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   Table of Contents - Current issue
Coverpage
January-April 2019
Volume 31 | Issue 1
Page Nos. 1-82

Online since Monday, April 15, 2019

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EDITORIAL  

Read, learn, and grow p. 1
VA Bastin
DOI:10.4103/kjo.kjo_30_19  
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GUEST EDITORIAL Top

Medical education in India - General Profile p. 2
Alex Joseph
DOI:10.4103/kjo.kjo_10_19  
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MAJOR REVIEWS Top

Atropine in the treatment of childhood myopia p. 4
Sanitha Sathyan
DOI:10.4103/kjo.kjo_6_19  
The practice of using topical atropine to prevent the progression of myopia in children has been going on for decades in some Asian populations. The encouraging results obtained from Atropine for the treatment of childhood myopia (ATOM) studies and animal studies have created much interest among the practitioners regarding the use of atropine in preventing myopic progression. This review aims to summarize the major research works done on the subject and its implications in clinical practice.
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Ptosis: Evaluation and management Highly accessed article p. 11
Marian Pauly, R Sruthi
DOI:10.4103/kjo.kjo_2_19  
Blepharoptosis, or ptosis of the eyelid, refers to drooping of the upper eyelid that usually results from a congenital or acquired abnormality of the muscles that elevate the eyelid. Ptosis may be the presenting sign or symptom of a serious neurologic disease. Regardless of the etiology, when ptosis obstructs vision, it is disabling. The appropriate management requires recognition of the underlying cause. This review article highlights the various aspects of ptosis evaluation and management.
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Optical coherence tomography in the evaluation of disc edema p. 17
Deepa Gaur, H Vijaya Pai
DOI:10.4103/kjo.kjo_91_18  
Optic disc oedema is a common clinical problem where the ophthalmologist plays an important role in the diagnosis, management. Many optic nerve diseases can cause disc oedema like papilloedema, papillitis, anterior ischaemic optic neuropathy, central retinal vein occlusion, optic nerve head drusen etc. It is important to differentiate pseudoneuritis as in hypermetropia from true disc oedema. The clinical features, fundus examination sometimes may not give the correct diagnosis. Fundus fluorescein angiogram helps to differentiate pseudo from true disc oedema. However it is an invasive procedure. With newer technologies like optical coherence tomography which helps to image the optic disc, it is possible to differentiate pseudo from true disc oedema, also to recognise the aetiology of disc oedema. In this review article we are highlighting the OCT findings in various causes of disc oedema.
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CLINICAL QUERY Top

The use of atropine in childhood myopia: Experience in Indian eyes p. 24
Sanitha Sathyan
DOI:10.4103/kjo.kjo_9_19  
This clinical query section discusses the use of topical atropine in childhood myopia among Indian children. Experts from across the country share their viewpoints, clinical experience, and concerns on the subject.
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ORIGINAL ARTICLES Top

