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   2006| July-September  | Volume 54 | Issue 3  
 
 
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BRIEF REPORTS
Congenital Horner's syndrome and the usefulness of the apraclonidine test in its diagnosis
Hasan Mirzai, Esin F Baser
July-September 2006, 54(3):197-199
DOI:10.4103/0301-4738.27073  PMID:16921219
We present a seven-month-old baby with miosis of the left pupil, left hypochromia, mild ipsilateral ptosis, left hemifacial anhidrosis and asymmetrical facial flushing. A diagnosis of Horner's syndrome (HS) was presumed and was confirmed by instillation of apraclonidine eye drops. Miosis was reversed upon apraclonidine instillation. Magnetic resonance imaging of the head, neck and thorax and ultrasonography of the neck and abdomen did not reveal any pathological conditions. Although delivery-related brachial plexus injury is known as the most common cause of congenital HS, it should be investigated and should include neuroimaging of the sympathetic pathway, to exclude a serious underlying disease. As in our case, a specific etiology may not always be elicited. Pharmacological testing with apraclonidine may be a practical alternative to cocaine in the diagnosis of HS.
  15,650 634 10
REVIEW ARTICLE
Techniques of periocular reconstruction
Vidushi Sharma, Ross Benger, Peter A Martin
July-September 2006, 54(3):149-158
DOI:10.4103/0301-4738.27064  PMID:16921210
Eyelid and periocular reconstruction is often needed in ophthalmic practice, as a result of defects created by excision of lesions or following trauma. A variety of techniques have been described for the repair of these defects. However, it is important to have a knowledge of the basic principles underlying all these techniques and the advantages and disadvantages of each, so as to ensure the selection of the optimal technique in a particular case. Different authors have popularized different techniques based on individual preferences and experiences and a brief overview of the different techniques will be helpful to compare them. The articles referenced in this manuscript were looked up through PubMed by feeding the keywords 'periocular reconstruction' and 'eyelid reconstruction' and then looking for relevant cross-references. In this review, we have discussed the various techniques available and also illustrated them diagrammatically to have a quick overview of the topic.
  13,813 1,182 12
BRIEF REPORTS
Acute myopia and angle closure caused by topiramate, a drug used for prophylaxis of migraine
Charuta Mandke Desai, Suresh J Ramchandani, Sunil G Bhopale, Sushama S Ramchandani
July-September 2006, 54(3):195-197
DOI:10.4103/0301-4738.27072  PMID:16921218
Acute transient myopia with shallowing of the anterior chamber is a rare idiosyncratic response to many systemic and topical medications, including sulfonamides. Several such cases have been reported in the past, but are less frequently reported in recent times. We report a case of acute progressive myopia and bilateral angle closure due to Topiramate - a drug used for epilepsy and migraine prophylaxis
  13,693 674 26
ORIGINAL ARTICLE
Smith-method assessment of anterior chamber depth for screening for narrow anterior chamber angles
Turki M Al-Mubrad, Kelechi C Ogbuehi
July-September 2006, 54(3):165-168
DOI:10.4103/0301-4738.27066  PMID:16921212
Purpose: To compare the axial anterior chamber depth (ACD) using the Smith method, in patients under treatment for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), with an age-matched control group. Materials and Methods: Triplicate just-touching-slit-length (JTSL) measurements of the axial anterior chamber depth were determined in 198 eyes of 99 patients (39 control; 36 POAG; and 24 PACG) recruited from King Saud University clinics, Riyadh, Saudi Arabia. Goldmann tonometry and gonioscopy were carried out as a part of the patient's routine examination. Subjects with a history of intraocular surgery for glaucoma or any other anterior segment disease were excluded form the study. The average ACD estimate by the JTSL method were compared among the various groups. Results: The average JTSL estimates were: Control group 2.33±0.68 mm (axial ACD estimate = JTSL estimate ´ 1.4); POAG group 1.98±0.97 mm; PACG group 0.65±0.41 mm. There was no significant reduction ( P = 0.068) of the JTSL estimate in the POAG group, compared to the control group. There was a statistically significant ( P < 0.001) reduction of the JTSL estimate in the PACG group, compared to both the control and POAG groups. Conclusion: The Smith-method JTSL technique may be used for non-invasive rapid screening, to help identify patients at risk of developing angle-closure, during routine examination of patients in the ophthalmology clinic.
