Background The study was conducted to assess the impact of a workshop intervention designed to enhance presentation skills of ophthalmology fellows. Methods A 10-hour workshop was conducted for ophthalmology trainees. Trainees were invited via email to participate by preparing a five-minute slide presentation and presenting it in person. Trainees from the fellowship 2022 batch (19 females and ten males) were included in the study. Participants completed a self-rating questionnaire to assess improvement in their presentation skills at different time points: Pre-Workshop (after introduction), During the Workshop (after trainee presentation), End-Workshop Intervention (after conclusion of all presentations), and Post-Workshop (scope of improvement). The self-rating questionnaire utilized a ten-point rating scale (1–10) and evaluated properties and content (PC) and soft skills (SS). Data were analysed using SPSS software. Friedman and post-hoc tests compared self-ratings at four time points. Statistical significance was set at p-value < 0.05. Results The self-rating scores indicated presentation skills PC and SS significantly (Friedman Test, p<0.001) improved at the post-workshop self-rating (PC4 and SS4) compared to earlier time points (PC1, PC2, PC3 and SS1, SS2, SS3). Conclusions Presentation skills empower medical professionals to better communicate with diverse audiences, demonstrating their currency in medical knowledge, lobbying for correct understanding, and bringing praxis to pedagogy. The findings support the integration of similar workshops into medical curricula to foster well-rounded medical professionals.
A 40-year-old woman presented with sudden painless diminution of vision in left eye. The best corrected visual acuity was 20/20 in the right eye and 20/400 in the left eye. The vision loss occurred 3 days after the onset of fever with chills and rigour. Rapid diagnostic test and peripheral blood smear examination revealed Plasmodium falciparum malaria. The left eye fundus showed a pale disc with marked attenuation of arterioles. A detailed systemic evaluation including cardiovascular, haematological and angiographic assessments was performed which did not reveal any abnormality. A diagnosis of central retinal artery occlusion (CRAO) associated with uncomplicated P. falciparum malaria was made. In this communication, we report that acute loss of vision in a patient with P. falciparum malaria, CRAO needs to be ruled out.
To report a novel clinical sign in patients with intraocular tuberculosis. The current study is an observational consecutive case series of patients diagnosed with intraocular tuberculosis managed at a tertiary eye care centre from June 1, 2012 to December 31, 2015.The diagnosis of intraocular tuberculosis was made in 6 patients based on ocular features suggestive of tuberculosis along with a positive tuberculin skin testing and chest X-ray consistent with tuberculosis. All patients presented with decreased visual acuity ranging from 20/25 to 20/400, anterior chamber reaction, vitritis, multifocal choroiditis and vasculitis. All patients had an area of active chorioretinitis within the zone of pre-existing chorioretinal atrophy, apart from various other signs suggestive of intraocular inflammation. All patients were started on anti-tubercular therapy for a period of 9 months alone or in combination with oral corticosteroids tapered over 3-4 months. A prompt response to the treatment with resolution of chorioretinitis within the chorioretinal atrophy occurred in all patients. In addition, there was resolution of vitritis and improvement in the visual acuity ranging from 20/20 to 20/40 at last follow-up.Active chorioretinitis within an area of chorioretinal atrophy is a novel clinical sign that may indicate intraocular tuberculosis.
Purpose: The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. Design: Retrospective, interventional, multicentric case series. Methods: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed. Results: The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3–76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5–40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02). Conclusions: Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.
AS-OCT features of two anterior uveitis cases are described. Case 1: [Fig. 1a] Iris pigments on anterior lens capsule appeared as bright hyperreflective lesions with backshadowing [Fig. 1b], and inferior fibrin appeared as a horizontal homogenous hyperreflective lesion [Fig. 1c]. Sunray-like artifact is denoted by asterisk sign at the edge of pupillary border.Figure 1: (a) Case 1 slit-lamp photograph depicting the presence of iris pigments on anterior lens capsule (mustard arrow) and inferior fibrin (yellow arrow), which on anterior segment optical coherence tomography (AS-OCT) appeared as a bright hyperreflective lesion with backshadowing ((b) mustard down arrow) and as a homogenous hyperreflective lesion in the anterior segment cavity ((c) yellow arrow). (d) Case 2 slit-lamp photograph depicting the presence of keratic precipitates on anterior lens capsule (mustard arrow) and inferior berlin nodule (yellow arrow), which on anterior segment optical coherence tomography (AS-OCT) appeared as a dull hyperreflective lesion with less prominent backshadowing ((e) mustard down arrow) and as a heterogenous hyperreflective lesion in anterior segment cavity ((e) yellow arrow) with central vacuoles-like appearanceCase 2: Keratic precipitates appeared as round, blobby dull hyperreflective lesions with indistinct backshadowing and the iris nodule as a heterogenous structure with central vacuoles [Fig. 1d and e]. Keratic precipitates have dull hyperreflectivity and backshadowing compared to iris pigments, which have bright hyperreflectivity on AS-OCT. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Purpose: To describe clinical presentations and comparative outcomes of primary versus deferred intraocular lens (IOL) explantation in delayed-onset endophthalmitis. Methods: In this retrospective study, a total of 77 eyes of 77 patients that were diagnosed clinically as delayed-onset endophthalmitis and underwent IOL explantation from January 1990 to January 2018 were included undiluted vitreous biopsy and IOL were subjected to microbiologic evaluation. Duration of symptoms, presenting visual acuity, organisms isolated, time to IOL explantation, time to endophthalmitis, resolution after explantation, number of repeat intravitreal injections, and final visual acuity were compared in the primary and the deferred IOL explantation groups. Results: There were primary and deferred IOL explantations. Interval between inciting event and endophthalmitis, between onset of symptoms to presentation, total follow-up, complication rate, and final visual acuity was comparable between the two groups. Median time to IOL explantation in the deferred group was 70 days. Between the primary and deferred IOL explantation groups the number of repeat intravitreal injections was 0.58 ± 0.86 and 2.62 ± 1.78 respectively, (P < 0.0001, 95% confidence interval, CI 2.00–2.22); the number of days to resolution after IOL explantation was 35.16 ± 14.26 and 55.5 ± 8.24 respectively, (P < 0.0001, 95% CI 15.22–25.45). Conclusion: Early IOL explantation in delayed-onset endophthalmitis causes faster clinical resolution and reduces the number of repeat intravitreal injections. Final visual improvement, however, may be unaffected.
