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   Table of Contents - Current issue
Coverpage
August 2019
Volume 67 | Issue 8
Page Nos. 1259-1385

Online since Monday, July 22, 2019

Accessed 19,388 times.

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EDITORIAL  

National Medical Commission Bill, 2019 – Good intent but unmet expectations Highly accessed article p. 1259
Santosh G Honavar
DOI:10.4103/ijo.IJO_1324_19  PMID:31332103
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GUEST EDITORIAL Top

Cutting corners, or simplifying technology to reach more patients; using the body as its own incubator for epithelial regeneration Highly accessed article p. 1261
Virender S Sangwan, Nidhi Gupta, Aastha Singh, Sheila MacNeil
DOI:10.4103/ijo.IJO_632_19  PMID:31332104
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ONE MINUTE OPHTHALMOLOGY Top

Unilateral enophthalmos Highly accessed article p. 1264
Grace L Su, Sara E Lally, Carol L Shields
DOI:10.4103/ijo.IJO_1019_19  PMID:31332105
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REVIEW ARTICLE Top

Simple limbal epithelial transplantation (SLET): Review of indications, surgical technique, mechanism, outcomes, limitations, and impact Highly accessed article p. 1265
Swapna S Shanbhag, Chaitali N Patel, Ritin Goyal, Pragnya R Donthineni, Vivek Singh, Sayan Basu
DOI:10.4103/ijo.IJO_117_19  PMID:31332106
Simple limbal epithelial transplantation (SLET) is an innovative limbal stem cell transplantation technique that has gained increasing popularity over the last few years. Different groups from across the world have published the clinical results of SLET in large case series with varying types and severities of limbal stem cell deficiency (LSCD). This review attempts to place all the available knowledge on SLET together in one place for the benefit of not only cornea specialists and trainees but also for residents and general ophthalmologists. It follows a balanced approach of blending evidence with experience by providing an objective analysis of published results along with helpful insights from subject experts, starting from preoperative considerations including the role of newer imaging modalities to the technical aspects of the surgery itself and the management of possible complications. Original data and novel insights on allogeneic SLET for bilateral LSCD are included in the review to address the few remaining lacunae in the existing literature on this topic. This review intends to inform, educate, and empower all aspiring and practicing SLET surgeons to optimize their clinical outcomes and to have maximal positive impact on the lives of the individuals affected by unilateral or bilateral chronic LSCD.
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COMMENTARY Top

Commentary: SLET - A paradigm shift in limbal transplantation p. 1277
Jayesh Vazirani
DOI:10.4103/ijo.IJO_610_19  PMID:31332107
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REVIEW ARTICLE Top

Quality assurance in ophthalmic imaging p. 1279
Suneeta Dubey, Kanika Jain, T Nirmal Fredrick
DOI:10.4103/ijo.IJO_1959_18  PMID:31332108
Quality assurance (QA) is the maintenance of a desired level of quality in a service, by means of attention to every stage of process of delivery. Correct image acquisition along with accurate and reproducible quantification of ophthalmic imaging is crucial for evaluating disease progression/stabilization, response to therapy, and planning proper management of these cases. QA includes development of standard operating procedures for the collection of data for ophthalmic imaging, proper functioning of the ophthalmic imaging equipment, and intensive training of technicians/doctors for the same. QA can be obtained during ophthalmic imaging by not only calibration and setting up of the instrument as per the manufacturer's specifications but also giving proper instructions to the patients in a language which they understand and by acquisition of good quality images. This review article will highlight on how to achieve QA in imaging which is commonly being used in ophthalmic practice.
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COMMENTARY Top

Commentary: Quality assurance in ophthalmic imaging p. 1288
Harshit Vaidya, Muna Bhende
DOI:10.4103/ijo.IJO_1149_19  PMID:31332109
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ORIGINAL ARTICLE Top

