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   Table of Contents - Current issue
Coverpage
September-December 2018
Volume 30 | Issue 3
Page Nos. 159-230

Online since Monday, December 17, 2018

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EDITORIAL  

Rethinking research p. 159
VA Bastin
DOI:10.4103/kjo.kjo_92_18  
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GUEST EDITORIAL Top

Strabismus: Widening horizons p. 160
Elizabeth Joseph
DOI:10.4103/kjo.kjo_89_18  
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MAJOR REVIEWS Top

Pediatric cataract p. 162
Elizabeth Joseph, CK Meena
DOI:10.4103/kjo.kjo_85_18  
Pediatric cataract remains a very important and difficult problem to manage, in spite of dramatic advances that have occurred in the field over the past 10 years. Since early treatment is the most important factor in determining the visual outcome in congenital cataract, prompt detection and treatment in the neonatal period are the aims. This review is to update the reader on advances and present concepts on the topic.
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Neovascular glaucoma p. 172
Seshadri J Saikumar, Anup Manju, Nair Abhilash
DOI:10.4103/kjo.kjo_77_18  
Neovascular glaucoma (NVG) is an intractable secondary glaucoma characterized by the growth of new vessels accompanied by a fibrovascular membrane over the iris and iridocorneal angle. Majority of the cases of NVG are associated with ischemia and hypoxia of retina. The three most common predisposing conditions are ischemic central retinal vein occlusion, proliferative diabetic retinopathy, and ocular ischemic syndrome. Early identification of anterior segment neovascularization followed by prompt treatment is very important to prevent significant visual impairment. A high index of suspicion, with careful anterior segment evaluation and gonioscopy in an undilated pupil, is the key for early detection of neovascularization of iris and angle. Early stages of the disease can be managed with panretinal photocoagulation along with adjunctive use of vascular endothelial growth factor inhibitors with or without intraocular pressure lowering agents. Medical management may not be sufficient in advanced disease and may require surgical intervention.
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ORIGINAL ARTICLES Top

