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  Citation statistics : Table of Contents
   2014| March  | Volume 62 | Issue 3  
    Online since April 11, 2014

 
 
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ORIGINAL ARTICLES
Influence of capsular tension ring on posterior capsule opacification in myopic eyes
Ismail Halili, Fatih Mehmet Mutlu, F Cüneyt Erdurman, Fatih C Gündogan, Selim Kiliç
March 2014, 62(3):311-315
DOI:10.4103/0301-4738.116469  PMID:24008791
Purpose: To determine the effect of a capsular tension ring (CTR) implantation in preventing posterior capsular opacification (PCO) after cataract surgery in patients with high myopia. Materials and Methods: In this prospective single-surgeon standardized-surgical-procedure fellow-eye comparison trial, 34 patients with high myopia had phacoemulsification surgery. Although one eye received an acrylic intraocular lens (IOL) and CTR, other eye received only an IOL as control. PCO, within the capsulorhexis overlap, was documented by standardized digital retroillumination images at least 2 years post-operatively, and the percentage area of PCO was scored (scale 0%-100%) using the POCOman software system. The PCO score and the incidence of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy of groups, and correlations between PCO score and presence of CTR, age, phaco time, refraction, and axial length (AL) were determined. Results: The mean time interval from surgery to PCO measurement was 43.4 ± 11.2 months for the eyes with a CTR and 43.1 ± 11.6 months for the controls (P = 0.91). The PCO score of the eyes with a CTR was significantly lower than in the controls (5.9 ± 4.3 vs. 22.3 ± 12.2, respectively; P < 0.001). There were statistically insignificant correlations between PCO score and pre-operative refraction (r = 0.02; P = 0.90), AL (r = 0.03; P = 0.80), phaco time (r = 0.11; P = 0.53), and patient's age (r = 0.23; P = 0.55). No patient with a CTR had a Nd: YAG laser capsulotomy, but it was six in controls (P = 0.025). Conclusions: CTR implantation seems to be effective in reducing the PCO and Nd: YAG laser capsulotomy rates in high myopic eyes.
  2 2,630 250
Multifocal visual evoked potential in optic neuritis, ischemic optic neuropathy and compressive optic neuropathy
Manju Jayaraman, Rashmin Anilkumar Gandhi, Priya Ravi, Parveen Sen
March 2014, 62(3):299-304
DOI:10.4103/0301-4738.118452  PMID:24088641
Purpose: To investigate the effect of optic neuritis (ON), ischemic optic neuropathy (ION) and compressive optic neuropathy (CON) on multifocal visual evoked potential (mfVEP) amplitudes and latencies, and to compare the parameters among three optic nerve disorders. Materials and Methods: mfVEP was recorded for 71 eyes of controls and 48 eyes of optic nerve disorders with subgroups of optic neuritis (ON, n = 21 eyes), ischemic optic neuropathy (ION, n = 14 eyes), and compressive optic neuropathy (CON, n = 13 eyes). The size of defect in mfVEP amplitude probability plots and relative latency plots were analyzed. The pattern of the defect in amplitude probability plot was classified according to the visual field profile of optic neuritis treatment trail (ONTT). Results: Median of mfVEP amplitude (log SNR) averaged across 60 sectors were reduced in ON (0.17 (0.13-0.33)), ION (0.14 (0.12-0.21)) and CON (0.21 (0.14-0.30)) when compared to controls. The median mfVEP relative latencies compared to controls were significantly prolonged in ON and CON group of 10.53 (2.62-15.50) ms and 5.73 (2.67-14.14) ms respectively compared to ION group (2.06 (-4.09-13.02)). The common mfVEP amplitude defects observed in probability plots were diffuse pattern in ON, inferior altitudinal defect in ION and temporal hemianopia in CON eyes. Conclusions: Optic nerve disorders cause reduction in mfVEP amplitudes. The extent of delayed latency noted in ischemic optic neuropathy was significantly lesser compared to subjects with optic neuritis and compressive optic neuropathy. mfVEP amplitudes can be used to objectively assess the topography of the visual field defect.
  2 2,301 282
Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution
Sanjiv K Gupta, Ajai Kumar, Swati Agarwal, Siddarth Agarwal
March 2014, 62(3):333-336
DOI:10.4103/0301-4738.109521  PMID:23571260
Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. Aims: Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure. Settings and Design: The study is a prospective interventional case series, conducted at tertiary care institution. Materials and Methods: Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted. Statistical Analysis Used: Paired samples student-t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis. Results: Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis. Conclusions: Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.
