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   Table of Contents - Current issue
May-August 2018
Volume 30 | Issue 2
Page Nos. 71-157

Online since Tuesday, August 28, 2018

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“Moving on…” p. 71
VA Bastin
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Clinical applications of multicolor imaging technology in epiretinal membrane p. 72
Anantharaman Giridhar, PC Ranjith
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Biological response modifiers in Ophthalmology: New horizons, new challenges and new hopes p. 76
Kaberi Biswas Feroze
“Biologic response modifier”(BRM) treatment refers to the treatment of human diseases with a diverse group of agents which are generated from living cells, and which act on the immune system, altering the body's immune response. The principal mechanism of action of these agents includes immunomodulation, interference with cellular proliferation, and direct toxic action on cells. They are designed targeted to specific genes or protein receptors, thus making their mechanisms highly attractive as they act on individual entities in the inflammatory pathway. In ophthalmology, biological response modifiers are being studied for use in the treatment of conditions such as noninfectious uveitis, scleritis, Sjogren syndrome, ocular cicatricial pemphigoid, macular edema, idiopathic inflammatory pseudotumors, Behcet's disease, ocular surface disorders, neovascular disorders, and intraocular lymphoma to name a few. BRMs represent a novel and highly exciting mode of therapeutic intervention in some ocular conditions, especially those resistant to conventional treatment. Although newer molecules are being discovered, a lot of research is still needed to evaluate the long-term efficacy and the safety profile of these agents.
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Pediatric retinal detachment: An overview p. 87
Divya Balakrishnan
Retinal detachment is rare in children. It is different from adults in terms of its presentation, etiologies, and management. It remains a challenge to manage these cases due to delayed presentation and mostly, bilateral involvement. The various etiologies, their management and the surgical tips that is specific to each type of retinal detachment is discussed here.
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Optical coherence tomography in neurophthalmology p. 94
JK Ann, Ani Sreedhar, Rita Mary Tomy, Dona Ann Mathew
Optical coherence tomography (OCT), widely used in the management of macular disorders and glaucoma, has proved its usefulness in many neurophthalmic disorders. OCT can quantify the retinal nerve fiber layer thickness and ganglion cell layer thickness and provides an idea about the neuronal integrity of the anterior visual pathway, which cannot be picked up by routine fundoscopy. Here, we are discussing some neurophthalmic and neurologic diseases where OCT can contribute to the diagnosis, disease monitoring and can provide prognostic information.
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Quantitative and morphological analysis of endothelial cells of donor corneas p. 103
Aruna Kumari R. Gupta, Roopam Kumar R. Gupta
Aim: The aim of this study was to analyze the endothelial cell count and morphology of the endothelial cell of donor corneas using Eye Bank Specular Microscope (EBSM). Materials and Methods: Eye bank data of 100 donor corneas procured and processed between January 2016 and December 2017, at an eye bank associated with a medical college hospital were retrospectively analyzed. Endothelial cell density (ECD), coefficient of variance (CV), and percentage age of hexagonality (6A) of donor cornea were compared across different age groups, gender, and phakic status of the donor tissue. Results: The mean age of the donors was 63.53 ± 19.92 (range 15–92 years). The mean ECD of the donor cornea was 2708.93 ± 271.52 cells/mm2; the average CV was 28.37 ± 6.3; and the average percentages of hexagonal cells were 63.85%. The cell count was significantly greater in the age group of <20 years when compared to rest of the age groups. There were no significant differences between the age groups on CV and 6A. The ECD of the male donors (66%) was more than that of female donors (34%). The ECD of the phakic donors was significantly more than that of pseudophakic (PP) and aphakic (AP) donors. Conclusion: ECD is significantly greater in younger age group as compared to older age groups; however, there are no significant differences in CV and 6A. The ECD of the phakic donors was more than that of PP and AP donors. Endothelial cell analysis by EBSM alters the final grading of tissues and its subsequent utilization for corneal transplantation with good prognosis for graft survival.
