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   2013| July  | Volume 61 | Issue 7  
    Online since July 30, 2013

 
 
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ORIGINAL ARTICLES
Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma
Sirisha Senthil, Harsha L Rao, Jonnadula G Babu, Anil K Mandal, Chandra Sekhar Garudadri
July 2013, 61(7):338-342
DOI:10.4103/0301-4738.109520  PMID:23571259
Purpose: To compare the safety and efficacy of trabeculectomy with Ologen implant vs. trabeculectomy with Mitomycin C (MMC). Materials and Methods: In a prospective, randomized, pilot study, 39 eyes of 33 subjects with medically uncontrolled primary glaucoma, aged 18 years or above underwent trabeculectomy either with MMC (20 eyes) or with Ologen implant (19 eyes). The primary outcome measure was cumulative success probability, defined as complete if the intraocular pressure (IOP) was > 5 and ≤ 21 mm Hg without anti-glaucoma medications or additional surgery and qualified if an IOP was > 5 and ≤ 21 mm Hg with or without anti-glaucoma medications. Results: Mean (± standard deviation) follow-up in Ologen group was 19.1 ± 8.1 months, and in MMC group was 18.0 ± 8.4 months. Mean IOP reduction at 6 months was significantly lower (P = 0.01) in the MMC group (11.9 ± 2.9 mm Hg) as compared to Ologen group (14.6 ± 2.7 mm Hg). However, at 12 months (P = 0.81) and 24 months (P = 0.32), the mean IOP was similar between the 2 groups. Complete success probability at the end of 6 months in Ologen group was 100% (95% confidence interval: 59.1 - 99.0) was similar (P = 0.53) to that in MMC group (93.8%, 95% CI: 63.2 - 99.1). The incidences of early post-operative complications were similar in the 2 groups, except hyphema, which was significantly more in Ologen group (P = 0.02). Conclusion: In this pilot study, the success of trabeculectomy and complications were similar in both Ologen and MMC groups at the end of 6 months.
  9,697 708 37
Contact lens use and its compliance for care among healthcare workers in Pakistan
Muhammed Hamza Khan, Syed Muhammed Mubeen, Tanveer Anjum Chaudhry, Shaharyar Ahmed Khan
July 2013, 61(7):334-337
DOI:10.4103/0301-4738.97552  PMID:23552347
Background: Poor care and hygiene of contact lens (CL) results in eye problems and infections. Healthcare workers have an important role in advocating correct lens care. Objectives: To determine the practices of CL care and the adverse consequences of poor CL care among healthcare workers. Setting and Design: A cross-sectional study in one public and three private sector hospitals in Karachi, Pakistan, in 2009-2010. Materials and Methods: We questioned 500 healthcare workers of all ages and both sexes, who wore CL, about compliance with advice on care and any complications due to improper hygiene practices. Ethical approval was obtained. Chi-square tests were used to determine significance and p-value less than 0.05 was considered statistically significant. Results: Of the total CL users, 385 (77%) were females. Most (75%) respondents wore CL to correct myopia, whereas 54% wore CL only occasionally. Surprisingly, only 24% knew the CL cleaning protocol. Lens solution was changed daily by 33% of users and after more than 2 weeks by 42%. Although 412 (82%) participants practised reasonable hand hygiene before inserting CL, 88 (18%) did not. Infection and eye dryness were statistically significantly (P < 0.01) associated with sex, hand-washing, and frequency of CL use. Conclusion: Noncompliance with the CL protocol was common among healthcare workers in our society. This behavior calls for targeted health education and awareness programs for healthcare workers.
  8,036 403 4
The relationship between binocular vision symptoms and near point of convergence
Momeni-Moghaddam Hamed, A Goss David, Ehsani Marzieh
July 2013, 61(7):325-328
DOI:10.4103/0301-4738.97553  PMID:23552348
Aim and Background: Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students. Materials and Methods: In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter "E" of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann-Whitney U test and receiver operating characteristic (ROC) curve. Results: The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study. Conclusion : The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.
