oculoplasty & Ocular Oncology, Aravind Eye Hospital, Madurai, India.

Objective: Invasive sino-orbital fungal infections in immunocompetent patients are a rare clinical entity; the diagnosis and management of which is challenging. We present a large case series of invasive sino-orbital fungal granulomas in patients without pre-existing systemic immunocomprimising condition.

Design: Retrospective case series.

Participants: Twenty cases of invasive sino-orbital/naso-orbital fungal granulomas in immunocompetent individuals.

Methods: We retrospectively analyzed all patients with orbital fungal granuloma who were treated at a tertiary referral eye center in South India between January 2005 and December 2012. Histopathologic confirmation of tissue invasion by fungal elements and presence of granulomatous inflammation was established in all cases included in the study.

Main Outcome Measures: Relief of patient symptoms, resolution/no progression of disease on orbital imaging, ocular, and vision salvage were the treatment outcomes studied.

Results: Twenty patients (11 male and 9 female) were studied. Mean age of patients was 47.4 years ranging from 24-65 years. Aspergillus was the causative fungus in 18 cases while 2 were cases of mucormycosis. Surgical debulking of the orbital disease was performed in 7 patients. Exenteration was performed in 2 patients to prevent spread to the CNS. Medical therapy consisted of oral itraconazole in all patients and intravenous amphotericin B was administered in 2 patients. Average duration of medical therapy required to achieve relief from symptoms was 6-8 months. Recurrences are common and long-term follow-up is essential.

Conclusions: Orbital fungal infections are challenging in terms of both diagnosis and treatment. Debulking along with prolonged antifungal therapy seems to be effective in controlling the infection.
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http://dx.doi.org/10.1038/s41433-019-0358-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707179PMC
June 2019

Smartphone-based application improves the detection of retinoblastoma.

Eye (Lond) 2019 06 11;33(6):896-901. Epub 2019 Jan 11.

Department of Orbit, Oculoplasty and Oncology, Aravind Eye Hospital, Madurai, India.

Purpose: To improve and validate the smartphone-based leukocoria detection application so that non-ophthalmologists could make use of the smartphone for early detection of Retinoblastoma (RB) in young children without anesthesia and pharmacological dilatation of the pupil.

Methods: Two apps, MDEyeCare and CRADLE, developed for red reflex based leukocoria detection were used in iPhone 6s. MDEyeCare methodology was modified with respect to ambient lighting, the distance between camera and eye and different gazes for better performance. We analyzed totally 34 eyes of 23 RB patients and four normal children. Each of the RB patients was confirmed with clinical examination and radiological investigations.

Results: Modification in the methodology of MDEyeCare app could detect the leukocoria in early stages of RB (50% of Group B, 83% of Group C). In late stages (Group D and E), 100% of tumors were detected. The CRADLE app failed to provide adequate leukocoria detection except four late stage RB eyes. Among the 14 normal eyes (6 from unilateral RB and eight from normal children), pseudo-leukocoria was observed in three eyes only at lateral gaze even with MDEyeCare app.

Conclusion: Improved methodology in smartphone-based app enhanced the detection of RB and this may translate into better outcome after treatment with respect to vision salvage.
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http://dx.doi.org/10.1038/s41433-018-0333-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707147PMC
June 2019

What may lie beneath!

Saudi J Ophthalmol 2017 Apr-Jun;31(2):124-125. Epub 2017 Feb 28.

Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Anna Nagar, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.1016/j.sjopt.2017.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436374PMC
February 2017

Orbital melanoma with calcification: A diagnostic dilemma.