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Visual outcome and complications of posterior iris-claw intraocular lens implantation: A follow-up analysis p. 107
HS Shanida, Smita Narayan, KC Rajini
Purpose: The aim of this study was to assess the final visual outcome and various complications, encountered in the posterior iris-claw intraocular lens (IOL) implantation in aphakic eyes with inadequate capsular support. Methodology: Prospective case series of 30 eyes of 29 patients who underwent posterior iris-claw intraocular lens implantation in a tertiary care center within 1 year (January 2016 to June 2017) with a follow-up period of 6 months. All patients with visually significant posterior segment problems were excluded from the study. Main outcome measures were visual acuity, anterior chamber reaction, corneal edema, the stability of IOL, and cystoid macular edema (CME) at 6 months. Results: Of the 30 eyes enrolled in the study, 24 (86.7%) eyes were taken for elective secondary implantation. Four (13.3%) eyes were for primary iris-claw implantation, where subluxated or dislocated lens was noticed preoperatively. The indications for posterior iris-claw IOL in our study were surgical aphakia (24/30), traumatic subluxation of the cataractous lens (2/30), dislocated lens (2/30), and decentered posterior chamber IOL (2/30). Postoperative mean best-corrected visual acuity (BCVA) was LogMAR 0.3. Analysis of complications showed that the most common postoperative complications were iritis (36%), corneal edema (30%), striate keratitis (26.6%), hyphema (6.66%), iris capture (6.66%), and CME (3.33%). Conclusion: Surgical aphakia is the most common indication for posterior iris-claw IOL implantation. Postoperative mean BCVA is comparable with other methods. Iritis is the most common complication. This technique is a relatively safe and easy procedure learned by postgraduate students.
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Gonioscopic features of pseudoexfoliation syndrome and its relation with glaucoma p. 112
Ebitha Kalarikkal Elias, Gargi Sathish, Vijayamma Narayaniyamma
Aim: The aim is to determine the gonioscopic features of pseudoexfoliation (PXF) and to study its relation with glaucoma as measured by intraocular pressure (IOP) and optic nerve head changes. Materials and Methods: A cross-sectional study was conducted among forty eyes with PXF at a tertiary care center in South India from March 2016 to March 2017. Corrected IOP based on central corneal thickness was recorded and gonioscopic examination was done to grade angle, detect PXF deposits in angle and grade trabecular meshwork and sampaolesi line (SL). Eyes were dilated for glaucomatous optic disc change and optical coherence tomography was done to record retinal nerve fiber layer thickness. Data were entered in Microsoft Excel and frequency of different variables was calculated. Statistical analysis was done using Chi-square test and t-test as applicable. Results: Thirteen eyes had Grade 4 pigmentation, of which seven eyes had high IOP and ten had disc damage. Seven eyes had PXF in angle with glaucomatous change in four eyes. Two eyes had occludable angle with both eyes having glaucomatous change. SL was seen in 15 eyes. Conclusion: Pigmentation of trabecular meshwork, pseudoexfoliation deposits in angle and occludable angle in gonioscopy have positive correlation with high IOP and degree of glaucomatous disc damage. This study proves the significance of gonioscopy in PXF.
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Spontaneous globe rupture in dengue: A case series p. 117
PT Jyothi, AP Farseenamol, AS Subi, Anju Emla George
Dengue is the most common mosquito-borne viral disease in humans. It has now become a major public health problem in India. Various ophthalmic manifestations are seen in dengue. Globe rupture is a very rare complication. Ophthalmologists should be aware of this complication, to suspect and intervene early in the clinical course. We report three cases of spontaneous globe rupture presented to our emergency department following dengue. This is the largest case report on the subject till date.
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Single-stage reconstruction of the upper lid after the excision of malignant melanoma p. 121
Susan Prakash Minu, Cherungottil Viswanathannair Radhadevi
The most common treatment for eyelid carcinomas is surgical resection with reconstruction of lid. Reconstructing an eyelid after excision of a lesion can be challenging because of the dynamic movement of the lid and the unique anatomic requirements of the upper eyelid. A single-stage reconstruction of the upper lid after the excision of malignant melanoma done in a female patient is reported here.
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Management of angle-closure glaucoma secondary to spherophakia: A report and brief review of treatment options p. 124
Ashish George Kuruvilla, Shilpa Elizabeth Kuruvilla
A 16-year-old girl presenting with chronic headaches had findings of high myopia, uniformly shallow anterior chambers, and spherical crystalline lenses in both eyes with elevated intraocular pressure (IOP) in the left eye. The optic discs were healthy and axial lengths were normal. Antiglaucoma medications were initiated. Inadvertent cycloplegia paradoxically aided control of pressures within 24 h. On review, gonioscopy revealed nonsynechial angle closure. Dilatation revealed no zonulodialysis or subluxation bilaterally. The edge of the lens was clearly seen. A diagnosis of bilateral spherophakia with secondary angle-closure glaucoma in the left eye was made. She underwent sequential phacoemulsification with foldable intraocular lens implantation which adequately controlled her IOPs. Identifying spherophakia when presented with high myopia, raised IOPs and shallow anterior chambers, and documenting peripheral synechiae, subluxation, and zonular weakness may prove crucial in the management of secondary angle-closure glaucoma in such cases.
