Toxic epidermal necrolysis (TEN) is associated with a significant mortality of 30–50% and long-term sequelae. Treatment includes early admission to a burn unit, where management with precise fluid, electrolyte, protein, and energy supplementation, moderate mechanical ventilation, and expert wound care can be provided. Specific treatment with immunosuppressive drugs or immunoglobulins did not show an improved outcome in most studies and remains controversial. We have treated the cutaneous lesions of seven patients of TEN with collagen sheet dressings and have found a significant reduction in morbidity. The sheets are a one-time dressing, easy to apply and they reduce fluid loss, prevent infection, reduce pain, avoid repeated dressings and gradually peal off as the underlying lesions heal.
Objective: Diabetic macular edema (DME) is the major cause of vision loss in patients with diabetic retinopathy (DR). The purpose of this study was to assess the prevalence of DME in pre diagnosed Type II diabetes mellitus cases, to analyze DME pattern based on Optical Coherence Tomography (OCT) images and to correlate it with glycemic control. Methods: In cross sectional study, 200 eyes of 100 pre diagnosed type II diabetes mellitus cases were examined for DR, DME and OCT was performed to look for central macular thickness. Result: 200 eyes were examined, 95 of them were diagnosed to have DR and 19 eyes were diagnosed to have DME. Three characteristics were found in the images of OCT in cases with DME: Diffuse retinal thickening in 9 eyes(42.4%), cystoid macular edema in7 eyes(36.8%) and serous retinal detachment in 3(15.8%). Statistical analysis showed that there was positive correlation of prevalence of DME with poor glycemic control (p<0.046), duration of diabetes (p<0.013), and severity of DR (p<0.000) but not with pattern of DME. There was statistic significance between central macular thickness and increasing grade of DME (p<0.000). Conclusion:The prevalence of DME is 9.5% in type II diabetes mellitus cases in this study. Prevalence is correlated with DR severity, duration of diabetes, and poor glycemic control. Three patterns of DME are demonstrated with OCT images. The macular thickness is correlated to severity of DME.
Toxic epidermal necrolysis (TEN) is associated with a significant mortality of 30–50% and long-term sequelae. Treatment includes early admission to a burn unit, where management with precise fluid, electrolyte, protein, and energy supplementation, moderate mechanical ventilation, and expert wound care can be provided. Specific treatment with immunosuppressive drugs or immunoglobulins did not show an improved outcome in most studies and remains controversial. We have treated the cutaneous lesions of seven patients of TEN with collagen sheet dressings and have found a significant reduction in morbidity. The sheets are a one-time dressing, easy to apply and they reduce fluid loss, prevent infection, reduce pain, avoid repeated dressings and gradually peal off as the underlying lesions heal.
The aim of our study is to evaluate the intraocular pressure changes after Nd:YAG posterior capsulotomy. For the purpose of this study, 220 out of the initially enrolled 253 subjects with visually significant posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy and subsequent monitoring of intraocular pressure (IOP) immediately after the procedure and then 3 hours and 1 day after the procedure. We found that there was a significant fall in the mean intraocular pressure (IOP) was observed immediately post procedure on comparing with the pre-procedure levels (15.25 ± 2.46 mmHg), with mean change from the baseline being-0.55 (p=0.024), following a rise in IOP, peaking at 3 hours at an average of with a mean positive change from the baseline being 0.42 although the change was not significant (p=0.070). On repeating the IOP after 1 day we found that the IOP tended to return towards the baseline values i.e. the pre-procedure values, with the mean deflection from the baseline being only 0.09. More patients with higher grade [Grade III (p=0.001) & Grade IV (p=0.008)] required significantly higher energy for capsulotomy as compared to the lower grades [Grade I (p <0.001) & grade II (p=0.015)]. There was a greater fall in IOP from the baseline when lesser amount of energy was used and the association was highly significant (p=0.02; F= 5.134) and 3 hours after the capsulotomy, we found that the rise in IOP from the initial fall was higher when higher amount of energy was used and this difference was highly significant (p<0.001). We concluded from the study that there was an immediate fall in IOP followed by a spike at 3 hours but the IOP tended to return to normal baseline values after 1 day and the rise in IOP was proportional to the amount of energy used. Hence, we recommend the use of long acting topical IOP lowering agent immediately post capsulotomy before the patient is discharged.
Introduction: Peculiar case of a tuberculoma in the midbrain, leading to superior oblique and inferior rectus palsy along with a moderate degree of ptosis of the right eye. Presenting features: 5 year-old female patient with complaints of fever, drooping of the right upper eyelid and uprolling of the right eye. 15 degree Hypertropia of the right eye with head tilt on the left side. The pupils showed sluggish reaction. Total restriction of ocular movements in the downward gaze suggesting the under action of the superior oblique and inferior rectus muscle. Moderate degree of unilateral ptosis. Vertical diplopia in downward gaze. Investigations: Cranial MRI with Intravenous contrast revealed a well-defined enhancing lesion measuring about 10 × 8 mm with small non-enhancing area noted within with significant edema in the midbrain. Presence of a tuberculoma in midbrain involving the trochlear nerve nucleus, the dorsolateral and central nucleus of the occulomotor nerve. Discussion: Partial fascicular oculomotor palsy leading to isolated inferior rectus palsy caused by midbrain infarction suggesting the possible selective involvement of an individual fascicle. Compression of the central caudal nucleus of the occulomotor nerve by the edema present around the tuberculoma gives rise to moderate ptosis in the patient. Patient received anti tubercular treatment. The improvement of the ocular symptoms after one month of anti-tubercular treatment confirmed the finding of a tuberculoma.
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