Correlation between ocular axial length and anterior chamber depth and a differential analysis in same-sized eyes p. 28
Rakesh Maggon, Sumit Kumar Singh, Maneesh Jha, Avinash Mishra, Sandeep Gupta, Vivek Sharma
DOI:10.4103/kjo.kjo_93_18  
Purpose: To study correlation between ocular axial length and anterior chamber depth in eyes and to differentially analyse strength of this correlation in eyes with near-equal axial length. Materials and Methods: We conducted an observational study where keratometry and optical biometry records of 872 patients reporting for cataract surgery were taken. A comparative analysis using Optical Biometry (Zeiss IOL master) for pre-operative measurement of Axial length (AL), Anterior chamber depth (ACD) and calculated IOL power was done. Statistical Analysis: Data was analysed to determine overall correlation between two parameters. Patients were then classified into various groups of near-equal AL for a differential comparison within the group. Kendall-Pearson product-moment correlation test was used to assess relationship between AL and ACD, overall and within each subgroup. A P-value < 0.05 was considered as statistically significant. Results: 872 eyes were analysed and it was seen that as the mean AL (23.28mm), increased, mean ACD (2.97mm) also increased in overall analysis. In group analysis correlation between AL and ACD varied widely from 0.86 (AL-17-21 mm) to a negative -0.14 (AL 21-22mm). Conclusions: As mean AL increases ACD also increases. In eyes with near-equal AL there is wide variability in ACD which is either due to variable lens thickness or lens location in different eyes. Since lens thickness variability was obviated by taking age-matched eyes, location of lens is the probable cause. Therefore, Effective Lens Position (ELP) based formulae (Haigis & Holladay II) have an inherent unpredictability and may result in post-operative refractive surprises.
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Acute acquired comitant esotropia in children: A benign entity or an ominous sign? p. 33
R Neena, Anantharaman Giridhar
DOI:10.4103/kjo.kjo_11_19  
Purpose: The purpose is to study the clinical features of acute acquired comitant esotropia (AACE) in children and analyze the course and outcome. Materials and Methods: A retrospective, clinical study of all patients under the age of 18 years with acute onset, nonaccommodative comitant esotropia in a tertiary eye care center from September 2013 to December 2016. Parameters studied were age, sex, visual acuity, eye involved, age of onset, precipitating event, amount of deviation, presence or absence of amblyopia, cycloplegic refraction, systemic involvement, surgical or nonsurgical intervention, course, and outcome. All patients underwent magnetic resonance imaging of brain and orbits, and systemic evaluation was done in suspicious cases. Minimum follow-up period was 6 months. Results: Out of 12 patients, 8 were male. Average age of the patients was 7.9 years. The mean esodeviation was 33.75 PD, and mean age of onset was 6.14 years (range: 2–15 years). There was left eye preponderance. Three patients (25%) had a history of a precipitating event. Cycloplegic refraction ranged from +0.50 DS to −6.75 DS, with majority having <+2.00 DS. Amblyopia was noted in 8 (66.6%) patients. Systemic involvement was seen in three patients in the form of ocular myasthenia, central nervous system glioma, and viral fever, respectively. Esotropia disappeared in one patient with overcorrected, high myopia following atropinization, and change of glass. Eight patients (66.6%) underwent strabismus surgery with good postoperative alignment, and the rest were managed conservatively. Conclusion: AACE is an unusual ocular alignment disorder characterized by a nonaccommodative esodeviation which can occur in older children, adults, and even the elderly. Although most children with this form of esotropia are otherwise healthy, systemic diseases must be considered and ruled out before planning surgery. Prompt amblyopia therapy and timely surgery can result in a satisfactory outcome in those without systemic involvement.
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Outcomes of multifocal intraocular lens implantation in pediatric eyes p. 39
Minnu Parakal, Swapna Nair
DOI:10.4103/kjo.kjo_12_19  
Objective: To study the pre operative profile and postoperative visual, quality of life outcomes and complications in pediatric eyes with multifocal intraocular lens implants. Methods: All children requiring primary or secondary intraocular lens implantation where the IOL could be placed in the capsular bag were assigned to this prospective study. The cause for cataract, laterality, preoperative and postoperative corrected and uncorrected distance and near visual acuity, slit lamp observations, intraocular pressures, type of surgery, postoperative IOL positioning, intra and post operative complications and quality of life estimates were recorded. SPSS ver21 was used for data analysis and the outcomes were documented. Results: 21 eyes of 14 pediatric patients were included in this study, 7 of them underwent bilateral surgery. The age range was 1 to 14 years. The logmar best corrected visual acuity for distance and near improved in 100% of eyes. The average corrected distant visual acuity was 0.3 (6/12p) and average near vision was 0.38 (N6-N8) without near addition. The average residual spherical power was 0.26DS and astigmatism was -0.22DC. 9 eyes had raised IOP immediate post procedure. The average IOP after 1 month was 13.71 mm of Hg. The quality of life questionnaire indicated satisfactory levels of performance at school and play. Conclusions: Multifocals IOLs are an effective and safe implant to impart instant near vision correction, thereby bypassing the need to wear or be compliant with bifocals, thus aiding in overcoming amblyogenic influences.
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Posterior chamber phakic intraocular lenses in refractive surgery: Preoperative profile and postoperative outcomes p. 45
VL Divya, Swapna Nair
DOI:10.4103/kjo.kjo_17_19  
Objective: To assess the pre operative visual, refractive and topographic profile and to analyse postoperative vision, contrast and complications of patients undergoing phakic intraocular lens implantation. Methods: This prospective study enrolled patients that underwent phakic intraocular lens implantation after refractive surgery work up. The corrected pre op and uncorrected post op distance visual acuity, pachymetry, keratometry, topography, white to white, anterior chamber depth, and specular microscopy, along with postoperative anterior chamber angles, corneal and lens status and vaulting of the phakic IOL were recorded at 1 month. Results: 59 eyes of 32 patients with myopia, simple and compound myopic astigmatism underwent posterior chamber phakic IOL. The average sphere corrected was -8.4 D and the average cylinder was -1.5 D with 45.8 +/- 2.2 being the average steep k values. The mean central corneal thickness, WTW and ACD in these patients were 511.9 +/-42,11.44 +/- 0.65 mm, 3.24 +/- 0.33 mm respectively. The average post op UCDVA was 0.1 logmar with most eyes gaining more lines than preop CDVA. The average post op phakic IOL vault wrt the natural lens was 455 micron and average IOP 13.74 +/- 2.8 mmHg. Conclusion: Posterior chamber phakic IOLs are a safe and predictable means of providing good vision especially in high myopes with borderline corneae. Accurate preoperative sizing of the lens is key to optimum results.
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CASE REPORTS Top

