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  Citation statistics : Table of Contents
   2013| September  | Volume 61 | Issue 9  
    Online since October 8, 2013

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Growth of Scytalidium sp. in a counterfeit bevacizumab bottle
Gerardo Garcia-Aguirre, Virginia Vanzinni-Zago, Hugo Quiroz-Mercado
September 2013, 61(9):523-525
DOI:10.4103/0301-4738.119455  PMID:24104716
After drawing a dose from an closed bevacizumab (Avastin) bottle, a fungus-like foreign body was observed inside. Samples from the vial were cultured in Sabouraud Emmons media. Growth of multiple light brown colonies with dark pigment was observed after 10 days. The species was identified as Scytalidium sp.Vial, analysis reported that the seal was lacking proper identification measures and that the label, batch number and expiry date did not correspond to a genuine product. Chemical analysis showed no protein, but 3% of polyethylene glycol, citrate and ethanol. Counterfeit bevacizumab is a real situation that poses a significant risk for ophthalmology and oncology patients. The medical community should be aware of this situation in order to enforce adequate preventive measures.
  3 1,594 136
Bilateral central serous chorioretinopathy with retinal pigment epithelium tears following epidural steroid injection
Sung-Bok Lee, Jung-Yeul Kim, Woo-Jin Kim, Chul-Bum Cho, Takeshi Iwase, Young-Joon Jo
September 2013, 61(9):514-515
DOI:10.4103/0301-4738.119441  PMID:24104712
The cause of central serous chorioretinopathy (CSC) is mostly idiopathic. Other cause such as stressful event or use of corticosteroid has been associated with severe form of CSC. Atypical presentation of CSC has widespread degeneration of retinal pigment epithelium (RPE) or bullous retinal detachment. In this report, we describe a case of bilateral CSC with RPE tear after epidural steroid injection.
  2 1,455 195
Comparison of efficiency of intravitreal ceftazidime and intravitreal cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis
Nurettin Deniz, Orhan Aydemir, Mete Güler, Nusret Akpolat, Ahmet Kizirgil
September 2013, 61(9):525-527
DOI:10.4103/0301-4738.119457  PMID:24104717
In this study, we evaluated the efficiency of cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis. We compared the findings with the standard dose of ceftazidime (1 mg/0.1 ml). Thirty-six New-Zealand White rabbits were divided into 6 equal groups and were treated with different methods (Group 1 = sham, Group 2 = 0.5 mg/0.1 ml cefepime, Group 3 = 1 mg/0.1 ml cefepime, Group 4 = 2 mg/0.1 ml cefepime, Group 5 = 1 mg/0.1 ml ceftazidime, Group 6 = control). The eyes of rabbits in each group were examined clinically on 1 st , 3 rd , and 6 th day of the experiment. At 6 th day, 0.1 ml vitreous humor aspirates were obtained and plated for quantification on the blood agar and the results were expressed as colony-forming unit/ml. Subsequently, the eyeballs were enucleated and the histopathological evaluation was performed. Our findings denoted beneficial effects of cefepime in treatment groups (especially, in Groups 3 and 4). Intravitreal cefepime may be an alternative drug in the treatment of P. aeruginosa endophthalmitis.
  1 1,040 163
One day wonder: Fast resolution of macular edema following intravitreal ranibizumab in retinal venous occlusions
Lalit Verma, Arindam Chakravarti, Avnindra Gupta, Smriti Prakash
September 2013, 61(9):528-530
DOI:10.4103/0301-4738.119458  PMID:24104718
Macular edema is a significant cause of vision loss in patients with central retinal vein occlusions and branch retinal vein occlusions. Vascular endothelial growth factor (VEGF) appears to be a key factor in the pathogenesis of this disease. Anti-VEGF therapy, such as intravitreal ranibizumab provides an effective treatment against vision-threatening macular edema. We report three patients of retinal vein occlusion with macular edema who demonstrated overnight resolution of macular edema following treatment with intravitreal ranibizumab (0.5 mg). 3D optical coherence tomography (Optovue) was used as a tool for comparison of the macular thickness before and after treatment. The significant reductions in the central foveal thickness demonstrated in these patients one night after intravitreal injections could have significant influence on modifying current treatment protocols. Early treatment of macular edema related to retinal venous occlusive disease with anti-VEGF injections could result in faster visual rehabilitation in these patients.
