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   2014| April  | Volume 62 | Issue 4  
    Online since May 8, 2014

 
 
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COMMUNITY EYE CARE
Prevalence and causes of low vision and blindness in an urban population: The Chennai Glaucoma Study
Lingam Vijaya, Ronnie George, Rashima Asokan, Lokapavani Velumuri, Sathyamangalam Ve Ramesh
April 2014, 62(4):477-481
DOI:10.4103/0301-4738.111186  PMID:23619490
Aim: To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population. Settings and Design: Population-based cross-sectional study. Exactly 3850 subjects aged 40 years and above from Chennai city were examined at a dedicated facility in the base hospital. Materials and Methods: All subjects had a complete ophthalmic examination that included best-corrected visual acuity. Low vision and blindness were defined using World Health Organization (WHO) criteria. The influence of age, gender, literacy, and occupation was assessed using multiple logistic regression. Statistical Analysis: Chi-square test, t-test, and multivariate analysis were used. Results: Of the 4800 enumerated subjects, 3850 subjects (1710 males, 2140 females) were examined (response rate, 80.2%). The prevalence of blindness was 0.85% (95% CI 0.6-1.1%) and was positively associated with age and illiteracy. Cataract was the leading cause (57.6%) and glaucoma was the second cause (16.7%) for blindness. The prevalence of low vision was 2.9% (95% CI 2.4-3.4%) and visual impairment (blindness + low vision) was 3.8% (95% CI 3.2-4.4%). The primary causes for low vision were refractive errors (68%) and cataract (22%). Conclusions: In this urban population based study, cataract was the leading cause for blindness and refractive error was the main reason for low vision.
  7,189 486 -
ORIGINAL ARTICLES
Use of subjective and objective criteria to categorise visual disability
Garima Kajla, Jolly Rohatgi, Upreet Dhaliwal
April 2014, 62(4):400-406
DOI:10.4103/0301-4738.121146  PMID:24817743
Context: Visual disability is categorised using objective criteria. Subjective measures are not considered. Aim: To use subjective criteria along with objective ones to categorise visual disability. Settings and Design: Ophthalmology out-patient department; teaching hospital; observational study. Material and Methods: Consecutive persons aged >25 years, with vision <20/20 (in one or both eyes) due to chronic conditions, like cataract and refractive errors, were categorized into 11 groups of increasing disability; group-zero: normal range of vision, to group-X: no perception of light, bilaterally. Snellen's vision; binocular contrast sensitivity (Pelli-Robson chart); automated binocular visual field (Humphrey; Esterman test); and vision-related quality of life (Indian Visual Function Questionnaire-33; IND-VFQ33) were recorded. Statistical Analysis: SPSS version-17; Kruskal-wallis test was used to compare contrast sensitivity and visual fields across groups, and Mann-Whitney U test for pair-wise comparison (Bonferroni adjustment; P < 0.01). One-way ANOVA compared quality of life data across groups; for pairwise significance, Dunnett T3 test was applied. Results: In 226 patients, contrast sensitivity and visual fields were comparable for differing disability grades except when disability was severe (P < 0.001), or moderately severe (P < 0.01). Individual scales of IND-VFQ33 were also mostly comparable; however, global scores showed a distinct pattern, being different for some disability grades but comparable for groups III (78.51 ± 6.86) and IV (82.64 ± 5.80), and groups IV and V (77.23 ± 3.22); these were merged to generate group 345; similarly, global scores were comparable for adjacent groups V and VI (72.53 ± 6.77), VI and VII (74.46 ± 4.32), and VII and VIII (69.12 ± 5.97); these were merged to generate group 5678; thereafter, contrast sensitivity and global and individual IND-VFQ33 scores could differentiate between different grades of disability in the five new groups. Conclusions: Subjective criteria made it possible to objectively reclassify visual disability. Visual disability grades could be redefined to accommodate all from zero-100%.
  5,263 314 -
COMMUNITY EYE CARE
Awareness, knowledge, and practice: A survey of glaucoma in north Indian rural residents
Parveen Rewri, Mukesh Kakkar
April 2014, 62(4):482-486
DOI:10.4103/0301-4738.132105  PMID:24817749
Background: Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population. Materials and Methods: A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned. Results: Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2 - 98.9) participants, including 3104 males (63%; 95% CI: 61.7 - 64.3) and 1823 females (37%; 95% CI: 35.7 - 38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6 - 9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55 - 2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information. Conclusions: There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.