Microkeratome-assisted ultrathin Descemet's stripping automated endothelial keratoplasty: A randomized trial comparing single-pass versus double-pass technique p. 1289
Namrata Sharma, Aarifa Yasmin Hussain, Ritu Nagpal, Anubha Rathi, Prafulla K Maharana, Rajesh Sinha, Tushar Agarwal, Jeewan Singh Titiyal
DOI:10.4103/ijo.IJO_1660_18  PMID:31332110
Purpose: To compare the outcomes of two techniques, for preparation of microkeratome-assisted ultrathin grafts for Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods: The study involved 20 eyes of 20 patients with pseudophakic bullous keratopathy, randomized into two groups. Group 1 eyes underwent microkeratome-assisted DSAEK using the single-pass technique for lenticule preparation, whereas group 2 eyes underwent microkeratome-assisted DSAEK using the double-pass technique. Patients were followed up till 6 months, postoperatively. Best-corrected visual acuity (BCVA) at final follow-up was considered as the primary outcome measure, whereas graft thickness (GT) contrast sensitivity and endothelial cell loss were considered as the secondary outcome measures. A P value of <0.05 was considered as statistically significant. Results: Baseline characteristics of two groups were comparable. The mean central GT was comparable in both groups at 6 months follow-up [group 1: 98 ± 24.46 μm, group 2: 129 ± 31.46 μm (P = 0.18)]. Both groups fared equally in terms of BCVA (P = 0.33). Contrast sensitivity was significantly better in group 1 eyes (P = 0.045). A statistically significant negative correlation was found between postoperative BCVA and postoperative GT (R = −0.728, P = 0.016). The percentage endothelial cell loss was slightly higher in group 2 eyes, although not statistically significant. Two eyes in group 2 experienced complications during lenticule preparation. None of the eye experienced any complication in the postoperative period. Conclusion: Both techniques provided grafts with comparable thickness and endothelial cell loss and were associated with comparable BCVA, at final follow-up visit. The contrast sensitivity was, however, better in eyes receiving grafts prepared with the single-pass technique.
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COMMENTARIES Top

Commentary: Ultrathin Descemet's stripping automated endothelial keratoplasty p. 1294
Abhishek Dave, Manisha Acharya
DOI:10.4103/ijo.IJO_863_19  PMID:31332111
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Commentary: Microkeratome-assisted ultrathin Descemet's stripping automated endothelial keratoplasty p. 1295
Hariprasad Vokuda, Krishnaprasad Kudlu
DOI:10.4103/ijo.IJO_555_19  PMID:31332112
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ORIGINAL ARTICLES Top

