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   Table of Contents - Current issue
May-August 2017
Volume 29 | Issue 2
Page Nos. 65-148

Online since Thursday, August 10, 2017

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Desperate to innovate? p. 65
Ashok Nataraj
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Seeing vision with the eyes of math p. 66
V Srinivasa Chakravarthy
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Complications of contact lens p. 68
C Prasannakumary, PT Jyothy
Contact lens is valuable optical aid to vision in the presence of severe refractive error and treatment of certain chronic diseases. Complications can be prevented by precise fitting, regular follow-up, early recognition, and management of complications by an experienced ophthalmologist. The ocular complications range from harmless irritation to sight-threatening corneal ulceration.
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Microbiology for general ophthalmologists p. 72
V Babitha, PT Jyothi
Since ocular surface infections are very common in everyday ophthalmic practice, every ophthalmic personnel are familiar with their etiologies and the basic techniques for the diagnosis.
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Prisms in clinical practice Highly accessed article p. 79
J Antony
Prisms are used in diagnosis and Therapy of Ophthalmic disorders. Prismotherapy provides symptomatic relief not only in many kinds of squints, but also in non strabismic conditions like convergence insufficiency, nystagmus, heminopia etc. One of the most important therapeutic skill we have acquire in this direction, is the localisation of such clinical needs and the timely use of the wonderful therapeutic functions of prisms for the relief of such conditions. Thin Fresnel prisms are now more used in clinical practice.
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Comparison of fibrin glue and autologous blood for conjunctival autograft fixation in pterygium p. 86
Priyanka Patkar, Saurabh Shrivastava, Reshma Ramakrishnan, Minal Kanhere, Zahna Riaz
Aim: The aim of this study is to compare the outcome of conjunctival autograft (CAG) surgery for pterygium using autologous serum versus fibrin glue. Materials and Methods: A prospective, randomized controlled trial was carried out on 40 patients over a period of 2 years. Group I (20 eyes) underwent CAG with fibrin glue and Group II (20 eyes) underwent CAG with autologous serum. Postoperatively, the parameters noted in both the groups were the time taken for surgery in both the groups, postoperative outcomes such as redness and discomfort during blinking, outcome of the graft (graft edema, graft retraction, graft rejection, graft displacement, and graft loss), and recurrence of the pterygium. Results: In Group I (autologous serum), the mean surgical time was 34.8 min (standard deviation [SD] = 3.664912), whereas in Group II (fibrin glue), the mean surgical time was 22.95 min (SD = 3.086047). The intensity of postoperative discomfort was greater in Group I (autologous serum) than Group II (fibrin glue) on postoperative visits. However, the difference was not statistically significant. Graft rejection was observed in one patient belonging to the fibrin glue group, after 1 month postoperatively, which eventually by the end of 3 months led to graft loss. We found decreased postoperative inflammation and decreased recurrence rate at both a 3- and 6-month time period with the use of fibrin glue compared with autologous serum. Conclusion: Fibrin glue is generally considered safe; however, since it is made from human plasma, it carries the risk of transmitting infections. There was marked reduction in the operating time in fibrin glue group as compared with the autologous blood group. Cost of the surgery was more with fibrin glue. The graft edema, graft loss, graft retraction, and displacement of the graft were more with the use of fibrin glue. However, the difference was not statistically significant.
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Comparison of vertical cup-disc ratio and disc damage likelihood scale with respect to visual field global indices in primary open-angle glaucoma patients: A cross-sectional study p. 91
Smita Narayan, Reshmi Sreekumari
Background: In primary open-angle glaucoma (POAG), structural changes in optic nerve head precede functional changes in visual field (VF). Hence, it is important to detect glaucoma early as well as to monitor changes in glaucomatous damage. Aims: The aim of this study was to determine the correlation between each of vertical cup/disc ratio (VCDR) and the disc damage likelihood scale (DDLS) with global indices of Humphrey Field Analyzer II (HFA II). Methods: A total of 142 eyes of 71 patients diagnosed with POAG who fulfilled the inclusion and exclusion criteria were examined to grade DDLS score VCDR. HFA II Swedish Interactive Threshold Algorithm Standard 24-2 VFs were obtained. Statistical Analysis: The correlation of cup/disc (C/D) ratio with mean deviation (MD) and pattern standard deviation (PSD) was calculated by Spearman's correlation coefficient. Similar coefficients were obtained for DDLS also. Correlation values of selected variables were compared to find the difference in correlations. Results: DDLS shows strong negative correlation with MD (− 0.725) and strong positive correlation (0.625) with PSD when compared to C/D ratio. However, the differences between these correlations were not statistically significant. Conclusion: The DDLS shows stronger correlation with VF global indices than C/D ratio. Attention to disc diameter and rim width may increase the value of clinical optic disc examination
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Retrospective study of effect of therapy on computer vision syndrome patients having convergence insufficiency p. 97
Nidhi Tiwari, Uma Paul, Prajakta Paritekar
Aim: To study effect of therapy among computer users having convergence insufficiency. Materials and Methods: Hundred people between age group of 20-35 and who worked in IT companies were enrolled in the study. They were subjected to orthoptic evaluation to establish diagnosis of convergence insufficiency. They were then called for in-office therapy for 12 days daily. They underwent brock string exercises and at the end of therapy re-evaluation was done. Results: All the patients who underwent the therapy showed improvement in Near point of convergence at the end of therapy. They were also symptomatically better. Conclusions: Convergence insufficiency is a common occupation hazard among IT professionals. But it can be treated with appropriate therapy.