  4,617 573 1
ORIGINAL ARTICLES
Retinal nerve fiber layer thickness in normal Indian pediatric population measured with optical coherence tomography
Neelam Pawar, Devendra Maheshwari, Meenakshi Ravindran, Renagappa Ramakrishnan
April 2014, 62(4):412-418
DOI:10.4103/0301-4738.121185  PMID:24817744
Purpose: To measure the peripapillary retinal nerve fiber layer (RNFL) thickness in normal Indian pediatric population. Subjects and Methods: 120 normal Indian children ages 5-17 years presenting to the Pediatric Clinic were included in this observational cross-sectional study. RNFL thickness was measured with stratus optical coherence tomography (OCT). Children with strabismus or amblyopia, with neurological, metabolic, vascular, or other disorders and those with abnormal optic discs were excluded. One eye of each subject was randomly selected for statistical analysis. The effect of age, refraction and gender on RNFL thickness was investigated statistically. Result: OCT measurements were obtained in 120 of 130 (92.3%) subjects. Mean age was 10.8 ± 3.24 years (range 5-17). Average RNFL thickness was (± SD) 106.11 ± 9.5 μm (range 82.26-146.25). The RNFL was thickest inferiorly (134.10 ± 16.16 μm) and superiorly (133.44 ± 15.50 μm), thinner nasally (84.26 ± 16.43 μm), and thinnest temporally (70.72 ± 14.80 μm). In univariate regression analysis, age had no statistical significant effect on RNFL thickness (P = 0.7249) and refraction had a significant effect on RNFL thickness (P = 0.0008). Conclusion: OCT can be used to measure RNFL thickness in children. Refraction had an effect on RNFL thickness. In normal children, variation in RNFL thickness is large. The normative data provided by this study may assist in identifying changes in RNFL thickness in Indian children.
  2,677 354 1
OPHTHALMOLOGY PRACTICE
Ophthalmic masquerades of the atherosclerotic carotids
Anupriya Arthur, Anika Alexander, Simerpreet Bal, Ajith Sivadasan, Sanjith Aaron
April 2014, 62(4):472-476
DOI:10.4103/0301-4738.121183  PMID:24817748
Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome). These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient's presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.
  2,613 266 1
BRIEF COMMUNICATIONS
Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis
Nilufer Kocak, Taylan A Ozturk, Suleyman Kaynak
April 2014, 62(4):513-515
DOI:10.4103/0301-4738.100005  PMID:23571248
X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment.
  2,657 170 -
Linezolid-induced optic neuropathy
Divya Karuppannasamy, Andavar Raghuram, Devisundaram Sundar
April 2014, 62(4):497-500
DOI:10.4103/0301-4738.118451  PMID:24088636
Many systemic antimicrobials have been implicated to cause ocular adverse effects. This is especially relevant in multidrug therapy where more than one drug can cause a similar ocular adverse effect. We describe a case of progressive loss of vision associated with linezolid therapy. A 45-year-old male patient who was on treatment with multiple second-line anti-tuberculous drugs including linezolid and ethambutol for extensively drug-resistant tuberculosis (XDR-TB) presented to us with painless progressive loss of vision in both eyes. Color vision was defective and fundus examination revealed optic disc edema in both eyes. Ethambutol-induced toxic optic neuropathy was suspected and tablet ethambutol was withdrawn. Deterioration of vision occurred despite withdrawal of ethambutol. Discontinuation of linezolid resulted in marked improvement of vision. Our report emphasizes the need for monitoring of visual function in patients on long-term linezolid treatment.
  2,439 325 -
ORIGINAL ARTICLES
Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia
Alessandro Meduri, Lucia Scorolli, Sergio Zaccaria Scalinci, Pier Luigi Grenga, Stefano Lupo, Miguel Rechichi, Enrico Meduri
April 2014, 62(4):424-428
DOI:10.4103/0301-4738.119420  PMID:24145571
Background: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). Materials and Methods: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. Results: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. Conclusions : Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. Financial Disclosure: No author has any financial or proprietary interest in any material or method used in this study. Trial Registration: Current Controlled Trials ISRCTN73824458.
  2,438 195 1
Quality of vision in patients implanted with aspherical and spherical intraocular lens: Intraindividual comparison
Francesco Semeraro, Mario R Romano, Sarah Duse, Ciro Costagliola
April 2014, 62(4):461-463
DOI:10.4103/0301-4738.116489  PMID:24008781
Aims: To compare the quality of vision in pseudophakic patients implanted with aspherical and spherical intraocular lenses (IOLs). Materials and Methods: Randomized prospective longitudinal intrapatient comparison between aspherical and spherical IOLs performed on 22 patients who underwent bilateral cataract surgery. Best corrected visual acuity, subjective contrast sensitivity, Strehl ratio and spherical aberrations (SA), and higher order wavefront aberrations for a 3.5 mm and a 6.0 mm pupil were measured after 3 months of cataract surgery. Results: SA (Z4,0) decreased significantly in eyes with aspherical IOL implant (P = 0.004). Modulation transfer function (MTF) and point spread function (PSF) resulted no significant difference between the two groups (P = 0.87; P = 0.32). Conclusion: Although the SA is significantly lower in eyes implanted with aspherical IOL, the quality of vision determined with MTF and PSF does not significantly differ for subjective and objective parameters that were analyzed.
