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Murthy K.R.,Vittala International Institute of Ophthalmology | Murthy K.R.,Prabha Eye Clinic and Research Center | Murthy P.R.,Vittala International Institute of Ophthalmology | Shah D.A.,Vittala International Institute of Ophthalmology | And 3 more authors.
British Journal of Ophthalmology | Year: 2013

Purpose: To identify and compare the profile of retinopathy of prematurity (ROP) in premature babies in urban and semiurban neonatal intensive care units (NICUs). Methods: A prospective study of babies admitted to NICUs of two urban and seven semiurban centres. They were <36 weeks of gestational age and were subjected to fundus photography with a RetCam shuttle camera. Photos and NICU details were uploaded on a secure website. Photographs were read by a single observer. Infants were followed till retinal vascularisation was complete, or 45 weeks post conceptional age. Babies developing severe ROP were lasered. Results: 500 babies were screened (243, urban group; 257, semiurban group). Incidence of ROP in the urban and semiurban groups was 16.5% (40) and 14.8% (38) respectively. Mean gestational age was 30.90 weeks and 31.53 weeks respectively. Mean birth weight was 1344 g and 1375 g respectively. 28 babies were lasered, 15 and 13 from each group respectively. There was no statistically significant difference between any of the parameters compared. Level of significance was fixed at 0.05. Conclusions: The magnitude of the burden of ROP is comparable between urban and semiurban NICUs stressing the need for effective screening strategies in semiurban and rural areas as well.


Babu K.,Vittala International Institute of Ophthalmology | Kini R.,Vittala International Institute of Ophthalmology | Mehta R.,Fortis Hospitals | Philips M.,National Institute of Mental Health and Neuro Sciences | And 2 more authors.
Retina | Year: 2012

AIM: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population METHODS: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. RESULTS: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. CONCLUSION: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population. Copyright © by Ophthalmic Communications Society, Inc.


Babu K.,Vittala International Institute of Ophthalmology | Murthy K.R.,Vittala International Institute of Ophthalmology | Krishnakumar S.,Vision Research Foundation
Ocular Immunology and Inflammation | Year: 2010

Purpose: To report 2 successive ocular malignancies in the same eye of a HIV-positive patient at different CD4 counts. Materials and methods: A 36-year-old retrovirus-positive male presented with no perception of light in the left eye of 1 month duration. CD4 counts were 44 cells/mm3. Ultrasonography showed an exudative retinal detachment. Retinal biopsy suggested an intraocular B-cell lymphoma for which he received radiotherapy and chemotherapy. He presented 3 years later with a growth in the left eye with CD4 counts of 360 cells/mm3. Results: Histopathology of enucleated eye showed a low-grade conjunctival squamous cell carcinoma. At 1-year follow-up, there is no mass in the anophthalmic socket. Conclusions: This case highlights the development of 2 ocular malignancies in the same eye of an HIV-positive patient, at different CD4 counts, allowing the authors to speculate on additional factors involved in the development of the second malignancy. © 2010 Informa Healthcare USA, Inc.


Murthy K.R.,Vittala International Institute of Ophthalmology | Murthy P.R.,Vittala International Institute of Ophthalmology | Kapur A.,World Diabetes Foundation | Owens D.R.,University of Cardiff
Diabetes Research and Clinical Practice | Year: 2012

The prevalence of diabetes in developing countries is on the increase and along with it the need to provide structured care to avoid the feared long term complications among them loss of vision and blindness due to diabetic retinopathy (DR). The biggest hurdle facing most developing countries is the lack of resources and trained manpower to both screen and treat the large number of people with DR. Countries also face the additional problem of unequal distribution of resources between the urban and rural areas. To overcome these challenges models of mobile diabetic retinopathy screening and treatment aided by the use of telemedicine have been introduced and demonstrated to be popular and effective. The aim of this review article is to describe different mobile diabetic retinopathy screening and treatment models developed in India, which can be readily replicated in developing countries presented with similar difficulties. © 2012 Elsevier Ireland Ltd.


Babu K.,Vittala International Institute of Ophthalmology | Murthy P.R.,Vittala International Institute of Ophthalmology
Ocular Immunology and Inflammation | Year: 2010

Purpose: To report a rare case of Lyme disease with neuroretinitis from South India. Materials and Methods: Retrospective case report. A 45-year-old lady who hails from the Nagarhole forest in South India presented with a history of tick bite followed by diminution of vision in the left eye. Fundus evaluation of the left eye showed neuroretinitis. Mantoux test, Treponema pallidum hemagglutination test, serum angiotensin converting enzyme, and ELISA for toxoplasmosis and rickettsial infections were negative. ELISA for Lyme disease was positive for IgM antibodies. This was confirmed by Western blot test. Results: Ocular inflammation resolved with a course of doxycyline and oral steroids. The species of the tick was also identified. Conclusion: This case highlights the need to consider Lyme disease, though rare in India, in the differential diagnosis of neuroretinitis especially if the patient hails from a forest area. © 2010 Informa Healthcare USA, Inc.


