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   2008| March-April  | Volume 56 | Issue 2  
    Online since February 16, 2008

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Visual field defect as a presenting sign for hemorrhagic stroke caused by sildenafil
Morteza Mehdizadeh, Hamid Hosseini, Taher Yazdchi, Siamak Farahangiz
March-April 2008, 56(2):159-160
DOI:10.4103/0301-4738.39127  PMID:18292633
Herein, we describe the presenting symptoms, history, ophthalmic examination, visual fields and brain magnetic resonance imaging of a patient who developed left homonymous hemianopia due to right occipital lobe hemorrhage after ingestion of sildenafil citrate (Novagra Forte). To the best of our knowledge, association of homonymous hemianopia with sildenafil usage has not been reported before.
  8,397 313 1
Optic nerve sheath decompression for visual loss in intracranial hypertension: Report from a tertiary care center in South India
Suneetha Nithyanandam, George J Manayath, Ravindra R Battu
March-April 2008, 56(2):115-120
DOI:10.4103/0301-4738.39115  PMID:18292621
Aim: Severe visual loss is the only serious complication of intracranial hypertension secondary to idiopathic intracranial hypertension (IIH) and some cases of cerebral venous thrombosis (CVT). Optic nerve sheath decompression (ONSD) has been shown to improve or stabilize visual function in patients with IIH, while its role in CVT is yet to be established. We report our experience with optic nerve sheath decompression for visual loss in IIH and CVT. Materials and Methods: In this prospective noncomparative, interventional study, 41 eyes of 21 patients with IIH and CVT and visual loss underwent ONSD. The main outcome measures included best-corrected visual acuity (BCVA), visual fields, pupillary light reflex, optic nerve sheath diameter on B-scan and resolution of papilledema which were evaluated preoperatively and at follow-up at four days, two weeks, one month, three months and final follow-up. In 7/41 eyes with absent light perception preoperatively, the functional outcome was analyzed separately. Results: Following ONSD BCVA and visual fields stabilized or improved in 32/34 (94%) eyes. Statistically significant improvement in BCVA, visual fields and pupillary light reflex occurred over the three month follow-up period. Surgical success was indicated by reduction in optic nerve diameter and papilledema resolution occurred in all patients. The outcome in the IIH and CVT groups was comparable. Four eyes with absent light perception showed marginal improvement in visual acuity. Four eyes had transient benign complications. Conclusion: Optic nerve sheath decompression is an effective and safe procedure to improve or stabilize vision in patients with visual loss caused by IIH and CVT.
  6,807 536 6
Evaluation of distance and near stereoacuity and fusional vergence in intermittent exotropia
Pradeep Sharma, Rohit Saxena, Makarand Narvekar, Ritu Gadia, Vimla Menon
March-April 2008, 56(2):121-125
DOI:10.4103/0301-4738.39116  PMID:18292622
Aim: To evaluate the role of distance and near stereoacuity and fusional vergence in patients with intermittent exotropia [X(T)] and their change after surgery. Materials and Methods: This prospective interventional institution-based clinical study included 31 cases of X(T) requiring surgery and 33 age, sex-matched controls. All subjects underwent complete orthoptic assessment including near stereopsis (Randot stereogram) and distance stereopsis by polaroid stereo-projector apparatus using special paired slides and fusional vergence assessment at distance and near prism bar at baseline and one week, one month, three months and six months after surgery in X(T). Results: The successful surgical alignment rate was 74.2%. Preoperatively, cases demonstrated significantly poor distance and near stereoacuity, compared to controls ( P < 0.001). Mean distance stereoacuity (sec of arc) in normals, (X)T preoperatively and postoperatively was 344.8 139.5, 1149.2 789.4 and 450.1 259 while mean near stereoacuity was 34.7 9.5, 68.7 31.1 and 47.4 22.6 respectively. Postoperatively at six months, significant improvement in stereoacuity was observed both at near and distance ( P < 0.05). Mean distance fusional convergence (in prism diopter) in normals, X(T) preoperatively and postoperatively was 20.7 4.7, 18.0 3.3 and 21.4 3.6 respectively, mean near fusional convergence was 27.8 6.3, 24.1 5.5 and 29.1 5.5 respectively. There was good correlation between fusional vergence amplitudes for distance and near indicating any one would suffice. Conclusion: Early detection of abnormal stereoacuity (near and if possible distance) and near fusional vergence amplitudes may help to decide proper timing of surgery in X(T).
