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   2014| December  | Volume 62 | Issue 12  
    Online since January 12, 2015

 
 
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ORIGINAL ARTICLES
Optical coherence tomography in papilledema and pseudopapilledema with and without optic nerve head drusen
Shikha Talwar Bassi, Kuppuswamy Parthasarthy Mohana
December 2014, 62(12):1146-1151
DOI:10.4103/0301-4738.149136  PMID:25579359
Aim: To compare the spectral domain optical coherence tomography (SD-OCT) findings of the optic disc and the peripapillary retina of patients with a true papilledema and pseudopapilledema with and without optic nerve head drusen (ONHD). Study Design: Retrospective Case Control Study. Subjects and Methods: Peripapillary retinal nerve fiber layer (PPRNFL) thickness as depicted by SD-OCT of 94 eyes of 66 patients with papilledema (30 eyes), pseudopapiledema (31 eyes), and normal controls (33 eyes) was analyzed. The mean RNFL thickness, total retinal thickness (TRT) at a superior and inferior edge of the disc and the quadrant wise topography of increased RNFL were compared in all three groups. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) were calculated for all the parameters. Results: The median RNFL thickness was 185.4 (129.5-349.3 μm), 122.3 (109-156.3 μm) and 91.62 ± 7 μm in papilledema, pseudopapilledema, and controls, respectively. Papilledema group had thicker PPRNFL in all quadrants except temporal quadrant. TRT was thicker in papilledema and pseudopapilledema compared to controls. ONHD could be directly visualized as high reflective clumps in the sub-retinal space or the RNFL in 30 eyes. Increased RNFL thickness in all four quadrants was noted 43.3% in papilledema and 9.7% in pseudopapilledema. Normal RNFL thickness in all four quadrants was noted in 0% in papilledema and 32.3% in pseudopapilledema. Nasal RNFL had the highest AROC (0.792) indicating high diagnostic ability to differentiate papilledema from pseudopapilledema. Conclusion: SD-OCT can be used as a tool to differentiate between papilledema and pseudopapilledema.
  31,286 1,269 34
BRIEF COMMUNICATIONS
Successful use of intravitreal and systemic colistin in treating multidrug resistant Pseudomonas aeruginosa post-operative endophthalmitis
Preetam Samant, Sarika Ramugade
December 2014, 62(12):1167-1170
DOI:10.4103/0301-4738.126991  PMID:25579363
We report a case series of post-operative endophthalmitis due to Pseudomonas aeruginosa. A total of 8 patients operated for cataract, were referred to our facility with acute onset of decreased vision 1-2 days following surgery. All patients had clinical evidence of acute exogenous endophthalmitis with severe anterior chamber exudative reaction. Ocular samples (aqueous aspirate and vitreous tap) for microbiology were taken from all eyes. Microbiology from all revealed P. aeruginosa which was resistant to all antibiotics except colistin. With prompt and accurate microbiological support it was possible to control the infection in all the eyes with the use of colistin intravitreally and intravenously which to the best of our knowledge, has been never reported. Intravitreal injection of colistin could be an option effective in the management of multi-drug-resistant endophthalmitis caused by Gram-negative bacteria.
  5,295 497 10
EDITORIAL
Pragmatic research in ophthalmology: Need of the hour
Sundaram Natarajan
December 2014, 62(12):1113-1114
DOI:10.4103/0301-4738.149127  PMID:25579352
  1,521 3,529 -
ORIGINAL ARTICLES
Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital
Anna T Do, Krishanmurthy Ilango, Dhivya Ramasamy, Suriya Kalidasan, Vijayakumar Balakrishnan, Robert T Chang
December 2014, 62(12):1125-1131
DOI:10.4103/0301-4738.149130  PMID:25579355
Context: In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized. Aims: Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India. Subjects and Methods: The low vision quality of life (LVQOL) questionnaire measures vision-related quality of life through 25 questions on a Likert scale of 0-5 that pertain to (1) mobility, distance vision, and lighting; (2) psychological adjustment; (3) reading and fine work; and (4) activities of daily living. This tool was translated into Tamil and verbally administered to 55 new low vision referral patients before their first visit at the low vision clinic at Aravind Eye Hospital. Low vision aids (LVAs) were prescribed at the discretion of the low vision specialist. 1-month later, the same questionnaire was administered over the phone. Results: About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001). Conclusion: Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.