  12,834 601 5
LETTER TO EDITOR
Snellen chart may be preferable over early treatment diabetic retinopathy study charts for rapid visual acuity assessment
Hem Kumar Tewari, Vandana Kori, Parul Sony, Pradeep Venkatesh, Satpal Garg
July-September 2006, 54(3):214-214
DOI:10.4103/0301-4738.27087  PMID:16921230
  11,951 512 1
ORIGINAL ARTICLE
Evaluation of the anterior chamber angle in Asian Indian eyes by ultrasound biomicroscopy and gonioscopy
Sushmita Kaushik, Rajeev Jain, Surinder Singh Pandav, Amod Gupta
July-September 2006, 54(3):159-163
DOI:10.4103/0301-4738.27065  PMID:16921211
Purpose: To compare the ultrasound biomicroscopic measurement of the anterior chamber angle in Asian Indian eyes, with the angle width estimated by gonioscopy. Materials and Methods: Participants: Patients with open and closed angles attending a glaucoma clinic were recruited for the study. Observation Procedures: Temporal quadrants of the angles of patients were categorized by gonioscopy as Grade 0 to Grade 4, using Shaffer's classification. These angles were quantified by ultrasound biomicroscopy (UBM) using the following biometric characteristics: Angle opening distance at 250 µ (AOD 250) and 500 µ (AOD 500) from the scleral spur and trabecular meshwork-ciliary process distance (TCPD). The angles were further segregated as "narrow angles" (Schaffer's Grade 2 or less) and "open angles" (Schaffer's Grade 3 and 4). Main Outcome Measures: The UBM measurements were computed in each case and analyzed in relation to the gonioscopic angle evaluation. Results: One hundred and sixty three eyes of 163 patients were analyzed. One hundred and six eyes had "narrow angles" and 57 eyes had "open angles" on gonioscopy. There was a significant difference among the mean UBM measurements of each angle grade estimated by gonioscopy ( P < 0.001). The Pearson correlation coefficient between all UBM parameters and gonioscopy grades was significant at the 0.01 level. The mean AOD 250, AOD 500 and TCPD in narrow angles were 58±49 µ, 102±84 µ and 653±124 respectively, while it was 176±47 µ, 291±62 µ and 883±94 µ in eyes with open angles ( P < 0.001) respectively. Conclusions: The angle width estimated by gonioscopy correlated significantly with the angle dimensions measured by UBM. Gonioscopy, though a subjective test, is a reliable method for estimation of the angle width.
  11,203 805 22
Ocular motor nerve palsy: A clinical and etiological study
Jean-Claude Mwanza, Georgette B Ngweme, David L Kayembe
July-September 2006, 54(3):173-175
DOI:10.4103/0301-4738.27068  PMID:16921214
Purpose: To clinically describe cases of ocular motor nerve palsy and to determine the possible causes. Materials and Methods: Thirty-one consecutive patients with ocular motor nerve palsies were investigated. All underwent complete ophthalmological, as well as neurological, otorhinolaryngological and general examination. Computerised tomography (CT)-scan of the brain and complementary laboratory tests were obtained from each participant. Results: Paralysis of the sixth (38.4%) and the third (35.3%) cranial nerve were the most common. The Lees screen test was found to be very sensitive, confirming the diagnosis of ocular motor nerve palsy, even in cases with minimal manifestations. Complete ptosis and full mydriasis were mostly seen in isolated cases of the third cranial nerve palsy. The majority of eyes (63.2%) with third cranial nerve palsy had pupil sparing. Overall, an etiological diagnosis was made in 93.5% of cases. The common causes were vascular conditions (25.8%), otorhinolaryngologic diseases (19.7%) and trauma (12.9%). CT scan failed to reveal any abnormality in 54.8% of cases. Conclusion: Patients with ocular motor nerve palsy should be carefully examined in close collaboration with other specialists, especially where sophisticated, complementary investigations are impossible.
  10,108 1,024 8
COMMUNITY OPHTHALMOLOGY
Need for optical and low vision services for children in schools for the blind in North India
Nikhil Pal, Jeewan S Titiyal, Radhika Tandon, Rasik B Vajpayee, Sanjeev Gupta, GVS Murthy
July-September 2006, 54(3):189-193
DOI:10.4103/0301-4738.27071  PMID:16921217
Context: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). Aim: To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. Setting and Design: Cross-sectional study conducted in 13 blind schools in Delhi, North India. Materials and Methods: Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. Results: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. Conclusion: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.
