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   2015| October  | Volume 63 | Issue 10  
    Online since December 10, 2015

 
 
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ORIGINAL ARTICLES
Surgeon point-of-view recording: Using a high-definition head-mounted video camera in the operating room
Akshay Gopinathan Nair, Saurabh Kamal, Tarjani Vivek Dave, Kapil Mishra, Harsha S Reddy, David Della Rocca, Robert C Della Rocca, Aleza Andron, Vandana Jain
October 2015, 63(10):771-774
DOI:10.4103/0301-4738.171506  PMID:26655001
Objective: To study the utility of a commercially available small, portable ultra-high definition (HD) camera (GoPro Hero 4) for intraoperative recording. Methods: A head mount was used to fix the camera on the operating surgeon's head. Due care was taken to protect the patient's identity. The recorded video was subsequently edited and used as a teaching tool. This retrospective, noncomparative study was conducted at three tertiary eye care centers. The surgeries recorded were ptosis correction, ectropion correction, dacryocystorhinostomy, angular dermoid excision, enucleation, blepharoplasty and lid tear repair surgery (one each). The recorded videos were reviewed, edited, and checked for clarity, resolution, and reproducibility. Results: The recorded videos were found to be high quality, which allowed for zooming and visualization of the surgical anatomy clearly. Minimal distortion is a drawback that can be effectively addressed during postproduction. The camera, owing to its lightweight and small size, can be mounted on the surgeon's head, thus offering a unique surgeon point-of-view. In our experience, the results were of good quality and reproducible. Conclusions: A head-mounted ultra-HD video recording system is a cheap, high quality, and unobtrusive technique to record surgery and can be a useful teaching tool in external facial and ophthalmic plastic surgery.
  4,245 339 -
BRIEF COMMUNICATIONS
Ocular manifestations in lipoid proteinosis: A rare clinical entity
Sumana J Kamath, HimaBindu Marthala, BinduMadhavi Manapragada
October 2015, 63(10):793-795
DOI:10.4103/0301-4738.171517  PMID:26655007
Lipoid proteinosis is a rare autosomal recessive genodermatosis with abnormal lipid protein complexes deposition in different parts of the body, especially in the skin and mucus membranes of the upper aerodigestive tract. Though ocular involvement in lipoid proteinosis is rare, ophthalmologists may encounter diverse ocular complications accompanying this syndrome in clinical practice. We describe a case of lipoid proteinosis involving bilateral eyelids with pathognomonic moniliform blepharosis in a 33-year-old gentleman who presented with the complaints of itching of eye lids on and off since 10 years.
  2,754 225 -
ORIGINAL ARTICLES
A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients
Priyanka Singh, Lopa Sarkar, HS Sethi, VS Gupta
October 2015, 63(10):779-784
DOI:10.4103/0301-4738.171508  PMID:26655003
Background: Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients. Methods: In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications. Results : After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B. Conclusion: Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study.
  2,510 444 -
BRIEF COMMUNICATIONS
Bilateral congenital lacrimal fistulas in an adult as part of ectrodactyly-ectodermal dysplasia-clefting syndrome: A rare anomaly
Debangshu Ghosh, Somnath Saha, Sumit Kumar Basu
October 2015, 63(10):800-803
DOI:10.4103/0301-4738.171524  PMID:26655010
Ectrodactyly-ectodermal dysplasia and clefting syndrome or "Lobster claw" deformity is a rare congenital anomaly that affects tissues of ectodermal and mesodermal origin. Nasolacrimal duct (NLD) obstruction with or without atresia of lacrimal passage is a common finding of such a syndrome. The authors report here even a rarer presentation of the syndrome which manifested as bilateral NLD obstruction and lacrimal fistula along with cleft lip and palate, syndactyly affecting all four limbs, mild mental retardation, otitis media, and sinusitis. Lacrimal duct obstruction and fistula were managed successfully with endoscopic dacryocystorhinostomy (DCR) which is a good alternative to lacrimal probing or open DCR in such a case.