  1 1,263 164
Donor disc attachment assessment with intraoperative spectral optical coherence tomography during descemet stripping automated endothelial keratoplasty
Edward Wylegala, Anna K Nowinska, Ewa Wroblewska-Czajka, Dominika Janiszewska
September 2013, 61(9):511-513
DOI:10.4103/0301-4738.119440  PMID:24104711
Optical coherence tomography has already been proven to be useful for pre- and post-surgical anterior eye segment assessment, especially in lamellar keratoplasty procedures. There is no evidence for intraoperative usefulness of optical coherence tomography (OCT). We present a case report of the intraoperative donor disc attachment assessment with spectral-domain optical coherence tomography in case of Descemet stripping automated endothelial keratoplasty (DSAEK) surgery combined with corneal incisions. The effectiveness of the performed corneal stab incisions was visualized directly by OCT scan analysis. OCT assisted DSAEK allows the assessment of the accuracy of the Descemet stripping and donor disc attachment.
  1 1,460 136
Causes and characteristics of work-related eye injuries in western Turkey
Mustafa Serinken, Ibrahim Turkcuer, Ebru Nevin Cetin, Atakan Yilmaz, Hayri Elicabuk, Ozgur Karcioglu
September 2013, 61(9):497-501
DOI:10.4103/0301-4738.119435  PMID:24104708
Objectives: To analyze descriptive data and characteristics of work-related eye injuries (WREI) admitted into the emergency department (ED) and obtain information to utilize in planning measures to prevent WREI. Materials and Methods: This prospective study recruited patients with WREI admitted to the center in the two-year study period. Only the casualties occurred at the workplace and while working constituted the sample. The data were collected via face-to-face contact in the ED. Results: Males comprised the majority of the sample (95.3%, n = 778) and mean age of the patients was 28.1 ± 6.5 (range: 15-54) with the biggest percentage in between 25 and 34 years of age (46.2%, n = 377). Most patients were working in the metal and machinery sectors (66.4%, n = 542). Nearly half of the patients had less than 1 year of experience (50.4%, n = 411). The most common mechanism of WREI was noted to be exposures to welding light (26.9%, n = 219), followed by drilling/cutting injuries (21.1%, n = 172). "Carelessness" and "hurrying up" were the most commonly reported causes of WREIs among 'worker-related causes' (21.4% and 16.1%, respectively). Lack of protective measures ranked the highest among workplace-related causes (18.7%, n = 207). Conclusions: Programs to increase awareness on workplace safety and sound preventive strategies for both parties-employers and employees are to be pursued. Occupational safety efforts should include training on workplace eye safety and campaigns to raise knowledgeability on this disease among workers.
  1 1,693 239
Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India
Ujwala S Saboo, Manish Jain, Jagadesh C Reddy, Virender S Sangwan
September 2013, 61(9):486-489
DOI:10.4103/0301-4738.119431  PMID:24104706
Purpose: To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India. Materials and Methods: Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006. Results: Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively. Conclusion: Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.
  1 3,688 690
Conservative treatment modalities in retinoblastoma
Bhavna Chawla, Amit Jain, Rajvardhan Azad
September 2013, 61(9):479-485
DOI:10.4103/0301-4738.119424  PMID:24104705
Retinoblastoma is the most common primary intraocular malignancy of childhood. A potentially curable cancer, its treatment has improved significantly over the last few decades. The purpose of this article is to review the literature on various conservative treatment modalities available for the treatment of retinoblastoma and their effectiveness, when used alone or in combination. Pubmed, Medline, Embase, and the Cochrane library were searched through 2012 for published peer reviewed data on conservative treatment modalities for retinoblastoma. Various studies show that while enucleation remains the standard of care for advanced intraocular tumors, conservative modalities that can result in globe salvage and preservation of useful vision are being increasingly employed. Such modalities include systemic chemotherapy, focal consolidation with transpupillary thermotherapy, laser photocoagulation and cryotherapy, plaque brachytherapy, and delivery of local chemotherapy using subconjunctival, sub-tenon, or intra-arterial routes. When used alone or in combination, these treatment modalities can help in avoidance of external beam radiotherapy or enucleation, thus reducing the potential for long-term side effects, while salvaging useful vision. Radioactive plaque brachytherapy has an established role in selected patients with intraocular retinoblastoma. Local injections of chemotherapeutic agents via the sub-tenon or sub-conjunctival route have been used with varying degrees of success, usually as an adjunct to systemic chemotherapy. Intra-arterial ophthalmic artery delivery of melphalan has shown promising results. It is important to recognize that today, several treatment options are available that can obviate the need for enucleation, and cure the cancer with preservation of functional vision. A thorough knowledge and understanding of these conservative treatment modalities is essential for appropriate management.
  1 4,569 651

September 2013, 61(9):536-536
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Peeling and aspiration of elschnig pearls! An effective alternative to Nd:YAG laser capsulotomy!