  2,343 231 -
BRIEF COMMUNICATIONS
Spheniodal mucocele causing bilateral optic neuropathy and ophthalmoplegia
Ambika Selvakumar, Balasubramanyam Mahalaxmi, V Ananth, Cugati Gautam
April 2014, 62(4):515-517
DOI:10.4103/0301-4738.99863  PMID:23571243
Sphenoid sinus mucocele comprises only 2% of all paranasal sinus mucoceles. In literature, there is a case report on sphenoidal mucocele causing bilateral optic neuropathy, with unilateral partial recovery and cranial nerve palsy, but we did not come across any literature with bilateral optic neuropathy and ophthalmoplegia together caused by spheno-ethmoidal mucocele. We present such a rare case of spheno-ethmoidal mucocele causing bilateral optic neuropathy and unilateral sixth nerve palsy who had postsurgery, unilateral good vision recovery, and complete resolution of sixth nerve palsy.
  2,384 187 -
ORIGINAL ARTICLES
Short wavelength automated perimetry can detect visual field changes in diabetic patients without retinopathy
Othman Ali Zico, Amany Abdel-Fattah El-Shazly, Eslam Elsayed Abdel-Hamid Ahmed
April 2014, 62(4):383-387
DOI:10.4103/0301-4738.126986  PMID:24817740
Purpose: The purpose of the following study is to compare short wave automated perimetry (SWAP) versus standard automated perimetry (SAP) for early detection of diabetic retinopathy (DR). Materials and Methods: A total of 40 diabetic patients, divided into group I without DR (20 patients = 40 eyes) and group II with mild non-proliferative DR (20 patients = 40 eyes) were included. They were tested with central 24-2 threshold test with both shortwave and SAP to compare sensitivity values and local visual field indices in both of them. A total of 20 healthy age and gender matched subjects were assessed as a control group. Results: Control group showed no differences between SWAP and SAP regarding mean deviation (MD), corrected pattern standard deviation (CPSD) or short fluctuations (SF). In group I, MD showed significant more deflection in SWAP (−4.44 ± 2.02 dB) compared to SAP (−0.96 ± 1.81 dB) (P = 0.000002). However, CPSD and SF were not different between SWAP and SAP. In group II, MD and SF showed significantly different values in SWAP (−5.75 ± 3.11 dB and 2.0 ± 0.95) compared to SAP (−3.91 ± 2.87 dB and 2.86 ± 1.23) (P = 0.01 and 0.006 respectively). There are no differences regarding CPSD between SWAP and SAP. The SWAP technique was significantly more sensitive than SAP in patients without retinopathy (p), but no difference exists between the two techniques in patients with non-proliferative DR. Conclusion: The SWAP technique has a higher yield and efficacy to pick up abnormal findings in diabetic patients without overt retinopathy rather than patients with clinical retinopathy.
  2,232 324 -
BRIEF COMMUNICATIONS
Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?
Richa Sharma, Abadan K Amitava, Sadat AO Bani
April 2014, 62(4):508-511
DOI:10.4103/0301-4738.118448  PMID:24088635
Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS). Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon's signed rank test. Results: On the first post-operative day, only FBS (P = 0.01) and TIS (P = 0.04) showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04), congestion (P = 0.04), FBS (P = 0.02), and TIS (P = 0.04) were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04) and TIS (P = 0.05) were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.
  2,285 220 -
ORIGINAL ARTICLES
Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane
Hamid Khakshoor, Alireza Eslampoor, Saeed Shokoohi Rad, Amirhossein Vejdani
April 2014, 62(4):392-395
DOI:10.4103/0301-4738.121108  PMID:24817742
Aims: To determine the clinical efficacy of modified deep anterior lamellar keratoplasty (DALK) for the treatment of advanced-stage keratoconus with steep curvature. Materials and Methods: In this interventional, non-comparative case series, 30 patients with advanced stages of keratoconus and curvature of more than 60 D underwent a modified DALK procedure. In this technique, after big-bubble formation, posterior stromal lamella was cut and removed 5 mm centrally (baring Descemet's membrane completely) with posterior stromal layer remaining peripherally. Results: The study included 30 eyes (30 patients with a mean ± SD age of 25 ± 5.4 years). The follow-up examination was performed for all participants up to 12 months after the surgery. The mean uncorrected visual acuity (UCVA) increased from 20/800 before the surgery to a subsequent 3/10 (P = 0.12). Likewise, best spectacle corrected visual acuity (BSCVA) improved, reaching 6/10 postoperatively (former quantity 20/200) (P = 0.18). In addition, mean keratometry and keratometric astigmatism managed to achieve considerable improvement, from 58.8 ± 5.4 D to 46.5 ± 2.1 D and 7.8 ± 2.1 to 4.54 ± 1.54 D, respectively (P = 0.52). Descemet's membrane wrinkling was not seen in any patient postoperatively. Conclusions: This technique is effective in restoring acceptable vision and corneal regularity in advanced cases of keratoconus with a curvature more than 60 D who are also at risk of Descemet's membrane wrinkling after DALK. Therefore, this procedure could prevent from Descemet membrane wrinkling in such cases.