Effect of topical glaucoma medication on tear lipid layer thickness in patients with unilateral glaucoma p. 1297
Sang M Lee, Ji-Eun Lee, Sung I Kim, Jae H Jung, Jonghoon Shin
DOI:10.4103/ijo.IJO_2100_18  PMID:31332113
Purpose: To compare the lipid layer thickness (LLT) using the LipiView® ocular surface interferometer (TearScience® Inc, Morrisville, NC) between the eye treated with glaucoma medication and untreated normal eye in the unilateral glaucoma patients, and evaluate the effect of topical glaucoma medication on the LLT parameters in glaucoma eyes. Methods: The participants in this cross-sectional comparative study were unilateral glaucoma patients treated with topical glaucoma medications for more than 12 months. Three LLT parameters (average, minimum, and maximum) obtained by the LipiView® were compared between the glaucomatous eye and normal eye. The factors associated with LLT parameters in the eyes treated with glaucoma medication were investigated with multiple regression analysis. Results: Thirty patients with unilateral normal tension glaucoma were enrolled in the present study. Lipid layer average, minimum, and maximum were 64.83 ± 16.50, 51.63 ± 16.73, and 82.53 ± 20.62 in glaucomatous eyes, 77.26 ± 17.81, 62.83 ± 20.99, and 86.13 ± 15.42 in normal eyes. Lipid layer average and minimum were significantly thinner than those in normal eyes (P < 0.001, P < 0.001, respectively). Longer duration of glaucoma eye drops and a greater number of glaucoma medications were associated with the lower LLT average (β = −0.456, P < 0.001, β = −8.517, P = 0.003, respectively), and increasing glaucoma medications have a significant correlation with lower LLT minimum in glaucoma eyes (β = −8.814, P = 0.026). Conclusion: The present study highlights that patients with long-term glaucoma medications need to be assessed for LLT parameters objectively evaluate their ocular surface health.
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Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber p. 1303
Devendra Maheshwari, Shylesh Dabke, Sindhushree Rajagopal, Mohideen A Kadar, Rengappa Ramakrishnan
DOI:10.4103/ijo.IJO_1341_18  PMID:31332114
Purpose: To evaluate the outcome of a nonvalved Aurolab aqueous drainage implant (AADI) in the management of refractory glaucoma. Methods: Retrospective case series of patients with refractory glaucoma underwent AADI implantation in posterior segment (PS group) or anterior chamber (AC group) with minimum follow-up of 1 year. Primary outcome criterion was success, defined as intraocular pressure (IOP) <18 or >6 mm Hg or IOP reduced to <20% from baseline, for two consecutive visits after 3 months. Failure was defined as inability to meet IOP criteria, any additional glaucoma surgery, loss of light perception, and implant explantation. Secondary outcome criteria compared groups based on mean IOP, mean glaucoma medication use, best-corrected visual acuity, and complications at each postoperative visit. Results: In the AC and PS group of 64 patients, 32 tubes each were placed. Preoperative mean IOP was 37.41 ± 8.6 and 43.38 ± 10.3 mm Hg in AC and PS, respectively. Postoperatively IOP reduced to 14.22 ± 4.9 and 15.21 ± 8.1 mm Hg in AC and PS groups, respectively (P < 0.001). Preoperative mean antiglaucoma medication changed from 2.56 ± 0.9 and 3.44 ± 0.5 to 1.03 ± 0.9 and 1.67 ± 0.5 in AC and PS, respectively, postoperatively (P < 0.001). No significant change in VA was noted in either group. At 12 months, success rate was 84% in AC group and 72% in PS group, with PS group having 2.63 times higher hazard (risk) of failure than AC group. Conclusion: AADI implantation in PS or AC is a safe and effective method for IOP control in refractory glaucoma with its low cost being of significance in developing countries.
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COMMENTARY Top

Commentary: Clinical outcome of a nonvalved Aurolab aqueous drainage implant in posterior segment versus anterior chamber p. 1308
Manish Panday
DOI:10.4103/ijo.IJO_873_19  PMID:31332115
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ORIGINAL ARTICLES Top

Role of ultrasonographic optic nerve sheath diameter in the diagnosis and follow-up of papilledema and its correlation with Frisén's severity grading p. 1310
Nithya Raghunandan, Mary Joseph, Suneetha Nithyanandam, Shubhashree Karat
DOI:10.4103/ijo.IJO_1827_18  PMID:31332116
Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.
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Association of pupil responses with severity of erectile dysfunction in diabetes mellitus p. 1314
Veysel Cankurtaran, Serdar Ozates, Serkan Ozler
DOI:10.4103/ijo.IJO_220_19  PMID:31332117
Purpose: To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM). Methods: This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy). Results: Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each). Conclusion: Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM.
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COMMENTARIES Top

Commentary: Abnormal pupillary light reflexes - A sign of diabetic autonomic neuropathy p. 1319
Rohit Saxena, Rebika Dhiman
DOI:10.4103/ijo.IJO_770_19  PMID:31332118
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Commentary: Recognizing pupillary dysfunction in diabetic autonomic neuropathy p. 1320
Padmaja Sudhakar
DOI:10.4103/ijo.IJO_794_19  PMID:31332119
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SURGICAL TECHNIQUE Top

A new device for intraocular lenses explantation p. 1322
David Pérez-Silguero, Amado Rivero-Santana
DOI:10.4103/ijo.IJO_1171_18  PMID:31332120
Intraocular lenses (IOLs) used in cataract surgery sometimes have to be explanted because of eventual complications like incorrect power, dysphotopsia, opacification, or rupture during implantation. However, current explantation procedures present several shortcomings related to the need for incision enlargement and/or potential damage to ocular structures. We present a new device which increases safety while cutting the lens, allowing the explantation through the original incision, and applicable to any type of IOL.
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COMMENTARIES Top