  2 2,620 324
BRIEF COMMUNICATIONS
Limbal dermoid in Nager acrofacial dysostosis: A rare case report
Rohit Malik, Sumit Goel, Saurabh Aggarwal
March 2014, 62(3):339-341
DOI:10.4103/0301-4738.111194  PMID:23619496
Nager syndrome, also called preaxial acrofacial dysostosis, comprises two groups of defects involving the limbs and craniofacial region, respectively. This syndrome is rare and only 70 cases have been reported in the literature. The exact cause of this syndrome is unknown, but there is indication that it is genetically based. Ocular manifestations of this syndrome include widely separated downward slanting eyes, absence of eyelashes, ptosis of upper eyelids and colobomas on the inner aspect of lower eyelids. We report limbal dermoid in a patient with Nager syndrome. We did not find such an association of "Limbal dermoid in Nager acrofacial dysostosis syndrome" on PubMed using Nager acrofacial dysostosis, limbal dermoid and ocular manifestations as the keywords.
  1 1,830 148
Meibomian gland dysfunction in a case of ichthyosis follicularis with alopecia and photophobia syndrome
Tarannum Fatima, Umang Mathur, Manisha Acharya
March 2014, 62(3):365-367
DOI:10.4103/0301-4738.116486  PMID:24008802
We are reporting an interesting case of ichthyosis follicularis with alopecia and photophobia syndrome in a daughter and father from the Indian subcontinent associated with Meibomian gland dysfunction. A three-year-old female child presented with pain, redness and severe photophobia in both eyes since one month. Cutaneous examination revealed ichthyosis, absence of hair all over the body including eyebrows, scalp and angular cheilosis. Ocular examination revealed bilateral severe meibomianitis, multiple superficial punctate keratitides in right eye and corneal epithelial defect in the left eye. Other systemic features were prominent high forehead and large ears. Her father had similar symptoms. Her symptoms improved after adequate treatment of meibomian gland dysfunction. She is asymptomatic at present.
  1 1,602 128
ORIGINAL ARTICLES
Intraocular pressure and influencing systemic health parameters in a Korean population
Young Sang Han, Ji Woong Lee, Jong Soo Lee
March 2014, 62(3):305-310
DOI:10.4103/0301-4738.116453  PMID:24008798
Aim: To evaluate the relationship between intraocular pressure (IOP) and systemic health parameters such as age, gender, body mass index (BMI), total cholesterol, high density lipoprotein (HDL), and triglyceride (TG) in a Korean population. Materials and Methods: A total of 30,893 healthy subjects underwent automated multiphasic tests, including non-contact tonometry, automated perimetry, fundus photography, and blood samplings for total cholesterol, HDL, and TG. Seven age groups were divided by decades ranging from 20 to 29 years to 80 + years. The association between IOP and BMI, plasma lipid profiles was examined using cross-sectional analysis. Results: The mean age of subjects was 47.7 years. The mean IOP of subjects was 15.4 ± 3.2 mmHg for both eyes. The mean IOP of men was significantly higher than women ( P = 0.000). By multiple linear regression analysis, IOP was positively associated with gender (male), BMI, total cholesterol, and TG and negatively associated with age ( P = 0.000). BMI, total cholesterol, and TG had significantly positive correlations with IOP after adjusting for age, gender, and other variables which can influence the IOP ( P = 0.000). Conclusions: In a Korean population, the mean IOP, total cholesterol, TG, and BMI values of men were higher than women. IOP was found to increase with total cholesterol, TG, BMI, and to decrease with only age regardless of sex.
  1 1,763 178
Normative spectral domain optical coherence tomography data on macular and retinal nerve fiber layer thickness in Indians
Bindu Appukuttan, Anantharaman Giridhar, Mahesh Gopalakrishnan, Sobha Sivaprasad
March 2014, 62(3):316-321
DOI:10.4103/0301-4738.116466  PMID:24008793
Aim: To provide the normative data of macular and retinal nerve fiber layer (RNFL) thickness in Indians using spectral domain OCT (Spectralis OCT, Heidelberg Engineering, Germany) and to evaluate the effects of age, gender, and refraction on these parameters. Design: Observational, cross-sectional study. Materials and Methods: The eyes of 105 healthy patients aged between 20-75 years, with no ocular disease and best corrected visual acuity of 20/20, were scanned using standard scanning protocols by a single examiner. Exclusion criteria included glaucoma, retinal diseases, diabetes, history of prior intraocular surgery or laser treatment. The mean macular and RNFL thickness were recorded, and the effects of age, gender, and refraction on these parameters were evaluated. This data was compared with published literature on Caucasians to assess the ethnic variations of these parameters. Results: The normal central foveal thickness in healthy Indian eyes measured using Spectralis OCT was 260.1 ± 18.19 ΅m. The nasal inner quadrant showed maximum retinal thickness (338.88 ± 18.17 ΅m).The mean RNFL thickness was 101.43 ± 8.63 ΅m with maximum thickness in the inferior quadrant. The central foveal thickness showed a gender-based difference (P = 0.005) but did not correlate significantly with age (P = 0.134), whereas the parafoveal, perifoveal thickness, macular volume, and RNFL thickness showed significant negative correlation with age. Conclusions: Our study provides the normative database for Indians on Spectralis OCT. It also suggests that age should be considered while interpreting the macular thickness and RNFL, whereas gender should also be given consideration in central foveal thickness.