  1,971 399 -
Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence
Mustafa Ozsutcu, Emre Ayintap, Julide C U Akkan, Arif Koytak, Cengiz Aras
April 2014, 62(4):407-411
DOI:10.4103/0301-4738.120220  PMID:24178405
Aims: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. Materials and Methods: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. Results: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P = 0.1806). The recurrence rates were similar in Group B and C (P > 0.05). Conclusions: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.
  2,013 300 -
Is being female a risk factor for shallow anterior chamber? The associations between anterior chamber depth and age, sex, and body height
Wei-Cherng Hsu, Elizabeth P Shen, Yi-Ting Hsieh
April 2014, 62(4):446-449
DOI:10.4103/0301-4738.119344  PMID:24145564
Aim of Study: To analyze the association between anterior chamber depth (ACD) and age, sex, and body height (BH). Materials and Methods: One thousand four hundred eighty eyes of 1480 adults 40 years of age and older receiving preoperative evaluation for cataract surgery were recruited consecutively from June 1, 2006, to December 31, 2010. ACD was measured with the Zeiss IOLMaster. Univariate and multivariate linear regression models were used to analyze the correlations, and receiving operator characteristic (ROC) curves and the area under the curve (AUC) were used for evaluating the predictability of an ACD less than 2.70 mm. Results: ACD was negatively correlated with age and positively correlated with BH in both univariate and multivariate regression analysis (P < 0.001). Sex was associated with ACD in univariate analysis, but not after adjustment with age and BH. In predicting an ACD less than 2.70 mm, the AUCs of ROC curves for 'age and sex', 'age and BH', and 'age, sex, and BH' were 0.687, 0.689, and 0.689, respectively. Conclusion: Age and BH were independent associating factors of ACD; however, sex was not. Older people and shorter ones likely had shallower ACD, and therefore were predisposed to Primary angle closure glaucoma (PACG). The predictability of ACD by age and BH solely was low, and adding sex did not increase it.
  2,035 211 -
OPHTHALMOLOGY PRACTICE
Benign Fibrous Histiocytoma
Pushpa Varma, Shweta Walia, Raju Manglawat
April 2014, 62(4):464-467
DOI:10.4103/0301-4738.132104  PMID:24817747
Fibrous histiocytomas (FHs) are mesenchymal tumors that may be benign or malignant. Ocular involvement by FHs is infrequent and primarily limited to the orbit. Rarely, FHs can also involve the conjunctiva and perilimbal area. We report the case of a 38-year-old male with lid, conjunctival, and neck FHs. The diagnosis was confirmed by histopathology.
  1,985 240 -
ORIGINAL ARTICLES
The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac
Kyoung-Nam Kim, Yeon-Hee Lee, Jung-Yeul Kim, Sung-Bok Lee
April 2014, 62(4):442-445
DOI:10.4103/0301-4738.120229  PMID:24178409
Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac. Materials and Methods: The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042). Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.
  1,998 197 -
Anatomic study of the lacrimal fossa and lacrimal pathway for bypass surgery with autogenous tissue grafting
Hai Tao, Zhi-zhong Ma, Hai-Yang Wu, Peng Wang, Cui Han
April 2014, 62(4):419-423
DOI:10.4103/0301-4738.121137  PMID:24817745
Purpose: To study the microsurgical anatomy of the lacrimal drainage system and to provide anatomical evidence for transnasal endoscopic lacrimal drainage system bypass surgery by autogenous tissue grafting. Materials and Methods: A total of 20 Chinese adult cadaveric heads in 10% formaldehyde, comprising 40 lacrimal ducts were used. The middle third section of the specimens were examined for the following features: the thickness of the lacrimal fossa at the anterior lacrimal crest, vertical middle line, and posterior lacrimal crest; the cross section of the upper opening, middle part, and lower opening of the nasolacrimal canal; the horizontal, 30° oblique, and 45° oblique distances from the lacrimal caruncle to the nasal cavity; the distance from the lacrimal caruncle to the upper opening of the nasolacrimal duct; and the included angle between the lacrimal caruncle-nasolacrimal duct upper opening junction and Aeby's plane. Results: The middle third of the anterior lacrimal crest was significantly thicker than the vertical middle line and the posterior lacrimal crest (P > 0.05). The horizontal distance, 30° oblique distance, and 45° oblique distance from the lacrimal caruncle to the nasal cavity exhibited no significant differences (P > 0.05). The included angle between the lacrimal caruncle and the lateral wall middle point of the superior opening line of the nasolacrimal duct and Aeby's plane was average (49.9° ± 1.8°). Conclusion: The creation of the bony tunnel should start from the middle or posterior middle part of the lacrimal fossa, extending toward the anterior inferior region with an optimal downward oblique angle of 45°.