Commentary: Indications and surgical techniques for intraocular lens explantation p. 1324
Mahipal S Sachdev
DOI:10.4103/ijo.IJO_1171_19  PMID:31332121
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Commentary: Intraocular lens explantation techniques p. 1325
Jeewan S Titiyal, Manpreet Kaur
DOI:10.4103/ijo.IJO_965_19  PMID:31332122
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SURGICAL TECHNIQUE Top

Buckling surgery on a goat's eye: A simple technique to enhance residents' surgical skill p. 1327
Amar Pujari, Suneel Kumar, Ashish Markan, Rohan Chawla, Sourav Damodaran, Atul Kumar
DOI:10.4103/ijo.IJO_1779_18  PMID:31332123
Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.
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PHOTO ESSAY Top

Concentric retinal pigment epithelium tear in central serous chorioretinopathy p. 1329
Darshana Daga, Vinod Kumar, Shorya V Azad
DOI:10.4103/ijo.IJO_105_19  PMID:31332124
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Flat irregular pigment epithelium detachment in central serous chorioretinopathy: Correlation with choroidal neovascular membrane p. 1330
Rajan Gupta, Jay Chhablani
DOI:10.4103/ijo.IJO_2092_18  PMID:31332125
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MRI documentation of acute perioptic hemorrhage in dengue syndrome - A case report p. 1332
Mrinal Matish, Ullas V Acharya, Lakshmi Mahesh, Rupa Ananthasivan, Balasubramanyam Shankar
DOI:10.4103/ijo.IJO_1636_18  PMID:31332126
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Spontaneous regression of angiolymphoid hyperplasia with eosinophilia of lacrimal gland in an HIV-positive patient p. 1334
Pooja Kumari, Nirupama Kasturi, Gayatri Nagarajan, Tharini Senthamizh, BK Ramesh, Hanuman S Bheemanathi
DOI:10.4103/ijo.IJO_1634_18  PMID:31332127
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Optic disc pit maculopathy and its spectrum of management p. 1336
Rebika Dhiman, Srikant K Padhy, Toshit Varshney, SJ Vikas, Prashant Kumar, Atul Kumar
DOI:10.4103/ijo.IJO_1937_18  PMID:31332128
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OPHTHALMIC IMAGES Top

AS-OCT in diffuse conjunctival lymphangiectasia p. 1338
Nikhil S Gokhale
DOI:10.4103/ijo.IJO_2080_18  PMID:31332129
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Iris nodules in Fuchs heterochromic iridocyclitis p. 1339
Nawazish Shaikh, Vinod Kumar, Pradeep Venkatesh
DOI:10.4103/ijo.IJO_2105_18  PMID:31332130
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Inert angle foreign body with late manifestation p. 1340
Ashwin Segi, Siva Prasanna Thilagar, Premanand Chandran
DOI:10.4103/ijo.IJO_2137_18  PMID:31332131
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Retained gold intralenticular foreign body p. 1341
Devashish Dubey, Samendra Karkhur, Alok Sen
DOI:10.4103/ijo.IJO_145_19  PMID:31332132
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Scheimpflug imaging in Christmas tree cataract p. 1342
Sonam Yangzes, Surinder Singh Pandav, Jagat Ram
DOI:10.4103/ijo.IJO_2147_18  PMID:31332133
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Ultra-wide field imaging of nucleus drop in vitreous p. 1343
Chitaranjan Mishra, Naresh Babu, Piyush Kohli, Kim Ramasamy
DOI:10.4103/ijo.IJO_80_19  PMID:31332134
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Central retinal vein occlusion and branch retinal vein occlusion in the same eye p. 1344
M Dheepak Sundar, Prabhav Puri, Rohan Chawla, Nasiq Hasan
DOI:10.4103/ijo.IJO_168_19  PMID:31332135
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A middle hyper-reflective band on spectral domain optical coherence tomography in a case of acute nonarteritic central retinal artery occlusion with sparing of cilioretinal artery p. 1345
Nishat Bansal, Rakesh K Bansal
DOI:10.4103/ijo.IJO_2138_18  PMID:31332136
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Imaging hydration folds following retinal detachment repair p. 1346
Sugandha Goel, A Joash Rijey, Saurabh Kumar, Rupak Roy
DOI:10.4103/ijo.IJO_27_19  PMID:31332137
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Bilateral focal choroidal excavation in high myopia p. 1347
Vinod Kumar, Srikanta Kumar Padhy, T Nithya Bhai, Shorya V Azad
DOI:10.4103/ijo.IJO_3_19  PMID:31332138
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CASE REPORTS Top