  9,445 662 8
ORIGINAL ARTICLE
Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series
Harinder Singh Sethi, Vimla Menon, Pradeep Sharma, Sudarshan Khokhar, Radhika Tandon
July-September 2006, 54(3):177-183
DOI:10.4103/0301-4738.27069  PMID:16921215
Purpose: To evaluate the clinical profile, response to dexamethasone treatment and visual function outcome in Indian patients with acute optic neuritis. Materials and Methods: We conducted an observational study of patients with acute optic neuritis who were treated with intravenous dexamethasone (100 mg in 250 ml of 5% dextrose over 1-2 hours daily, for three consecutive days) and had completed at least two years of follow-up. Parameters assessed included visual acuity, contrast sensitivity, color vision, visual fields, relative afferent pupillary defect (RAPD) and visually evoked potentials. Out of 40 patients studied, 26 patients (33 eyes) had all visual function parameters assessed. Twenty three patients (28 eyes) had completed two years of follow-up and were included for statistical analysis. Results: Improvement in visual acuity was statistically significant for distance after 24 hours of the first dose ( P = < 0.001) and for near vision after 24 hours of the second dose ( P = 0.006); improvement in color and contrast sensitivity was statistically significant 24 hours after the third dose ( P = < 0.001 for color vision and P = 0.013 for contrast sensitivity). Significant improvement in RAPD and visual fields were seen by 1 month ( P = 0.005). Recurrence was seen in 4 eyes of 4 patients. No serious side effects were observed. At two years, 82.14% (23 out of 28) eyes had visual acuity > 20/40. Conclusion: Treatment with intravenous pulsed dexamethasone led to rapid recovery of vision in acute optic neuritis, without any serious side effects.
  8,607 698 20
Preoperative prediction of posterior capsule plaque in eyes with posterior subcapsular cataract
Abhay R Vasavada, MR Praveen, Urvi D Jani, Sajani K Shah
July-September 2006, 54(3):169-172
DOI:10.4103/0301-4738.27067  PMID:16921213
Aim: To determine whether the plaque on the posterior capsule can be predicted preoperatively, in patients with posterior subcapsular cataract (PSC), undergoing cataract surgery. Materials and Methods: A prospective study of 140 consecutive eyes with PSC, who underwent cataract surgery, was conducted. The prediction of preoperative presence or absence of plaque within the PSC was noted on slit lamp examination, in dilated pupils. A single observer made the observations under oblique illumination, where the slit lamp was placed at an angle of 30° to 45°. Evaluation of the plaque through slit lamp examination was standardized in terms of illumination and magnification. The observations were recorded using a video camera (Image archiving system, Carl Zeiss, Jena Germany) attached to a slit lamp (Carl Zeiss, SL 120 Jena, Germany), keeping the illumination at 100%. The prediction of plaque was noted in terms of its presence or absence on the posterior capsule. All the patients received counseling regarding the presence of plaque. Capsule polishing of the posterior capsule in Cap Vac mode, was done in all cases. The posterior capsule was examined for presence or absence of plaque, either on the first postoperative day, or within a week, with maximal mydriasis. The observer's results were tabulated and later analyzed to judge the incidence of predictability of plaque in PSC. Results: The mean age of the patients was 45±6.2 years (range 32-61 years); 104 (74.3%) were males. One hundred and eight (77.1%) patients were under 50 years. The presence or absence of plaque was predicted correctly in 124 (88.6%) eyes. The prediction of plaque was incorrect in 16 (11.4%) eyes. Conclusion: The prediction of presence or absence of plaque was accurate in 88.6% cases. We believe that counseling patients with posterior capsule plaque before the surgery is the key to avoiding unpleasant surprises.
  8,288 455 8
BRIEF REPORTS
Congenital eversion of upper eyelids: Case report and management
Rajat Maheshwari, Sejal Maheshwari
July-September 2006, 54(3):203-204
DOI:10.4103/0301-4738.27076  PMID:16921222
Congenital eversion of the upper eyelids is a rare condition, the exact cause of which remains unknown. It is more frequently associated with Down's syndrome and black babies. If diagnosed early and treated properly, the condition can be managed without surgery. We report a case of congenital bilateral severe upper eyelid eversion in a normal infant, born by vaginal delivery. The case was conservatively managed by lubricants, antibiotics and eyelid patching.