  1,916 228 -
Efficacy of combined intravitreal bevacizumab and triamcinolone for branch retinal vein occlusion
Rasha I Ali, Kapil G Kapoor, Adeel N Khan, Syed K Gibran
April 2014, 62(4):396-399
DOI:10.4103/0301-4738.120227  PMID:24178408
Purpose: To evaluate the efficacy of combined treatment with intravitreal bevacizumab (IVB) and triamcinolone acetate (IVT) for patients with macular edema secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Retrospective analysis of 20 eyes injected with 1.25 mg IVB and 2 mg IVT for clinically identified BRVO within 8 weeks of onset. All patients lacked concomitant ocular pathology and completed 6 months' follow-up. Clinical examination including LogMAR visual acuity (VA) and central macular thickness (CMT) by spectralis optical coherence tomography (OCT) was performed preoperatively and at 1, 3 and 6 months post-operatively. Results : Mean patient age was 61.3 years with a mean BRVO diagnosis time of 3 weeks at presentation. VA improved from logMAR 1.08 preoperatively to Mean logMAR VA of 0.55 ± 0.17 at 1 month (P < 0.001), 0.56 ± 0.21 at 3 months (P < 0.001), and 0.38 ± 0.1 at 6 months (P < 0.001) Mean CMT improved from 482 ± 107 μm preoperatively to 319 ± 53 μm at 1 month (P < 0.001), 344 ± 89 μm at 3 months (P < 0.001), and 241 ± 29 μm at 6 months (P < 0.001). Mean IOP preoperatively was 16.5 mmHg, 21 mmHg at 1 month, and 15 mmHg at 6 months. Six out of 20 patients (30%) were re-injected with IVB and IVT at 3 months. Conclusions: Early combined treatment with IVB and IVT is effective in improving anatomic and functional outcomes in patients with macular edema secondary to BRVO.
  1,801 337 -
Clinical features and outcomes of vitrectomy in pediatric ocular injuries-eye injury vitrectomy study
Xuefeng Feng, Kang Feng, Yuntao Hu, Zhizhong Ma
April 2014, 62(4):450-453
DOI:10.4103/0301-4738.120222  PMID:24178406
Context: Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently. Aims: To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS). Settings and Design: Retrospective, consecutive, interventional case series. Materials and Methods: Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009. Statistical analysis used: Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.). Results: Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively. Conclusions: Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.
  1,885 238 -
BRIEF COMMUNICATIONS
Perioperative visual loss with non-ocular surgery: Case report and review of literature
Nidhi Pandey, Ashok K Chandrakar, Mangi L Garg
April 2014, 62(4):503-505
DOI:10.4103/0301-4738.116464  PMID:24008804
Perioperative visual loss (POVL), a rare but devastating complication, has been reported after spine, cardiac, and head-neck surgeries.The various causes include ischemic optic neuropathy, central or branch retinal artery occlusion, and cortical blindness. The contributory factors described are microvascular diseases and intraoperative hemodynamic compromise. However, the exact association of these factors with post-operative blindness has not yet been confirmed. A case of POVL with caesarian section surgery is being presented. The visual loss occurred due to a combined occlusion of central retinal artery and vein.The causes, presentation, and risk factors of POVL after non-ocular surgery are being discussed.
  1,809 239 -
Management of macular epiretinal membrane by vitrectomy and intravitreal triamcinolone
Dhananjay Shukla
April 2014, 62(4):511-512
DOI:10.4103/0301-4738.99850  PMID:23571236
A patient underwent successful vitrectomy for macular epiretinal membrane with anatomical and functional improvement. 10 weeks later, there was a recurrence of macular edema with corresponding visual decline. An intravitreal injection of triamcinolone acetonide not only restored the macular anatomy but also improved the visual outcome beyond that achieved after surgery.
  1,808 195 -
An unusual cause of optic atrophy in a child
Nishant Kumar, Anirudh Singh, Rohit Saxena, Vimla Menon, Sanjay Sharma
April 2014, 62(4):494-495
DOI:10.4103/0301-4738.132111  PMID:24817753
A 13-year-old child presenting with gross visual impairment was diagnosed as a case of optic atrophy. However, radiological investigations revealed osteopetrosis, which, though rare, can result in optic atrophy. The aim of this case report is to highlight this possibility while evaluating cases of optic atrophy in young patients.
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OPHTHALMOLOGY PRACTICE
Batch-related sterile endophthalmitis following intravitreal injection of bevacizumab
Morteza Entezari, Alireza Ramezani, Hamid Ahmadieh, Hassan Ghasemi
April 2014, 62(4):468-471
DOI:10.4103/0301-4738.111192  PMID:23619494
Background: To report a series of patients with sterile endophthalmitis after intravitreal bevacizumab (IVB) injection from 2 different batches of bevacizumab. Materials and Methods: Records of 11 eyes with severe inflammation after IVB injections from two different batches (7 eyes from one and 4 from the other) on two separate days were evaluated. Fifteen eyes of 15 patients in one day were treated with one batch and 18 eyes of 17 patients were treated another day using another batch injected for different retinal diseases. Each batch was opened on the day of injection. We used commercially available bevacizumab (100 mg/4 ml) kept at 4°C. Severe cases with hypopyon were admitted to the ward and underwent anterior chamber and vitreous tap for direct smear and culture. Results: Pain, redness and decreased vision began after 11-17 days. All had anterior chamber and vitreous reactions and 5 had hypopyon. Antibiotics and corticosteroids were initiated immediately, but the antibiotics were discontinued after negative culture results. Visual acuity returned to pre-injection levels in 10 eyes after 1 month and only in one eye pars plana vitrectomy was performed. Mean VA at the time of presentation with inflammation (1.76 ± 0.78 logMAR) decreased significantly (P = 0.008) compared to the initial mean corrected VA (1.18 ± 0.55 logMAR); however, final mean corrected VA (1.02 ± 0.48 logMAR) improved in comparison with the baseline but not to a significant level (P = 0.159). Conclusions: We report a cluster of sterile endophthalmitis following intravitreal injection of bevacizumab from the same batch of bevacizumab that has a favorable prognosis.