The ocular surface after simple limbal epithelial transplant (SLET): A high-resolution OCT study of the early postoperative period p. 1348
Bhaskar Ray Chaudhuri, Anirban Bhaduri, Manikuntala Sengupta
DOI:10.4103/ijo.IJO_1722_18  PMID:31332139
Simple limbal epithelial transplantation (SLET) is an emerging technique for treating unilateral limbal stem cell deficiency. We report the high-resolution, anterior segment optical coherence tomography (OCT) features of the first 2 weeks of a patient undergoing SLET for an old acid injury of the right eye, repeatedly from postoperative day 1 through day 14. Three out of 11 explants with the subjacent human amniotic membrane (hAM) and the overlaid bandage contact lens were imaged. The hAM was intact and of the same thickness throughout the study period; the sub-hAM space increased from day 3 to 9 and disappeared by day 10; the explants started thinning from day 3 with the fibrin around them starting to decrease from day 2 and completely disappeared by day 4. Epithelialization occurred between day 8 and 14 and proceeded more rapidly towards the limbus than centrally. There was no change of the corneal stromal thickness or reflectivity. This case report uses high-definition, spectral-domain OCT to document the events on the ocular surface after a successful SLET surgery and opens up an avenue to study epithelialization in a convenient and noninvasive manner.
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Unilateral acute hydrops in a child with bilateral microcornea and iridofundal coloboma p. 1351
Rinky Agarwal, Grisilda Nongrem, Prafulla K Maharana, Namrata Sharma
DOI:10.4103/ijo.IJO_1671_18  PMID:31332140
A 15-year-old female child with history of bilateral poor vision since childhood presented with sudden onset pain, photophobia, and diminution of vision OD for 10 days. Visual acuity was hand motion OD and 1/60 OS. Slit lamp examination revealed microcornea OU with multiple intrastromal fluid clefts OD and an irregular cornea and iridofundal coloboma OS. A clinical diagnosis of acute corneal hydrops OD was made, and the child was subjected to intraoperative optical coherence tomography guided intrastromal fluid drainage with air tamponade. The corneal edema resolved completely within 2 weeks resuming visual acuity to 3/60 allowing laser delimitation of fundal coloboma OD.
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Post-small incision lenticule extraction phacoemulsification with multifocal IOL implantation: A case report p. 1353
Sri Ganesh, Sheetal Brar, Karthik Sriprakash
DOI:10.4103/ijo.IJO_2069_18  PMID:31332141
A 54-year-old patient presented with cataract, 5 years after undergoing SMILE for high myopia in both eyes. He was motivated in achieving spectacle free vision and his post SMILE-induced aberrations were minimal, due to which he was found suitable for a trifocal IOL implant. Of the various methods considered, the IOL power predicted by a novel combined telecentric keratometry and swept source OCT-based method was finally selected. One month post-operatively, the patient achieved a binocular UDVA of 20/20p and near vision of N.6, suggesting that newer IOL formulae could be superior in providing satisfactory outcomes in post refractive patients.
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Explantation of BrightOcular cosmetic iris implant and goniosynechialysis: A case report p. 1357
David J Mathew, Avner Belkin, Matthew B Schlenker
DOI:10.4103/ijo.IJO_2000_18  PMID:31332142
A 48-year-old lady presented with bilateral symptomatic uveitis. She had bilateral cosmetic iris implantation 4 years ago. She underwent bilateral cosmetic iris explantation and goniosynechialysis to open up areas of angle compromise. This patient presented before significant angle compromise. This case report also serves to highlight the serious potential risks associated with cosmetic iris implantation. Patients with cosmetic iris implants should be warned of the potential complications and advised explantation at the earliest.
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A case of idiopathic necrotizing scleritis with secondary glaucoma treated successfully with golimumab and Ahmed valve implantation p. 1360
Parthopratim Dutta Majumder, Jayshree, Rathini Lilian David, Viswanath Kaushik
DOI:10.4103/ijo.IJO_2081_18  PMID:31332143
A 52-year-old woman presented with idiopathic active scleritis not responding to oral cyclophosphamide, azathioprine, and oral steroid. Her intraocular pressure in the left eye was 45 mm of Hg in spite of using combination of brinzolamide 1% and brimonidine 0.2% (thrice a day), timolol maleate 0.5% (twice a day) eye drops in both eyes and oral acetazolamide. She was administered subcutaneous golimumab 50 mg injection every 4 weeks along with oral methotrexate 15 mg/week. The scleral inflammation responded and she underwent Ahmed glaucoma valve implantation after two months of initiation of golimumab therapy. After one week of surgery her IOP in left eye was the reduced to 8 mm of Hg. The index case showed that Golimumab can be a useful drug in the management of necrotizing scleritis refractory to the conventional therapy.
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Tubercular posterior scleritis: A case report and review of literature p. 1362
Aanchal Mehta Agarwal, Parthopratim Dutta Majumder
DOI:10.4103/ijo.IJO_1942_18  PMID:31332144
A 47-year-old female presented with optic disc oedema, peripapillary subretinal fluid and scattered areas of choroiditis. Her ultrasound B-scan showed sclerochoroidal thickening with widening of sub-Tenon space. Subsequent investigations revealed a positive Mantoux test and high-resolution computed tomography of the chest was suggestive of pulmonary involvement. She responded well to antitubercular treatment and systemic corticosteroid. A review of the literature was conducted to identify additional reports on similar cases and discussed. A high index of suspicion and appropriate laboratory work-up can aid in the diagnosis of tuberculous posterior scleritis.
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COMMENTARIES Top

