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   2014| August  | Volume 62 | Issue 8  
    Online since September 18, 2014

 
 
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BRIEF COMMUNICATIONS
Open angle glaucoma in a case of Type IV Ehler Danlos syndrome: A rarely reported association
Arijit Mitra, R Ramakrishnan, Mohideen Abdul Kader
August 2014, 62(8):880-884
DOI:10.4103/0301-4738.141060  PMID:25230966
A 26-year-old male presented to us with defective vision in the left eye. He had best corrected visual acuity (BCVA) of hand movement (HM) in right eye and 6/9 in left eye. He had ptosis with ectropion in both eyes and relative afferent pupillary defect (RAPD) in right eye. Intraocular pressure (IOP) was 46 and 44 mmHg in right and left eye, respectively. Fundus showed glaucomatous optic atrophy (GOA) in right eye and cup disc ratio (CDR) of 0.75 with bipolar rim thinning in left eye. Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. He gave history of easy bruising and tendency to fall and history of intestinal rupture 5 years ago for which he had undergone surgery. He was diagnosed as a case of Type IV Ehler-Danlos syndrome (EDS) with open angle glaucoma. He underwent trabeculectomy in both eyes. This is a rare case that shows glaucoma in a patient of EDS Type IV. Very few such cases have been reported in literature.
  2,617 141 -
ORIGINAL ARTICLES
Scleral fixation of one piece intraocular lens by injector implantation
Ertugrul Can, Resat Basaran, Adem Gul, Hakki Birinci
August 2014, 62(8):857-860
DOI:10.4103/0301-4738.141042  PMID:25230961
Aim of Study: With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fixation through small clear corneal incision. Materials and Methods: Case report and literature review. Results: This procedure has been performed in eight aphakic eyes with four different types of IOLs. Good centration was achieved with minimal technical effort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up. Conclusion: We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fluid leakage and consecutive hypotony can be minimized.
  2,384 301 -
Relationship of lifestyle and body stature growth with the development of myopia and axial length elongation in Taiwanese elementary school children
Chung-Ying Huang, Chiun-Ho Hou, Ken-Kuo Lin, Jiahn-Shing Lee, Meng-Ling Yang
August 2014, 62(8):865-869
DOI:10.4103/0301-4738.141047  PMID:25230963
Context: The development of myopia and growth of the eye, occur at a time when body stature is increasing. Aims: To investigate the relationship of lifestyle and body growth with axial elongation and myopia development among schoolchildren aged 7 to 9 years. Settings and Design: Prospective study. Materials and Methods: Children in elementary schools without serious eye disorders were invited to participate. We measured cycloplegic refraction, corneal curvature, intraocular pressure, axial length, body height, and weight. Questionnaires about the children's daily lifestyles, family members' myopia and parents' socio-demographic status were completed. The children were followed up every 6 months in a 3-year period. Statistical Analysis Used: Bivariate correlations, simple and multiple regression. Results: Eighty-eight children participated in this study. Forty-eight were myopic at the beginning of the study, and their myopia correlated with longer axial length and parental myopia (P = 0.015, 0.012). Sixty-five children (74%) completed the study, and the rates of change per year were -0.43 ± 0.58 (mean + standard deviation) diopters in spherical equivalence, 0.32 ± 0.25 mm in axial length (AL), 5.73 ± 2.71 cm in body height, and 3.84 ± 2.23 kg in weight. The axial length change was positively correlated with the height change (P < 0.001). The myopia shift was correlated to axial length change (P = 0.000) but not correlated to height change. Using multiple regression test, near work was the only significant risk factor for myopia progression (P = 0.022). Conclusions: Our study showed that body height increment was correlated to axial length elongation but not to myopia shift in children aged 7-9 years. Genetic factors such as parental myopia and body height had a possible influence on myopia development, and the environment factor as near work intensity was related to myopia progression.
  2,346 337 -
Comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery
Sirel Gur Gungor, Begum Bulam, Ahmet Akman, Meric Colak
August 2014, 62(8):861-864
DOI:10.4103/0301-4738.141045  PMID:25230962
Purpose: To compare the results of intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification. Materials and Methods: Sixty eyes of 60 patients that underwent cataract surgery with phacoemulsification were randomized into two groups. Preoperative visual acuity of all patients was 0.5 or lower and intraocular pressures were under 21mmHg. After surgery, eyes in group 1 (30 eyes) were injected with 0.4 mg/0.1 ml dexamethasone into the anterior chamber, and eyes in group 2 (30 eyes) were injected with 2 mg/0.05 ml triamcinolone acetonide into the anterior chamber. All eyes received standard postoperative prednisolone acetate and moxifloxacin eye drops. The biomicroscopic evaluation, visual acuity, and intraocular pressure measurements were done at baseline (preoperatively) and on postoperative days 1, 7 and 30. Results: There were no statistically significant differences in mean visual acuity, the amount of anterior cells and flare between the two groups (P ≥ 0.05). Mean intraocular pressure values at postoperative first day were significantly higher in group 2 than in group 1 (P = 0.009). The mean intraocular pressures on days 7 and 30 after surgery were not statistically different between the two groups (P ≥ 0.05). Conclusions: Intracameral dexamethasone and intracameral triamcinolone acetonide were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures on postoperative first day were higher in patients receiving intracameral triamcinolone acetonide. The highest intraocular pressure in triamcinolone acetonide group was 24 mmHg, and stabilized in a few days, therefore using triamcinolone acetonide may impose a minimal risk to patients. Nevertheless, intracameral dexamethasone seems to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 hours.
