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Cataract is defined as opacification of the human crystalline lens. It is      drugs (anticonvulsant, steroid) and natal or prenatal infections with
the most common cause of treatable blindness and it was treated in 6th         TORCH group are other common causes.
century BC by Indian physician, Sushruta when couching was done to
restore the vision.                                                            The long list of systemic diseases – diabetes, atopic dermatitis,
                                                                               galactosemia, Wilson's disease and galactokinase deficiency, etc.
The name 'Cataract' is derived from the Latin word 'cataracta' which           also are implicated.
means waterfall because the vision becomes hazy (as if like seeing
through a waterfall).                                                          Ophthalmic factors include trauma (blunt or penetrating injuries to eye)
                                                                               and eye diseases like anterior uveitis, high myopia, retinitis pigmentosa.
The most common etiology is due to age in which oxidative stress
hampers the normal metabolism of lens and makes it opaque.                     Symptoms of cataract includes diminution in quality and quantity of vision
                                                                               which comprises blurring, glare in sunlight or night driving, decrease in
It can be congenital or infantile where some disturbance to the normal         colour saturation and contrast sensitivity.
development occurs. Maternal factors like smoking, alcohol intake and
                                                                               The treatment of cataract is only surgical by removing the opacified lens
                                                                               and putting an artificial intraocular lens.

                                                                               In the past few decades there have been major advancements in cataract
                                                                               surgery. We have come a long way from couching in ancient times to
                                                                               femtosecond laser assisted phacoemulsification in modern times.
                                                                               Intraocular lens are also drastically improved and now we have a whole
                                                                               plethora of lenses from non-foldable
                                                                               to microincision lens, monocular, toric,
                                                                               multifocal and aspheric. The goals
                                                                               of the surgery have also changed
                                                                               from restoration of vision to gaining
                                                                               unaided normal vision with minimum
                                                                               post-operative recovery time.

                                                                                Dr. Neha Rathi

                                                                               Mohan Eye Institute


TOXOPLASMIC CEREBELLITIS                                                       A repeat MRI showed new multiple ring enhancing lesions in medulla,
                                                                               thalami, cerebellar vermis and in the body of corpus callosum. All previous
A young 42-year-old male, resident of Nepal got admitted on 12th October,      lesions showed increase in size and edema meningeal enhancement of
2016 with complaints of headache for 1 month duration, dizziness since         tentorium cerebelli.
20 days, occasional fever off and on, difficulty in walking since 1 week and
inability to sit or stand for 2-3 days. He was conscious, oriented, with mild  Meanwhile, he tested positive for HIV serology and the CD4 count was
dysarthria and gaze evoked nystagmus right > left. The power was 4/5 in        found to be 59. Additionally, the Toxoplasma serology was strongly positive
all limbs and plantars were bilaterally flexor type. On testing, he showed      with IGg titres > 250iu/ml .
marked intentional tremors in both hands, incoordination on finger nose
testing, severe truncal ataxia in the form of head titubation, swaying on      He was started on trimethoprim and cotrimoxazole and he started
both sides and unable to sit unsupported.                                      improving the very next day, remained stable on ventilator, fully conscious
                                                                               and responding well. However, he continued to have nystagmus on
MRI (Brain) showed multiple nodular and ring enhancing granulomas              right gaze with paresis of left gaze, right ptosis and marked limb ataxia
in cerebellum vermis and both hemispheres, bilateral thalami. CSF              persisted in spite of initial good response. He was finally extubated on
examination showed 14 cells which were lymphomononuclear and initial           27th October, 2016. The pre-treatment and post-treatment scans are given
tests for Cryptococcus as well as mycobacterium were not contributory.         to highlight the efficacy of timely treatment.

He was started on antitubercular treatment initially but his condition
worsened. He became drowsy, with severe dysarthria, ataxia and difficulty
in swallowing and breathlessness requiring ventilatory support.

Prior to starting the treatment  After treatment for 15 days

                                                                               Dr. Dinesh Sareen

                                                                                   MBBS, MD, DM (Neuro)
                                                                                          Sr. Consultant,
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