Commentary: Presumed tubercular posterior scleritis - What is our understanding so far? p. 1365
Aniruddha Agarwal
DOI:10.4103/ijo.IJO_732_19  PMID:31332145
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Commentary: Tubercular posterior scleritis - Nuances in practice! p. 1366
Sivaraman Bala Murugan
DOI:10.4103/ijo.IJO_695_19  PMID:31332146
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CASE REPORTS Top

Swept-source optical coherence tomography angiography of choroidal neovascularization in vertically oriented oval dome-shaped maculopathy p. 1368
Aniruddha Agarwal, Kanika Aggarwal, Vishali Gupta, for the OCTA Study Group
DOI:10.4103/ijo.IJO_2077_18  PMID:31332147
A 48-year-old female presented with complaints of recent onset diminution of vision of the left eye (OS) for the past 2 months. She was highly myopic and was using glasses for the past 30 years. Ocular examination revealed presence of a myopic fundus with high axial lengths in both the eyes. Fundus examination of the OS revealed a myopic tessellated fundus with prominent choroidal vessels and a blunted foveal reflex. There was a small pale whitish lesion just superior to the foveal center. Optical coherence tomography (OCT) scans (both horizontal and vertical) confirmed presence of dome-shaped maculopathy. There was subretinal fluid in the OS. A vertical OCT scan also revealed a subretinal hyperreflective material, which was confirmed to be due to a small mixed type 1 and type 2 choroidal neovascularization (CNV) on swept-source (SS) OCT angiography in the OS. The patient was given intravitreal injection of ranibizumab (0.5 mg/0.05 mL) in the OS. At 1-month follow-up, the subretinal fluid completely resolved. The CNV lesion regressed significantly on SS-OCT angiography. The best-corrected visual acuity improved from 20/80 to 20/20 in the OS, which was maintained at 3 months of follow-up.
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A rare masquerade of chalazion: Adenoid cystic carcinoma p. 1371
Vikas Menon, Rashmi Deshmukh, Kaustubh Mulay
DOI:10.4103/ijo.IJO_2009_18  PMID:31332148
Adenoid cystic carcinoma (ACC) is a rarely seen malignant epithelial tumor of the eyelids. We present a rare case of primary ACC arising from the tarsal plate of the lower lid that clinically resembled a chalazion. A 66-year-old female presented with a recurring nodule in her left lower lid. She gave history of surgery for chalazion removal from the same site twice earlier. An initial diagnosis of a recurrent chalazion was made, and incision and curettage was done. Light microscopy showed a solid tumor composed predominantly of sheet-like and nested pattern of basaloid to low-columnar cells with intervening fibrovascular septa and lacking an obvious cribriform or tubular architecture. The tumor cells were positive for pan-cytokeratin and CD117 and negative for adipophilin, HMB45, and BerEP4. A diagnosis of solid variant of ACC of the eyelid was made. Wide excision was performed and eyelid defect was reconstructed.
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Endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid: Clinicopathologic features, immunohistochemical findings and review of literature p. 1374
