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   Table of Contents - Current issue
Coverpage
January-April 2018
Volume 30 | Issue 1
Page Nos. 1-69

Online since Thursday, June 7, 2018

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EDITORIAL  

The only constant thing in life is change… p. 1
VA Bastin
DOI:10.4103/kjo.kjo_37_18  
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GUEST EDITORIALS Top

Community Ophthalmology: Is it still relevant in our country? p. 2
S Tony Fernandez
DOI:10.4103/kjo.kjo_21_18  
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Journey in uveitis through 28 years p. 5
Jyotirmay Biswas
DOI:10.4103/kjo.kjo_13_18  
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MAJOR REVIEWS Top

Angle-closure glaucoma p. 12
Lakshmi Sravani Mandava, Ganesh V Raman
DOI:10.4103/kjo.kjo_23_18  
In India primary angle closure disease comprises approximately fifty percent of primary glaucoma. It is the leading cause of blindness from glaucoma. Appropriate identification and institution of therapy can prevent long term morbidity from this disease. The use of Pilocarpine and the application of laser iridotomy early in the treatment of angle closure glaucoma has to be underscored. Long term prognosis depends upon identification of the variety of presentations and appropriate use of medical and laser and surgical therapy to maintain a good quality of life for the patients. Family screening plays an important role in detecting new patients at an early stage of the disease.
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The art of retinoblastoma management - Curable yet challenging p. 17
Fairooz P Manjandavida, Shaifali Chahar
DOI:10.4103/kjo.kjo_26_18  
Retinoblastoma (RB) is the most common intraocular childhood malignancy, and it is considered potentially fatal if untreated. The management of RB has undergone a tremendous leap in the past four decades, with a global effort to save life along with eye and vision. Despite the on-going genetic and clinical research, there is a lack of clinical expertise and understanding of optimal management as it is customized and has to be tailored individually depending on various factors. In this review, we explore the management of RB and various chemotherapeutic alternatives using intravenous chemotherapy and the newer modalities such as intra-arterial and intravitreal chemotherapy in combating this deadly but curable disease. The strategy of management is challenging and mainly depends on the stage of the disease and tumor laterality.
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ORIGINAL ARTICLES Top

