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   2015| November  | Volume 63 | Issue 11  
    Online since December 16, 2015

 
 
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OPHTHALMOLOGY PRACTICE
Minimally invasive surgery for thyroid eye disease
Milind Neilkant Naik, Akshay Gopinathan Nair, Adit Gupta, Saurabh Kamal
November 2015, 63(11):847-853
DOI:10.4103/0301-4738.171967  PMID:26669337
Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12-18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.
  8,949 447 -
ORIGINAL ARTICLES
Epidemiology and clinical characteristics of patients with glaucoma: An analysis of hospital data between 2003 and 2012
Yang Zhao, Jia-Li Fu, Yu-Li Li, Ping Li, Feng-Lan Lou
November 2015, 63(11):825-831
DOI:10.4103/0301-4738.171963  PMID:26669333
Purpose: To assess demographic and clinical characteristics of glaucoma patients in an Ophthalmologic Hospital of Jinan, China from 2003 to 2012. Materials and Methods: Medical charts of patients with primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), and secondary glaucoma (SG) were reviewed. The main outcome measures of patients with glaucoma included basic demographic data (age at presentation, gender, and residence), clinical characteristics (admission date, intraocular pressure, and naked vision), and previous history (injury, cardiovascular disease, diabetes mellitus, hypertension, smoking, and alcohol consumption). Results: Data from 1458 glaucoma patients were reviewed, of which PACG and SG patients accounted for 45.40% and 47.19%, respectively. The average age of all patients with glaucoma increased from 56.05 years in 2003 to 57.83 years in 2012, and the proportion of patients from rural areas rose from 46.43% to 59.13% during 10-year period. Female gender, cardiovascular disease, and hypertension were associated with PACG. POAG was related to smoking and alcohol consumption. There was positive correlation between SG and history of injury and diabetes mellitus. Conclusion: PACG and SG are the major types of glaucoma. Gender, injury, diabetes mellitus, cardiovascular disease, hypertension, smoking, and alcohol consumption were associated with different types of glaucoma.
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A cross-sectional study to compare intraocular pressure measurement by sequential use of Goldman applanation tonometry, dynamic contour tonometry, ocular response analyzer, and Corvis ST
Sushma Tejwani, Shoruba Dinakaran, Anuja Joshi, Rohit Shetty, Abhijit Sinha Roy
November 2015, 63(11):815-820
DOI:10.4103/0301-4738.171956  PMID:26669331
Objective: To study the correlation and effect of sequential measurement of intraocular pressure (IOP) with Goldmann applanation tonometer (GAT), ocular response analyzer (ORA), dynamic contour tonometer (DCT), and Corvis ST. Setting and Design: Observational cross-sectional series from the comprehensive clinic of a tertiary eye care center seen during December 2012. Methods: One hundred and twenty-five study eyes of 125 patients with normal IOP and biomechanical properties underwent IOP measurement on GAT, DCT, ORA, and Corvis ST; in four different sequences. Patients with high refractive errors, recent surgeries, glaucoma, and corneal disorders were excluded so as to rule out patients with evident altered corneal biomechanics. Statistical Analysis: Linear regression and Bland-Altman using MedCalc software. Results: Multivariate analysis of variance with repeated measures showed no influence of sequence of device use on IOP (P = 0.85). Linear regression r 2 between GAT and Corvis ST, Corvis ST and Goldmann-correlated IOP (IOPg), and DCT and Corvis ST were 0.37 (P = 0.675), 0.63 (P = 0.607), and 0.19 (P = 0.708), respectively. The Bland-Altman agreement of Corvis ST with GAT, corneal compensated IOP, and IOPg was 2 mmHg (−5.0 to + 10.3), −0.5 mmHg (−8.1 to 7.1), and 0.5 mmHg (−6.2 to 7.1), respectively. Intraclass correlation coefficient for repeatability ranged from 0.81 to 0.96. Conclusions: Correlation between Corvis ST and ORA was found to be good and not so with GAT. However, agreement between the devices was statistically insignificant, and no influence of sequence was observed.
  4,011 439 -
Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India
Deepa John, Swetha Sara Philip, Rashmi Mittal, Sheeja Susan John, Padma Paul
November 2015, 63(11):843-846
DOI:10.4103/0301-4738.171966  PMID:26669336
Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study. Results: Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2-13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of  protective eyewear should be considered.