  4,451 581 8
Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma
Indira M Madgula, Nitin Anand
December 2014, 62(12):1115-1120
DOI:10.4103/0301-4738.149128  PMID:25579353
Purpose: To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment. Design: Noncomparative case-series. Materials and Methods: Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings. Results: 10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up. Conclusions: An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.
  2,554 2,387 13
Evaluation of predictors for anatomical success in macular hole surgery in Indian population
Atul Kumar, Varun Gogia, Prakhar Kumar, Srivats Sehra, Shikha Gupta
December 2014, 62(12):1141-1145
DOI:10.4103/0301-4738.149135  PMID:25579358
Purpose: The aim was to evaluate outcomes and predictors for anatomical success in macular hole (MH) surgery. Materials and Methods: This was a prospective cohort study of patients operated for idiopathic MH with stages II, III or IV. Patients underwent pars plana vitrectomy with internal limiting membrane (ILM) peeling, internal gas tamponade, and postoperative face down positioning. The primary outcome measure was anatomical closure of MH, while secondary outcome measure was postoperative external limiting membrane (ELM) continuity. Effect of MH size, duration of MH, size of ILM peel, type of gas tamponade (SF6 vs. C3F8) and macular hole index (MHI) on anatomical MH closure was also evaluated. Results: Of the 62 eyes operated, anatomical closure of MH was achieved in 55 eyes (88.7%). The median duration of follow-up was 8 months (range: 6-15 months). Mean BVCA improved from 0.94 ± 0.26 at baseline to 0.40 ± 0.23 logMAR at last follow-up (P = 0.01). There was a statistically significant association between size of ILM peel and anatomical closure of MH (P = 0.04). Duration of symptoms, size of MH, type of gas tamponade, MHI had no effect on anatomical closure (P = 0.22, 0.28, 0.40 respectively, Chi-square test). Postoperative continuity of the ELM was significantly associated with a shorter symptom duration (<6 months) before surgery. Conclusion: Acceptable anatomical closure could be attained with the defined technique. Size of ILM peel is a new predictor of anatomical success while symptom duration affects postoperative ELM continuity.
  3,994 408 2
Development of Pocket Vision Screener and its effectiveness at screening visual acuity deficits
Monica Raja, Dharani Ramamurthy, Krithica Srinivasan, L Srinivasa Varadharajan
December 2014, 62(12):1152-1155
DOI:10.4103/0301-4738.149137  PMID:25579360
Aim: The aim was to construct a visual acuity chart and find its effectiveness at screening visual acuity deficits. Materials and Methods: Two phases were involved in this study.Construction of the screener: Ten Sloan letters (C, D, H, K, N, O, R, S, V, and Z) were selected and the letters were constructed and reduced to 0.2 logMAR acuity size (6.92 mm) for viewing at 3 m. The screener contains three lines with seven letters in each. Few combinations of the seven letter sequences were chosen based on the row legibility scores. Three seven letter combinations close to the median of all combinations were selected, such that maximum difficulty score difference between the lines are <1%. Finding the effectiveness of the screener: 100 literate subjects with unaided visual acuity better than or equal to 6/60 were recruited for the study. Unaided visual acuity was tested using both the newly constructed Pocket Vision Screener and a logMAR visual acuity chart and the time taken to measure the visual acuity using both the charts was noted. Results: The mean age of the subjects was 43 ± 17 years. Subjects were classified as normal or deficient based on the logMAR visual acuity measurement. The screener was found to have 81% sensitivity, 94% specificity. The positive and negative predictive values were found to be 91% and 87%, respectively. A significant difference (P < 0.001) was found in the time taken to record visual acuity using both the charts. Conclusion: The Pocket Vision Screener can be used as a quick and accurate tool to screen subjects for visual acuity deficits, being highly sensitive, specific, and cost-effective.