  5,327 518 13
Comparison of refractive errors and factors associated with spectacle use in a rural and urban South Indian population
Raju Prema, Ronnie George, Ramesh Sathyamangalam Ve, Arvind Hemamalini, Mani Baskaran, Govindaswamy Kumaramanickavel, McCarty Catherine, Lingam Vijaya
March-April 2008, 56(2):139-144
DOI:10.4103/0301-4738.39119  PMID:18292625
Purpose: To compare the prevalence of refractive errors and factors associated with spectacle use in a rural and urban south Indian population. Materials and Methods: Four thousand eight hundred subjects (age >39 years) each from rural and urban Tamil Nadu were enumerated for a population-based study. All participants underwent a complete ophthalmic evaluation including best-corrected visual acuity (BCVA), objective and subjective refraction. Out of 3924 rural responders 63.91% and out of 3850 urban responders 81.64% were phakic in the right eye with BCVA of 20/40 or better and were included in the study. Association of spectacle use and refractive errors with different parameters were analysed using logistic regression. Statistical Analysis: Chi square, t test, Chi square for trend and Pearson's correlation coefficient were used for analysis. Results: Spectacle use was significantly higher and positively associated with literacy and employment in the urban population. The age and gender-adjusted prevalence of emmetropia, myopia of spherical equivalent (SE) ≤-0.50 diopter sphere (DS), high myopia (SE ≤-5.00DS), hyperopia (SE >0.50DS) and astigmatism ≤ 0.50 diopter cylinder (DC) were 46.8%, 31.0%, 4.3%, 17.9% and 60.4% respectively in the rural population and 29.0%, 17.6%, 1.5%, 51.9%, 59.1% respectively in the urban population. The prevalence of emmetropia decreased with age ( p < 0.001); prevalence of myopia and high myopia increased with age ( p = 0.001) and were associated with nuclear sclerosis ( p = 0.001) in both populations. Hyperopia was commoner among women than men ( p = 0.001); was positively associated with diabetes mellitus ( p = 0.008) in the rural population and negatively with nuclear sclerosis ( p = 0.001) in both populations. Conclusion: Spectacle use was found to be significantly lower in the rural population. The pattern of refractive errors was significantly different between both populations.
  4,765 498 13
Effects of intraoperative oxidated regenerated cellulose on wound healing reaction after glaucoma filtration surgery: A comparative study with Interceed and Surgicel
Nuray Akyol, Nusret Akpolat
March-April 2008, 56(2):109-114
DOI:10.4103/0301-4738.39114  PMID:18292620
Background: The successful lowering of the intraocular pressure after glaucoma filtration surgery depends mostly on the nature of the healing response, which is also the single most important modifiable factor. Aims: To evaluate and compare the effectiveness of two oxidated regenerated cellulose material, Interceed and Surgicel on wound healing reaction after glaucoma filtration surgery. Setting and Design: University hospital, prospective study. Materials and Methods: Full thickness filtration surgery was carried out on three groups of rabbits. Interceed and Surgicel was applied in Groups 1 and 2 respectively. The third group was the controls. Intraocular pressure, anterior chamber depth and bleb appearance were checked on the first, third, seventh and 14 th days. The rabbits were sacrificed on the14 th day and the trabeculectomy area with overlying conjunctiva was excised, fixed, stained and evaluated histopathologically. Statistics: The values obtained from the clinical and histopathologic evaluation were statistically analyzed using non-parametric tests (Mann Whitney-U and Kruskall Wallis tests) in SPSS for Windows v-10. P values under 0.05 for statistical significance in comparisons were considered significant. Results: The groups were similar with respect to intraocular pressure, anterior chamber depth, bleb appearance and number of the fibroblasts and neutrophils on the seventh and 14 th days. Mean number of the eosinophils and vessels was significantly less in Groups 1 and 2 ( P = 0.014, P = 0.20 respectively). Macrophages in Group 2 were significantly less than Group 1 ( P = 0.047). Conclusion: Both these agents seem to suppress vascularization. Since they have no significant effect on fibroblast proliferation, it is controversial to talk about wound healing modulation.