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Barriers responsible for delay in surgical correction of strabismus: A study among adults undergoing strabismus surgery at a tertiary care center in Kerala p. 102
Sanitha Sathyan, Jasmine Jose
Aim: The aim of this study is to analyze the factors responsible for delay in surgical treatment among adults with strabismus. Materials and Methods: A validated questionnaire-based study on fifty adult strabismic patients, enrolled through simple random sampling, who underwent surgical correction of strabismus at the strabismus clinic of a tertiary care eye hospital. Results: A total of fifty patients in the age group 18– 45 years, including 28 males (56%) and 22 females (44%) were studied. 24% were students, 22% were professionals, 18% were skilled laborers, and 18% were homemakers. Strabismus had significant psychological impact on the quality of life of the patient and 50% suffered from low self-esteem attributable to squint 32% reported peer pressure and bullying. Lack of awareness about surgery (32%), fear of surgery (24%), and nonaffordability were the most common reasons reported by patients for delayed the surgical correction. The reasons for seeking surgical treatment in adulthood were for improving self-esteem and quality of life (32%) and due to pressure from family and friends (24%). Conclusion: Social factors predominate as obstacles for timely correction of strabismus. Economic factors and lack of awareness among medical communities also contribute toward delay in treatment.
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Standard versus widefield angiography in detecting new vessels in proliferative diabetic retinopathy p. 108
S Sindhu, Shruti Chandra, Mahesh Gopalakrishnan
Purpose: The purpose of this study was to find out the accuracy of detecting new vessels (NVE) using standard field and widefield (SF and WF) angiographic imaging modality in eyes with proliferative diabetic retinopathy (PDR). Methods: This is a retrospective, cross-sectional study of 88 patients who underwent fundus fluorescein angiography (FFA) for suspected PDR from March 2015 to August 2015. Angiography was performed on the SPECTRALIS (Heidelberg, Germany) using SF 55° lens at primary, up, down, right, and left gaze and Staurenghi WF 102° lens in primary gaze. NVE were diagnosed by standard definition on FFA and a number of NVE were counted. Comparison of NVE detected on WF versus SF in primary gaze and WF versus SF in peripheral gaze was made. Fisher's exact t-test was used for statistical analysis. Results: The mean age of the patients was 56.87 ± 12.42 years. PDR was bilateral in 73 eyes and unilateral in 15 eyes. On comparing WF versus SF in primary gaze, 117 and 99 eyes were correctly detected as having NVE, respectively. On comparison of WF with SF in peripheral gaze, NVE picked up was 117 and 114 eyes, respectively. The missed NVE count in both comparisons was found to be statistically significant (P < 0.02). The sensitivity of SF in primary gaze was calculated to be 84.6%, whereas in peripheral gazes, it improved to 97.4%. Conclusion: As evident by our study results, SF images in primary as well as all peripheral gazes tend to miss out on NVE, thereby incorrectly diagnosing PDR eyes as non-PDR, which were picked up on WF as having NVE. Hence, we propose that WF angiography can be considered as gold standard for accurately diagnosing the presence of NVE in eyes with PDR.