  3,790 339 17
Long-term results after primary intraocular lens implantation in children operated less than 2 years of age for congenital cataract
Jaspreet Sukhija, Jagat Ram, Nishant Gupta, Ashish Sawhney, Savleen Kaur
December 2014, 62(12):1132-1135
DOI:10.4103/0301-4738.149131  PMID:25579356
Purpose: To study the long-term outcome of cataract surgery with primary intraocular lens (IOL) in children <2 years. Materials and Methods: Retrospective analysis of bilateral cases that were operated before 2 years age for congenital cataract. All underwent primary posterior capsulotomy with anterior vitrectomy and primary IOL implantation. Only those with a follow-up of at least 8 years were evaluated. Results: Twenty-six eyes of 13 children with bilateral cataract met the inclusion criteria. Average age at surgery was 14.15 months with a mean follow-up of 102 months. Average preoperative axial length (AL) was 19.93 mm. There was a refractive shift from a mean spherical equivalent of 1.64 D at 2 weeks after surgery to -1.42 D measured at last follow-up. Twenty-four eyes out of 26 (92%) achieved final visual acuity (VA) of 6/18 or more at last follow-up with 19/26 (73%) having acuity of 6/12 or greater. Raised intraocular pressure was documented in one eye only. Average AL recorded at last follow-up was 22.21 mm. Conclusion: Primary IOL implantation in children <2 years is a safe surgical procedure with excellent long-term results. The myopic shift is well-controlled and final VA achieved is reasonably good.
  3,513 505 8
BRIEF COMMUNICATIONS
Ocular manifestations of Noonan syndrome in twin siblings: A case report of keratoconus with acute corneal hydrops
Anna Lee, Monali V Sakhalkar
December 2014, 62(12):1171-1173
DOI:10.4103/0301-4738.126992  PMID:25579364
Ocular manifestations of Noonan syndrome (NS) in a set of healthy 20-year-old African-American fraternal twins are reported with emphasis on a rare finding of keratoconus with acute corneal hydrops in one twin. Both the twins had learning disabilities and attended a special needs school. Evaluation included visual acuity assessment, tonometry and external eye, slit lamp and dilated fundus examinations, topography with Pentacam and external photographs. The first case was more remarkable as keratoconus with acute corneal hydrops was observed. The patient presented with severe cloudy vision that had worsened over a span of 1 month. It improved significantly on follow-up. The second case included a unique constellation of ocular pathology that highlights the diversity of NS manifestations even amongst twins. Conservative treatment of keratoconus with acute corneal hydrops in a NS patient helped largely resolve the patient's condition. We report the diverse spectrum of ocular manifestations associated with this rare congenital disorder.
  3,398 230 6
OPHTHALMOLOGY PRACTICE
Macular function and morphology in acute retinal pigment epithelitis
Fatih C Gundogan, Oktay Diner, Ahmet Tas, Abdullah Ilhan, Umit Yolcu
December 2014, 62(12):1156-1158
DOI:10.4103/0301-4738.149140  PMID:25579361
A 20-year-old man applied with vision loss in the left eye. Right eye examination was unremarkable. Best-corrected visual acuity (BCVA) in the left eye was 20/200. Fundus examination revealed a few yellow spots within a round-shaped macular lesion. Autofluorescence imaging showed hyperautofluorescence in the lesion. Central amplitudes in multifocal electroretinogram (mfERG) were depressed. The patient reported a rhinopharyngitis 7-10 days before the visual loss. The patient was diagnosed as acute retinal pigment epithelitis. BCVA improved gradually up to 20/20 in 4 weeks. mfERG amplitudes returned to normal. A slight pigmentary distortion was the only residual fundus finding.
  3,239 275 2
BRIEF COMMUNICATIONS
Occlusion-amblyopia following high dose oral levodopa combined with part time patching
Mihir Kothari
December 2014, 62(12):1163-1165
DOI:10.4103/0301-4738.109516  PMID:23571255
Part time occlusion therapy is not reported to cause occlusion (reverse) amblyopia. However, when combined with high dose oral levodopa, an increase in the plasticity of the visual cortex can lead to occlusion amblyopia. In this case report, we describe a six year old child who developed occlusion amblyopia following part time patching combined with oral levodopa.