One case, one pearl: Back to basics p. 51
Privila Elamana, Vengayil Sujith Nayanar
DOI:10.4103/kjo.kjo_4_19  
The majority of community-acquired cases of infectious keratitis resolve with empiric therapy and are managed without smears or cultures. Smears and cultures are indicated, however, in cases that involve a corneal infiltrate that is central, large, and extends to the deep stroma; that are chronic in nature or unresponsive to broad-spectrum antibiotic therapy; or that have atypical clinical features suggestive of fungal, amoebic, or mycobacterial keratitis. Before initiating antimicrobial therapy, cultures are indicated in sight-threatening or severe keratitis of suspected microbial origin. This case report highlights the importance of scraping in the diagnosis and management of corneal ulcer and also need for rational use of medicines.
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Management of traumatic telecanthus by medial canthopexy p. 54
Rohan Dilip Newadkar, Ujwala Rohan Newadkar
DOI:10.4103/kjo.kjo_15_19  
The medial part of the orbital region is a complex structure of several facial bones. It has attachments for support of the eye and lacrimal collecting system. In that, medial canthus is an important structure for esthetic and functional reasons. Medial canthal deformities can result from nasoethmoidal trauma, cancer resection, craniofacial exposure, congenital malposition, or age-related change. Various techniques have been used for medial canthal reconstruction, specifically to achieve bony fixation of the medial canthal tendon. The surgical treatment of traumatic telecanthus remains one of the most challenging areas in facial reconstruction. Transnasal wiring has been one of the most commonly used methods to perform medial canthopexy. However, it is technically difficult and may cause damage to the contralateral orbital structures. Here, we present a case report of management of traumatic telecanthus by medial canthopexy in an 11-year-old female patient using titanium miniplate.
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Papilledema due to cerebral venous thrombosis in obstructive sleep apnea p. 57
Revati Ramesh, Sneha Raju, Freddy T Simon, Gigy V Kuruttukulam
DOI:10.4103/kjo.kjo_18_19  
A 59-year-old male presented with episodic headaches and blurring vision, and papilledema (PE) on examination. He had been advised continuous positive airway pressure (CPAP) treatment for moderate obstructive sleep apnea (OSA) and an apneic–hypopneic index of 21 but had not commenced the treatment. Magnetic resonance imaging of the brain was normal, but a contrast examination was not done. Magnetic resonance venography performed to assess the PE, revealed cerebral venous thrombosis (CVT) affecting the superior sagittal, transverse, and sigmoid sinuses. Oral anticoagulants and CPAP resulted in a speedy reversal of both PE and CVT. CVT may complicate OSA and require identification and treatment. Contrast studies are crucial in the evaluation.
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PHOTO ESSAY Top

Focal choroidal excavation on spectral domain-optical coherence tomography p. 60
Anubhav Goyal, Anatharaman Giridhar, Mahesh Gopalakrishnan
DOI:10.4103/kjo.kjo_23_19  
We report the imaging characteristics of focal choroidal excavation (FCE) and associated choroidal neovascular membrane (CNVM) and interpret the probable etiopathogenesis of FCE through findings detected by multimodal imaging. FCE was found as an acquired entity in our case subsequent to the treatment of CNVM. In addition, the association of FCE with pachychoroid spectrum is reaffirmed through this case.
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INNOVATION Top

How-to guide for smartphone slit-lamp imaging Highly accessed article p. 64
John Davis Akkara, Anju Kuriakose
DOI:10.4103/kjo.kjo_24_19  
Ophthalmology is a very visual science; therefore, visualizing the eye and its pathology in good clarity is essential for a diagnosis. Over the past several years, smartphones have evolved to replace several gadgets in our daily life, including cameras. In ophthalmology, they have been very useful to take good quality photographs through slit lamp, gross photographs and also fundus photos using low-cost smartphone fundus cameras. In this article, we elaborate on the techniques, tips, and tricks to obtain excellent smartphone ophthalmic photographs and videos with a mid-level smartphone camera. We teach how to take diffuse and slit photographs, with and without an adapter, in addition, how to take Gonioscopy, specular microscopy, and fundus via 90D. These photos and videos can also be edited on the smartphone itself and used for case discussion, second opinion, teaching, presentations, and publications.
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INSTRUMENT CORNER Top

Ocular surface analyzer p. 72
Rose Mary George, Prashob Mohan
DOI:10.4103/kjo.kjo_26_19  
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JOURNAL REVIEW Top

Journal Review p. 75
Reeja Choondanil Menon
DOI:10.4103/kjo.kjo_13_19  
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PG CORNER Top

Refraction and glass prescription in pediatric age group p. 78
Akshaya Ashok
DOI:10.4103/kjo.kjo_5_19  
The pediatric population with refractive error needs regular assessment and prescription adjustment. Detection of refractive error and accurate prescription of glasses to prevent amblyopia in children is possible only if the general ophthalmologist is aware of the basic steps of assessment and prescription. This paper discusses the considerations for prescribing a refractive correction in infants and children, with reference to the current literature.
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LETTER TO EDITOR Top

Neovascular glaucoma p. 81
KR Reesha
DOI:10.4103/kjo.kjo_29_19  
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SPOT DIAGNOSIS Top

A case of posterior polar cataract p. 82
Bharat Gurnani, Kirandeep Kaur, Prasanth Gireesh
DOI:10.4103/kjo.kjo_98_18  
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