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  Citation statistics : Table of Contents
   2009| July-August  | Volume 57 | Issue 4  
    Online since June 30, 2009

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Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: Experience of over a decade
Usha Gopinathan, Savitri Sharma, Prashant Garg, Gullapalli N Rao
July-August 2009, 57(4):273-279
DOI:10.4103/0301-4738.53051  PMID:19574694
Purpose : To review the epidemiological characteristics, microbiological profile, and treatment outcome of patients with suspected microbial keratitis. Materials and Methods : Retrospective analysis of a non-comparative series from the database was done. All the patients presenting with corneal stromal infiltrate underwent standard microbiologic evaluation of their corneal scrapings, and smear and culture-guided antimicrobial therapy. Results : Out of 5897 suspected cases of microbial keratitis 3563 (60.4%) were culture-proven (bacterial - 1849, 51.9%; fungal - 1360, 38.2%; Acanthamoeba - 86, 2.4%; mixed - 268, 7.5%). Patients with agriculture-based activities were at 1.33 times (CI 1.16-1.51) greater risk of developing microbial keratitis and patients with ocular trauma were 5.33 times (CI 6.41-6.44) more likely to develop microbial keratitis. Potassium hydroxide with calcofluor white was most sensitive for detecting fungi (90.6%) and Acanthamoeba (84.0%) in corneal scrapings, however, Gram stain had a low sensitivity of 56.6% in detection of bacteria. Majority of the bacterial infections were caused by Staphylococcus epidermidis (42.3%) and Fusarium species (36.6%) was the leading cause of fungal infections. A significantly larger number of patients (691/1360, 50.8%) with fungal keratitis required surgical intervention compared to bacterial (799/1849, 43.2%) and Acanthamoeba (15/86, 17.4%) keratitis. Corneal healed scar was achieved in 75.5%, 64.8%, and 90.0% of patients with bacterial, fungal, and Acanthamoeba keratitis respectively. Conclusions : While diagnostic and treatment modalities are well in place the final outcome is suboptimal in fungal keratitis. With more effective treatment available for bacterial and Acanthamoeba keratitis, the treatment of fungal keratitis is truly a challenge.
  63 8,903 1,651
Diabetic retinopathy, visual impairment and ocular status among patients with diabetes mellitus in Yemen: A hospital-based study
Mahfouth A Bamashmus, Abdallah A Gunaid, Rajiv B Khandekar
July-August 2009, 57(4):293-298
DOI:10.4103/0301-4738.53055  PMID:19574698
Background : We present a series of patients with diabetes mellitus (DM) who attended an eye hospital in Sana, Yemen during 2004. Aim: To determine the magnitude and risk factors of diabetic retinopathy (DR). Design: Cross-sectional study. Materials and Methods: Ophthalmologists assessed vision, ocular pressure, ocular media and posterior segment to note ocular manifestations among patients with DM. DR was graded by using bio-microscope and Volk lens. The prevalence and 95% confidence interval of ocular complications of DM were calculated. Risk factors of DR like age, sex, duration of diabetes and hypertension were evaluated. Statistical a0 nalysis : Univariate and multivariate analysis. Results : Our series comprised 350 patients suffering from DM. The duration of diabetes was ≥15 years in 101 (29%) patients. Physician was treating 108 DM patients with insulin. The prevalence of DR was 55% (95% CI 49.6-60.1). The proportions of background diabetic retinopathy (BDR), preproliferative diabetic retinopathy (PPDR), proliferative diabetic retinopathy (PDR) and diabetic macular edema were 20%, 13%, 17% and 22% respectively. The prevalence of blindness among DM patients was 16%. The prevalence of cataract and glaucoma was 34.3% and 8.6%. Duration of DM was the predictor of DR. One-fifth of the patients had sight-threatening DR and needed laser treatment. Conclusions : DR was of public health magnitude among our patients. An organized approach is recommended to address DR in the study area.