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Clinical utility of anterior segment optical coherence tomography in strabismus surgery: Prospective observational study p. 112
Joseph John, Elizabeth K Joseph, CK Meena, Sanitha Sathyan
Aim: The aim of this study is to evaluate the accuracy of the anterior segment optical coherence tomography (AS-OCT) in measuring the distance from the limbus to the insertion of primary and previously operated horizontal rectus muscles. Materials and Methods: This was prospective observational study; we did AS-OCT preoperatively and measured the distance from angle of anterior chamber to muscle insertion using the caliper tool provided in the software. We calculated limbus-insertion distance by adding 1 mm to the angle-insertion distance. We compared this value with intraoperative measurement obtained with surgical caliper. Results: Totally 35 muscles were evaluated, including 12 previously operated muscles. 88.6% of the measurements were within the 1 mm difference considered clinically acceptable. Bland– Altman plots showed good agreement between the two methods. Conclusions: AS-OCT can image the horizontal rectus muscle insertions well and provide good reliability and accuracy in measurement of the limbus-insertion distance.
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Aravind eye care system p. 116
Kalpana Narendran
Aravind Eye Hospital was founded in 1976, by Dr. G. Venkataswamy, a man known to most of us simply as Dr. V. In an eleven bed hospital manned by 4 medical officers, he saw the potential for what is today, one of the largest facilities in the world for eye care. Over the years, this organization has evolved into a sophisticated system dedicated to compassionate service for sight. The Aravind Eye Care System now serves as a model, for India, and the rest of the world.
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Vision screening at schools: Strategies and challenges p. 121
Sanitha Sathyan
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Dowsing in a case of recurrent central serous Chorioretinopathy p. 131
Apoorva Ayachit, VV Sameera, Shrinivas M Joshi, Guruprasad Ayachit
We present a case of a 34-year-old male with diminution of vision in his left eye. He was diagnosed as a case of central serous chorioretinopathy (CSCR) on clinical examination and optical coherence tomography (OCT). The episode resolved in 1 month. Nine months later, the patient had a recurrence. This time, the CSCR was imaged using spectral domain-OCT, enhanced depth imaging-OCT, fundus autofluorescence, and fundus fluorescein angiography. The patient was noted to have an associated extrafoveal subretinal fluid pocket with a focal choroidal excavation.
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Postpartum central retinal vein occlusion p. 134
Amit Mohan, Jalpa Thakarani, Rini Sukhwal
Ophthalmic complications are possible during pregnancy or soon after child birth even in normal uneventful pregnancy. Here we are presenting a rare case of central retinal vein occlusion in a 26 year old female during 4th week of her puerperium without any history of preeclampsia. Fundus examination showed dilated tortuous veins, multiple flame shaped haemorrhage, and disc oedema. Optical coherence tomography revealed cystoid macular oedema. Intravitreal avastin injection was given. There was improvement in visual acuity with complete resolution of fundus findings within 6 months.
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A case of pediatric ocular dirofilariasis p. 136
KM Seema
A 4 year old boy presented with an inflammed subconjunctival swelling in the right eye which was responsive to topical steroids but recurred on discontinuing steroids. Parasitic granuloma was suspected and an excision biopsy performed which revealed a dirofilarial worm inside the granuloma. This case report is being presented to emphasise the presence of this rare zoonosis in our state.
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Acute demyelinating encephalomyelitis masquerading as a tumor p. 139
R Remya, JK Ann, Ani Sreedhar
A 34-year-old female presented with a history of acute onset severe bilateral defective vision for 2 weeks. Examination revealed visual acuity CFat1 m in the right eye and 6/60 in the left eye. Right eye had Grade 1 relative afferent pupillary defect. Magnetic resonance imaging (MRI) brain was done which showed well-defined T1-hypointense, T2 and FLAIR hyperintense lesion of approximately 1.8 cm × 1.6 cm × 1.7 cm size in the right frontal lobe cortex and underlying white matter with a thin rim of contrast enhancement with well-defined outer border and a cortex broken arc appearance. MR spectroscopy showed increase in choline peak within the enhancing walls of the lesion and no decrease in N-acetyl aspartate peak suggestive of demyelination. Diagnosis of acute demyelinating encephalomyelitis was made and with a course of large dose steroid vision improved dramatically.
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Spontaneous teeth loss following herpes zoster p. 142
Anubhav Chauhan, Neeraj Sharma, Shveta Chauhan
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Macular hole surgery revisited: Effect of tamponading agents and different size of internal limiting membrane peeling on anatomical and functional outcomes p. 144
Rutul R Patel, Mahesh Gopalakrishnan
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Bilateral exudative detachments – “All that detaches is not Vogt-Koyanagi-Harada” p. 146
Rajesh Puthussery
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Author's reply p. 146
Natasha Radhakrishnan
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Spot diagnosis p. 148
Remya Mareen Paulose
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