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BRIEF COMMUNICATIONS
An unusual complication of blunt ocular trauma: A horseshoe-shaped macular tear with spontaneous closure
Umut Karaca, Hakan A Durukan, Tarkan Mumcuoglu, Cuneyt Erdurman, Volkan Hurmeric
April 2014, 62(4):501-503
DOI:10.4103/0301-4738.121138  PMID:24817754
A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT) is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.
  1,767 185 -
ORIGINAL ARTICLES
Effects of triamcinolone acetonide on human trabecular meshwork cells in vitro
Ashish Sharma, A Jayaprakash Patil, Navin Gupta, MF Estrago-Franco, Saffar Mansoor, Vincent Raymond, M Cristina Kenney, Baruch D Kuppermann
April 2014, 62(4):429-436
DOI:10.4103/0301-4738.121143  PMID:24817746
Aim: To study the effects of triamcinolone acetonide (TA) on cultured human trabecular meshwork (HTM) cells. Materials and Methods: HTM cells were cultured and treated with 125, 250, 500 and 1000 μg/mL concentration of TA for 24 h. The cells were treated with both crystalline TA (TA-C) (commercial preparation) and solubilized TA (TA-S). Cell viability was measured by a trypan blue dye exclusion test. The activity of caspse-3/7 was measured by a fluorescence caspase kit and DNA laddering was evaluated by electrophoresis on 3% agarose gel. Levels of lactate dehydrogenase (LDH) were assessed with LDH cytotoxicity assay kit-II. Results: Mean cell viabilities of HTM cells after 24 h exposure to TA-C 125, 250, 500, and 1000 μg/mL were 75.4 ±2.45% (P < 0.0001), 49.43 ± 1.85% (P < 0.0001), 17.07 ± 2.39% (P < 0.0001), and 3.7 ± 0.9% (P < 0.0001), respectively, compared with the untreated HTM cells 92.49 ± 1.21%. The mean cell viabilities with 125, 250, 500, and 1000 μg/mL of TA-S were 94.47 ± 1.60% (P > 0.05), 90.13 ± 0.40% (P < 0.01), 85.57 ± 0.47% (P < 0.001), and 71.67 ± 3.30% (P < 0.0001), respectively, compared to DMSO-equivalent cultures. Untreated HTM control had a cell viability of 96.57 ± 1.98%. DMSO-treated controls of 125, 250, 500, and 1000 μg/mL had a cell viability of 94.73 ± 0.57%, 96.97 ± 1.08%, 93.97 ± 1.85%, and 97.27 ± 1.15%, respectively. There was no increase of caspase-3/7 activity in cultures treated with either TA-C or TA-S. DNA laddering showed no bands in the TA-C or TA-S treated cultures. There were significantly higher LDH release rates at all concentrations of TA-C compared to TA-S. Conclusions: Results show that the effect of TA-C and TA-S on HTM cells is due to cell death by necrosis at all concentrations except 125 μg/mL of TA-S. Elevated levels of LDH confirmed necrotic cell death. Our study also infers the relative safety of TA-S over TA-C.
  1,542 194 -
Comparison of the antimicrobial effect of heavy silicone oil and conventional silicone oil against endophthalmitis-causing agents
Nurgül Örnek, Teoman Apan, Reyhan Oğurel, Kemal Örnek
April 2014, 62(4):388-391
DOI:10.4103/0301-4738.126994  PMID:24817741
Purpose: To conduct an in vitro experimental study comparing the effectiveness of conventional silicone oil and heavy silicone oil against endophthalmitis-causing agents. Materials and Methods: The antimicrobial activity of conventional silicone oil (RS OIL 5000) and heavy silicone oil (heavySil 1500) was tested. The antimicrobial effects of both silicone oils were determined by the growing capability of the microorganism. Results: The number of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans decreased to zero levels at the second day of inoculation in heavy silicone oil. In conventional silicone oil, the microorganisms survived longer than in heavy silicone oil. Conclusion: Heavy silicone oil seems to be more effective than conventional silicone oil against endophthalmitis-causing agents.