Optical coherence tomography characteristics in eyes with optic disc pit with or without maculopathy p. 28
Dhileesh P Chandrasekharan
DOI:10.4103/kjo.kjo_11_18  
Purpose: The purpose of this study is to study the optical coherence tomography (OCT) characteristics of optic disc pit with or without maculopathy and to validate the mechanism of fluid passage from the optic disc pit to the macula. Materials and Methods: The medical records of 28 patients (28 eyes) with the diagnosis of optic disc pit were reviewed. Clinical features that were studied included the duration of visual impairment, initial visual acuity, and associated fundus features. OCT characteristics including the presence or absence of macular changes, communication with pit, layer (s) of retina involved in schisis, and presence of serous macular detachment (SMD) were noted. Results: The mean age of the patients was 35.32 years. The mean best-corrected visual acuity (BCVA) at presentation was 0.814 ± 0.684 (log of the minimum angle of resolution). Ten of the 28 eyes (35.7) had combined outer and inner layer schisis with no SMD, whereas 6 eyes (21.4%) had combined outer and inner layer schisis with SMD. Four eyes had outer layer schisis only and two eyes presented with outer layer schisis and subretinal fluid. One eye had inner layer schisis alone and one eye had atrophic macula with no schitic changes. Four eyes had no evidence of any maculopathy on OCT. Communication between the schitic cavity to the gap in the lamina cribrosa at the level of the optic pit could be demonstrated on enhanced depth imaging (EDI-OCT) in 14 eyes. The OCT characteristics between the eyes with BCVA >6/12 (Group A) and <6/12 (Group B) were compared. Outer layer retinoschisis was seen in six eyes in Group A compared to 14 eyes in Group B. This was statistically significant (P = 0.044, Fisher's exact test). Mean central macular thickness was 414.5 ± 136.84 μm in Group A and 746.37 ± 433.9 μm in Group B. The difference was statistically significant (P = 0.023, Mann–Whitney U-test). Conclusion: This study validates the hypothesis that cerebrospinal fluid could be the source of fluid in optic disc pit maculopathy as a communication could be demonstrated between the schitic cavity to gap in the lamina cribrosa could be demonstrated on EDI.
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Demographic profile of newly detected refractive errors among schoolgoing children in Thrissur district of Kerala p. 32
Sanitha Sathyan, Melanie Unnikrishnan, Anciya Kunjachan, KP Praseetha, Neethu Santy, Dona Wilson, Annie John, Merin Paul, Josni Jose
DOI:10.4103/kjo.kjo_19_18  
Aim: This study aims to analyze the demographic profile of newly detected refractive errors among schoolgoing children in Thrissur district of Kerala. Materials and Methods: In this population-based cross-sectional study, 91,628 schoolgoing children between 6 and 17 years of age, from Thrissur district of Kerala were evaluated through school screening programs conducted at the respective schools. Demographic and clinical profiles of refractive errors among children with newly prescribed spectacles were analyzed. Statistical Analysis: Demographic data were represented as bar charts and pie diagrams. Subgroup analysis for type for the influence of age, sex, and rural–urban location on the pattern of refractive error was analyzed using odds ratio. Results: Out of the total 91,628 schoolgoing children, 1079 (1.18%) were newly prescribed with spectacles. Out of these, 549 (50.80%) were boys and 530 (49.20%) were girls. Myopic astigmatism was the most common refractive error (68.30%) in all the age groups taken together and individually. Simple myopia was seen in 13.81%, hypermetropic astigmatism in 13.07%, mixed astigmatism in 3.89%, and simple hypermetropia in 1.20% newly prescribed cases. In the 10–12 year age group, there was a significantly higher chance of occurrence of refractive errors of all types among the rural children in comparison to their urban counterparts. In the 6–9 years' age group, there was a significantly higher chance of occurrence of hypermetropia, hypermetropic astigmatism, and mixed astigmatism among the rural children when compared to the urban children. Conclusion: Prevalence of spectacle use was less than the need for spectacle correction among schoolgoing children in Thrissur district of Kerala. As the prevalence of uncorrected/undercorrected refractive errors was more among the rural upper primary and lower primary school children, targeted strategies to address this deficit in service delivery need to be formulated.
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Role of overminus therapy in intermittent exotropia Highly accessed article p. 38
Sharika Erikapatil Mangad, Leila Mohan, MS Vijayalakshmi, Padmaja Krishnan, Shruthi P Babu
DOI:10.4103/kjo.kjo_7_18  
Aim: The aim is to study the change in Newcastle Control Score (NCS) and angle of deviation after a trial of overminus therapy in intermittent exotropia (IXT). Context: Overminus therapy in IXT. Settings and Designs: This prospective observational study was conducted at Comtrust Eye Hospital, Calicut, Kerala, which is a tertiary eye care center from July 2015 to May 2017. Materials and Methods: Fifty-three children with IXT, aged 1–5 years, were recruited. NCS scores and angle of deviation were recorded. Treatment was instigated with the minimum minus lens required to achieve control of the manifest deviation. NCS and angle of deviation were recorded with the overminus glasses at 6 weeks, 6 months, and 1 year. Statistical Analysis: Data were tabulated and analyzed using the SPSS software (SPSS statistics for Windows 17.0 Chicago, SPSS Inc). Paired t-test was used to compare change in NCS and angle of deviation before and after treatment. P < 0.05 was taken as statistically significant. Results: Fifty-three children were recruited, 31 females and 22 males with a mean age of 3.6 ± 1.633 years. Majority were of the basic type of IXT. The NCS at 1 year showed significant reduction from baseline values. At 1 year, 27% patients had the same NCS as baseline, 32% showed a reduction by 1, 21% reduced by 2, and 5% showed a reduction by 3 in the total score. The angle of deviation with the overminus for both distance and near also showed significant reduction. Conclusion: This study showed definite improvement in control of IXT with overminus, and hence, a trial of overminus therapy is recommended for IXT in children below 5 years, as surgery has its own side effects like overcorrection, leading to consecutive esotropia with loss of stereopsis and high amount of recurrence.
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CASE REPORTS Top