  17 4,442 676
Current concepts in the pathophysiology of glaucoma
Renu Agarwal, Suresh K Gupta, Puneet Agarwal, Rohit Saxena, Shyam S Agrawal
July-August 2009, 57(4):257-266
DOI:10.4103/0301-4738.53049  PMID:19574692
Glaucoma, the second leading cause of blindness, is characterized by changes in the optic disc and visual field defects. The elevated intraocular pressure was considered the prime factor responsible for the glaucomatous optic neuropathy involving death of retinal ganglion cells and their axons. Extensive investigations into the pathophysiology of glaucoma now reveal the role of multiple factors in the development of retinal ganglion cell death. A better understanding of the pathophysiological mechanisms involved in the onset and progression of glaucomatous optic neuropathy is crucial in the development of better therapeutic options. This review is an effort to summarize the current concepts in the pathophysiology of glaucoma so that newer therapeutic targets can be recognized. The literature available in the National Medical Library and online Pubmed search engine was used for literature review.
  14 11,137 1,826
Functional and anatomical outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 retinopathy of prematurity
Pramod Bhende, Lingam Gopal, Tarun Sharma, Aditya Verma, Rupak Kanti Biswas
July-August 2009, 57(4):267-271
DOI:10.4103/0301-4738.53050  PMID:19574693
Background: While lens-sacrificing vitrectomy is the standard approach to manage Stage 5 retinopathy of prematurity (ROP), scleral buckling has been used to manage some cases of Stage 4. Lens-sparing vitrectomy was popularized by Maguire and Trese in selected cases of Stage 4 disease. Purpose: To assess the functional and visual outcomes after primary lens-sparing pars plana vitrectomy for Stage 4 ROP. Materials and Methods: In a retrospective, interventional, consecutive case series, the records of 39 eyes of 31 patients presenting with Stage 4 retinal detachment secondary to ROP who underwent primary two or three-port lens-sparing vitrectomy from January 2000 to October 2006 were evaluated. The outcomes studied at the final follow-up visit were the retinal status, lens and medial clarity and visual acuity . Favorable anatomical outcome was defined as the retinal reattachment of the posterior pole at two months after the surgery; and favorable functional outcome was defined as a central, steady and maintained fixation, with the child following light. Results: At mean follow-up of 15 months, 74% of the eyes had a favorable anatomical outcome with single procedure. The visual status was favorable in 63% . The lens remained clear in all the eyes at the last follow-up, and the media clarity was maintained in 87%. Intraoperative complications included vitreous hemorrhage, pre-retinal hemorrhage and retinal break formation. Conclusions: Lens-sparing vitrectomy helps to achieve a favorable anatomical and functional outcome in selected cases of Stage 4 ROP.
  7 3,417 561
Comparison of psychosocial and emotional consequences of childhood strabismus on the families from rural and urban India
Mihir Kothari, Suwarna Balankhe, Rinkle Gawade, Svetlana Toshnival
July-August 2009, 57(4):285-288
DOI:10.4103/0301-4738.53053  PMID:19574696
Purpose : To compare the psychosocial consequences of horizontal comitant strabismus in children between the families of urban and rural India. Materials and Methods : In this cohort study, an eight-question quality-of-life instrument was administered by trained staff to the guardians of strabismic children from rural and urban areas by a live interview. Results : This study included 93 strabismic-children aged 4-16 years of which 52 were females. Forty-one had esodeviation and 52 had exodeviation. Seventy per cent parents were extremely distressed due to squint, 65% were extremely distressed due to people's remarks, 65% were extremely worried, 55% children were extremely distressed due to people's remarks, 57% children were severely ostracized, 38% had severe difficulty in communication and 50% had difficulty to cope; 64% parents were not advised a corrective surgery. The difference between families from rural and urban areas, or whether a male child was affected or a female child or for an esodeviation or an exodeviation was statistically not significant. The questionnaire had a good internal consistency (Cronbach's Alpha = 0.71). Conclusions : There was a significant negative psychosocial and emotional impact of childhood strabismus that was not affected by the rural or urban location of the family or the gender of the strabismic child or type of the deviation. The quality-of-life instrument can be used as part of the clinical examination for strabismic children.