  1 3,606 456
Effect of strabismus surgery on torticollis caused by congenital superior oblique palsy in young children
Ramesh Kekunnaya, Sherwin J Isenberg
March 2014, 62(3):322-326
DOI:10.4103/0301-4738.116468  PMID:24008792
Purpose: To evaluate the outcome of strabismus surgery for congenital superior oblique palsy (SOP) in relation to correction of head tilt and hypertropia. The cohort of patients mainly involved very young children. This is the first study to use a standardized instrument to objectively measure torticollis before and after surgery. Materials and Methods: A non-comparative interventional case series of 13 cases of congenital superior oblique palsy with head tilt, who underwent simultaneous superior oblique tuck and inferior oblique recession between Jan 2000 and Dec 2008, were studied. Results: The mean duration of SOP until surgery was 36.8 months. Of the 12 unilateral cases, 8 were right-sided. Mean follow-up period was 17 months (range 7-36). The outcome was determined at the last follow-up. Mean pre-and post-operative hypertropia (p.d.) in forced primary position was 19 ± 7 and 2 ± 6, respectively ( P < 0.0001). The head tilt reduced from mean of 17 ± 9 to 2 ± 2 degrees ( P < 0.0001). Success, defined as hypertropia <5 PD and head tilt less than 5 degrees, was achieved in 69% (9/13. C.I. 42-88%) and 85% (11/13. C.I. 56-96%), respectively. The success rate for achieving both criteria was 61.5% (C.I. 35-88%). Five patients required additional surgery; usually a contralateral inferior rectus muscle recession, which was successful in all cases. One case developed asymptomatic Brown syndrome (7.69% - C.I. 6.7-22.2). Conclusions: Simultaneous superior oblique tuck and inferior oblique muscle recession can successfully treat selected cases of congenital superior oblique palsy. About one-third required an additional procedure, which led to total normalization of the head position.
  1 2,827 266
Barriers to follow-up for pediatric cataract surgery in Maharashtra, India: How regular follow-up is important for good outcome. The Miraj Pediatric Cataract Study II
Parikshit Gogate, Shailbala Patil, Anil Kulkarni, Ashok Mahadik, Rahin Tamboli, Rekha Mane, Rishiraj Borah, GV Rao
March 2014, 62(3):327-332
DOI:10.4103/0301-4738.116465  PMID:24008794
Background: Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery. Aim: To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up. Subjects: 262 children (393 cataracts) who underwent cataract surgery in 2004-8. Materials and Methods: The children were identified and examined in their homes and a "barriers to follow-up" questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed. Statistical Analysis: SPSS version 19. Results: Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group ( P < 0.001), less education of mother ( P = 0.012), father's occupation ( P = 0.031), how much money spent on travel ( P = 0.033) and was it paid or free surgery ( P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up. Conclusion: Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.
  1 2,681 206
Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion
Mehmet Demir, Burcu Dirim, Zeynep Acar, Yekta Sendul, Ersin Oba
March 2014, 62(3):279-283
DOI:10.4103/0301-4738.105769  PMID:23571251
Aim: To compare the effects of intravitrealbevacizumab (IVB) and intravitreal triamcinolone acetonide (IVT) in the treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO). Materials and Methods: There were 20 patients treated with IVB (1.25 mg/0.05 mL) and 16 treated with IVT (4 mg/0.1 mL). The two groups were compared with regard to best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), slit-lamp biomicroscopy and fundus fluorescein angiography results, intraocular pressure (IOP), numbers of injections, and adverse events. Results: The mean follow-up times in the IVB and IVT groups were 17.45±8.1 months (range: 8-33 months) and 19.94±10.59 months (range: 6-40 months), respectively (P = 0.431). Visual acuity increased and CMT decreased significantly within both groups, but no differences were observed between the groups (P = 0.718). The percentages of patients with increased IOP and iatrogenic cataracts were significantly higher in the IVT group than in the IVB group. Conclusions: Treatment with IVB and IVT both resulted in significant improvement in visual acuity and a decrease in CMT in patients with ME secondary to non-ischemic CRVO, with no difference between the two treatments. The incidence of adverse events, however, was significantly greater in the IVT group than in the IVB group. IVB may be preferred over IVT for the treatment of ME in patients with non-ischemic CRVO.