  7,705 460 17
Recurrent Salzmann's nodular degeneration: Report of two cases and review of literature
Rajesh Sinha, Manpreet S Chhabra, Rasik B Vajpayee, Seema Kashyap, Radhika Tandon
July-September 2006, 54(3):201-202
DOI:10.4103/0301-4738.27075  PMID:16921221
Recurrence of Salzmann's nodular degeneration following corneal transplantation is uncommon. The earlier reports of recurrence of Salzmann's degeneration were based on clinical evidence. We report two histopathologically proven cases of recurrence of Salzmann's nodular degeneration following keratoplasty; one recurring after lamellar keratoplasty and the other following penetrating keratoplasty. Two male patients (40 yrs and 24 yrs) presented to us with a clinical picture of Salzmann's nodular degeneration. One patient had undergone lamellar keratoplasty in both eyes for Salzmann's degeneration, 22 years ago. A repeat lamellar keratoplasty was performed in the right eye (7.5 mm/8 mm). In the other patient, penetrating keratoplasty was performed in the left eye, 6 years ago for the same. Lamellar keratoplasty was performed in the left eye (8 mm/8 mm). The histopathologic evaluation of the host button in both the cases, showed features very much suggestive of a recurrence of Salzmann's nodular degeneration.
  7,048 300 6
Primary orbital neuroblastoma in a neonate
Hasan Mirzai, Esin F Baser, Nermin Tansug, Nalan Nese, Aydin Isisag
July-September 2006, 54(3):206-208
DOI:10.4103/0301-4738.27078  PMID:16921224
Neuroblastoma is an undifferentiated malignant tumor of the primitive neuroblasts. Orbital neuroblastoma is typically a metastatic tumor. We describe a two-days-old girl, who presented with a large tumor in her left orbit. Magnetic resonance imaging revealed that the tumor originated from the retrobulbar area, extending into the upper and lateral orbit. She was operated on the fifth day of life. A histopathologic diagnosis of neuroblastoma was made. Medical evaluation including chest roentgenogram, ultrasonography of the abdomen, whole body computerized tomogram and bone scintigraphy showed no evidence of systemic involvement or metastasis. Neuroblastoma should be considered in the differential diagnosis of neonatal orbital tumors.
  6,357 460 7
ORIGINAL ARTICLE
25 gauge vitrectomy under topical anesthesia: A pilot study
Biju Raju, NSD Raju, Anju S Raju
July-September 2006, 54(3):185-188
DOI:10.4103/0301-4738.27070  PMID:16921216
Aims: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. Settings and Design: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. Materials and Methods: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes), retained cortex (1 eye) and postoperative endophthalmitis (4 eyes). Subjective pain and discomfort were graded from 0 (no pain or discomfort) to 4 (severe pain and discomfort). Patients underwent an immediate postoperative assessment, followed by day one and one week postoperative evaluation. Results: All patients had grade 0 pain during the surgery. Five patients had grade 2 pain during the placement of the sclerotomies. None of the patients required any sedation during the procedure. No inadvertent eye movements were noted during surgery. Except one patient, none required postoperative analgesics. Five eyes had a favorable outcome. No eyes in this pilot study had any procedure-related complications. Conclusion: With appropriate case selection, topical anesthesia is a safe and effective alternative to infiltrative anesthesia for 25 gauge vitrectomy. A larger series of patients with a longer follow-up is required to validate the findings of this pilot study.
  6,183 359 10
BRIEF REPORTS
Combined central retinal artery and vein occlusion secondary to systemic non-Hodgkin's lymphoma
Dhananjay Shukla, Amit Arora, Khazaei M Hadi, Mahesh Kumar, Satish Baddela, Ramasamy Kim
July-September 2006, 54(3):204-206
DOI:10.4103/0301-4738.27077  PMID:16921223
We report a rare case of low-grade systemic B-cell non-Hodgkin's lymphoma (NHL) causing central retinal artery and vein occlusion, which was the only manifestation of disease recurrence. A young man with resolved systemic NHL underwent fluorescein angiography, magnetic resonance imaging and computed tomography to investigate a severe unilateral visual loss. A combined vascular occlusion was observed in the right eye. Neuroimaging detected optic nerve infiltration; but no systemic/ central nervous system involvement was observed. The patient was treated with high-doses of corticosteroids and optic nerve irradiation. The optic neuropathy and vascular occlusion were resistant to treatment. The subsequent neovascular glaucoma was treated by panretinal photocoagulation, which relieved the pain, but vision was not recovered. No further recurrence was observed over the following year.