Rahul Bhargava, Prachi Kumar, Shiv K Sharma, Sumat Sharma, Namrata Mehra, Anuraag Mishra
September 2013, 61(9):518-520
DOI:10.4103/0301-4738.119449  PMID:24104714
To evaluate the efficacy of peeling and aspiration of Elschnig pearls. Retrospective study in a medical college hospital. Records of 217 eyes which underwent surgical peeling and aspiration for membranous PCO between 2006 and 2009, was reviewed. Peeling and aspiration was fashioned with a blunt tipped 20G cannula after stabilizing anterior chamber with anterior chamber maintainer. Post-operative vision and complications were analyzed. Mc Nemar and Chi square tests. The mean age was 56.84 years. 85.71% patients achieved best corrected visual acuity (BCVA) of 20/20 at 3 m. Recurrence of pearls, uveitis and cystoid macular edema were the most common causes of reduced vision. Peeling and aspiration of pearls seem to be a viable alternative to Neodymium yttrium garner aluminium (Nd: YAG) laser capsulotomy for membranous PCO.
  - 2,823 236
Reverse masquerade syndrome: Fungal adnexal infection mimicking carcinoma in a HIV-positive patient
Bipasha Mukherjee, Raka Chatterjee, Jyotirmay Biswas
September 2013, 61(9):521-523
DOI:10.4103/0301-4738.119454  PMID:24104715
A known HIV-positive male patient presented with a rapidly progressive ulcerative lesion involving the conjunctiva, lids, and anterior orbit along with a decrease in vision in the right eye. He was on anti retro-viral and anti-tubercular therapy. In view of the clinical features, our provisional clinical diagnosis was a malignant lesion of the eyelid with orbital involvement, possibly squamous cell carcinoma. However, incisional biopsy revealed absence of malignant cells. On Gomori Methenamine Silver staining, plenty of fungal filaments were seen, which was confirmed by culture as Candida albicans. Hence, it turned out to be a case of fungal adnexal infection mimicking carcinoma in a HIV-positive patient. The patient responded well to systemic anti-fungals.
  - 1,966 165
Anti-vascular endothelial growth factor in age-related macular degeneration: Puzzle or a silent beginning!
Sundaram Natarajan
September 2013, 61(9):475-478
DOI:10.4103/0301-4738.119421  PMID:24104704
  - 1,331 248
SD-OCT based management of traumatic sub-macular hemorrhage-Our experience
Raju Sampangi, BC Hemalatha
September 2013, 61(9):531-531
DOI:10.4103/0301-4738.119459  PMID:24104719
  - 968 130
Eat the pie or imbibe the ribbon: An epochal moment at the crossroads of mechanized cataract surgery
Bali Jatinder, Bali Renu Thakur
September 2013, 61(9):531-532
DOI:10.4103/0301-4738.119460  PMID:24104720
  - 646 103
Structural-functional dissociation in glaucoma: An attempt to end controversy
N Venugopal, G Kummararaj, Sherin Kummararaj, B Bharathi
September 2013, 61(9):532-533
DOI:10.4103/0301-4738.119461  PMID:24104721
  - 1,055 122
Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic Oculomotor nerve palsy
Sahil Bhandari, Dayakar Yadalla
September 2013, 61(9):533-534
DOI:10.4103/0301-4738.119462  PMID:24104722
  - 917 165
Factors having implications on re-retinal detachments after silicone oil removal
Manish P Nagpal, Rituraj P Videkar, Kamal M Nagpal
September 2013, 61(9):534-534
DOI:10.4103/0301-4738.119463  PMID:24104723
  - 801 142
Authors' reply
Nishant Vijay Radke, Krishnan Panakanti Tandava
September 2013, 61(9):534-535
  - 483 83
Intravitreal anti-VEGF monotherapy for thick submacular hemorrhage of less than 1 week duration secondary to neovascular age-related macular degeneration
Sachin Jain, Kamal Kishore, Yog Raj Sharma
September 2013, 61(9):490-496
DOI:10.4103/0301-4738.119432  PMID:24104707
Aim: To investigate the role of anti-VEGF monotherapy in patients with thick submacular hemorrhage (SMH) of ≤1 week duration secondary to neovascular age-related macular degeneration (N-AMD). Materials and Methods: A retrospective chart review of 14 eyes of 14 patients presenting with acute decrease in central vision of ≤1 week duration secondary to a thick SMH measuring ≥ 2 MPS disk areas from N-AMD was performed. Intravitreal injections of bevacizumab 1.25 mg (13 eyes) or ranibizumab 0.5 mg (1 eye) were given monthly until resolution of SMH and less frequently thereafter, based on treat-and-extend approach utilizing spectral domain optical coherence tomography (SDOCT). Patients with follow-up of ≥6 months were included. Results: Patients presented after a median of 4 (range 1-7) days from the onset of SMH. Mean lesion size was 27.9 mm 2 (range 5.47-100, median 15), with blood comprising 77-98% of the lesion. Presenting visual acuity (VA) ranged from 20/60 to hand motions (median 20/200). Patients received a mean of 11.4 (range 5-20) injections over 18.4 (range 7-50) months. SMH resolved in all eyes in a mean of 4.8 (range 2-8) months. At 6 months follow-up, mean VA gain was −0.54 logMAR (range: −1.5 to +1, Snellen range 20/25-20/400, median 20/100, P = 0.0037), with 11 gaining ≥0.2 logMAR. Mean change in VA from baseline at final follow-up was −0.58 logMAR (range −1.6 to +1, Snellen range 20/30-20/400, median 20/60; P = 0.0022). Conclusion: A good anatomical and visual outcome can be accomplished in patients with thick SMH secondary to N-AMD treated with anti-VEGF monotherapy within 1 week.