  2,216 435 -
Intraoperative floppy iris syndrome in Indian population: A prospective study on incidence, risk factors, and impact on operative performance
Shilpa Goyal, Deepansh Dalela, Neeraj Kumar Goyal, Shobhit Chawla, Rajat Dhesi, Bela Kamboj, Abha Dalela
August 2014, 62(8):870-875
DOI:10.4103/0301-4738.141051  PMID:25230964
Purpose: The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance. Materials and Methods : Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS. Results : Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases. Conclusion : The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.
  2,050 405 -
Sensitivity and specificity of nonmydriatic digital imaging in screening diabetic retinopathy in Indian eyes
Vishali Gupta, Reema Bansal, Amod Gupta, Anil Bhansali
August 2014, 62(8):851-856
DOI:10.4103/0301-4738.141039  PMID:25230960
Background: Nonmydriatic digital imaging (NMDI) is ideal for screening diabetic retinopathy (DR), but its use in Indian eyes has not been evaluated. Aim: The aim was to evaluate the sensitivity and specificity of NMDI as a screening tool in detecting DR in Indian eyes. Design: A prospective, nonrandomized, noncomparative, noninterventional study. Materials and Methods: A total of 500 diabetic patients visiting the endocrinology clinic (September 2008-June 2010) underwent NMDI (Zeiss Procam), followed by routine dilated fundus photography (FP; Zeiss Visupac 450+) of 345° retinal fields (1) optic disc and macula, (2) superotemporal, and (3) nasal to optic disc. Two-masked retina specialists graded the images for quality and severity of DR, and compared between NMDI and dilated FP. Statistical Analysis: SPSS Windows 17 for version. Results: Mean age was 52.97 ± 13.46 years (306 males: 194 females). The rate of ungradable images was 30.6% and 31% by the two observers. By observer 1, the sensitivity and specificity of detecting any DR was 58.8% and 69.1%, respectively, (κ = 0.608) and sight-threatening DR (STDR) was 63.1% and 68.9%, respectively, (κ = 0.641). By observer 2, the sensitivity and specificity was 57.3% and 68.3%, respectively, for any DR (κ = 0.593) and 62.8% and 68.3%, respectively, for STDR (κ = 0.637). The level of agreement between two observers was high (κ = 0.96). Conclusion: A high rate of poor quality photographs and low sensitivity limited the use of NMDI as a perfect screening system, particularly in dark iris population with diabetes as seen in Indian eyes.
  2,004 304 -
BRIEF COMMUNICATIONS
Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery
Su-Na Lee
August 2014, 62(8):890-892
DOI:10.4103/0301-4738.141067  PMID:25230969
Toxic anterior segment syndrome (TASS) is an acute sterile postoperative anterior segment inflammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop.
  1,871 230 -
Ocular involvement in tumoral calcinosis
Harsha Bhattacharjee, Kasturi Bhattacharjee, Dina Kumar Yambem
August 2014, 62(8):884-887
DOI:10.4103/0301-4738.141063  PMID:25230967
We report a 32-year-old male who presented with blurring of vision in the right eye since 1.5 years. He had history of swelling over the extensor surfaces of large joints which were migratory in nature. Few of them spontaneously subsided following suppuration of chalky white discharges except over the gluteal region. Ophthalmological examination revealed visual acuity of counting fingers (CF) at 1 m in the right eye and perilimbal conjunctival calcific deposits and retinal angiod streaks in both eyes. There was choroidal neovascular membrane with subretinal hemorrhage in right eye, confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). B scan ultrasonography and simultaneous vector A scan detected calcification of the subretinal neovascular membrane and the adjoining sclera.