  7 3,232 423
Tear ascorbic acid levels and the total antioxidant status in contact lens wearers: A pilot study
Sai Jyothi Aluru Venkata, Angayarkanni Narayanasamy, Vidhya Srinivasan, Geetha Krishnan Iyer, Ramakrishnan Sivaramakrishnan, Madhumathi Subramanian, Rajeshwari Mahadevan
July-August 2009, 57(4):289-292
DOI:10.4103/0301-4738.53054  PMID:19574697
Aims: The tear ascorbate owing to its high concentration, functions as an effective antioxidant against the oxidative damage of cornea. Contact lens wearers (CLW) are prone to oxidative stress due to the lens-induced hypoxic conditions. A pilot study was done to compare the tear ascorbic acid level and the total antioxidant capacity give as in normal and CLW. Materials and Methods: In this study 21 CLW (Mean age 23 3 years ; M-2, F-19), who were daily wear users, with duration of wear not more than four years, along with age-matched 28 controls (Mean age 28 3 ; M-15, F-13) were recruited in the study for collection of reflex tears using Schirmer's strip. Ascorbic acid in tears was determined using high-performance liquid chromatography (HPLC), total antioxidant capacity (TAC) and total protein assay by spectrophotometric analysis. Results: CLW showed no significant change in the tear ascorbic acid levels (0.4 0.26 mM) compared to the control subjects (0.61 0.59 mM). The amount of ascorbic acid in tears did not correlate with the TAC or the total protein of the tears. The mean TAC in CLW was 0.69 0.16 mM, with a total protein of 1.35 0.46 mg/ml while in controls it was 0.7 0.18 mM and 1.21 0.47 mg/ml respectively . Conclusions: Soft contact lens wear did not show any significant change in tear ascorbic acid, TAC and total protein levels compared to controls.
  5 4,153 457
Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole
Raju Biju, Daniel Sushil, Nainan K Georgy
July-August 2009, 57(4):306-308
DOI:10.4103/0301-4738.53058  PMID:19574701
Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency. Voriconazole, a broad-spectrum triazole antifungal agent, attains therapeutically significant concentrations in the vitreous cavity after systemic administration. We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole. Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.
  4 2,763 504
Keratouveitis caused by Euphorbia plant sap
Samar K Basak, Partho K Bakshi, Sabitabrata Basu, Soham Basak
July-August 2009, 57(4):311-313
DOI:10.4103/0301-4738.53060  PMID:19574703
The milky sap or latex of Euphorbia plant is highly toxic and an irritant to the skin and eye. This report illustrates the spectrum of ocular inflammation caused by accidental inoculation of latex of Euphorbia plant. Three patients presented with accidental ocular exposure to the milky sap of Euphorbia species of recent onset. The initial symptoms in all cases were severe burning sensation with blurring of vision. Visual acuity reduced from 20/60 to counting fingers. Clinical findings varied from kerato-conjunctivitis, mild to severe corneal edema, epithelial defects, anterior uveitis and secondary elevated intraocular pressure. All symptoms and signs had resolved by 10-14 days with active supportive medication. People who handle Euphorbia plants should wear eye protection. It is always advisable to ask the patient to bring a sample of the plant for identification.
  4 3,326 330
Vision recovery in human immunodeficiency virus-infected patients with optic neuropathy treated with highly active antiretroviral therapy: A case series
Kalpana Babu, Krishna R Murthy, Nirmala Rajagopalan, B Satish
July-August 2009, 57(4):315-318
DOI:10.4103/0301-4738.53062  PMID:19574705
We describe three patients with bilateral, presumed human immunodeficiency virus (HIV)-induced optic neuropathy. The above diagnosis was made by exclusion of infectious agents and neoplasms by detailed clinical and laboratory investigations. All patients had decreased visual acuity, pale optic discs and constriction of visual fields. Improvement was documented in all three patients for visual acuity and in one patient for visual fields following treatment with highly active antiretroviral therapy (HAART). Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. This article emphasizes the effectiveness of HAART in presumed HIV-induced optic neuropathy.