  1 1,995 318
Clinical profile and short-term outcomes of optic neuritis patients in India
Rohit Saxena, Swati Phuljhele, Vimla Menon, Shailesh Gadaginamath, Ankur Sinha, Pradeep Sharma
March 2014, 62(3):265-267
DOI:10.4103/0301-4738.121131  PMID:24722269
Purpose: To evaluate the clinical profile and short-term visual outcome of optic neuritis (ON) patients in India. Materials and Methods: In this prospective study carried out over a period of 3 years, 99 eyes of 83 ON patients were examined and followed up for 10.8 ± 8.2 months for type of presentation, recurrence rate, and visual outcome. Results: Mean age was 27.6 ± 8.8 years. Female preponderance was seen (70% of cases). Papillitis (53.5% of eyes) was more common than retrobulbar neuritis (46.5% of eyes). Bilateral presentation was seen in 19.3% cases. Baseline median logMAR visual acuity (VA) was 1.6 ± 0.8, which improved to 0.2 ± 0.6, with approximately 64% of eyes retaining VA of 20/40 or more. Two patients had previous diagnosis of multiple sclerosis (MS). MS was newly diagnosed in two patients. Recurrence was seen in 16% of eyes and was more common in cases of retrobulbar neuritis. Conclusion: The clinical profile of ON in Indian patients is different from that in the Western population. Unlike reported in the Western literature, papillitis is frequent in the Indian setup, with lower recurrence rates but poorer outcomes.
  1 3,592 615
Intraocular soluble intracellular adhesion molecule-1 correlates with subretinal fluid height of diabetic macular edema
Dan Zhu, He Zhu, Chunyan Wang, Dayong Yang
March 2014, 62(3):295-298
DOI:10.4103/0301-4738.111184  PMID:23619489
Objective: To investigate the correlations between aqueous concentrations of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), soluble intracellular adhesion molecule-1 (sICAM-1) and diabetic macular edema (DME). Materials and Methods: VEGF, MCP-1 and sICAM-1 concentrations in aqueous humor samples of 22 patients with DME and 23 patients with cataract of a control group were measured with solid-phase chemiluminescence immunoassay. Results: Aqueous VEGF (89.2 ± 58.5 pg/ml versus 48.5 ± 27.8 pg/ml, P = 0.006), MCP-1 (684.2 ± 423.4 pg/ml versus 432.4 ± 230.4 pg/ml, P = 0.019) and sICAM-1 (3213.8 ± 2581.6 pg/ml versus 260.2 ± 212.2 pg/ml, P < 0.001) all vary significantly between DME group and control group. Maximum height of submacular fluid measured by Optical coherence tomography (OCT) was significantly associated with aqueous sICAM-1 (r = -0.45, P = 0.034). The maximum height of macular thickness measured by OCT was not significantly associated with either VEGF (P = 0.300), MCP-1 (P = 0.320) or sICAM-1 (P = 0.285). Conclusions: Our results suggest that sICAM-1 may majorly contribute to the formation of subretinal fluid in DME patients and imply that MCP-1 and sICAM-1 may be the potential therapy targets, besides VEGF.
  1 1,504 154
BRIEF COMMUNICATIONS
A rare case of toxic optic neuropathy secondary to consumption of neem oil
AR Suresha, P Rajesh, KS Anil Raj, Radhika Torgal
March 2014, 62(3):337-339
DOI:10.4103/0301-4738.121129  PMID:24722271
A 35-year-old female was referred to our hospital with bilateral loss of vision of two days duration. She gave history of consumption of about 150 ml of neem oil five days back.Examination revealed no perception of light in both eyes. Both pupils were dilated and sluggishly reacting to light. Her fundus examination showed bilateral hyperemic, edematous discs and also edema extending along the superior and inferior temporal vascular arcade. Magnetic resonance imaging (MRI) scan showed bilateral putaminal regions with altered signal, hypointensities in T1-weighted images, hyperintensities on T2-weighted, images and hyperintense on Fluid Attenuation Inversion Recovery (FLAIR) images suggestive of cytotoxic edema due to tissue hypoxia. Her vision improved to 20/200 in both eyes with treatment after two months. This is the first case report of such nature in the literature to the best of our knowledge.