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Neurosurgical strike by a coconut “shell”: A rare case of isolated internuclear ophthalmoplegia following closed head injury due to coconut fall p. 127
Vasu Kamaladevi Lathika, Tia Sebastin, Charles Kakkuzhyil Skariah
A 24-year-old female patient presented to the casualty following coconut fall on the head a few hours back with acute-onset binocular diplopia maximum on the left gaze and also on looking to the left and downward. Clinical examination revealed no external injuries, focal neurological deficits, or features of raised intracranial pressure. Computed tomography imaging was within normal limits. Hence, she was referred to ophthalmology by the neurosurgeon as a case of suspected partial third nerve palsy. Ocular examination revealed best-corrected visual acuity of 6/6 BE. There was limitation of adduction in the right eye and nystagmus in the left eye on attempted laevoversion. Convergence was absent. Anterior segment and fundus of both eyes were normal. Diplopia charting showed crossed diplopia which was maximum on left gaze. A clinical diagnosis of right anterior internuclear ophthalmoplegia (type-1) was made. It was confirmed by magnetic resonance imaging which revealed acute infarcts in the region of superior pons near right medial longitudinal fasciculus. The patient was treated with occlusion glasses.
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Persistent hypotony in cyclodialysis: When direct cyclopexy fails-role of vitrectomy p. 131
Pramod Shetty, Jacob Chacko, Joel Anthony, Krishnaprasad Kudlu
The purpose of the study was to report a case of a cyclodialysis cleft with hypotony maculopathy. A 19-year-old boy with a history of blunt ocular trauma was referred for persistent hypotony. His vision was counting fingers (CFs) at 1 m with cataract, hypotony maculopathy, inferior choroidal detachment and cyclodialysis cleft, and intraocular pressure (IOP) 6 mmHg. Optical coherence tomography revealed macular thickening with retinal folds and epiretinal membrane (ERM). He failed to respond to conservative management with atropine and steroids. Cataract surgery with pars plana vitrectomy with ERM peel and SF6 tamponade was done. After 1 month, IOP was 17 mmHg, and best-corrected visual acuity was 20/30. Vitrectomy may be effective in refractive hypotony.
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Macular hemorrhage in high altitudes traveler p. 136
Amit Mohan, Navjot Kaur
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Innovative smartphone apps for ophthalmologists Highly accessed article p. 138
John Davis Akkara, Anju Kuriakose
The first iPhone was released in 2007 and the first Android phone in 2008. Ten years later, smartphones are becoming ubiquitous. They now have more advanced sensors, cameras and more processing power, which have allowed several innovative apps to be made, which were not possible a few years ago. These apps will change the way we interact with patients and with clinical data, provide affordable and advanced testing, enhance the way we learn, and hopefully improve doctor–patient interactions. However, most of these apps are made without professional input and needvalidation before use. We try to review the current landscape of Smartphone Apps in Ophthalmology.
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SPECTRALIS optical coherence tomography in glaucoma p. 145
Smita Narayan
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Journal review p. 149
Anu Joseph
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Preparation of fortified antimicrobial eye drops Highly accessed article p. 152
Hilda K Nixon
Fortification means to intensify or strengthen the medication, to achieve adequate drug concentration. Fortified antimicrobials are not commercially available, thus should be, prepared of optimal constitution in a sterile pharmaceutical dispensary. This article provides guidelines on topical fortified therapy dosage concentration and methodology of preparation of drugs for patients with infectious keratitis. Acquaintance on fortified antimicrobial medication, its appropriate usage and timely intervention will help us to treat most of the resistant microbial keratitis and prevent the need for surgical intervention.
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Waardenburg syndrome p. 155
Anubhav Chauhan, Shveta Chauhan
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Author's reply p. 156
Neha Chauhan, Gaurav Sharma, Rajeev Tuli
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What is the diagnosis? p. 157
Natasha Radhakrishnan
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