Purpose: The aim of this work was to study the demographic profile, clinical diagnostic features, challenges in management, treatment outcomes, and ocular morbidity of microbiological culture-proven Pythium keratitis in a tertiary eye care hospital in South India. Methods: Retrospective analysis of microbiologically proven Pythium keratitis patients was performed at a tertiary eye center from October 2017 to March 2020. Demographic details, risk factors, microbiological investigations, clinical course, and visual outcomes were analyzed. Results: Thirty patients were analyzed. The mean age was 43.1±17.2 years. Most common risk factors were history of injury in 80% and exposure to dirty water in 23.3%. Visual acuity at baseline was 20/30 to perception of light (PL). The most common clinical presentation was stromal infiltrate and hypopyon in 14 (46.6%) patients each. The microbiological confirmation was based on culture on blood agar and vesicles with zoospores formation with incubated leaf carnation method. Seven (23.3%) patients improved with topical 0.2% Linezolid and topical 1% Azithromycin, 19 (63.3%) patients underwent Therapeutic keratoplasty (TPK) and 4 were lost to follow-up. Seven (23.3%) patients had graft reinfection, and 3 (10%) developed endophthalmitis. The final visual acuity was 20/20- 20/200 in 6 (20%) patients, 20/240-20/1200 in 5 (16.6%) patients, hand movement to positive perception of light in 16 patients and no perception of light (Pthisis Bulbi) in 3 (10%) patients. Conclusion: P. insidiosum keratitis is a rapidly progressive infectious keratitis with prolonged and relapsing clinical course. It usually results in irreparable vision loss in majority of the patients. Prompt diagnosis, clinical awareness, and specific treatment options are needed for successfully managing this devastating corneal disease.

Purpose: Pythium insidiosum causes a rare sight-threatening keratitis and is a devastating ocular pathology with a high morbidity. It is frequently mistaken as fungal keratitis. Here we highlight a rare case of pediatric Pythium insidiosum keratitis which was successfully managed using an antibiotic combination of linezolid and azithromycin with cyanoacrylate glue. Case description: A 9-year-old young male child presented to our clinic with defective vision, pain, redness in the right eye for 5 days post stick injury. In the right eye, Snellen’s best-corrected visual acuity (BCVA) was 6/12 which deteriorated to hand movements within 5 days of treatment. Ocular examination revealed 6 × 5 mm dry-looking mid stromal corneal infiltrate with feathery margin involving the visual axis. The clinical picture was suggestive of fungal keratitis. Corneal scraping and smear examination with 10% KOH and Gram stain revealed long slender hyaline hyphae with sparse septations. Before the culture result, the patient was started on 5% Natamycin and 1% Itraconazole hourly, but still, the infiltrate progressed. Further, P. Insidiosum keratitis was considered as the differential, which was confirmed on blood agar culture. After receiving culture results, the patient was managed with 0.2% Linezolid and 1% Azithromycin hourly. Due to the rapid progression of infiltrate, corneal melt, and younger age, cyanoacrylate glue, and bandage contact lens were used. On the last follow-up, the BCVA recovered to 6/12. Conclusion and importance: Prompt diagnosis, clinical awareness, and a specific treatment regime is needed for managing this devastating corneal entity. Cyanoacrylate glue due to its antibacterial properties can be a potential rescuer and can be considered for managing these cases.

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Background: Levobupivacaine has increasingly been used in the clinical anesthesia practice since last few years because of its safer pharmacological profile. Literary evidence has established the safety of levobupivacaine over bupivacaine when used in regional anesthesia as the incidence of various adverse outcomes is higher with the latter as compared to levobupivacaine. Aim: Comparative evaluation of Epidural Levobupivacaine and levobupivacaine with fentanyl for pediatric abdominal surgeries. Methods: Sample size of 50 patients in pediatric age group between 8 years to 13 years of ASA Grade I coming for abdominal surgeries were included. Patients are randomly selected and allocated into two groups. Group LN [N=25] received 0.25% of levobupivacaine and 0.5ml of normal saline, Group LF [N=25] received 0.25% of levobupivacaine + 1 μg/kg of fentanyl. Results: Levobupivacaine with fentanyl group onset of sensory block was 14.2 ± 1.155. Levobupivacaine with normal saline onset of sensory block was 14.72 ± 1.542. The onset of motor blockade in 0.25% levobupivacaine with normal saline was mean 19.56 ± 1.71. At the same time motor blockade of 0.25% levobupivacaine with fentanyl was mean 18.64 ± 1.72. Level of blockade of both LF and LN groups are comparable but not significant. Duration of Anesthesia for LF was 84.4 ± 17.5, LN group was 79.6 16.7. Duration of Analgesia for LF group was 11.2 ± 0.39 and LN group was 10.94 ±0.37. Conclusion: This study showed that combining lower dose levobupivacaine with fentanyl and sufentanil provides faster onset of sensorial block, lower frequency and shorter duration of motor block, and longer analgesia time in TURP under spinal anesthesia.