  3 1,770 317
Evaluation of central, steady, maintained fixation grading for predicting inter-eye visual acuity difference to diagnose and treat amblyopia in strabismic patients
Mihir Kothari, Amar Bhaskare, Deepali Mete, Svetlana Toshniwal, Priti Doshi, Shalini Kaul
July-August 2009, 57(4):281-284
DOI:10.4103/0301-4738.53052  PMID:19574695
Background : Diagnosis of amblyopia in preverbal strabismic patients is frequently made by binocular fixation preference (BFP) testing. The reports on reliability of BFP are equivocal. This study evaluated the reliability of BFP testing in patients with horizontal strabismus. Materials and Methods: This prospective observational study included patients with manifest, horizontal, comitant deviation >10 prism diopter (PD). Inter-eye acuity difference (IEAD) was calculated by converting Snellen visual acuity to logMAR and was compared with BFP testing. The fixation behavior of the non-preferred eye was evaluated by a single investigator as central or uncentral, steady or unsteady and maintained or unmaintained. Amblyopia was defined as the IEAD of >0.2 logMAR. Results: Of total 61 patients 36 were females and 36 had convergent squint, mean age 9.8 years. The correlation of BFP testing with IEAD was good for esotropia and exotropia. The sensitivity, specificity, positive and negative predictive value of central, steady, maintained (CSM) grading was 93%, 78%, 79%, and 93% respectively. Sensitivity and negative predictive values were higher in children aged four to nine years and anisometropia >1 diopter. The correlation between IEAD and lower grades of BFP testing was poor. Conclusions: CSM grading for BFP testing is useful for the detection of strabismic amblyopia but not useful to differentiate the depth of the amblyopia.
  3 5,812 487
Retinal pigment epithelium atrophy following indocyanine green dye-assisted surgery for serous macular detachment
Vinod Kumar, Basudeb Ghosh, Meenakshi Thakar, Neha Goel
July-August 2009, 57(4):326-327
DOI:10.4103/0301-4738.53069  PMID:19574712
  2 1,398 242
Aniridia associated with congenital aphakia and secondary glaucoma
Mayur Moreker, Rajul Parikh, Shefali R Parikh, Ravi Thomas
July-August 2009, 57(4):313-314
DOI:10.4103/0301-4738.53061  PMID:19574704
We report a case of aniridia associated with congenital aphakia and secondary glaucoma. A 35-year-old male presented with aniridia, congenital aphakia and secondary glaucoma in both eyes. After an unsuccessful medical management, he underwent trabeculectomy with mitomycin C and anterior vitrectomy under local anesthesia in his left eye. Postoperatively, at the end of six months, intraocular pressure (IOP) in his left eye was controlled without medications. This case highlights the rare association of aniridia with congenital aphakia and secondary glaucoma.
  1 1,857 350
Schwannoma of the eyelid: Apropos of two cases
Raja Anane Touzri, Khalil Errais, Rachida Zermani, Sarra Benjilani, Amel Ouertani
July-August 2009, 57(4):318-320
DOI:10.4103/0301-4738.53063  PMID:19574706
Schwannoma, also referred to as neurilemmoma, is a benign tumor of peripheral nerve arising from Schwann cells that form the neural sheath. Schwannoma of ophthalmic interest is rare although it has been reported in relation with the orbit, and less frequently with the uveal tract and conjunctiva. Isolated eyelid schwannoma is extremely uncommon. Up until now, only eight cases have been reported in literature. Herein, we report two cases of eyelid schwannoma.
  1 1,910 285
Fibrinous anterior uveitis following laser in situ keratomileusis
Pragya Parmar, Amjad Salman, M Rajmohan, Nelson CA Jesudasan
July-August 2009, 57(4):320-322
DOI:10.4103/0301-4738.53064  PMID:19574707
A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.
  1 1,943 274
Vertical lid split approach for optic nerve sheath decompression
Venkatesh C Prabhakaran, Dinesh Selva
July-August 2009, 57(4):305-306
DOI:10.4103/0301-4738.53057  PMID:19574700
We describe a vertical lid split orbitotomy approach to perform optic nerve sheath fenestration which was done in a patient with idiopathic intracranial hypertension. A vertical lid split incision was used to enter the superomedial orbit and approach the optic nerve sheath. This approach resulted in a successful nerve sheath fenestration, with improvement in the patient's symptoms. The vertical lid split incision provides access to the optic nerve sheath with minimal morbidity and may be an option for optic nerve sheath decompression.