  1,728 131 -
ORIGINAL ARTICLES
Comparing acromegalic patients to healthy controls with respect to intraocular pressure, central corneal thickness, and optic disc topography findings
Emine Sen, Yasemin Tutuncu, Ufuk Elgin, Melike Balikoglu-Yilmaz, Dilek Berker, F Nur Aksakal, Faruk Ozturk, Serdar Guler
August 2014, 62(8):841-845
DOI:10.4103/0301-4738.141035  PMID:25230958
Aims: The aim was to compare the intraocular pressure (IOP), central corneal thickness (CCT), and optic disc topography findings of biochemically controlled acromegalic patients and the control group and to evaluate the effect of the duration of acromegaly and serum growth hormone and insulin-like growth factor-1 (IGF-1) levels on these ocular parameters. Materials and Methods: IOP measurement with Goldmann applanation tonometry, CCT measurement with ultrasonic pachymetry, and topographic analysis with Heidelberg retinal tomograph III were performed on 35 biochemically controlled acromegalic patients and 36 age- and gender-matched controls. Results: Mean IOP and CCT were 14.7 ± 2.9 mmHg and 559.5 ± 44.9 μm in the acromegaly patients and 13.0 ± 1.6 mmHg and 547.1 ± 26.7 μm in controls (P = 0.006 and P = 0.15, respectively). A significant moderate correlation was found between the duration of acromegaly and CCT (r = 0.391) and IOP (r = 0.367). Mean retinal nerve fiber layer (RNFL) thickness was significantly lower in the acromegalic patients (0.25 ± 0.05 mm) as compared to controls (0.31 ± 0.09 mm) (P = 0.01). A significant moderate correlation was detected between IGF-1 level and disc area (r = 0.362), cup area (r = 0.389) and cup volume (r = 0.491). Conclusion: Biochemically controlled acromegalic patients showed significantly higher CCT and IOP levels and lower RNFL thickness compared to healthy controls and the duration of disease was correlated with CCT and IOP levels.
  1,621 232 -
Morphometric analysis of fovea with spectral-domain optical coherence tomography and visual outcome postsurgery for retinal detachment
Manish Nagpal, Kiran Shakya, Navneet Mehrotra, Kartikey Kothari, Kalyani Bhatt, Rajen Mehta, Chaitanya Shukla
August 2014, 62(8):846-850
DOI:10.4103/0301-4738.141037  PMID:25230959
Purpose: The purpose of this study was to correlate the postoperative best-corrected visual acuity (BCVA) with spectral-domain optical coherence tomography (SD-OCT) findings in fovea involving rhegmatogenous retinal detachment (RRD) surgery. Materials and Methods: Thirty eyes with preoperative fovea-involving RRD, who underwent scleral buckling (SB) (6 eyes) and pars plana vitrectomy (PPV) (19 eyes) and combined SB and PPV (5 eyes) were recruited. Patients underwent clinical examination and SD-OCT scan of fovea preoperatively and at 30 days and 90 days postoperatively. The correlations between SD-OCT findings and BCVA were analyzed. Results: Inner segment/outer segment (IS/OS) junction integrity was the indicator of better BCVA at 30 days and 90 days (P = 0.0002 and P = 0.0003, respectively) whereas outer retinal corrugation (ORC) was related to worse BCVA at 30 days and 90 days (P = 0.001). External limiting membrane did not have a co-relation with visual outcome, but cystoid macular edema showed co-relation at 90 days (P = 0.047). All eyes of SB and 3 eyes of PPV had a minimal subfoveal fluid at 30 days follow-up that had no effect on visual acuity. All retinas were attached at final follow-up. Conclusion: IS/OS junction integrity and ORC may be important predictors of postoperative visual outcome after anatomically successful RRD surgery.
  1,529 233 -
EDITORIAL
The sweeter side of retina
Sundaram Natarajan
August 2014, 62(8):839-840
DOI:10.4103/0301-4738.141032  PMID:25230957
  1,395 289 -
OPHTHALMOLOGY PRACTICE
Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation
Uzeyir Gunenc, Nilufer Kocak, A Taylan Ozturk, Gul Arikan
August 2014, 62(8):876-878
DOI:10.4103/0301-4738.116451  PMID:24008801
We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o'clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.
  1,374 178 -
LETTERS TO THE EDITOR
Inverted ILM peeling for idiopathic and other etiology macular holes
Mahesh P Shanmugam, Rajesh Ramanjulu, Madhu Kumar, Gladys Rodrigues, Srinivasulu Reddy, Divyansh Mishra
August 2014, 62(8):898-899
DOI:10.4103/0301-4738.141077  PMID:25230973
  1,349 191 -
BRIEF COMMUNICATIONS
Aspergillus terreus endogenous endophthalmitis: Report of a case and review of literature
Pradeep Kumar Panigrahi, Rupak Roy, Swakshyar Saumya Pal, Anjan Mukherjee, Aneesha Lobo
August 2014, 62(8):887-889
DOI:10.4103/0301-4738.141065  PMID:25230968
We report a rare case of Aspergillus terreus endogenous endophthalmitis in an immunocompetent patient with subretinal abscess and also review the reported cases. A 50-year-old healthy male presented with sudden painful loss of vision in right eye. He was diagnosed with endogenous endophthalmitis and underwent urgent vitrectomy. Aspergillus terreus growth was obtained in culture. At final follow-up, there was complete resolution of the infection but visual acuity was poor due to macular scar. Aspergillus terreus is a rare cause of endophthalmitis with usually poor outcomes. Newer antifungals like Voriconazole can be sometimes associated with better prognosis.