  7,584 661 11
Effect of air bubble on inflammation after cataract surgery in rabbit eyes
Goktug Demirci, Levent Karabas, Hale Maral, Sengül Ozdek, Gökhan Gülkilik
July 2013, 61(7):343-348
DOI:10.4103/0301-4738.109528  PMID:23571264
Purpose: Intense inflammation after cataract surgery can cause cystoid macular edema, posterior synechia and posterior capsule opacification. This experimental study was performed to investigate the effect of air bubble on inflammation when given to anterior chamber of rabbit eyes after cataract surgery. Materials and Methods: 30 eyes of 15 rabbits were enrolled in the study. One of the two eyes was in the study group and the other eye was in the control group. After surgery air bubble was given to the anterior chamber of the study group eye and balanced salt solution (BSS; Alcon) was left in the anterior chamber of control eye. Results: On the first, second, fourth and fifth days, anterior chamber inflammations of the eyes were examined by biomicroscopy. On the sixth day anterior chamber fluid samples were taken for evaluation of nitric oxide levels as an inflammation marker. When the two groups were compared, in the air bubble group there was statistically less inflammation was seen. (1, 2, 4. days P = 0,001, and 5. day P = 0,009). Conclusions: These results have shown that when air bubble is left in anterior chamber of rabbits' eyes after cataract surgery, it reduced inflammation. We believe that, air bubble in the anterior chamber may be more beneficial in the cataract surgery of especially pediatric age group, uveitis patients and diabetics where we see higher inflammation. However, greater and long termed experimental and clinical studies are necessary for more accurate findings.
  7,236 269 3
BRIEF COMMUNICATIONS
The association of carotid cavernous fistula with Graves' ophthalmopathy
Ozlem Celik, Deram Buyuktas, Civan Islak, A Murat Sarici, A Sadi Gundogdu
July 2013, 61(7):349-351
DOI:10.4103/0301-4738.109533  PMID:23571267
Graves' ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature.
  6,452 239 7
Distant metastatic retinoblastoma without central nervous system involvement
Mohammad Javed Ali, Santosh G Honavar, Vijay Anand Reddy
July 2013, 61(7):357-359
DOI:10.4103/0301-4738.97077  PMID:23548316
Retinoblastoma is the most common intraocular malignancy in children, with a reported incidence ranging from 1 in 15,000 to 1 in 18,000 live births. Metastatic retinoblastoma is rare in developed countries, with a reported range from 4.8% in the United States to 5.8% in the United Kingdom. However, the frequency reported from developing countries varies from 9 to 11% at presentation. The mortality is very high owing to late presentations, delayed diagnosis compounded by socio-economic factors. The management of metastatic retinoblastoma is evolving, but it is still a challenge in pediatric oncology. We present a case of an extensive skeletal metastasis that initially presented as a massive orbital retinoblastoma.
  4,673 270 4
JOURNAL ABSTRACT
Posterior capsular opacification: A review
Rajesh Sinha, Himanshu Shekhar, Namrata Sharma, Jeewan S Titiyal, Rasik B Vajpayee
July 2013, 61(7):371-376
DOI:10.4103/0301-4738.115787  PMID:23896457
  4,086 517 9
ORIGINAL ARTICLES
The effects of melatonin on anxiety and pain scores of patients, intraocular pressure, and operating conditions during cataract surgery under topical anesthesia
Marzieh Beigom Khezri, Hamid Merate
July 2013, 61(7):319-324
DOI:10.4103/0301-4738.99637  PMID:23552356
Aims: To evaluate the effects of melatonin premedication on anxiety and pain scores of patients, operating conditions, and intraocular pressure during cataract surgery under topical anesthesia. Materials and Methods: Sixty patients were randomly assigned to receive either sublingual melatonin 3 mg or placebo 60 min before surgery. Verbal anxiety scores and verbal pain scores, heart rate, systolic and diastolic blood pressure, intraocular pressure, and quality of operating conditions were recorded. Results: Melatonin significantly reduced the anxiety scores (median, interquartile range) from 5 and 5-3 to 3 and 2-4 after premedication and to 3 and 2-3 during surgery and to 0 and 0-1 postoperatively before discharge from the recovery room. There were significant differences between two groups in anxiety scores after premedication (95% CI 3-3.5; P = 0.023), intraoperatively (95% CI 2.5-3.5; P = 0.007), and postoperatively (95% CI 0.5-1; P = 0.007). The surgeon reported better quality of operating conditions in the melatonin group (P = 0.001). No significant difference in intraoperative and postoperative pain scores, intraocular pressure, heart rate, and systolic and diastolic blood pressure between two groups was recorded. Conclusion: Sublingual melatonin premedication for patients undergoing cataract surgery under topical anesthesia reduced the anxiety scores in patients and provided excellent operating conditions.