  2,477 165 -
ORIGINAL ARTICLES
Efficacy of Ozurdex implant in treatment of noninfectious intermediate uveitis
Swetha Palla, Jyotirmay Biswas, Chokkahalli K Nagesha
October 2015, 63(10):767-770
DOI:10.4103/0301-4738.171505  PMID:26655000
Aims: To report our experiences using Ozurdex, a biodegradable implant, containing 0.7 mg of dexamethasone in the treatment of noninfectious intermediate uveitis. Settings and Design: Retrospective study design. Methods: We conducted a retrospective study of medical records of patients with noninfectious intermediate uveitis having either cystoid macular edema (CME) or vitritis who were not responsive to standard treatment and subsequently received Ozurdex implant from March 2011 to April 2013. The outcomes measured were best-corrected visual acuity, central retinal thickness (CRT), and vitreous haze score. Statistical Analysis Used: Paired t-test was used to test the significance of difference between quantitative variables. A P < 0.05 is taken to denote significant relationship. Results: Twenty eyes of 15 patients with mean age of 39.8 years who received Ozurdex implant were included in the study. The mean baseline visual acuity improved from 0. 666 logarithm of the minimum angle of resolution (logMAR) units to 0.479 logMAR units at 6 weeks after the implant. The mean CRT improved from 536.1 to 361.4 microns at 6 weeks postimplant both parameters were statistically significant. The ocular inflammation was controlled in almost all the patients. Cataract and raised intraocular pressure were documented complications. Conclusion: Ozurdex implant is a promising treatment option and efficient in controlling the inflammation and CME in cases of noninfectious intermediate uveitis not responding to standard treatment.
  2,083 361 -
Factors affecting treatment outcome in congenital nasolacrimal duct obstruction: A retrospective analysis from South India
Sahil Bhandari, Sabyasachi Sengupta, Dayakar Yadalla, Jayagayathri Rajagopalan, Girish Bharat Velis, Deepti Talele, Sameer Kushwaha
October 2015, 63(10):759-762
DOI:10.4103/0301-4738.171503  PMID:26654998
Purpose: To investigate outcomes for different treatment modalities in congenital nasolacrimal duct obstruction (CNLDO) in an Indian population. Design: Retrospective, interventional, case series. Materials and Methods: In an institutional setting, case records of patients with CNLDO from January 2008 to 2012, were reviewed, and data on patient demographics, clinical presentation, and treatment details (sac massage, probing, and/or dacryocystorhinostomy) were recorded. Success of treatment was defined as complete resolution of symptoms and negative regurgitation on pressure over lacrimal sac (ROPLAS) area. Results: Two hundred and ninety-eight eyes of 240 patients with a mean age of 22.2 ± 26.14 months (median = 12 months, interquartile range = 17) were analyzed. Sac massage (n = 226) was successful in 67 eyes (30%). Multivariable logistic regression analyses showed that children with mucoid ROPLAS were almost 6 times more likely (odds ratio [OR] = 5.55 vs. clear ROPLAS, 95% confidence interval [CI] = 2.35-13.09, P < 0.001) to experience failure of sac massage. Overall probing (n = 193) was successful for 143 (74%) eyes. Multivariable logistic regression showed that older children were 25% more likely to experience probing failure (OR = 1.25 for every 6 months increment in age, 95%, CI = 1.09-1.42, P = 0.001). Conclusion: Sac massage is successful in only a third of our patients and those with mucoid ROPLAS are more likely to experience failure. Probing is successful in three-quarter of our subjects, and its success declines with a progressive increase in age. Lower socioeconomic status, poor general health, and recurrent respiratory infections are unique to our population and may influence outcomes.
  1,975 359 -
Predicting postoperative visual outcomes in cataract patients with maculopathy
Tamer A Macky, Abdel Moniem Hasaballah Mohamed, Ahmed M Emarah, Amr Abdellatif Osman, Ahmed S Gado
October 2015, 63(10):775-778
DOI:10.4103/0301-4738.171507  PMID:26655002
Purpose: To assess the accuracy of the potential acuity meter (PAM) in predicting postcataract surgery visual acuity outcome in patients with healed inactive maculopathies. Study Design: Prospective interventional clinical trial. Patients and Methods: Patients scheduled for phacoemulsification had preoperative and 1 month postoperative best-corrected visual acuity (BCVA), PAM test, fluorescein angiography, and macular optical coherence tomography. Patients were grouped to following preoperative BCVA: PRE1: 0.29 and better, PRE2: 0.25-0.13, and PRE3: 0.1 or worse; age: G1 <60, G2 = 60-70, and G3 >70 years. PAM accuracy was divided into: Grade 1: Postoperative BCVA ≤1 or less line error of the PAM score, Grade 2: Between 1 and 2 lines error, and Grade 3: ≥3 lines or more error. Results: This study enrolled 57 patients with a mean age of 71.05 ± 6.78 years where 34 were females. There were 21 (36.84%) patients with diabetic maculopathy and 36 (63.16%) with age-related macular degeneration. The mean preoperative BCVA was 0.198 ± 0.12 (0.1-0.5). The mean PAM score was 0.442 ± 0.24 (0.1-1.3). The mean postoperative BCVA was 0.4352 ± 0.19 (0.17-1.00). The PAM score was in Grade 1, 2, and 3 in 46 (80.7%), 54 (94.7%), and 56 (98.2), respectively. There was a highly significant correlation between the PAM score and the postoperative BCVA (P < 0.001, Chi-square test). There was no correlation between the PAM test accuracy and age, gender, diagnosis, and preoperative BCVA (P = 0.661, 0.667, 0. 0.991, 0.833, Chi-square test; respectively). Conclusion: The PAM is an accurate method of predicting postoperative visual acuity for eyes with nuclear cataracts Grade I and II and inactive maculopathies.