  - 1,936 169
Collagen cross-linking in the treatment of pellucid marginal degeneration
Ziad Hassan, Gabor Nemeth, Laszlo Modis, Eszter Szalai, Andras Berta
March 2014, 62(3):367-370
DOI:10.4103/0301-4738.109523  PMID:23571261
Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months follow-up after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.
  - 5,086 374
Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye
Subashini Kaliaperumal, Robin Troutbeck, Wallop Iemsomboon, Adrian Farinelli
March 2014, 62(3):371-372
DOI:10.4103/0301-4738.109515  PMID:23571254
This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.
  - 1,482 100
Implantation of iris-claw Artisan intraocular lens for aphakia in Fuchs' heterochromic iridocyclitis
Ahmad Kheirkhah, Mojgan Nikdel, Hadi Ghadimi
March 2014, 62(3):373-374
DOI:10.4103/0301-4738.109513  PMID:23571252
Implantation of iris-claw Artisan intraocular lens (IOL) is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs' heterochromic iridocyclitis (FHI) due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.
  - 1,724 225
Rhodotorula mucilaginosa Keratitis: A rare fungus from Eastern India
Suman Saha, Jayangshu Sengupta, Debapriya Chatterjee, Debdulal Banerjee
March 2014, 62(3):341-344
DOI:10.4103/0301-4738.111133  PMID:23619486
Rhodotorula mucilaginosa rarely cause keratitis in immunocompromised individuals. A 30 year old male with history of minor trauma presented with cotton wool like stromal infiltration and hypopyon in left eye. Microbiological examination of corneal scraping showed fungal hyphae and yeast cells in direct smear. Molecular identification of the organism was performed which showed 100% homology with Rhodotorula mucilaginosa. Management of these cases is difficult often necessitating surgical procedures. However further reports are necessary to understand the disease and establish a treatment protocol.
  - 2,199 170
Cholesterol granuloma of the orbit: An atypical presentation
Syed A R Rizvi, Mahboob Hasan, Mohammad S Alam
March 2014, 62(3):344-346
DOI:10.4103/0301-4738.111187  PMID:23619491
Cholesterol granuloma is a rare, well-defined lesion of the orbit. In the orbit, diploe of the frontal bone is involved almost exclusively. We report an atypical case of cholesterol granuloma involving superomedial quadrant of orbit. A 42-year-old male presented with progressive, painless, proptosis with infero-temporal displacement of left eye. A large mass was felt beneath the bony orbital margin in the superomedial quadrant of the left orbit. Computerized tomography (CT) scan revealed an extraconal superomedial, heterogeneous enhancing mass which was isodense with brain and pushing the globe inferolaterally and anteriorly. Excision biopsy of the tumor revealed the typical features of a cholesterol granuloma without any epithelial elements. Cholesterol granuloma of the orbit is a rare entity, but it can be diagnosed and differentiated from other lesions of the superior orbit by its characteristic clinical, radiological and histopathological features. An appropriate intervention in time carries a good prognosis with almost no recurrence.
  - 1,484 137
Nonarteritic ischemic optic neuropathy developed after capsular block syndrome
Volkan Hurmeric, Atilla Bayer, Ali H Durukan, Fatih M Mutlu
March 2014, 62(3):346-348
DOI:10.4103/0301-4738.111135  PMID:23619487
A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.
  - 1,124 121
Spontaneous fracture of an implanted posterior chamber polyimide intraocular lens haptic: A case report
Haemin Kang, Kyung Eun Han, Tae-im Kim, Eung Kweon Kim
March 2014, 62(3):348-350
DOI:10.4103/0301-4738.111195  PMID:23619497
A 57-year-old male patient visited our clinic for decreased visual acuity in the right eye for 10 days. He denied any trauma history, but recalled that the symptom developed after straining. He had undergone uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation in the bag of the right eye 11 years ago. The IOL was a three-piece silicone polyimide-haptics design. On slit-lamp examination, the IOL optic and proximal part of nasal fractured haptic were found in the anterior chamber. The distal part of fractured haptic was observed in the capsular bag. He underwent IOL exchange. The fracture site of the haptic was near the optic-haptic junction. This is the unique case report of a spontaneous fracture of an implanted posterior chamber polyimide IOL haptic, which implies the possibility of IOL haptic fracture in various haptic materials.