  3,416 279 -
PHOTO ESSAY
A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction
Ankush Gondchawar, Jyotirmay Biswas, Sowmiya Murali, Lavanya Mayura Priya Eawaran
November 2015, 63(11):854-855
DOI:10.4103/0301-4738.171968  PMID:26669338
  3,347 241 -
ORIGINAL ARTICLES
Learning curves for strabismus surgery in two ophthalmologists
Yonguk Kim, Young Gyun Kim, Hye Ji Kim, Jae Ho Shin, Sang Beom Han, Seung Jun Lee, Moosang Kim
November 2015, 63(11):821-824
DOI:10.4103/0301-4738.171962  PMID:26669332
Purpose: To identify the average turning point by comparing the learning curves of two surgeons learning to perform strabismus surgery. Materials and Methods: Patients who underwent procedures to correct exotropia between January 2010 and December 2014 followed for at least 3 months were retrospectively assessed. The first 70 patients on whom each of two ophthalmologists (A and B) performed surgery to treat strabismus were divided into 7 cohorts comprising 10 patients each based on the chronological order of the surgery. Factors, including patient age, preoperative angle of deviation, operative time, and success or failure of the operation, were compared between the two surgeons. Learning curves were calculated based on changes in operative time and operation success rate. Operation success was determined by measuring the angle of deviation at a distance of 5 m 3 months after the operation. Results: A turning point was observed after 40 cases for Surgeon A and 50 cases for Surgeon B based on the operative time learning curve. No turning point was observed in the operation success rate learning curve based on the absence of a specific trend. Success rate by cohort was not significantly different between the two surgeons (P > 0.05). Surgeon B had a significantly longer mean operative time than Surgeon A (P = 0.045). Conclusions: Approximately 50 cases are required for an ophthalmologist to reach a turning point in strabismus surgery. This outcome can be used as a guideline when training surgeons to perform strabismus surgery.
  3,187 242 -
Intravitreal aflibercept treatment in eyes with exudative age-related macular degeneration following prior treatment with intravitreal ranibizumab
Daniel Sanju Narayan, James Muecke
November 2015, 63(11):832-836
DOI:10.4103/0301-4738.171964  PMID:26669334
Background: To investigate visual and anatomical outcomes in eyes with exudative age-related macular degeneration treated with intravitreal aflibercept following prior treatment with intravitreal ranibizumab. Materials and Methods: Retrospective, single-center study of 192 eyes treated with 0.5 mg intravitreal ranibizumab every 4 weeks for three consecutive doses followed by a variable dose schedule. After more than 12 months of ranibizumab treatment, eyes that required ranibizumab injections at 4-week or 6-week intervals were switched to aflibercept therapy. Results: After 12-69 months (42 months ± 18 months, mean ± standard deviation [SD]) of treatment with intravitreal ranibizumab, 80 eyes were changed to 2 mg intravitreal aflibercept treatment with follow-up after 12-18 months (16 months ± 1 month, mean ± SD). Thirty-nine eyes had persistent macular fluid after treatment with ranibizumab. Mean logMAR visual acuity (VA) in eyes treated with ranibizumab changed by − 0.089 ± 0.310 (mean ± SD; P = 0.0003), which correlates to an approximate gain of 4.5 letters. The number of eyes with macular fluid decreased from 39 to 23 after aflibercept treatment. Mean logMAR VA in eyes with intraretinal macular fluid treated with aflibercept changed by −0.079 ± 0.134 (mean ± SD; P = 0.006), which correlates to an approximate gain of 4 letters. Mean logMAR VA in eyes with submacular fluid was not significantly different after aflibercept treatment. Conclusion: Eyes with persistent intraretinal macular fluid had visual and anatomic response after changing from ranibizumab to aflibercept treatment.
  3,087 328 -
BRIEF COMMUNICATIONS
Unilateral acquired Brown's syndrome in systemic scleroderma: An unusual cause for diplopia
Neelam Pawar, Meenakshi Ravindran, Renagappa Ramakrishnan, Devendra Maheshwari, Bhakti Trivedi
November 2015, 63(11):861-863
DOI:10.4103/0301-4738.171971  PMID:26669341
Brown's syndrome can be congenital or acquired with multiple causes. It has been described as a ocular complication in various rheumatic and nonrheumatic diseases. We describe a case of 27-year-old female patient with 5 years old history of systemic scleroderma who developed vertical diplopia, a left head tilt, and restriction of left eye on elevation in adduction. The patient responded to systemic steroids with resolution of diplopia.