  1,701 217 -
BRIEF COMMUNICATIONS
Macular hole formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment documented by spectral-domain optical coherence tomography: Case report and literature review
Jin Young Kim, Sung Pyo Park
October 2015, 63(10):791-793
DOI:10.4103/0301-4738.171514  PMID:26655006
This case report describes macular hole (MH) formation and spontaneous closure after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A 58-year-old man referred with a macula-off superior RRD, in whom vitrectomy was performed. MH with vitreomacular traction (VMT) caused by the posterior vitreous cortex remnants developed 2 weeks after vitrectomy. Four weeks postoperatively, optical coherence tomography revealed resolution of the VMT and spontaneous closure of MH without providing any treatment. This is the first report of an MH formation and spontaneous closure after vitrectomy for RRD. This suggests that the VMT mediated by the posterior vitreous cortex remnants has an important role in the development of secondary MH.
  1,537 232 -
EDITORIAL
Outsmarted by the smartphone!
Sundaram Natarajan, Akshay Gopinathan Nair
October 2015, 63(10):757-758
DOI:10.4103/0301-4738.171502  PMID:26654997
  1,541 218 -
ORIGINAL ARTICLES
Changes in choroidal thickness after prophylactic iridectomy in primary angle closure suspect eyes using enhanced depth imaging optical coherence tomography
Wei Wang, Minwen Zhou, Wenbin Huang, Xinbo Gao, Xiulan Zhang
October 2015, 63(10):763-766
DOI:10.4103/0301-4738.171504  PMID:26654999
Purpose: The aim of the present study was to evaluate the effect of surgical peripheral iridectomy (SPI) on choroidal thickness in primary angle-closure suspect (PACS) eyes. Materials and Methods: This was a prospective observational case series of 30 subjects with PACS. Ocular biometry was performed before SPI (baseline) and then 1 week later. Choroid was imaged by enhanced depth imaging optical coherence tomography (EDI-OCT). The choroidal thickness of the subfoveal area at 1 and 3 mm diameter around the fovea was determined. Central anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD), and axial length (AL) were measured by A-scan ultrasound. Parameters were compared before SPI (baseline) and 1 week later. Results: Thirty eyes of 30 patients with mean age of 61.53 ± 7.98 years were studied. There was no significant difference in the choroidal thickness at all macular locations before and after SPI (all P > 0.05). Mean subfoveal choroidal thickness was 279.61 μm ± 65.50 μm before and 274.54 μm ± 63.36 μm after SPI (P = 0.308). There was also no significant change in central ACD, LT, VCD, and LT after SPI (all P > 0.05). Conclusions: SPI does not appear to alter choroidal thickness in PACS eyes, as assessed using EDI-OCT. Long-term follow-up of PACS eyes treated with SPI may provide further insight into the effects of this treatment modality on the choroid.
  1,451 208 -
BRIEF COMMUNICATIONS
Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation
Harsha Bhattacharjee, Rushil Kumar Saxena, Jnanankar Medhi
October 2015, 63(10):796-798
DOI:10.4103/0301-4738.171520  PMID:26655008
We report a rare case of bilateral spontaneous anterior partial in-the-bag intraocular lens (IOL) dislocation in a 75-year-old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in-the-bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option.