  5,911 442 13
LETTER TO EDITOR
Leber's hereditary optic neuropathy masquerading as ethambutol- Induced optic neuropathy in a young male
Bithi Chowdhury, AK Nagpaul, Debashish Chowdhury
July-September 2006, 54(3):218-219
DOI:10.4103/0301-4738.27091  PMID:16921234
  5,639 337 8
Classification of amblyopia
Vimla Menon, Zia Chaudhuri, Rohit Saxena, Kulwant Gill, MM Sachdeva
July-September 2006, 54(3):212-212
DOI:10.4103/0301-4738.27085  PMID:16921229
  5,283 502 -
GUEST EDITORIAL
Angle closure and India
Devindra Sood, NN Sood
July-September 2006, 54(3):147-148
DOI:10.4103/0301-4738.27063  PMID:16921209
  5,314 398 3
LETTER TO EDITOR
Hand held digital camera for digital video recording in ophthalmic surgery
Ankur Sinha, Rohit Saxena, Harinder singh Sethi, Kiran Turaka
July-September 2006, 54(3):209-209
DOI:10.4103/0301-4738.27079  PMID:16921225
  5,239 239 7
Floppy eyelid syndrome in an infant
Lavanya G Rao, Sulatha V Bhandary, Anjana R Devi, Shiji Gangadharan
July-September 2006, 54(3):217-218
DOI:10.4103/0301-4738.27090  PMID:16921233
  5,062 314 16
BRIEF REPORTS
Necrotizing scleritis following diode laser trans-scleral cyclophotocoa- gulation
Sudha K Ganesh, Kapil Rishi
July-September 2006, 54(3):199-200
DOI:10.4103/0301-4738.27074  PMID:16921220
We report a case of necrotizing scleritis following diode cyclo-photocoagulation (CPC). A-64-year-old-Asian Indian male presented with pseudophakic corneal decompensation with secondary angle closure glaucoma that was uncontrolled with maximum medical therapy. Trans-scleral diode CPC was performed in the inferior 180-degree section using a standard diode laser with a G-probe. One month later, the patient developed features suggestive of necrotizing scleritis that resolved with systemic steroid therapy. Necrotizing scleritis following diode CPC has been rarely reported. Ophthalmologists should be aware of the possible occurrence of surgically induced nectotizing scleritis following diode CPC.
  4,838 339 9
LETTER TO EDITOR
Acute idiopathic bilateral lower lid ectropion
Bhaskar Gupta, Bina Parmar, Jyoti Raina, JS Chawla
July-September 2006, 54(3):212-214
DOI:10.4103/0301-4738.27086  PMID:16921228
  4,139 229 1
Ultrastructural study of a contusion cataract
Koray Gumus, Hayyam Kiratli, Sinan Yuruker
July-September 2006, 54(3):215-216
DOI:10.4103/0301-4738.27088  PMID:16921231
  3,996 218 2
Comparing Subtenon's anesthesia with peribulbar technique for cataract surgery
Leena Barikh
July-September 2006, 54(3):210-211
DOI:10.4103/0301-4738.27083  PMID:16921226
  3,707 306 1
Birth centenary of Sir Harold Ridley (10th July 1906 - 25th May 2001)
Samar K Basak
July-September 2006, 54(3):219-220
DOI:10.4103/0301-4738.27092  PMID:16921235
  3,355 212 -
Spontaneous rupture of the anterior lens capsule
Jaspreet Sukhija, Jagat Ram, Gagandeep S Brar, Supratik Bandhyopadhyaya
July-September 2006, 54(3):216-217
DOI:10.4103/0301-4738.27089  PMID:16921232
  3,296 227 4
Bilateral dissociated vertical deviation in a case of congenital hereditary endothelial dystrophy
M Srinivasan
July-September 2006, 54(3):210-210
DOI:10.4103/0301-4738.27081  PMID:16921227
  2,451 244 -
Authors' reply
Biju Raju, NSD Raju, Anju S Raju, CP Sudhakaran, Abdul Razak
July-September 2006, 54(3):209-210
  2,355 162 -
Author's reply
Parikshit Gogate
July-September 2006, 54(3):211-211
  2,012 156 -
Authors' reply
Rahul Bhola, Rohit Saxena, Harinder Singh Sethi, Pradeep Sharma, Anita Panda, Seema Sen
July-September 2006, 54(3):210-210
  1,967 132 -