  2,926 283 -
Linguatula serrata in the anterior chamber of the eye
Muna Bhende, Abhishek , Jyotirmoy Biswas, M Raman, Pramod S Bhende
December 2014, 62(12):1159-1161
DOI:10.4103/0301-4738.149145  PMID:25579362
We report a case of intraocular Linguatula in healthy young female who presented with a history of trivial trauma, dislocated lens, inflammation and secondary glaucoma. A mobile worm was seen in the anterior chamber. Pars plana lensectomy and vitrectomy was planned to remove both the cataractous lens and the parasite during which the worm disappeared from view but was later recovered from the cassette fluid. It was identified as the nymphal form of Linguatula serrata (tongue worm).
  2,905 230 5
Oseltamivir (Tamiflu)-induced bilateral acute angle closure glaucoma and transient myopia
Ji Woong Lee, Ji Eun Lee, Hee Young Choi, Jong Soo Lee
December 2014, 62(12):1165-1167
DOI:10.4103/0301-4738.109531  PMID:23571265
A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG) and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP)-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir.
  2,815 257 12
ORIGINAL ARTICLES
A pharmacoeconomic analysis to determine the relative cost-effectiveness of bimatoprost 0.03% eye drops and brimonidine 0.2% eye drops in patients of primary open-angle glaucoma/ocular hypertension
Navreet Kaur Natt, A Gupta, G Singh, T Singh
December 2014, 62(12):1136-1140
DOI:10.4103/0301-4738.149134  PMID:25579357
Aims: The aim was to compare efficacy and cost-effectiveness of bimatoprost 0.03% and brimonidine 0.2% in primary open-angle glaucoma (POAG)/ocular hypertension (OHT). Settings and Design: Open, randomized, cross-over, comparative study. Materials and Methods: Forty patients of POAG or OHT with intraocular pressure (IOP) <30 mm Hg were included in the study after a written informed consent. The patients were divided randomly into two groups of 20 patients each. Patients of group A were administered bimatoprost 0.03% eye drops once daily, and those of group B brimonidine 0.2% eye drops twice daily for a period of 4 weeks. After a washout period of 4 weeks, the patients were crossed over that is, group A was administered brimonidine 0.2% and group B bimatoprost 0.03%. Fall in IOP at 4 weeks was recorded. The daily cost of each drug was calculated by maximum retail price and the average number of drops per bottle. The cost-effectiveness was then calculated as the cost of drug/mm Hg fall in IOP. Statistics: Independent samples t-test was used to compare the efficacy of both drugs. Results: IOP lowering with bimatoprost (8.9 ± 1.598 mm Hg) was significantly (P < 0.0001) higher than brimonidine (6.55 ± 1.26 mm Hg). The number of drops/ml were 33.43 ± 0.52 and 25.49 ± 0.26, respectively, for bimatoprost and brimonidine. Treatment with bimatoprost was costlier than brimonidine with daily costs/eye Rs. 4.02 ± 0.06 and 3.14 ± 0.03, yearly costs/eye Rs. 1467.46 ± 20.74 and 1147.75 ± 11.15, respectively. Bimatoprost was more cost-effective than brimonidine with the cost-effectiveness ratio (CER) respectively Rs. 13.10 ± 2.61/mm Hg and Rs. 13.96 ± 2.86/mm Hg. Incremental CER Rs. 10.43/mm Hg implies lower costs/mm Hg extra IOP lowering by bimatoprost than Rs. 13.96 for brimonidine. Conclusion: In spite of being costlier, bimatoprost is more efficacious and cost-effective than brimonidine.