  1,315 209 -
Endoilluminator-assisted scleral buckling: Our results
Varun Gogia, Pradeep Venkatesh, Shikha Gupta, Ashish Kakkar, Satpal Garg
August 2014, 62(8):893-894
DOI:10.4103/0301-4738.141068  PMID:25230970
Aims: The aim was to evaluate the long-term surgical outcomes of endoillumination assisted scleral buckling (EASB) in primary rhegmatogenous retinal detachment (RRD). Methods: Twenty-five eyes of 25 patients with primary RRD and proliferative vitreoretinopathy ≤C2 where any preoperative break could not be localised, were included. All patients underwent 25 gauge endoilluminator assisted rhegma localisation. Successful break determination was followed by cryopexy and standard scleral buckling under surgical microscope. Anatomical and functional outcomes were evaluated at the end of 2 years. Results: At least one intraoperative break could be localized in 23 of 25 (92%) eyes. Median age of these patients was 46 years (range: 17-72). Thirteen eyes (56.52%) were phakic, 8 (34.78%) were pseudophakic and 2 (8.6%) were aphakic. Anatomical success (attachment of retina) was achieved in 22 (95.63%) of 23 eyes with EASB. All eyes remained attached at the end of 2 years. Significant improvement in mean visual acuity (VA) was achieved at the end of follow-up (1.09 ± 0.46 log of the minimum angle of resolution [logMAR]) compared with preoperative VA (1.77 ± 0.28 logMAR) (P < 0.001). Conclusion: EASB can be considered an effective alternative to vitreoretinal surgery in simple retinal detachment cases with the added advantage of enhanced microscopic magnification and wide field illumination.
  1,185 151 -
Infrared reflectance as a diagnostic adjunct for subclinical commotio retinae
Nicholas H Andrew, James A Slattery, Jagjit S Gilhotra
August 2014, 62(8):879-880
DOI:10.4103/0301-4738.141056  PMID:25230965
Commotio retinae (CR) is an outer retinal disorder following blunt trauma to the eye. Histologically it is characterized by disruption of the photoreceptor outer segments (OS), typically without injury to other retinal layers. Using spectral-domain optical coherence tomography (OCT) the condition is visible as hyper-reflectivity of the OS. Most cases of CR are associated with transient grey-white discoloration of the retina and are easily diagnosed clinically, but there have been reports of OCT-confirmed CR without retinal discoloration. It is likely that this subclinical variant of CR is under-recognized as the OCT features of CR are subtle. Here, we report a case of OCT-confirmed subclinical CR that demonstrated prominent infrared hypo-reflectance, using the infrared protocol of the SPECTRALIS® OCT, Heidelberg Engineering. This case suggests that infrared reflectance may have a role in diagnosing cases of subclinical CR.
  1,088 144 -
LETTERS TO THE EDITOR
Live Subretinal Nematode: Management by Focal Argon Laser Photocoagulation with Spectral Domain OCT Analysis
Jay Sheth, Ashish Sharma, Selva Sundaramoorthy
August 2014, 62(8):899-901
DOI:10.4103/0301-4738.141081  PMID:25230974
  924 142 -
Manual tunnel incision cataract surgery with sandwich technique may be a rationale alternative for mature cataracts
Huseyin Bayramlar, Remzi Karadag, Aydin Yildirim, Ozgur Cakici, Unsal Sari
August 2014, 62(8):896-897
DOI:10.4103/0301-4738.141073  PMID:25230972
  678 147 1
Authors' Reply: Comment to Varied phenotype of Homocystinuria: Possible diagnostic error
Subashini Kaliaperumal, K Praveen Kumar, Bhuvaneshwari
August 2014, 62(8):897-897
PMID:25360472
  737 85 -
Comment on outcomes in patients with esotropic Duane retraction syndrome and a partially accommodative component
Siddharth Agrawal, Vinita Singh, Arun Kumar Sharma
August 2014, 62(8):895-895
DOI:10.4103/0301-4738.141069  PMID:25230971
  631 114 -
Authors' Reply: Comment to course of diabetic retinopathy before and after renal transplantation
Rupak Roy, Manmath K Das, Bikramjit P Pal, Suguneswari Ganesan, Rajiv Raman, Tarun Sharma
August 2014, 62(8):897-898
PMID:25360473
  605 104 -
Authors' Reply
Ramesh Kekunnaya, Federico G Velez, Stacy L Pineles
August 2014, 62(8):895-896
PMID:25360471
  567 101 -