Purpose: To report an outbreak of endophthalmitis in three eyes of two patients following intravitreal methotrexate, caused by Ralstonia pickettii . Design: Retrospective, noncomparative, consecutive case series. Methods: Medical records and microbiology results of two patients who presented with acute endophthalmitis following intravitreal methotrexate injection in November 2013 were reviewed. Results: Following intravitreal injections, the patients experienced pain and decrease in vision in the affected eye within 24 hours of receiving intravitreal methotrexate injection. The presenting visual acuity in case 1 was 20/50 in the left eye. The presenting visual acuity in case 2 was hand motions in the right eye and counting fingers at 1 m in the left eye. Both the patients received methotrexate prepared in the same manufacturing facility. Both the patients underwent vitreous biopsy and intravitreal injection of vancomycin 1 mg/0.1 mL, amikacin 400 µg/0.1 mL, and dexamethasone 400 µg/0.1 mL. Microbiology cultures from vitreous, and used and unused vials of methotrexate from the same batch grew R. pickettii . After 8 months of follow-up, both the patients had visual acuity 20/60 or better. Conclusion: R. pickettii can be rarely associated with outbreak of endophthalmitis. Timely intervention can be associated with good visual outcome in such patients. Keywords: Ralstonia pickettii , intravitreal injection, intravitreal methotrexate
A 41-year-old female presented to us with blurred vision in both eyes for the past 3 months. She was a known hypertensive and was treated for malignant hypertension in the past. She was diagnosed as hypertensive retinopathy with choroidopathy. Multiple hypopigmented linear streaks (Siegrist streaks) within the arcade and in the form of islands outside the arcades were noted. Fundus autofluorescence was performed to understand and classify the appearance and resolution of these streaks. Herein, we report the role of autofluorescence in describing Siegrist streaks secondary to hypertensive choroidopathy.
Abstract Background The objective of this study was to evaluate the microbiologic spectrum and antimicrobial susceptibility of isolates in post-traumatic endophthalmitis and compare with our earlier published report. A retrospective review was conducted on 581 consecutive patients with culture-proven post-traumatic endophthalmitis at L. V. Prasad Eye Institute, India, from January 2006 to March 2013. Findings A total of 620 isolates from 581 patients were identified (565 bacteria and 55 fungi). The most common isolate was Bacillus spp. (106/620, 17.1%) closely followed by Streptococcus pneumoniae (105/620, 16.9%), and coagulase-negative Staphylococci (97/620, 15.6%). In our earlier report, the commonest bacteria included Streptococcus spp. (30/139, 21.6%) and gram-positive coagulase-negative micrococci (26/139, 18.7%). Gram-positive isolates were usually susceptible to vancomycin (98.2%). Gram-negative isolates were generally susceptible to gatifloxacin (92.9%), ofloxacin (89.4%), chloramphenicol (88.6%, Pseudomonas isolates were often resistant), amikacin (83.5%), and ceftazidime (77.2%). Fourteen years ago, the most sensitive antibiotic was ciprofloxacin for both gram-positive bacteria (95.12%) and gram-negative bacteria (100%). Conclusions The microbiological spectrum of post-traumatic endophthalmitis has remained unchanged over the last 14 years, and Bacillus spp. continues as the most common infecting organism. Vancomycin is the drug of choice for empiric coverage of gram-positive bacteria. Susceptibility of gram-negative bacteria to commonly used antimicrobials (amikacin and ciprofloxacin) has decreased by 10% - 15% and to ceftazidime has increased by 10.5%.
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