Kaustubh Mulay, Vikas Menon, Sumeet Lahane, Mukesh Sharma, Santosh G Honavar
DOI:10.4103/ijo.IJO_1745_18  PMID:31332149
Sweat gland neoplasms are rare adnexal tumors that pose a diagnostic challenge for both, ophthalmologists and pathologists. Endocrine, mucin producing sweat gland carcinoma (EMPSGC), considered to be analogous to the solid papillary mammary carcinoma is one such tumor. It usually affects elderly, is more frequent in women and has a predilection for skin of the eyelid. Although it has an indolent clinical course, EMPSGC is believed to be a precursor of the invasive mucinous carcinoma and has a potential for local recurrence. We report a series of 10 biopsy-proven EMPSGCs with their immunohistochemical features and review the literature.
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A report of orbital metastasis from a urinary bladder adenocarcinoma p. 1377
Deepti Yadav, Manpreet Singh, Kirti Gupta, Manpreet Kaur, Pankaj Gupta
DOI:10.4103/ijo.IJO_1699_18  PMID:31332150
A 60-year-old man presented with sudden-onset proptosis of the left eye and intermittent diplopia of 2 months duration. Ophthalmic examination revealed bilateral eyelid retraction, left eye proptosis and a firm, non-tender mass (2 cm × 1.5 cm) in left supero-medial orbit with restricted extraocular movements. Contrast-enhanced computed tomography showed a well-defined, enhancing antero-medial orbital mass which was removed via anterior orbitotomy approach. The histopathology/immunohistochemistry showed adenocarcinoma; metastasis of urothelial origin. The oncology consultation and metastatic workup revealed a urinary bladder carcinoma with distant metastasis. Our patient expired within 6 months of diagnosis. The ophthalmic symptoms due to orbital metastasis may be the first presentation of some cancer patients.
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LETTERS TO THE EDITOR Top

Refractive errors and the red reflex- Bruckner test revisited p. 1381
Amber A Bhayana, Priyanka Prasad, Shorya V Azad
DOI:10.4103/ijo.IJO_2107_18  PMID:31332151
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Feasibility and outcome of simple limbal epithelial transplantation (SLET) in unilateral total limbal stem cell deficiency (LSCD) following chemical injury, in a semiurban location in Western India p. 1382
Sushmita G Shah, Shreya M Shah, Juhee Agarwal, Ankita Mulchandani
DOI:10.4103/ijo.IJO_1697_18  PMID:31332152
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Humphrey visual field printout: Illumination matters p. 1383
Tarannum Mansoori
DOI:10.4103/ijo.IJO_71_19  PMID:31332153
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Ophthalmic biosimilars: Lessons from India p. 1384
Ashish Sharma, Nilesh Kumar, Baruch D Kuppermann, Bandello Francesco, Anat Lowenstein
DOI:10.4103/ijo.IJO_430_19  PMID:31332154
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ERRATUM Top

Erratum: Intra-arterial chemotherapy in retinoblastoma – A paradigm change p. 1385

DOI:10.4103/0301-4738.263157  PMID:31332155
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