  4,175 414 25
BRIEF COMMUNICATIONS
Vitrectorhexis versus forceps posterior capsulorhexis in pediatric cataract surgery
Lav Kochgaway, Partha Biswas, Ajoy Paul, Sourav Sinha, Rupak Biswas, Puspen Maity, Sumita Banerjee
July 2013, 61(7):361-364
DOI:10.4103/0301-4738.101066  PMID:23571249
This study was done to compare the results of posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. Vitrectorhexis term was first used by Wilson et al in 1999. [1] Fifty eyes with congenital and developmental cataract were included in this study. The posterior capsulorhexis was created using utrata forceps in 17 eyes or through a vitrector in 33 eyes. Forceps capsulorhexis was performed before IOL implantation, while vitrectorhexis was performed after IOL implantation in the bag. The results of both the surgery were compared using the following criteria: incidence of extension of rhexis, ability to achieve posterior rhexis of appropriate size, ability to implant the IOL in the bag, the surgical time, and learning curve. Vitrectorhexis after IOL implantation was an easy to learn alternative to manual posterior continuous curvilinear capsulorhexis in pediatric cataract surgery. It was more predictable and reproducible, with a short learning curve and lesser surgical time.
  3,633 221 5
EDITORIAL
Recent trends in Glaucoma management
Sundaram Natarajan
July 2013, 61(7):317-318
DOI:10.4103/0301-4738.115786  PMID:23896452
  2,809 516 -
ORIGINAL ARTICLES
Intravitreal injection of methotrexate in an experimental rabbit model: Determination of ultrastructural changes
Ebru B Ozkan, Altan A Ozcan, Hande Taylan Sekeroglu, Yurdun Kuyucu, Hulya Ozgun, Sait Polat
July 2013, 61(7):329-333
DOI:10.4103/0301-4738.109518  PMID:23571257
Purpose: To investigate the ultrastructural changes of the rabbit retina induced by intravitreal methotrexate injection. Materials and Methods: Ten New Zealand white rabbits were enucleated bilaterally at different time periods after intravitreal methotrexate injection. One rabbit was used as control group and one rabbit was used as intact group. Histopathological examinations were performed under light and electron microscopy. Early (within first three days after injection) and long-term (one month after serial injections) effects of intravitreal methotrexate on the retina were investigated. Results: Retinal edema, vacuolization, and disintegration of mitochondria of the retinal cells were observed as early changes. The main long-term effects after serial injections were edema in the photoreceptor, inner nuclear, and ganglionic cell layers. Cellular disorganisation was seen on light microscopy. Electron microscopic examination revealed mitochondrial degeneration and vacuole formation in retinal cells, nuclear degeneration in outer nuclear layer, and membranous whorl formation in photoreceptor and nerve fiber layers. Conclusions High dose intravitreal methotrexate injection may cause significant ultrastructural changes in the rabbit retina in varying severity. This finding may highlight the potential side effects of methotrexate on human retina in higher doses.
  2,991 232 5
BRIEF COMMUNICATIONS
Different treatment modalities for choroidal neovascularization in two eyes of one patient with bilateral type 2A parafoveal telangiectasia
Vivek Dave, Jay Chhablani, Raja Narayanan
July 2013, 61(7):353-355
DOI:10.4103/0301-4738.99851  PMID:23571237
A 60-year-old diabetic man presented with a history of decrease in vision in both eyes since 2 weeks. At presentation, best corrected visual acuity (BCVA) in the right eye (RE) was 20/30 and that in the left eye (LE) was 20/80. The right fundus revealed a grayish reflex, yellowish crystalline deposits and retinal pigment epithelial hyperplasia at the macula. The left fundus showed subretinal fluid and temporal subretinal hemorrhage near a grayish reflex at the macula. A diagnosis in both eyes of idiopathic macular telangiectasia (IMT) type 2A with RE stage 4 and LE stage 5, choroidal neovascularization (CNVM) was made. The patient was treated with photodynamic therapy (PDT) in LE. The visual acuity improved to 20/40 over the next 6 months. At a 4-year follow-up, he developed decreased vision in RE diagnosed as IMT with CNV and was treated with intravitreal ranibizumab. At 6-month follow-up post injection, the vision was 20/40p.