  1 2,274 386
Vitamin A-first dose supplement coverage evaluation amongst children aged 12-23 months residing in slums of Delhi, India
Sandeep Sachdeva, Utsuk Datta
July-August 2009, 57(4):299-303
DOI:10.4103/0301-4738.53056  PMID:19574699
Objective: To determine vitamin A-first dose supplement coverage in children aged 12-23 months and to find out its correlates with selected variables . Materials and Methods: The 30-cluster sampling technique based on probability proportional to size advocated by the World Health Organization was used to assess vitamin A-first dose supplement amongst 210 children in the age group of 12-23 months residing in slums of a randomly selected municipal zone of Delhi during October to November 2005. Results: Only 79 (37.6%) children out of 210 had received vitamin A-first dose supplement. Further analysis of 79 children was carried out with regard to selected variables like religion, gender, birth order, place of birth, immunization status and literacy of mother. These analyses showed that 71 (89.9%) were Hindu and eight (10.1%) were non-Hindu ( P = 0.04). Nearly 44 (55.7%) males and 35 (44.3%) females had received vitamin A ( P = 0.74). The proportion of children born in a health institution who received first dose (57%) of vitamin A supplementation was significantly higher than of those who were born at home (43%) ( P < 0.001). Similarly, higher proportion of children with birth order-one (48.1%) in comparison to birth order-three or above (26.6%) received vitamin A ( P < 0.001). Thirty children though fully immunized for vaccine-preventable disease up to the age-of-one year had not received vitamin A-first dose supplement, suggesting that an opportunity had been missed. The association between receipt of vitamin A by the child and literacy status of mother was found to be significant ( P < 0.001). Conclusion: The study reflects low coverage of Vitamin A supplement.
  1 2,692 379
Microphthalmia and microcornea: In congenital cytomegalovirus
P Kava Maina, Nagarajan Lakshmi
July-August 2009, 57(4):323-323
DOI:10.4103/0301-4738.53065  PMID:19574708
  1 3,188 326
Entrapment of intravitreal triamcinolone behind the crystalline lens
Amjad Salman, Pragya Parmar, Vanila G Coimbatore, Rajmohan Meenakshisunderam, Nelson Jesudasan A Christdas
July-August 2009, 57(4):324-325
DOI:10.4103/0301-4738.53066  PMID:19574709
  1 1,492 271
Authors' reply
Nazimul Hussain, Subhadra Jalali, Alka Rani, Hema Rawal
July-August 2009, 57(4):327-327
  1 1,168 203
Optical coherence tomography in a patient with chloroquine-induced maculopathy
Suresh Ramchandani, Sushama Ramchandani
July-August 2009, 57(4):327-328
DOI:10.4103/0301-4738.53071  PMID:19574713
  1 1,572 310
Scleral ulceration after vitreoretinal surgery
Nikhil S Gokhale
July-August 2009, 57(4):309-310
DOI:10.4103/0301-4738.53059  PMID:19574702
Scleral ulceration after ocular surgery is a rare but serious complication. Determination of the underlying systemic and local causes is critical for treatment. An unusual case of ischemic scleral ulceration after vitreoretinal surgery in a diabetic patient is reported. Patient was successfully treated with a pedicle conjunctival graft.
  - 1,921 301
Off with the label and on the Avastin bandwagon: Why now and how far?
KS Santhan Gopal
July-August 2009, 57(4):253-256
DOI:10.4103/0301-4738.53048  PMID:19574691
  - 3,181 621
Anti-vascular endothelial growth factor in ophthalmology
Rajesh Sinha, Sunil Choudhary, Subijoy Sinha, Nagender Vashisht, Chandrashekhar Kumar
July-August 2009, 57(4):330-335
  - 2,092 561
Authors' reply
Sanita Korah, Thomas Kuriakose
July-August 2009, 57(4):328-329
  - 1,089 222
Polycythemia vera presenting with bilateral papilledema
Suneetha Nithyanandam
July-August 2009, 57(4):325-325
DOI:10.4103/0301-4738.53067  PMID:19574711
  - 1,373 272
Retinitis pigmentosa associated with blepharophimosis, blue dot cataract and primary inferior oblique overaction: A new syndrome complex or consummate myotonic dystrophy?
Pramod Kumar Pandey, Pankaj Vats, Pooja Jain, Ashish Amar, Yuvika Bansal
July-August 2009, 57(4):325-326
DOI:10.4103/0301-4738.53068  PMID:19574710
  - 1,744 247