  4,497 384 2
Surgical outcome in monocular elevation deficit: A retrospective interventional study
Rakhi Bandyopadhyay, Shashikant Shetty, P Vijayalakshmi
March-April 2008, 56(2):127-133
DOI:10.4103/0301-4738.39117  PMID:18292623
Background and Aim: Monocular elevation deficiency (MED) is characterized by a unilateral defect in elevation, caused by paretic, restrictive or combined etiology. Treatment of this multifactorial entity is therefore varied. In this study, we performed different surgical procedures in patients of MED and evaluated their outcome, based on ocular alignment, improvement in elevation and binocular functions. Study Design: Retrospective interventional study. Materials and Methods: Twenty-eight patients were included in this study, from June 2003 to August 2006. Five patients underwent Knapp procedure, with or without horizontal squint surgery, 17 patients had inferior rectus recession, with or without horizontal squint surgery, three patients had combined inferior rectus recession and Knapp procedure and three patients had inferior rectus recession combined with contralateral superior rectus or inferior oblique surgery. The choice of procedure was based on the results of forced duction test (FDT). Results: Forced duction test was positive in 23 cases (82%). Twenty-four of 28 patients (86%) were aligned to within 10 prism diopters. Elevation improved in 10 patients (36%) from no elevation above primary position (-4) to only slight limitation of elevation (-1). Five patients had preoperative binocular vision and none gained it postoperatively. No significant postoperative complications or duction abnormalities were observed during the follow-up period. Conclusion: Management of MED depends upon selection of the correct surgical technique based on employing the results of FDT, for a satisfactory outcome.
  4,426 439 4
First World Glaucoma day, March 6, 2008: Tackling glaucoma challenges in India
R George, L Vijaya
March-April 2008, 56(2):97-98
DOI:10.4103/0301-4738.39111  PMID:18292617
  4,389 393 3
A case of Goldenhar-Gorlin syndrome with unusual association of hypoplastic thumb
Amitava Das, Biswarup Ray, Debabrata Das, Somnath Das
March-April 2008, 56(2):150-152
DOI:10.4103/0301-4738.39123  PMID:18292629
A case of Goldenhar-Gorlin syndrome in a seven-month-old male infant presented with the features of epibulbar dermoid, microtia and hemifacial microsomia associated with thumb defect. The dermoid was bilateral and microtia was unilateral. Preauricular appendages and pits were double and single respectively on both the sides. Hemifacial microsomia was unilateral and was associated with cleft lip, macrostomia, dental misalignment, large tongue and high arched palate. The association of hypoplastic thumb with Goldenhar-Gorlin syndrome has not been documented in the past.
  4,332 324 2
Learning micro incision surgery without the learning curve
Ravi Thomas, Shoba Navin, Rajul Parikh
March-April 2008, 56(2):135-137
DOI:10.4103/0301-4738.39118  PMID:18292624
We describe a method of learning micro incision cataract surgery painlessly with the minimum of learning curves. A large-bore or standard anterior chamber maintainer (ACM) facilitates learning without change of machine or preferred surgical technique. Experience with the use of an ACM during phacoemulsification is desirable.