  - 1,851 147
Conjunctivitis due to Neisseria sicca: A case report
Ilker Eser, Alper Akcali, Muserref Tatman-Otkun, Arzu Taskiran-Comez
March 2014, 62(3):350-352
DOI:10.4103/0301-4738.98894  PMID:23552355
We report the first case, in Medline-based literature, of conjunctivitis caused by gram negative diplococcus, Neisseria sicca. Although it is not widely accepted as such, isolation from cultures of repeated eye swab samples suggests that N. sicca may be a pathogen in conjunctival infections. Positive culture for this organism should not be readily dismissed. Such conjunctivitis responded favorably to treatment with netilmicin eye drops.
  - 3,081 141
Excellent outcome of Aspergillous endophthalmitis in a case of allergic bronchopulmonary aspergillosis
Balbir Khan, Ravi Vohra, Rajwinder Kaur, Sukhwinder Singh, Ashapritpal , Vartika
March 2014, 62(3):352-354
DOI:10.4103/0301-4738.125552  PMID:24722272
While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infections have been reported in immunocompetent individuals. The purpose is to report an eye with post-operative Aspergillus endophthalmitis, which achieved a good visual outcome following early and aggressive treatment. A young patient, known case of allergic bronchopulmonary aspergillosis presented to us with post-cataract surgery endophthalmitis. He was treated with pars plana vitrectomy and intravitreal voriconazole and systemic itraconazole. The patient regained a vision of 20/30 with follow up of 2 years.
  - 1,317 151
Neonatal orbital abscess
Khalil M Al-Salem, Fawaz A Alsarayra, Areej R Somkawar
March 2014, 62(3):354-357
DOI:10.4103/0301-4738.116447  PMID:24008806
Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28-day-old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.
  - 1,459 169
Bilateral intraocular dirofilariasis
Viney Gupta, Preeti Sankaran, Mohanraj , Jyotish Chandra Samantaray, Vimla Menon
March 2014, 62(3):357-358
DOI:10.4103/0301-4738.116252  PMID:24008780
Ocular dirofilariasis mostly presents as a subconjunctival or eyelid lesion. [1] Intraocular dirofilarial infestation is rare. [2],[3] We report a case of a young woman who was accidentally detected to have a live motile worm in the anterior segment in one eye and a cystic lesion on the optic disc in the other eye. To our knowledge, bilateral intraocular dirofilariasis has never been reported.
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Novel occurrence of axenfeld: Rieger syndrome in a patient with blepharophimosis ptosis epicanthus inversus syndrome
Bhavin M Shah, Tanuj Dada, Anita Panda, Mukesh Tanwar, Shibal Bhartiya, Rima Dada
March 2014, 62(3):358-360
DOI:10.4103/0301-4738.121144  PMID:24722273
Blepharophimosis ptosis epicanthus inversus syndrome (BPES) is a complex eyelid malformation characterized by the classical tetrad of blepharophimosis, telecanthus, ptosis, and epicanthus inversus. It has been reported to be associated with other ocular anomalies such as euryblepharon, strabismus, nystagmus, amblyopia, microphthalmos, lacrimal drainage apparatus abnormality, extra ocular muscle abnormalities, microcornea, trabecular dysgenesis, optic nerve hypoplasias, and colobomas of the optic disk. We describe a case of BPES with Axenfeld-Rieger syndrome, a neurocristopathy characterized by maldevelopment of the anterior segment with predisposition to development of glaucoma. Interestingly, both syndromes are caused by mutations in the same class of genes, namely the winged-helix/forked transcription factors (FOX) involved in a variety of developmental processes.
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Annular elastolytic giant cell granuloma of conjunctiva: A case report
Karabi Konar, Saurabh Sanyal, Arindam Rakshit
March 2014, 62(3):361-363
DOI:10.4103/0301-4738.121142  PMID:24722274
Annular elastolytic giant cell granuloma is a condition characterized histologically by damaged elastic fibers associated with preponderance of giant cells along with absence of necrobiosis, lipid, mucin, and pallisading granuloma. It usually occurs on sun-damaged skin and hence the previous name actinic granuloma. A similar process occurs on the conjunctiva. Over the past three decades only four cases of conjunctival actinic granuloma have been documented. All the previous patients were females with lesions in nasal or temporal bulbar conjunctiva varying 2-3 mm in size. We report a male patient aged 70 years presenting with a 14 mm × 7 mm fleshy mass on right lower bulbar conjunctiva. Clinical differential diagnoses were lymphoma, squamous cell carcinoma in situ and amyloidosis. Surgical excision followed by histopathology confirmed it to be a case of actinic granuloma. This is the first case of isolated conjunctival actinic granuloma of such a large size reported from India.