Indian J Ophthalmol 2016 Dec;64(12):932-934

Department of Pathology, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

Primary orbital melanoma is rare and has varied initial presentation. A 28-year-old female presented with proptosis and decreased vision in the left eye. Computed tomography scan showed an orbital mass with contrast enhancement and calcification around the optic nerve leading to a diagnosis of meningioma. The patient chose to be on observation. Loss of vision with an increase in proptosis was seen at 6 months follow-up. On surgical exploration, a well-defined pigmented mass was seen encasing the optic nerve. Histopathological analysis revealed a malignant melanoma. Metastatic workup was negative. Left eye lid sparing exenteration was done. A high index of suspicion is necessary in a rapidly growing suspected optic nerve sheath meningioma and a differential diagnosis including orbital melanoma be considered.
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http://dx.doi.org/10.4103/0301-4738.198849DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322711PMC
December 2016

Primary cutaneous histoplasmosis mimicking basal cell carcinoma of the eyelid: A case report and review of literature.

Indian J Pathol Microbiol 2016 Apr-Jun;59(2):227-228

Department of Orbit, Oculoplasty and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute, Madurai, Tamil Nadu, India.

We present the case of a 46 years old gentleman with longstanding ulcerative lesion of the right upper eyelid. Biopsy of the lesion revealed intracellular periodic acid-Schiff positive round to oval organisms with a surrounding clear halo suggestive of histoplasmosis. Histoplasma capsulatum specific polymerase chain reaction was positive. The patient was treated with oral antifungals and showed a prompt response to treatment. We report this rare case of primary cutaneous histoplasmosis of the eyelid in an otherwise healthy adult patient.
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http://dx.doi.org/10.4103/0377-4929.182017DOI Listing
May 2016

Trematode Fluke Procerovum varium as Cause of Ocular Inflammation in Children, South India.

Emerg Infect Dis 2016 Feb;22(2):192-200

Trematodes are recognized as a group of emerging parasites in tropical countries. We identified a trematode as a cause of ocular granulomas that developed in children who bathed in ponds or rivers in South India. DNA was isolated from patients' surgically excised granulomas and from the trematode cercariae (larvae) released by the snail Melanoides tuberculata in water in which the children bathed. Real-time and conventional PCRs were performed that targeted ribosomal DNA regions spanning the internal transcribed spacer 2 and 28S sequences of this trematode. The PCR-amplified products were subjected to bidirectional sequencing. Analysis of sequences for the granuloma samples and the trematode cercariae showed maximum sequence similarity with Procerovum varium (family Heterophyidae). Our results confirmed the etiology of the ocular infection, implicating snail vectors as environmental risk factors for ocular parasitosis.
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http://dx.doi.org/10.3201/eid2202.150051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734527PMC
February 2016

Primary canaliculitis: The incidence, clinical features, outcome and long-term epiphora after snip-punctoplasty and curettage.

Saudi J Ophthalmol 2015 Oct-Dec;29(4):274-7. Epub 2015 Sep 7.

DNB Microbiology, Aravind Eye Hospital, 1, Anna-Nagar, Madurai, Tamil Nadu 625020, India.

Purpose: To study the incidence, clinical features and outcome of primary canaliculitis with special reference to long-term epiphora after Snip-punctoplasty and curettage.

Methods: Single center, retrospective, telephonic questionnaire study. The medical records of patients who visited Orbit and Oculoplasty clinic, Tertiary Eye Hospital, India from 01 July 2011 to 31 June 2012 were analyzed. Records of the patients with primary canaliculitis were reviewed for clinical profile and management. Post-surgical patients thus identified were telephonically contacted in December 2012. Questionnaire was used to assess the postsurgical epiphora. Symptomatic patients were given clinic appointment, reassessed and managed.

Results: 2245 patients visited Orbit and Oculoplasty clinic during the study period. The incidence of primary canaliculitis was 1.4% (31 patients). The median age of the patients with canaliculitis was 65 years (range, 14-80 yrs). Sixteen patients were male. All cases were unilateral and four eyes showed both upper and lower canalicular involvement. The commonest clinical presentations were pus or concretion from punctum (28), mucous discharge (23), epiphora (18) and conjunctival injection (18). Three snip punctoplasty and canalicular curettage was performed in 30 of these patients. Twenty of the 25 available culture results were positive and streptococcus species was the most common isolated organism. Records revealed that five (22%) of these patients had persistence of symptoms. Twenty-three patients could be contacted telephonically. The median follow-up of these patients was 11 months. On telephonic communication we found that two (8.7%) patients had epiphora. Munk epiphora score in these patients was three and one respectively.