  3,811 506 3
Optic disc topography of normal Indian eyes: An assessment using optical coherence tomography
Shaun Dacosta, Sheena Bilal, Babu Rajendran, P Janakiraman
March-April 2008, 56(2):99-102
DOI:10.4103/0301-4738.39112  PMID:18292618
Purpose: To study the optic disc topographic measurements of normal Indian eyes using optical coherence tomography (OCT). Materials and Methods: One hundred and fifty eyes selected randomly from 150 normal Indian subjects of both sex and various age groups underwent optic disc imaging with the OCT using the fast optic disc protocol. Results: Mean standard deviation of the optic disc topographic measurements were: disc area 2.63 0.55 mm 2 , cup area 0.87 0.45 mm 2 , neuroretinal rim area 1.78 0.55 mm 2 and cup to disc area ratio 0.33 0.15. There was no significant difference in the measurements between males and females. There was no significant correlation with respect to age and refractive errors ranging from -5.0 to +3.0 diopters of spherical equivalent. Conclusion: Our study provides a normative database for the various optic disc topographic measurements and its variations with age, sex and refractive error in normal Indian eyes using OCT.
  3,815 458 3
Clinical profile and visual outcome in cluster endophthalmitis following cataract surgery in Central India
Sumeet Malhotra, Partha Mandal, Gopal Patanker, Deepshikha Agrawal
March-April 2008, 56(2):157-158
DOI:10.4103/0301-4738.39126  PMID:18292632
The purpose of this study was to determine clinical presentation, microbiological spectrum and visual outcome of cluster endophthalmitis patients after cataract surgery in central India. The records of cluster endophthalmitis patients were retrospectively reviewed. Three clusters of patients were identified who had undergone vitreous biopsy followed by three-port pars plana vitrectomy with intraocular antibiotics and steroids. Good visual outcome was seen in eight (33%) of 24 patients. Six patients had corneal infiltration. Smear positivity was 58% and culture positivity was 42%. There was significant association ( P < 0.001) between presenting vision of <20/400 and growth in vitreous culture ( P = 0.006) with poor visual outcome. The association between type of surgery ( P = 0.6), duration of symptoms ( P = 0.64) and corneal infiltration ( P = 0.06) with visual outcome was not significant. Pseudomonas aeruginosa was the organism isolated in vitreous cultures. Thirty three percent patients benefit after appropriate vitreoretinal intervention in cluster endophthalmitis.
  3,902 355 7
Spontaneous late-onset comitant acute non-accommodative esotropia in children
Pramod Kumar Pandey, Pankaj Vats, Navjot Kaur, Ajit G Kulkarni
March-April 2008, 56(2):167-168
DOI:10.4103/0301-4738.39134  PMID:18292638
  3,636 211 2
'SIA-Soft' : A new software to calculate surgically induced astigmatism in comparison with manual mathematics by vector method
Samar K Basak, Soham Basak, Aritra Roy Chowdhury
March-April 2008, 56(2):170-170
DOI:10.4103/0301-4738.39137  PMID:18292641
  3,448 338 2
The probable associations for corticocapsular adhesions in patients undergoing cataract surgery: A clinic-based observational study
Abhay R Vasavada, Shetal M Raj, MR Praveen, Viraj A Vasavada, Vaishali A Vasavada
March-April 2008, 56(2):103-108
DOI:10.4103/0301-4738.39113  PMID:18292619
Background: Corticocapsular adhesions (CCA) are frequently seen between lens capsule and adjacent cortical layer. During cataract surgery, in the presence of CCA, excessive efforts to rotate the nucleus can result in zonular damage. To reduce morbidity, identification of associations with CCA can be helpful in appropriately modifying the surgical procedure. Aim: To investigate probable associations with CCA in patients undergoing cataract surgery. Setting and Design: Iladevi Cataract and IOL research center. Case-control study. Materials and Methods: A single eye of 600 patients, 200 patients with CCA (cases) and 400 patients without CCA (controls) were considered. A CCA diagnosis was based on: (i) preoperative presence of CCA on slit-lamp examination with visualization of furry surface of cortex during surgery; (ii) preoperative absence of CCA on slit-lamp examination but intraoperative visualization of furry surface of cortex. Variables such as age, gender, type of cataract, grade of cataract, high myopia, diabetes mellitus and hypertension were studied. Statistical Analysis: Multivariate logistic regression was done. Results were presented as odds ratio (OR) with 95% CI. Results: Mean age was 64.71 9.10 years in cases and 59.27 8.79 years in controls. Presence of CCA increased with age from 22% (n = 59) in 45 to 49 years to 70% (n = 110) in 70 to 79 years. An increase in age was associated with CCA by 3.3% (OR = 3.3%, P = 0.028). The odds of CCA for females were 83% higher ( P = 0.027). Presence of anterior cortical cataract increased odds of CCA by 9.5 times ( P = 0.001), while posterior cortical cataract increased odds by 3.3 times ( P = 0.001). Conclusion: Corticocapsular adhesions were strongly associated with cortical cataracts, increased age and female gender.