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Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery
Pukhraj Rishi, Sumanth Reddy, Ekta Rishi
March 2014, 62(3):363-365
DOI:10.4103/0301-4738.116452  PMID:24008807
A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C 3 F 8 gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C 3 F 8 gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.
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EDITORIAL
More about Retinal disorders
Sundaram Natarajan
March 2014, 62(3):263-264
DOI:10.4103/0301-4738.130427  PMID:24722268
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LETTERS TO THE EDITOR
Cunninghamella spinosum fungal corneal ulcer- first case report
Sulatha V Bhandary, H VijayaPai, Lavanya G Rao, Prakash Peralam Yegneswaran
March 2014, 62(3):375-376
DOI:10.4103/0301-4738.130436  PMID:24722275
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Pseudoexfoliation on the posterior capsule
Rajesh Subhash Joshi
March 2014, 62(3):376-377
DOI:10.4103/0301-4738.130437  PMID:24722276
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ORIGINAL ARTICLES
Results of diplopia and strabismus in patients with severe thyroid ophthalmopathy after orbital decompression
Radmilo Roncevic, Zorica Savkovic, Dusan Roncevic
March 2014, 62(3):268-273
DOI:10.4103/0301-4738.120206  PMID:24178400
Purpose: It has been frequently stated that the orbital decompression, in patients with thyroid ophthalmopathy, does not usually improve extraocular muscles function and that after the operation there is often a deterioration of these functions. The purpose of this article is evaluation of extraocular muscles function after applying personal method of 3 wall orbital decompression. Materials And Methods: Retrospective review of case records of 119 patients with severe thyroid ophthalmopathy seen and treated by the author between December 1986 and December 2010. All patents underwent 3 wall orbital decompression combined with removal of the periorbital, intraorbital and retrobulbar fat. Correction of coexistent eyelid retraction and deformities were also performed. Results: Comparison of preoperative and postoperative results was conducted in 65 patients three months after 3 wall decompression. All patients showed a significant reduction of exophthalmos [5-11 mm, 7.2 mm on average], reduction of intraocular pressure, marked improvement in ocular muscle function as well as considerable reduction in or disappearance of subjective symptoms. There were no cases of subsequent impairment of ocular motility. Strabismus surgery was performed in 6 patients with residual diplopia. There was an improvement in vision in 68% patients who had impaired vision before the operation. Less evident relapse of exophthalmos was recorded in 3 cases only and only one patient required unilateral reoperation. Conclusion: It can be concluded that this method of orbital decompression is logical, based on an understanding of the pathology, has less complication rates, is relatively easy to perform, gives very good functional and aesthetic long term results and allows rapid recovery.
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Manual cataract extraction via a subconjunctival limbus oblique incision for mature cataracts
J Yang, P Lai, D Wu, Z Long
March 2014, 62(3):274-278
DOI:10.4103/0301-4738.121135  PMID:24722270
Aims: To report the technique and outcomes of sutureless manual cataract extraction via a subconjunctival limbus oblique incision for mature cataracts. Materials and Methods: This retrospective study comprised of 112 eyes of 83 patients with mature cataract who all had manual cataract extraction via a subconjunctival limbus oblique incision. A transconjunctival tunnel is fashioned with a 3.0 mm keratome, 0.5 mm behind the limbal vascular arcades. A limbal tunnel, with a transverse extent of 9 mm in the cornea and 7.0 mm in the limbus, is created beneath the conjunctival/Tenon's tissue using an angled bevel-up crescent blade. Outcome measures included visual acuity, intraoperative complications, surgically induced astigmatism, endothelial cell loss rate and surgery time. Results: Self-sealing wound was achieved in 112 eyes (98.2%). The nucleus was delivered in whole in 108 eyes (96.4%). Intraoperative complications included hyphema in 3 eyes (2.7%), iridodialysis in 2 eyes 1.8%), posterior capsular rupture and zonular dialysis in 2 eyes (1.8%). At the 3-month follow-up, 91% patients achieved a best-corrected visual acuity of 20/20 or better, the mean of surgically induced astigmatism was -0.62 ± 0.41 Diopters and endothelial cell loss was 4.2%. Average surgical time was 3.75 min per case. Conclusion: This subconjunctival limbus oblique incision has the potential to serve as safe and effective technique for mature cataracts.