Babu K.,Vittala International Institute of Ophthalmology | Babu K.,Wockhardt Hospitals | Babu K.,Prabha Eye Clinic and Research Center | Kini R.,Vittala International Institute of Ophthalmology | Mehta R.,Wockhardt Hospitals
Ocular Immunology and Inflammation | Year: 2010

Aim: To report a rare presentation of a large scleral nodule with bilateral disc edema as the initial manifestation of sarcoidosis. Materials and Methods: Retrospective interventional case report. Results: A 58-year-old woman was referred for evaluation of nodular scleritis. Slit-lamp examination showed a large scleral nodule superiorly in the right eye. Fundus showed bilateral disc edema. High-resolution computed tomography of the thorax showed mediastinal and bilateral hilar lymphadenopathy. Transbronchial lymph node biopsy showed epitheloid granulomas. The scleral nodule and disc edema resolved at 6 weeks with oral steroids. Conclusions: This case highlights a rare presentation of a large scleral nodule with bilateral disc edema as the initial manifestation of systemic sarcoidosis. © 2010 Informa Healthcare USA, Inc.


Babu K.,Vittala International Institute of Ophthalmology | Babu K.,Prabha Eye clinic and Research Center
Journal of Ophthalmic Inflammation and Infection | Year: 2013

Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the developed world. However, recent reports suggest that the disease is found in the developing countries as well. Clinical, radiological, and histopathological similarities with tuberculosis pose a great challenge in countries endemic for tuberculosis. Mantoux test, high resolution computed tomography, and transbronchial lymph node and lung biopsies are diagnostic modalities, which play an important role in the diagnosis of sarcoid. In this review, we look at the epidemiology of sarcoid in tuberculosis-endemic regions, the sarcoidosis-tuberculosis link, clinical profile, diagnostic modalities, dilemma in the diagnosis, and the treatment of this disease. © 2013 Babu.


Babu K.,Vittala International Institute of Ophthalmology | Kini R.,Vittala International Institute of Ophthalmology | Murthy K.R.,Vittala International Institute of Ophthalmology
Ocular Immunology and Inflammation | Year: 2012

Aim: To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO). Methods: Case report. Case Report and Results: A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis. Conclusions: A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report. © 2012 Informa Healthcare USA, Inc.


Babu K.,Vittala International Institute of Ophthalmology | Kini R.,Vittala International Institute of Ophthalmology | Philips M.,National Institute of Mental Health and Neuro Sciences | Subbakrishna D.K.,National Institute of Mental Health and Neuro Sciences
Ocular Immunology and Inflammation | Year: 2014

Aim: To analyze the clinic profile of polymerase chain reaction proven viral anterior uveitis in a south Indian patient population. Materials & Methods: Retrospective, nonrandomized study between January 2009 and July 2012. Results: Out of the 36 patients with polymerase chain reaction (PCR)-positive viral anterior uveitis, 24 patients had varicella zoster virus (VZV) anterior uveitis, 7 patients had HSV anterior uveitis, 3 patients had cytomegalovirus (CMV) anterior uveitis, and 2 patients had chikungunya virus related anterior uveitis. Corneal involvement was seen in 21 cases (58.33%). An altered iris pattern was seen in 14 cases (38.89%). Increase in intraocular pressure (IOP) at the time of inflammation was seen in 10 cases (27.78%). Reactivations were seen in 22 cases (61.11%). A comparison of herpes simplex virus (HSV)- and VZV-related anterior uveitis did not reveal any significant factors except for a previous history of herpes zoster in VZV-associated uveitis. Conclusion: We see isolated viral anterior uveitis related to HSV, VZV, CMV, and chikungunya viruses in our patient population. Corneal involvement, pigmented keratic precipitates, an abnormal iris pattern, increase in IOP, and reactivations are seen as a spectrum of viral anterior uveitis in our patient population as well. © 2014 Informa Healthcare USA, Inc.


PubMed | Vittala International Institute of Ophthalmology
Type: Journal Article | Journal: Retinal cases & brief reports | Year: 2014

To report an interesting ocular finding and course of bilateral arteritis with cytomegalovirus retinitis in a patient infected with the human immunodeficiency virus (HIV).Retrospective single case report.A 39-year-old HIV-positive man on highly active antiretroviral therapy presented with a history of diminution of vision in both eyes of 1-month duration. Fundus examination showed vitritis, sheathing, and a cordlike appearance of the arteries with veins unaffected in both eyes. A patch of cystomegalovirus retinitis was noted temporally in the right eye. Fluorescein angiography showed gross areas of capillary nonperfusion in both eyes. Polymerase chain reaction of the aqueous tap was positive for cytomegalovirus in both eyes. Despite aggressive treatment with intravitreal ganciclovir followed by a course of intravenous ganciclovir, the right eye progressed to neovascularization, vitreous hemorrhage, neovascular glaucoma, and no perception of light. Segmentation and recanalization of arteries were noted in the left eye. Immune recovery uveitis developed in the left eye after 2 months and was treated with oral steroids and intravenous ganciclovir followed by a maintenance dose of valganciclovir. At 3 years follow up, his vision and ocular condition in the left eye is stable.An interesting finding of bilateral arteritis with cystomegalovirus retinitis in an HIV-positive patient is reported. The arteritis did not respond very well to intravitreal ganciclovir and required a course of intravenous ganciclovir. Early treatment with intravenous ganciclovir and laser photocoagulation in such cases may reduce visual morbidity.

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