  - 1,870 217
Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore
Rupesh Agrawal, Ho Sue Wei, Stephen Teoh
September 2013, 61(9):502-506
DOI:10.4103/0301-4738.119436  PMID:24104709
Objective: To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score. Materials and Methods: Retrospective case analysis of patients with open globe injuries at a tertiary referral eye care centre in Singapore was performed. Pre-operative factors affecting final vision outcome in patients with open globe injury and correlation of ocular trauma score in our study with international ocular trauma scoring system was performed. Results: Case records of 172 eyes with open globe injury were analyzed. Mean age was 36. 67 years. Mean follow up was 12.26 m. Males were pre-dominantly affected. Initial visual acuity was ≥20/40, 20/50 < 20/200, 20/200- CF, HM- PL and NLP in 24 (14%), 39 (22.7%), 16 (9.3%), 66 (38.4%) and 27 (15.7%) eyes respectively. Final visual acuity was ≤20/40, 20/50 < 20/200, 20/200- 1/200, HM- PL and NLP in 76 (44.2%), 28 (16.3%), 11 (6.4%), 30 (17.4%) and 27 (15.7%) eyes respectively. Ocular trauma score in our study correlates with international ocular trauma scoring system. Conclusion: The present study showed pre-operative variables such as mode of injury, pre-operative visual acuity, traumatic cataract, hyphaema, relative afferent papillary defect, vitreous lossand vitreous hemorrhage to be adversely affecting the final vision outcome. Our study showed a good synchrony with international ocular trauma score (OTS) and based on this study we were able to validate application of OTS in Singapore population. Recognizing these factors can help the surgeon in evidence based counseling.
  - 4,280 622
Foveal slope measurements in subjects with high-risk of age-related macular degeneration
Rajiv Raman, Sayalee Lahane, Aditi Gupta, D Sandeep, Tarun Sharma
September 2013, 61(9):507-510
DOI:10.4103/0301-4738.119437  PMID:24104710
Background: Recent reports indicated that the slope of the foveal depression influences the macular pigment (MP) spatial profile. MP has been shown to confer possible protection against age-related macular degeneration (ARMD) because of its antioxidant properties. Aims: To study the configuration of foveal slope and the foveal thickness in fellow eyes of subjects with unilateral neovascular ARMD. Settings and design: Case-control series. Materials and Methods: The study population consisted of 30 cases aged >50, who had unilateral choroidal neovascular membrane (CNVM) or disciform scar in the fellow eye and 29 controls aged >50, who had no sign of ARMD in the either eye. Using spectral-domain optical coherence tomography, foveal thickness at different locations including the central subfield foveal thickness (CSFT) was noted. The foveal slopes were calculated in the six radial scans (between 0.25° and 1° retinal eccentricity) as well as the 3D scan. Results: Cases had a significantly higher CSFT when compared to controls (215.1 ± 36.19 μ vs. 193.0 ± 17.38 μ, P = 0.004). On the 3D scan, the cases had shallower superior (cases 1.32 ± 0.32 vs. controls 1.45 ± 0.13, P = 0.04) and temporal slopes (cases 1.27 ± 0.21 vs. controls 1.39 ± 0.12, P = 0.01) in comparison to the controls. Conclusions: We noted a shallower superior and temporal foveal slope and a higher CSFT in the fellow eyes of subjects with a unilateral neovascular ARMD. Prospective studies observing the development of CNVM in subjects with altered foveal slope might provide more information on this optical coherence tomography finding.
  - 1,398 169
An unusual case of self-inflicted multiple needles injuries to eye
Shweta Gaur, HK Bist, Vishal Sinha, Mausam Gupta
September 2013, 61(9):516-517
DOI:10.4103/0301-4738.119444  PMID:24104713
Self-inflicted eye injuries among psychiatric patients are rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the severely disturbed patient. They have been associated with a variety of disorders, including paranoid schizophrenia, drug-induced psychosis, obsessive-compulsive disorder, depression, mental retardation, and ritualistic behavior. It has been described in both adults and children, but occurs most commonly in young adults with acute or chronic psychoses.
  - 1,041 167