  1,509 214 -
Evaluation of corneal biomechanical properties following penetrating keratoplasty using ocular response analyzer
Vanathi Murugesan, Ravi Bypareddy, Mahesh Kumar, Dada Tanuj, Panda Anita
April 2014, 62(4):454-460
DOI:10.4103/0301-4738.119317  PMID:24145556
Purpose: To evaluate corneal biomechanical properties in eyes that has undergone penetrating keratoplasty (PK). Materials and Methods: Retrospective observational study in a tertiary care centre. Data recorded included ocular response analyzer (ORA) values of normal and post-keratoplasty eyes [corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc)], corneal topography, and central corneal thickness (CCT). Wilcoxon signed rank test was used to analyze the difference in ORA parameter between post-PK eyes and normal eyes. Correlation between parameters was evaluated with Spearman's rho correlation. Results: The ORA study of 100 eyes of 50 normal subjects and 54 post-keratoplasty eyes of 51 patients showed CH of 8.340 ± 1.85 and 9.923 ± 1.558, CRF of 8.846 ± 2.39 and 9.577 ± 1.631 in post-PK eyes and normal eyes, respectively. CH and CRF did not correlate with post-keratoplasty astigmatism (P = 0.311 and 0.276, respectively) while a significant correlation was observed with IOPg (P = 0.004) and IOPcc (P < 0.001). Conclusion: Biomechanical profiles were significantly decreased in post-keratoplasty eyes with significant correlation with higher IOP as compared with that in normal eyes.
  1,529 180 -
BRIEF COMMUNICATIONS
Periorbital nodular fasciitis arising during pregnancy
Brandon N Phillips, Andrew S Eiseman
April 2014, 62(4):520-521
DOI:10.4103/0301-4738.99862  PMID:23571242
Nodular fasciitis (NF) is a benign proliferation of fibroblasts and myofibroblasts that rarely occurs in the periorbital region. We report what we believe to be the first case of periorbital NF associated with pregnancy. A case of intravascular fasciitis, a NF variant, has been reported during pregnancy, but it was not located in the periorbital region. A weak presence of estrogen receptors has been reported in NF. This may make it more susceptible to the hormone-related changes during pregnancy and contribute to the development of the lesion by stimulating fibroblasts and smooth muscle cell types. Although rare, NF should be considered in the differential diagnosis of periorbital soft-tissue masses arising during pregnancy.
  1,478 152 -
Cardiobacterium hominis-induced acute dacryocystitis and lacrimal abscess
Guru Prasad Manderwad, Manjulatha Kodiganti, Mohammad Javed Ali
April 2014, 62(4):495-497
DOI:10.4103/0301-4738.116461  PMID:24008805
Cardiobacterium hominis is a member of the HACEK (Haemophilus sp., Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella kingae) group commonly associated with endocarditits and is normally present in the respiratory tract. We describe the first case of acute dacryocystitis with lacrimal abscess caused by C. hominis along with a brief review of the literature. The patient responded to oral and topical ciprofloxacin after incision and drainage and awaits dacryocystorhinostomy.
  1,482 144 -
Medial canthus retiform hemangioendothelioma
Yasser H Al-Faky, Abdul Rahman Al-Mosallam, Ammar C Al-Rikabi, Mohammed O Al-Sohaibani
April 2014, 62(4):491-493
DOI:10.4103/0301-4738.126995  PMID:24817752
Retiform hemangioendothelioma (RH) is a distinct entity in the spectrum of vascular tumors with a high local recurrence rate. It is considered a low-grade, well-differentiated cutaneous angiosarcoma with low metastatic potential. We report here for the first time a case of medial canthus recurrent RH. It may be helpful in our practice to include RH as a differential diagnosis of eyelid lesions. It is noteworthy that the progressive course and recurrence tendency of RH might be misdiagnosed as angiosarcoma or basal cell carcinoma (BCC), if not expected and carefully evaluated by the pathologist.
  1,429 156 -
Multiple extra macular branch retinal vein occlusions in hyperhomocysteinemia
Abhijit Diwakar Gore, Girish Shiva Rao, Mansi Abhijit Gore, Abhishek R Desai
April 2014, 62(4):489-491
DOI:10.4103/0301-4738.132110  PMID:24817751
Hyperhomocysteinemia is a well-known modifiable risk factor for thromboembolism. Retinal vascular occlusion in patients having hyperhomocysteinemia is a known entity, particularly in young patients. However, multiple extra macular branch retinal vein occlusion (BRVO) is a rare condition, which can be a presentation of this disease. We present a patient who had multiple extra macular BRVO; on complete systemic workup, he was found to have raised homocysteine levels.