  2,676 333 2
Automated diabetic retinopathy imaging in Indian eyes: A pilot study
Rupak Roy, Aneesha Lob, Bikramjeet P Pal, Carlos Manta Oliveira, Rajiv Raman, Tarun Sharma
December 2014, 62(12):1121-1124
DOI:10.4103/0301-4738.149129  PMID:25579354
Aim: To evaluate the efficacy of an automated retinal image grading system in diabetic retinopathy (DR) screening. Materials and Methods: Color fundus images of patients of a DR screening project were analyzed for the purpose of the study. For each eye two set of images were acquired, one centerd on the disk and the other centerd on the macula. All images were processed by automated DR screening software (Retmarker). The results were compared to ophthalmologist grading of the same set of photographs. Results: 5780 images of 1445 patients were analyzed. Patients were screened into two categories DR or no DR. Image quality was high, medium and low in 71 (4.91%), 1117 (77.30%) and 257 (17.78%) patients respectively. Specificity and sensitivity for detecting DR in the high, medium and low group were (0.59, 0.91); (0.11, 0.95) and (0.93, 0.14). Conclusion: Automated retinal image screening system for DR had a high sensitivity in high and medium quality images. Automated DR grading software's hold promise in future screening programs.
  2,532 373 5
BRIEF COMMUNICATIONS
Cystoid macular edema in a patient with Danon disease
Heather G Mack
December 2014, 62(12):1161-1163
DOI:10.4103/0301-4738.109524  PMID:23571262
To report a patient with Danon retinopathy with cystoid macular edema treated with topical dorzolamide 2% eye drops and oral acetazolamide. A 37-year-old Caucasian man with Danon disease treated with topical and oral carbonic anhydrase inhibitors participated in the study. Examinations performed before and during treatment included visual acuity (VA), spectral-domain optical coherence tomography, and electroretinography. Following total 48 weeks of treatment, VA decreased from 20/30 OD, 20/200 OS, to 20/40 OD, CF OS. The mean central retinal thickness was unchanged from baseline 263 μm OD , 226 μm OS, after treatment 283 μm OD and 202 μm OS. In our case, carbonic anydrase inhibitors were not effective. However, a general recommendation cannot be given based on a single case.
  2,400 217 2
LETTERS TO THE EDITOR
Pregnancy and intraocular pressure
Sim Sai Tin, Viroj Wiwanitkit
December 2014, 62(12):1174-1174
DOI:10.4103/0301-4738.149154  PMID:25579366
  1,312 204 -
Comment on: Successful use of intravitreal and systemic colistin in treating multidrug resistant Pseudomonas aeruginosa postoperative endophthalmitis
Muammer Ozcimen, Yasar Sakarya, Rabia Sakarya, Sertan Goktas, Serap Ozcimen
December 2014, 62(12):1174-1174
DOI:10.4103/0301-4738.149152  PMID:25579365
  1,253 240 -
Bilateral optic neuritis following Mycoplasma pneumoniae infection
Gauri Bhushan, Neeraj Nischal, Prateeksha Sharma, Usha Kaul Raina
December 2014, 62(12):1175-1176
DOI:10.4103/0301-4738.149156  PMID:25579368
  1,323 154 1
Is it really a silicone sling assisted temporalis muscle transfer?
Ved Prakash Gupta, Pragati Gupta, Rigved Gupta
December 2014, 62(12):1179-1179
DOI:10.4103/0301-4738.149161  PMID:25579372
  1,310 140 1
Author Reply
Pukhraj Rishi, Sumanth Reddy, Ekta Rishi
December 2014, 62(12):1178-1178
  1,264 158 -
Anterior segment optical coherence tomography in angle closure glauma with topiramat use
Khichar Purnaram Shubhakaran
December 2014, 62(12):1174-1175
DOI:10.4103/0301-4738.149155  PMID:25579367
  1,106 143 1
Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery-our experience
Shalini Singh
December 2014, 62(12):1177-1177
DOI:10.4103/0301-4738.149158  PMID:25579370
  1,092 146 1
E-learning in ophthalmology: Where next?
Kieran Walsh
December 2014, 62(12):1178-1178
DOI:10.4103/0301-4738.149160  PMID:25579371
  1,090 134 1
Safe endoresection
Michael I Seider, Bertil E Damato
December 2014, 62(12):1176-1176
DOI:10.4103/0301-4738.149157  PMID:25579369
  1,004 144 -