Outcomes of surgical correction of exotropia in children between 4 to 12 years of age p. 178
Sanitha Sathyan
DOI:10.4103/kjo.kjo_72_18  
Purpose: This study aims to analyze the outcomes of surgical correction of exotropia in children between 4 to 12 years of age; and the factors associated with favorable surgical outcomes. Methods: In this prospective observational study, the surgical outcomes of 87 patients between 4 and 12 years of age, who underwent correction for primary exotropia (XT), by a single surgeon, were analyzed at 24 months. Results: Out of the total 87 patients, 46 (52.87%) were female and 41 (47.13%) were male. The mean age at surgery was 8.83 ± 3.26 years (range 4–12 years). There was a statistically significant reduction in preoperative prism bar cover test (PBCT), with PBCT at day: 1, 1 month, 6 months, 12 months, and 24 months after surgery (P = 0.00, ANOVA). Among the 42 patients analyzed for near stereoacuity (NSA), the change between preoperative and 24 months NSA was not statistically significant (P = 0.55, Chi-square test). Preoperative PBCT for distance was found to be a significant parameter associated with successful motor alignment at 24 months (P = 0.02, logistic regression). Other variables such as gender, age at surgery, preoperative best-corrected visual acuity, preoperative refractive status, and laterality of surgery were not significantly associated with successful motor alignment at 24 months. Conclusions: Surgical correction of exotropia in children between 4 to 12 years shows satisfactory ocular alignment at 24 months; although there was no significant improvement in NSA in the subgroup analyzed. The preoperative ocular deviation was the only significant factor associated with successful motor outcome at 24 months after surgery.
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Clinical profile and predictors of visual outcome in nonarteritic anterior ischemic optic neuropathy p. 183
PT Jyothi, S Bindu, Padma B Prabhu
DOI:10.4103/kjo.kjo_47_18  
Background: Nonarteritic anterior ischemic optic neuropathy (NAION) is a disorder of the optic nerve head causing acute painless visual loss in the elderly. Several ocular and systemic risk factors predispose to optic nerve head ischemia. Patients usually have a moderate visual loss which tends to stabilize in a few months, but complete recovery may not occur. Aim: This study aimed to study the clinical profile of NAION and to find the predictors of visual outcome in the study group. Materials and Methods: This prospective case series study included 25 patients with unilateral acute visual loss and clinical features suggestive of NAION. Detailed history and investigations were done to detect the risk factors implicated for the disease Patients were followed up for 6 months. Initial and final vision were analysed to assess the visual outcome. Statistical analysis was performed using SPSS. Results: Mean age was 58.08 ± 8.118 years. There was no gender predilection. The most common type of disc edema was diffuse hyperemic, and the most common field defect was inferior altitudinal. Systemic comorbid conditions such as dyslipidemia, smoking, hypotension, diabetes, and hypertension had higher odds of developing NAION even though not statistically significant. Correlation between initial vision and visual acuity at 6 months was statistically significant and spontaneous improvement in vision was seen in 16% of patients. Conclusion: Pallid disc edema and poor initial visual acuity were predictors of poor visual outcome. Female gender, hyperemic disc edema, and superior field defect had a favorable outcome. Associated comorbidities increased the risk of visual loss.
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Prospective study of hypermature cataract in Kanchipuram district: Causes of delayed presentation, risk of lens-induced glaucoma and visual prognosis p. 187
Shruti Prabhat Hegde, Machireddy R Sekharreddy, Mohan Ram Kumar, Vijay Kautilya Dayanidhi
DOI:10.4103/kjo.kjo_50_18  
Purpose: The aim of this study is to evaluate the reasons for delayed presentation, lens-induced glaucoma (LIG) incidence, intra- and post-operative course and visual outcome among patients with hypermature cataract in Kanchipuram district. Materials and Methods: A prospective interview-based study was undertaken among 304 patients with hypermature over 3 years in the Ophthalmology department of a medical College located in Kanchipuram. Presence of LIG was noted. After small incision cataract surgery, intra- and post-operative complications, final best-corrected visual acuity (BCVA) at 6 weeks were noted and compared with delayed presentation using Chi-square test. Results: Good visual acuity in the other eye was the reason for delayed presentation in 160 (52.6%) patients. Poor post-operative visual acuity was associated with delayed presentation (r = −0.203, n = 304 and P < 0.012). LIG was seen in 30 (10%) patients and 26 (8.5%) of these were pseudophakic in the fellow eye. 8 (2.6%) patients had zonular dehiscence. Difficulty in doing rhexis (156 patients), corneal edema (62 patients), and inferior subluxation of posterior chamber intraocular lens (12 patients) were the most common intraoperative, early and late postoperative complications. Final BCVA of 6/12 or better was seen in 282 patients. Conclusion: Hypermature cataract and LIG are still seen in rural and suburban India and are more likely to develop in patients having good visual acuity in the fellow eye following previous cataract surgery. As delayed presentation is associated with poor postoperative outcome, it is important to educate the community about the need for early surgery.
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Correlation between topographic color patterns, keratometric indices, and clinical features among young adults with keratoconus p. 193
Padma B Prabhu, Chellappan Prasannakumary, Poothatta T Jyothi, Valiyaveettil Babitha
DOI:10.4103/kjo.kjo_55_18  
Aim and Objectives: This study tries to estimate the relationship between corneal topographic patterns and topographic parameters with the clinical findings among keratoconus cases. Design: This was a descriptive cross-sectional study. Materials and Methods: Keratoconic patients between the age group of 10–30 years were included in this study. Biomicroscopic examination, retinoscopy, and corneal topography were done for the patients, and their correlation with topographic pattern was studied. Results: The study group included 89 keratoconic eyes having defective vision. The mean age of patients with keratoconus was 20.13 years (standard deviation ± 4.56). This study showed a statistically significant positive correlation between a few topographic pattern and inferior–superior values. Conclusion: Varied topographic patterns are seen among keratoconus cases diagnosed based on an elevated KISA index. Atypical patterns may be indicative of other causes of corneal ectasia. A comprehensive evaluation of clinical findings, topographic patterns, and keratometric values is essential in the diagnosis and follow-up of keratoconic eyes.
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CASE REPORTS Top