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Retinal sensitivity in healthy Indians using microperimeter
Laxmi Gella, Muneeswar Gupta Nittala, Rajiv Raman
March 2014, 62(3):284-286
DOI:10.4103/0301-4738.111211  PMID:23619501
Aims: To establish the retinal sensitivity values in healthy Indians using microperimeter. Materials and Methods: In this prospective study, 144 healthy volunteers were included. All the participants underwent a comprehensive ophthalmic examination including contrast sensitivity. Microperimetry was performed in the central 20° of the macula using 76 stimulus points to assess the retinal sensitivity, and the fixation characteristics in the study population were assessed. Results: The mean age of the study sample was 43.08 ± 10.85 years (range: 25-69). Mean retinal sensitivity was 18.26 ± 0.99 dB. Males had significantly increased retinal sensitivity (18.34 vs. 18.17 dB, P = 0.03). The linear regression analysis revealed a 0.04 dB per year age-related decline in mean retinal sensitivity. Contrast sensitivity was significantly correlated with the mean retinal sensitivity (r = 0.432, P < 0.001). Fixation stability in the central 2° and 4° were 69% and 89%, respectively. Conclusion: Microperimeter is an ideal tool to assess the retinal sensitivity and the fixation behavior. These normative values could help in drawing a meaningful conclusion in various retinal pathologies.
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Optical coherence tomography findings and retinal changes after vitrectomy for optic disc pit maculopathy
Gaurav Sanghi, Tapas R Padhi, Vivekanand U Warkad, Jayesh Vazirani, Vishali Gupta, Mangat R Dogra, Amod Gupta, Taraprasad Das
March 2014, 62(3):287-290
DOI:10.4103/0301-4738.111191  PMID:23619493
Purpose : To study the optical coherence tomography (OCT) patterns in optic disc pit maculopathy and retinal changes after vitreous surgery. Materials and Methods : Retrospective review of consecutive cases with optic disc pit maculopathy seen at two tertiary eye institutes from January 2005 to June 2009. Results : Twenty-four eyes of 23 patients are included. The presenting visual acuity ranged from 20/400 to 20/20 (median:20/80). The median age at presentation was 24 years (range, 6-57 years). Optical coherence tomography demonstrated a combination of retinoschisis and outer layer detachment (OLD) in 19 (79.17%) eyes, OLD only in 3 (12.5%) eyes and retinoschisis only in 2 (8.33%) eyes. An obvious communication (outer layer hole) between the schisis and OLD was seen in 14 (73.68%) of the 19 eyes with both features. Of the 21 eyes with retinoschisis, schisis was present in multiple layers in 15 (71.43%) and single layer in 6 (28.57%) eyes. Eleven eyes underwent pars plana vitrectomy including creation of posterior vitreous detachment (PVD), fluid-air exchange, low intensity laser photocoagulation at the temporal edge of the optic disc pit and non-expansile perfluoropropane gas (14%) injection. Five (45.45%) of 11 eyes undergoing vitrectomy had complete resolution and 4 (36.36%) eyes had partial resolution of maculopathy. Visual acuity improved in 8 (72.72%) of 11 eyes. Conclusion : Optical coherence tomography demonstrates multiple layer schisis and outer layer detachment as main features of optic disc pit maculopathy. Vitrectomy with PVD induction, laser photocoagulation and gas tamponade results in anatomical and visual improvement in most cases with optic disc pit maculopathy.
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Hyperhomocysteinia is a risk factor for retinal venous occlusion: A case control study
Fahad Al Wadani, Rajiv Khandekar, Gigani Salim, Mohammed Al Ali, Salman Ramzi
March 2014, 62(3):291-294
DOI:10.4103/0301-4738.111213  PMID:23619502
Background: We evaluated the role of hyperhomocysteinemia as a risk factor for retinal vein occlusion (RVO) in Indian patients. Type of Study: Matched case control type of longitudinal study was conducted in 2006-2007. Materials and Methods: Two medical retina specialists examined the eyes having an event of RVO in the last 15 days. A similar number of eyes without RVO were also examined. The serum and urine homocysteine levels of these persons were tested. Matched pair analysis was carried out to determine the risk of RVO among those with hyperhomocysteinemia. Results: We included 20 cases of RVO and 20 age- and sex-matched persons without RVO. The risk of RVO was significantly higher in persons with hyperhomocysteinemia [difference of mean 31.62 μmol/L (95% Confidence Interval 16.60-47 . 86), P = 2.1 × 10−13 ]. The mean urine homocysteine level among cases and controls was not statistically significant. There were 12 persons with hypertension in both cases and control groups. Conclusion: Hyperhomocysteinemia is a risk factor for RVO. Any list of investigations for a case of RVO should include total plasma homocysteine (tHcy) levels.
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