  3,232 393 -
A case of neurofibromatosis 1 presenting with optic pathway glioma with an early onset and an aggressive course
Suma Ganesh, Archana Gupta, Manish Sharma, Sandeep Bhuttan
March-April 2008, 56(2):161-162
DOI:10.4103/0301-4738.39128  PMID:18292634
Optic pathway glioma associated with neurofibromatosis 1 has a classically indolent course. However, involvement of the optic radiations is relatively rare and is associated with a more aggressive course. A three-year-old girl presented with strabismus and loss of vision in the left eye with relative afferent pupillary defect and optic disc pallor. She had multiple cafι au lait spots. Visually evoked potential was suggestive of an optic nerve conduction defect and magnetic resonance imaging of the brain was suggestive of an optic pathway glioma involving the optic nerves, the optic chiasma and the optic tracts. The optic radiations and the dentate nuclei had hamartomas. Optic nerve biopsy confirmed pilocytic astrocytoma. Radical radiotherapy under general anesthesia was subsequently given. This case report aims to highlight the involvement of the optic radiations and the unusually aggressive clinical course in this case.
  3,192 288 1
Warming device for computer vision syndrome
K Ilango
March-April 2008, 56(2):171-171
DOI:10.4103/0301-4738.39139  PMID:18292642
  2,926 446 -
Management of an irradiated anophthalmic socket following dermis-fat graft rejection: A case report
Kuldeep Raizada, Debraj Shome, Santosh G Honavar
March-April 2008, 56(2):147-148
DOI:10.4103/0301-4738.39121  PMID:18292627
Dermis-fat graft (DFG) is often the only promising option in cases of severely contracted sockets. However, there is an increased risk of graft failure in irradiated sockets with decreased vascularity. In such difficult cases, repeat DFG implantation also has higher risks of graft failure. We describe an ingenious method of successful management of an irradiated anophthalmic socket following DFG infection and necrosis, with acceptable cosmetic results. At surgery, an orbital impression was taken with ophthalmic grade alginate. Based on this measurement, a custom-made stem pressure socket-expander made up of high density polymethyl methacrylate (PMMA) was fitted, a week post surgery and kept in situ for six weeks. On review, the fornices had considerably deepened. The expander device was removed and the patient was now fitted with a custom-made thicker prosthesis made up of high-density PMMA. The patient has followed up for a year subsequently and the prosthesis has remained stable.
  2,838 299 6
Inherited partial aniridia, microcornea with high myopia and Bergmeister's papilla: A new phenotypic expression
Prashant Naithani, Ankur Sinha, Viney Gupta
March-April 2008, 56(2):145-146
DOI:10.4103/0301-4738.39120  PMID:18292626
We describe a rare case of familial partial aniridia with high myopia and Bergmeister papilla in five members of a family. Cataract surgery was performed on the proband wherein a brown black spherophakic lens was extracted.
  2,791 198 -
Ocular adnexal lymphoma in the Northeast Indian population
Dipankar Das, Panna Deka, Kasturi Bhattacharjee, Jayanta Kumar Das, Ganesh Kuri, Akshay Chandra Deka, Harsha Bhattacharjee
March-April 2008, 56(2):153-155
DOI:10.4103/0301-4738.39124  PMID:18292630
We present the clinical profile of biopsy and immunohistochemistry-proven ocular adnexal lymphomas in the Northeast Indian population. Nineteen patients between October 2004 and June 2006 with ocular adnexal lymphoma were analyzed retrospectively. Histopathological classification was done according to international working formulation. Twelve patients were male and seven were female. All were diagnosed as non-Hodgkin's lymphoma and the majority were B cell type (89%). Most of the cases (42%)were treated with radiotherapy followed by chemotherapy.