An unusual case of a spontaneous uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia p. 198
Tarun Sood, Praveen Panwar, Mandeep Tomar
DOI:10.4103/kjo.kjo_74_18  
Description of an unusual case of a spontaneous Uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia is presented. The literature is reviewed with particular reference to the etiology of spontaneous hyphema and relation of fibrinous uveitis with the fibrin degradation product.
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Serous macular detachments are not always benign p. 200
Thresika Uvaraj, Merie Mathew
DOI:10.4103/kjo.kjo_5_18  
The incidence of choroidal metastases from lung adenocarcinoma without a history of primary tumor detection was rarely reported. A 59-year-old male presented with diminution of vision in the left eye 10 days after starting the antitubercular treatment. The vision deteriorated dramatically, and ancillary tests revealed a metastatic lesion in the left eye from adenocarcinoma of the lung. This case report highlights the possibility of intraocular metastases in adults who present with symptoms of blurring of vision of short duration.
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Persistent hyaloid artery with posterior polar cataract in a young male: A rare presentation p. 203
Rajwinder Kaur, Balbir Khan, Ekta Syal, Harjeet Sidhu, Mandeep Kaur
DOI:10.4103/kjo.kjo_64_18  
Persistent fetal vasculature (PFV) is a rare congenital developmental malformation of the eye which results from a failure of the fetal hyaloid artery to involute. PFV is usually characterized by microphthalmia, a shallow anterior chamber, elongated ciliary processes, a posterior subcapsular cataract, and a fibrovascular stalk that extends from the optic disc to the lens. It is a rare and sporadic disease with an overall prevalence of 0.064%. We report a case of a young male who presented with decreased vision in the right eye. On examination, it was diagnosed with complete persistent hyaloid artery. The patient was advised regular follow-up.
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PHOTO ESSAY Top

“Interferon magic” in ocular surface squamous neoplasia p. 206
Sinumol Sukumaran Thulaseedharan, Vaikkakara Sudha, N Sujatha, Smita Narayan
DOI:10.4103/kjo.kjo_81_18  
An elderly patient with limbal growth in the left eye was diagnosed by impression cytology as ocular surface squamous neoplasia (OSSN) and subsequently treated with topical interferon α 2b (IFN-α 2b). Complete gross and histopathological resolution was seen by 3 months. Impression cytology and topical IFN-α 2b drops are simple, powerful, and affordable tools to manage OSSN. Flu-like syndrome in the first few days was the only adverse effect noted.
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INNOVATION Top

The magic of three-dimensional printing in ophthalmology Highly accessed article p. 209
John Davis Akkara, Anju Kuriakose
DOI:10.4103/kjo.kjo_86_18  
The technology of three-dimensional (3D) printing has evolved over the past few years with cumulative improvements in the resolution, accuracy, cost-effectiveness, and speed of this highly customizable manufacturing process. Ophthalmologists have designed multiple 3D printed smartphone based fundus cameras with some of the designs available as open-source for all to download and 3D-print. Now, the technology has been used for anything from eyewear and medical devices to printing of live cells and tissues like an artificial cornea. It also has uses in education and surgical planning. The author had the opportunity to work with a 3D printer and make some of these models. The future is bright for innovations in this field as we are only beginning to understand the capabilities of this technology.
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INSTRUMENT CORNER Top

Ultrasound biomicroscopy: An overview p. 216
K Girija, VK Smitha, Akshaya Ashok
DOI:10.4103/kjo.kjo_95_18  
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JOURNAL REVIEW Top

Journal Review p. 219
Neeta Sidhan
DOI:10.4103/kjo.kjo_87_18  
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PG CORNER Top

Management of eyelid lacerations p. 222
Rita Mary Tomy
DOI:10.4103/kjo.kjo_83_18  
Eyelid lacerations form a major bulk of the ocular trauma that we see in our casualty. These are managed differently depending on the depth, width, and location of the injury. Repairing of eyelid injuries requires good anatomic knowledge and meticulous approach. This article gives a brief overview of the practical aspects in managing an eyelid laceration.
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LETTER TO EDITOR Top

Monostotic fibrous dysplasia of the orbital plate of ethmoid: A rare cause of retro-orbital pain p. 228
Reddy Ravikanth
DOI:10.4103/kjo.kjo_78_18  
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SPOT DIAGNOSIS Top

What is the diagnosis? p. 230
Mallika Harikrishnan
DOI:10.4103/kjo.kjo_79_18  
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