Conclusions: Incidence of canaliculitis was 1.4%. Most common isolate was streptococcus species. Snip-punctoplasty and curettage is a safe and efficacious modality of treatment of canaliculitis. Post-operative epiphora occurred in 8.7% patients.
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http://dx.doi.org/10.1016/j.sjopt.2015.08.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625122PMC
November 2015

Subcutaneous Dissemination from an Orbital Diffuse Large B Cell Lymphoma.

Orbit 2015 9;34(6):338-9. Epub 2015 Oct 9.

a Department of Obit , Oculoplasty and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology , Anna Nagar, Madurai, Tamilnadu , India and.

Secondary cutaneous dissemination from an orbital diffuse large B cell lymphoma has not been described before. The authors report an unusual case of anaplastic variant of diffuse large B cell lymphoma which primarily presented in the orbit and during the course of disease had subcutaneous dissemination.
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http://dx.doi.org/10.3109/01676830.2015.1078364DOI Listing
June 2016

Knudson's hypothesis revisited in Indian retinoblastoma patients.

Asia Pac J Clin Oncol 2015 Dec 12;11(4):299-307. Epub 2015 Aug 12.

Department of Orbit, Oculoplasty and Ocular Oncology, Aravind Eye Hospital, Madurai, India.

Aim: Retinoblastoma (RB) is the most common primary intraocular malignancy affecting children under 5 years of age. This study aims to correlate the clinical parameters with RB1 mutation in the light of Knudson's two-hit hypothesis in Indian RB patients.

Methods: We analyzed the clinical details of 73 RB patients visiting Aravind Eye Hospital, Madurai, India, between January and October 2012. Data on gender, presenting age and sign, laterality, number of tumors in each eye and family history were collected. A semi log plot was derived based on Knudson's two-hit hypothesis. Genetic analysis of RB1 was carried out to identify the two hits.

Results: The mean age at diagnosis for unilateral and bilateral cases was 24.0 ± 15.1 and 9.8 ± 11.5 months, respectively. Familial RB was seen in 13 (17.8%) patients of whom 11 were bilateral. Multiple tumors were observed more frequently in bilateral than in unilateral cases. All unilateral and bilateral patients followed the two-hit and one-hit curves, respectively, confirming Knudson's hypothesis in Indian patients. Genetic analysis identified two somatic mutations in tumor samples of sporadic unilateral cases. Among the two bilateral patients, one received the first hit from her father and the other patient developed a de novo germline mutation during early development.

Conclusion: The two-hit hypothesis has been reestablished in Indian patients. Genetic analysis of tumor samples has also complemented the statistical analysis to reaffirm the two hits in tumor development.
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http://dx.doi.org/10.1111/ajco.12401DOI Listing
December 2015

A stepwise strategy for rapid and cost-effective RB1 screening in Indian retinoblastoma patients.

J Hum Genet 2015 Sep 18;60(9):547-52. Epub 2015 Jun 18.

Department of Molecular Genetics, Aravind Medical Research Foundation, Madurai, India.

India has the highest number of retinoblastoma (RB) patients among the developing countries owing to its increasing population. Of the patients with RB, about 40% have the heritable form of the disease, making genetic analysis of the RB1 gene an integral part of disease management. However, given the large size of the RB1 gene with its widely dispersed exons and no reported hotspots, genetic testing can be cumbersome. To overcome this problem, we have developed a rapid screening strategy by prioritizing the order of exons to be analyzed, based on the frequency of nonsense mutations, deletions and duplications reported in the RB1-Leiden Open Variation Database and published literature on Indian patients. Using this strategy for genetic analysis, mutations were identified in 76% of patients in half the actual time and one third of the cost. This reduction in time and cost will allow for better risk prediction for siblings and offspring, thereby facilitating genetic counseling for families, especially in developing countries.
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http://dx.doi.org/10.1038/jhg.2015.62DOI Listing
September 2015
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