  2,653 251 5
Combination of photodynamic therapy with intravitreal bevacizumab for post-peribulbar anesthesia (penetrating trauma)-persistent choroidal neovascular membrane
Nikunj Shah, Urmi Shah
March-April 2008, 56(2):163-164
DOI:10.4103/0301-4738.39129  PMID:18292635
We report a case of a choroidal neovascular membrane (CNVM) following ocular penetration during peribulbar anesthesia in a 55-year-old male patient. A combination of photodynamic therapy with intravitreal bevacizumab led to resolution of the persistent CNVM.
  2,327 220 3
Direct aspiration of capsular bag material in a case of sequestered endophthalmitis
Lingam Gopal, Amit Nagpal, Aditya Verma
March-April 2008, 56(2):155-157
DOI:10.4103/0301-4738.39125  PMID:18292631
Chronic recurrent endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens implantation secondary to organisms sequestered in the capsular bag. There is a need to identify these sequestered organisms to facilitate appropriate management. Frequently, specimens from the anterior chamber and vitreous cavity could be unyielding, especially in the early cases in which the vitreous is still uninvolved. This article highlights the technique of directly sampling the capsular bag material in the effective diagnosis of the organism, which facilitated the total cure by irrigation with appropriate antibiotics into the capsular bag.
  2,315 229 1
Suprachoroidal collection of internal tamponading agents through a choroidal hole
Lingam Gopal, Nishank Mittal, Aditya Verma
March-April 2008, 56(2):149-150
DOI:10.4103/0301-4738.39122  PMID:18292628
We report two cases of significantly large choroidal holes following penetrating trauma that led to suprachoroidal migration of internal tamponading agents during repair of retinal detachments with proliferative vitreoretinopathy secondary to penetrating trauma. In the first case, choroidal hole was a direct result of the injury and was identified immediately after vitreoretinal surgery which was done for traumatic retinal detachment with hemorrhagic choroidal detachment. In the second case, the hole occurred over a period of several months after the repair of traumatic retinal detachment with silicone oil tamponade. This was attributed to progressive fibrosis exerting traction on the bare choroid/retinal pigment epithelium. Choroidal hole significant enough to cause suprachoroidal migration of internal tamponading agents is a very rare complication seen in eyes with posttraumatic retinal detachment with proliferative vitreoretinopathy.
  2,335 184 2
Pigmented squamous cell carcinoma of the limbus area: A rare case
E Shirzadeh
March-April 2008, 56(2):169-169
DOI:10.4103/0301-4738.39136  PMID:18292639
  2,060 200 -
Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 g at birth
Niranjan Kumar, Vivek B Wani, Khalid Al Sabti
March-April 2008, 56(2):166-166
DOI:10.4103/0301-4738.39132  PMID:18292637
  1,786 241 1
Author's reply
Mihir Kothari
March-April 2008, 56(2):168-169
  1,861 133 -
Greenish discoloration of silicone intraocular lens
Rengaraj Venkatesh, Thangavel Thirumalai Kumar, Ravilla D Ravindran
March-April 2008, 56(2):170-171
DOI:10.4103/0301-4738.39138  PMID:18292640
  1,746 174 -
Oculosporidiosis in a tertiary care hospital of Western Orissa, India
Archana Sood, Badri Badhu
March-April 2008, 56(2):165-165
DOI:10.4103/0301-4738.39130  PMID:18292636
  1,751 165 -
Authors' reply
Anand Vinekar, Mangat R Dogra, Tiakumzuk Sangtam, Anil Narang, Amod Gupta
March-April 2008, 56(2):166-167
  1,262 137 1
Authors' reply
Ravindra K Chowdhury, Sharmistha Behera, Debendranath Bhuyan, Gunasagar Das
March-April 2008, 56(2):165-165
  1,193 112 -