Double trouble: Bilateral spontaneous posterior dislocation of cataractous lens p. 43
Seshadri J Saikumar, Anup Manju, M Varghese Leena, Jayasree Lakshmi
DOI:10.4103/kjo.kjo_1_18  
Subluxation or dislocation of clear or cataractous lens occurs commonly following ocular trauma or in association with systemic or other ocular risk factors. Spontaneous dislocation of lens in the absence of any of these risk factors is very rare. We report a case of bilateral spontaneous posterior dislocation of cataractous lens in a 64-year-old man who was on long-term antipsychotic medications with no preceding history of trauma or other risk factors. Simultaneous bilateral pars plana vitrectomy with lensectomy and glued scleral fixated intraocular lens implantation was done under general anesthesia, following which he had a good visual recovery.
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An unusual case of Waardenburg syndrome in a female child p. 46
Neha Chauhan, Gaurav Sharma, Rajeev Tuli
DOI:10.4103/kjo.kjo_15_18  
Ocular albinism is characterized by congenital nystagmus, reduced visual acuity, hypopigmentation of the iris pigment epithelium and the ocular fundus and foveal hypoplasia. We report a case with clinical manifestations consistent with the phenotypes of WS1. The differentiating feature from uniocular albinism is the presence of dystopia canthorum.
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Diagnosing pediatric cerebral venous sinus thrombosis p. 48
Vidhya Chandran, Niveditha Nikhil
DOI:10.4103/kjo.kjo_17_18  
Pediatric cerebral venous sinus thrombosis (CVST) is not an uncommon condition. It is a dreadful condition, which can be easily missed until we suspect on clinical grounds. Here, we present a case of pediatric CVST following kidney transplantation in a child and the challenges in diagnosing the condition.
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PHOTO ESSAY Top

Phacocele presenting as localized hematoma in a suspected case of traumatic occult scleral rupture p. 51
PM Mrudula, PT Jyothi, Padma B Prabhu, V Babitha
DOI:10.4103/kjo.kjo_14_18  
Trauma can result in subconjunctival dislocation of lens, which is a rare event. Here, we report a case of phacocele, which masqueraded as localized hematoma in a case of traumatic occult scleral rupture.
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INNOVATION Top

Review of recent innovations in ophthalmology p. 54
John Davis Akkara, Anju Kuriakose
DOI:10.4103/kjo.kjo_24_18  
Necessity and opportunity in the form of rapidly advancing technology has made affordable innovations possible at a fast pace in ophthalmology. This article tries to cover a few of the recent frugal innovations which have a clinical potential for ophthalmologists.
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INSTRUMENT CORNER Top

Photoscreening devices p. 58
M Manju, R Neena
DOI:10.4103/kjo.kjo_22_18  
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JOURNAL REVIEW Top

Journal Review p. 61
Dhanya Cheriyath
DOI:10.4103/kjo.kjo_31_18  
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PG CORNER Top

Intravitreal injections: A brief note p. 63
Anu Joseph
DOI:10.4103/kjo.kjo_34_18  
The delivery of medications directly into the vitreous cavity through an injection or implant has become a commonplace in ophthalmology. Common diseases treated by intravitreal injections include neovascular age-related macular degeneration, clinically significant macular edema/proliferative diabetic retinopathy, cystoid macular edema following retinal vein occlusions and uveitis, endophthalmitis, and choroidal neovascular membrane secondary to multiple retinal diseases. Intravitreal injection procedure as per VRSI guidelines has been described in detail. Complications of intravitreal injections include those related to the technique and those related to the drug being used. It is important for the retina specialists to master the right technique of intravitreal injection in an effective way for patient safety as well as for reduction of complications.
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LETTER TO EDITOR Top

Anterior orbital cysticercosis: A case presentation p. 67
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/kjo.kjo_9_18  
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AUTHORíS REPLY Top

Author's Reply p. 68
Sujit Das
DOI:10.4103/kjo.kjo_20_18  
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SPOT DIAGNOSIS Top

What is the diagnosis? p. 69
Natasha Radhakrishnan
DOI:10.4103/kjo.kjo_18_18  
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