  1,453 181 -
OPHTHALMOLOGY PRACTICE
A case of corneal cystinosis in a patient with rickets and chronic renal failure
Jae Yon Won, Hyung Bin Hwang, Sung Kun Chung
October 2015, 63(10):785-787
DOI:10.4103/0301-4738.171509  PMID:26655004
A 22-year-old man diagnosed with nephropathic cystinosis at the age of 4 years was found to have progressive bilateral corneal crystal deposition. He presented with severe photophobia and decreased visual acuity. Ocular cystinosis was diagnosed on observing the typical crystals. Optical coherence tomography showed multiple areas of stromal hyperreflectivity due to crystal deposits within the corneal stroma. Ex vivo transmission electron microscopy of the cornea showed pathognomonic crystal deposits in corneal stromal keratocytes. Using polymerase chain reaction sequencing of the entire coding region, we identified five gene mutations, including two unreported mutations.
  1,336 187 -
BRIEF COMMUNICATIONS
Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction
S Praveen Kumar, K V Praveen Kumar, Subashini Kaliaperumal, Arjun Ashokan
October 2015, 63(10):798-800
DOI:10.4103/0301-4738.171522  PMID:26655009
Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2-year-old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well-defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.
  1,344 138 -
Changes in stereoacuity following implantable Collamer lens implantation in patients with myopia
Sudarshan Khokhar, Shikha Gupta, Varun Gogia, Ruchir Tewari, Tushar Agarwal
October 2015, 63(10):788-790
DOI:10.4103/0301-4738.171510  PMID:26655005
The study evaluated the impact of implantable Collamer lens (ICL) implantation on stereoacuity in myopes in a retrospective case series. Ninety-five eyes of 48 patients were recruited. Distance and near stereoacuity were measured using distance Randot stereotest and TNO test, respectively, before surgery and at 4 weeks postoperatively. Mean age of the patients was 23.67 ± 3.7 years. Mean uncorrected distance visual acuity (UDVA) was 1.28 ± 0.37 logarithm of the minimum angle of resolution (logMAR) (median: 1.3; range: 0.3-1.8), and median best-corrected distance visual acuity (BDVA) was 0.18 logMAR (range: 0-0.6). There was a significant improvement in both UDVA and BDVA postsurgery (P < 0.001; Wilcoxon signed rank test). The overall improvement in stereopsis was observed in 15/48 (31.25%) and 13/48 (27.10%) subjects for near and distance, respectively, with no significant difference between the two (P = 0.82; Fisher's exact test). Among stereoblind individuals, the odd's ratio for near stereoacuity to improve in comparison to distance stereoacuity was 8.85 (95% confidence interval: 1.68-46.70; P = 0.01). ICL implantation for refractive correction aided stereoacuity improvement in myopes more so for near.
  1,128 141 -
LETTERS TO THE EDITOR
Varicella vasculopathy and chronic suppurative otitis media: Differential diagnosis for isolated sixth nerve palsy
N Venugopal
October 2015, 63(10):806-806
DOI:10.4103/0301-4738.171531  PMID:26655013
  1,104 151 -
Raynaud's phenomena and subclavian steal syndrome: Differential diagnosis for retinal artery occlusion
Natarajapillai Venugopal
October 2015, 63(10):809-810
DOI:10.4103/0301-4738.171538  PMID:26655016
  1,128 119 -
Fabricating a custom made ocular prosthesis
Ramesh Murthy, Madhulata Umesh
October 2015, 63(10):807-808
DOI:10.4103/0301-4738.171536  PMID:26655014
  1,052 162 -
Reply to comment: Conventional manual small-incision cataract surgery
Jun Yang, Pinghong Lai
October 2015, 63(10):804-804
DOI:10.4103/0301-4738.171526  PMID:26655011
  1,031 123 -
Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema: A prospective, randomized comparative study
Murat Kucukevcilioglu, Mehmet Talay Koylu, Onder Ayyildiz, Gokhan Ozge
October 2015, 63(10):804-805
DOI:10.4103/0301-4738.171528  PMID:26655012
  963 176 -
Respond to: An innovative impression technique for fabrication of a custom-made ocular prosthesis
Sunilchandra Tripuraneni, Sriharsha Babu Vadapalli, Kaleswararao Atluri, Ravikiran Potluri
October 2015, 63(10):808-809
DOI:10.4103/0301-4738.171537  PMID:26655015
  863 142 -
Authors' reply
Akshay Gopinathan Nair, Selvakumar Ambika, Veena Olma Noronha, Rashmin Anilkumar Gandhi
October 2015, 63(10):807-807
  604 86 -
Authors' reply
Seemant Raizada, Jamal Al Kandari, Fahad Al Diab, Khalid Al Sabah, Niranjan Kumar, Sebastian Mathew
October 2015, 63(10):805-806
  541 81 -