  1,326 178 -
ORIGINAL ARTICLES
Optical quality of hyperopic and myopic phakic intraocular lenses
Cari Pérez-Vives, Alberto Domínguez-Vicent, Teresa Ferrer-Blasco, David Madrid-Costa, Robert Montés-Micó
April 2014, 62(4):437-441
DOI:10.4103/0301-4738.119423  PMID:24145572
Aims: To assess and compare the optical quality of the myopic and hyperopic implantable collamer lens (ICL) from its wavefront aberrations for different powers and pupil diameters. Settings and Design: Prospective study. Material and Methods: The wavefront aberrations of two myopic (−3 and −6 diopters (D)) and two hyperopic V4b ICLs (+3 and +6D) were measured in vitro. To assess and compare the optical quality of different powers of ICLs, we analyzed the root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration at 3- and 4.5-mm pupil. In addition, the point spread functions (PSFs) of each ICL evaluated were calculated from the wavefront aberrations at 3- and 4.5-mm pupil. Statistical Analysis: A Student's t-test for unpaired data was used for comparison between myopic and hyperopic ICLs. Results: Myopic ICLs showed negative spherical aberration, in contrast hyperopic ICLs showed positive spherical aberration, which increases when the ICL power increases, due to the innate optical properties of the lens. All ICLs evaluated had negligible amounts of other aberrations. We did not find statistical significant differences in any Zernike coefficient RMS values analyzed between myopic and hyperopic ICLs at 3- and 4.5-mm pupil (P > 0.05). Conclusions: Myopic and hyperopic ICLs provide good and comparable optical quality for low to moderate refractive error. The ICLs evaluated showed values of wavefront aberrations clinically negligible to affect the visual quality after implantation.
  1,344 144 -
BRIEF COMMUNICATIONS
Eye wall resections for intraocular tumors: Our experience
Tandava Krishnan, Lingam Gopal, Jyotirmay Biswas, Prema Padmanabhan, Vikas Khetan
April 2014, 62(4):517-520
DOI:10.4103/0301-4738.98823  PMID:23545905
We conducted a retrospective review of 11 eyes undergoing eye wall resection between October 1998 and October 2009. The median age of 11 patients was 29 years. Decreased vision (eight) was the most common presenting symptom. Ciliary body medulloepithelioma was the most common clinical diagnosis (six). Medulloepithelioma was the most common histopathological diagnosis (four). The duration of follow-up ranged from 0.5 to 67 months (median 11 months). Three eyes needed to be enucleated in the postoperative period (margin involvement two eyes, recurrence one eye). Postoperative complications among others included retinal detachment (three), vitreous hemorrhage (three), cataract (two), and suprachoroidal hemorrhage (two). To conclude, prognosis of this procedure continues to be guarded needing close postoperative follow-up.
  1,356 123 -
Anterior chamber fixation of a posterior chamber intraocular lens: A novel technique
A Sahap Kükner, Gürsoy Alagöz, Mesut Erdurmus, Didem Serin, Ümit Dogan, Turgut Yilmaz
April 2014, 62(4):487-489
DOI:10.4103/0301-4738.132107  PMID:24817750
We aimed to evaluate the implantation of a posterior chamber intraocular lens (IOL) in the anterior chamber (AC) with the haptics passing through two iridectomies to the posterior chamber. A total of 33 eyes of 33 patients with inadequate posterior capsular support due to either previous aphakia or posterior capsular rupture during cataract extraction were included in the study. A double iridectomy was performed on all patients using a vitrectomy probe on the midperiphery of the iris. IOLs were implanted in the AC, and the haptics were passed through the iridectomies to the posterior chamber. The mean follow-up time was 25.3 months. AC hemorrhage occurred in five patients during the iridectomy procedure. Corneal edema was detected in eight of 14 patients with primary IOL insertions. Haptic dislocation was detected in only one patient. This technique may be a good alternative to scleral-fixated IOL implantation in eyes with aphakia.
  1,188 193 -
Increased choroidal thickness in patient with high-altitude retinopathy
Kyoko Hirukawa-Nakayama, Akito Hirakata, Kaoru Tomita, Tomoyuki Hiraoka, Makoto Inoue
April 2014, 62(4):506-507
DOI:10.4103/0301-4738.116483  PMID:24008803
We report a case of high-altitude retinopathy with increased choroidal thickness detected by spectral-domain optical coherence tomography (SD-OCT). A 36-year-old Japanese man developed an acute vision decrease in his left eye after he had trekked at an altitude of 4600 m in Tibet for 1 week. His visual acuity was 20/20 OD and 20/200 OS with refractive errors of − 0.25 diopters (D) OD and − 0.50 D OS 3 weeks after the onset of the visual decrease. Funduscopic examinations revealed multiple intraretinal hemorrhages bilaterally and a macular hemorrhage in the left eye. SD-OCT showed that the thickness of choroidal layer at the fovea was 530 μm OD and 490 μm OS which is thicker than that in normal subjects of approximately 300 μm. We suggest that the increase in the retinal blood flow under hypoxic conditions may be associated with an increase in the choroidal blood flow resulting in an increase in choroidal thickness.
  1,202 147 -
LETTERS TO THE EDITOR
Recurrent endophthalmitis following a scleral fixated intraocular lens in a glaucoma patient
Paromita Dutta, Viney Gupta, Ravi Byparedddy
April 2014, 62(4):522-522
DOI:10.4103/0301-4738.111193  PMID:23619495
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EDITORIAL
A close look at cornea
Sundaram Natarajan
April 2014, 62(4):381-382
DOI:10.4103/0301-4738.132102  PMID:24817739
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