  2,824 202 1
Localized bi-nasal macular edema in optic chiasmal syndrome
Alejandro J Lavaque, Taygan Yilmaz, Miguel Cordero-Coma
July 2013, 61(7):351-353
DOI:10.4103/0301-4738.97079  PMID:23548317
A 28-year-old healthy male complaining of vision loss in his right eye was discovered to have localized bi-nasal macular edema in the presence of a pituitary adenoma. The presence of a junctional scotoma composed by a central scotoma in the right eye associated with superior temporal quadrantanopia in the fellow eye was seen. The pattern detected in the visual field suggested the presence of an expansive mass at the level of the optic chiasm. Optical coherence tomography findings also revealed subtle macular thickness beyond normal in the superior and nasal quadrants of both maculae. This report illustrates the importance of suspecting a pituitary adenoma in the light of uncharacteristic retinal alterations.
  2,748 130 1
Conjunctival erosion after glaucoma drainage device surgery: A feasible option
Suneeta Dubey, Baswati Prasanth, Manisha C Acharya, Ritesh Narula
July 2013, 61(7):355-357
DOI:10.4103/0301-4738.99852  PMID:23571238
Glaucoma drainage devices (GDDs) have been used in the management of complicated glaucomas. GDDs are associated with various complications such as tube migration, tube or plate exposure or extrusion, ocular motility disturbance and infection. Erosion of conjunctiva and exposure of the GDD remains a risk factor for the development of endophthalmitis. A wide range of materials have been used for this purpose, including sclera, dura, pericardium, fascia lata and cornea. However, there is no evidence to prove that any of these methods is superior to another for providing tectonic durability in the long term. In this report, we present a case of neovascular glaucoma, who developed conjunctival melting over the tube of an Ahmed Glaucoma Valve implant and was successfully managed with Cap Doxycycline.
  2,559 215 4
Pseudoexfoliation on pseudophakos
Subashini Kaliaperumal, Vasudev A Rao, Shruthi B Harish, Lavanya Ashok
July 2013, 61(7):359-361
DOI:10.4103/0301-4738.109514  PMID:23571253
We report three patients with deposition of pseudoexfoliation (PXF) material on intraocular lens years after uneventful cataract surgery. PXF was not present before the cataract surgery. The PXF material was found on the anterior surface of the intraocular lens in the first patient and on the posterior surface as well in the other two patients. All the patients had a polymethylmethacrylate intraocular lens placed in the sulcus. The fellow eyes did not have PXF. All the patients had open angle glaucoma in both eyes.
  2,370 197 5
LETTERS TO THE EDITOR
Intralesional bleomycin injection for periocular capillary hemangiomas
VP Gupta, Pragati Gupta
July 2013, 61(7):367-368
DOI:10.4103/0301-4738.115790  PMID:23896454
  1,696 172 -
Can single stage surgery in Blepharophimosis syndrome be practiced universally?
Ruchi Goel, Amit Goel
July 2013, 61(7):368-369
DOI:10.4103/0301-4738.115796  PMID:23896455
  1,520 140 1
Single-stage surgery for Blepharophimosis syndrome
Kasturi Bhattacharjee, Harsha Bhattacharjee, Ganesh Kuri, Zeenat Tajmin Shah, Nilutparna Deori
July 2013, 61(7):369-370
DOI:10.4103/0301-4738.115788  PMID:23896456
  1,408 149 3
Macular drusenoid deposits in X-linked retinoschisis
Manish Tandon, Dhananjay Shukla
July 2013, 61(7):366-367
DOI:10.4103/0301-4738.115791  PMID:23896453
  1,379 122 -
Hemicentral retinal artery occlusion in young adults
Amresh Chopdar
July 2013, 61(7):365-365
DOI:10.4103/0301-4738.97559  PMID:23552353
  1,318 145 -
Ocular manifestations of the antineutrophil cytoplasmic antibody and antiphospholipid syndromes
Sujoy Khan
July 2013, 61(7):365-366
DOI:10.4103/0301-4738.111127  PMID:23619483
  1,278 156 1
Author's Reply
Derrick P Smit, David Meyer
July 2013, 61(7):368-368
  824 94 -