  3,239 172 -
ORIGINAL ARTICLES
Diagnostic accuracy of posterior pole asymmetry analysis parameters of spectralis optical coherence tomography in detecting early unilateral glaucoma
Paaraj Dave, Juhi Shah
November 2015, 63(11):837-842
DOI:10.4103/0301-4738.171965  PMID:26669335
Purpose: To report the diagnostic ability of posterior pole asymmetry analysis (PPAA) parameters of spectralis optical coherence tomography (OCT) in detecting early unilateral glaucoma. Methods: A prospective, cross-sectional study which included 80 eyes of 80 normal subjects and 76 eyes of 76 patients with unilateral early primary open-angle glaucoma by Hodapp-Anderson-Parrish classification. All subjects were of age more than 18 years, best-corrected visual acuity 20/40 or better, and a refractive error within ± 5 diopter (D) sphere and ± 3 D cylinder. Control subjects had a normal ocular examination, intraocular pressure (IOP) <22 mmHg, no past history of high IOP, no family history of glaucoma, normal optic disc morphology, and visual field in both eyes. One eye of the control subject was randomly included. All eyes underwent OCT for retinal nerve fiber layer (RNFL) analysis and PPAA. The number of continuous black squares was noted in the asymmetry analysis (right-left + hemisphere asymmetry). The area under curve (AUC) was calculated for all OCT parameters. Results: The best value for AUC for RNFL analysis was 0.858 for the inferotemporal quadrant thickness. This was similar to the best value for AUC for PPAA which was 0.833 for the inferior macular thickness parameter (P = 0.5). The AUC for the right-left and the hemisphere asymmetry part of PPAA was 0.427 and 0.499, respectively. Conclusion: The macular thickness PPAA parameters were equally good as the RNFL parameters. However, the asymmetry analysis parameters performed poorly and need further refinement before its use in early unilateral glaucoma diagnosis.
  3,074 267 -
EDITORIAL
It's never too early to start!
Sundaram Natarajan
November 2015, 63(11):813-814
DOI:10.4103/0301-4738.171955  PMID:26669330
  2,935 264 -
BRIEF COMMUNICATIONS
Temporary resolution of foveal schisis following vitrectomy with silicon oil tamponade in X-linked retinoschisis with retinal detachment
Neha Goel, Basudeb Ghosh
November 2015, 63(11):867-868
DOI:10.4103/0301-4738.171973  PMID:26669343
X-linked retinoschisis (XLR) is an uncommon bilateral vitreoretinal dystrophy characterized by typical foveoschisis in all patients that may be associated with peripheral retinoschisis. A young male with XLR with retinal detachment in his right eye underwent 23 gauge pars plana vitrectomy with silicone oil tamponade. Postoperatively, best-corrected visual acuity (BCVA) improved to 20/120 with an attached retina. Spectral-domain optical coherence tomography showed macular thinning with the collapse of the schitic cavities with silicone oil in situ. Following silicone oil removal at 6 months follow-up, the retina remained attached with a BCVA of 20/80 however the foveal schitic cavities reappeared. This unusual course has not been described previously.
  3,006 171 -
A benign presentation of primary ductal adenocarcinoma of lacrimal gland: A rare malignancy
Lindfay Laura Lau, Chong Ka Lung, Syed Shoeb Ahmad
November 2015, 63(11):856-858
DOI:10.4103/0301-4738.171969  PMID:26669339
A 34-year-old patient with a swelling over the upper eyelid for nearly 1 year was seen in our clinic. The history, examination and investigations were suggestive of a benign lacrimal gland tumor. The tumor and lacrimal gland were resected. Subsequent histopathological examination revealed the tumor was a primary ductal adenocarcinoma of the lacrimal gland. This is a very rare tumor with less than half a dozen cases reported so far. This case report is being presented to highlight an unusual presentation of this rare malignancy.
  2,892 163 -
LETTERS TO THE EDITOR
Comment on: Bilateral angle closure glaucoma: Differential diagnosis
N Venugopal
November 2015, 63(11):870-870
DOI:10.4103/0301-4738.171976  PMID:26669346
  2,706 139 -
BRIEF COMMUNICATIONS
Mobilizing slit lamp to the field: A new affordable solution
Javed Hussain Farooqui, Richard Jorgenson, Ahmed Gomaa
November 2015, 63(11):864-867
DOI:10.4103/0301-4738.171972  PMID:26669342
We are describing a simple and affordable design to pack and carry the slit lamp to the field. Orbis staff working on the Flying Eye Hospital (FEH) developed this design to facilitate mobilization of the slit lamp to the field during various FEH programs. The solution involves using a big toolbox, a central plywood apparatus, and foam. These supplies were cut to measure and used to support the slit lamp after being fitted snuggly in the box. This design allows easy and safe mobilization of the slit lamp to remote places. It was developed with the efficient use of space in mind and it can be easily reproduced in developing countries using same or similar supplies. Mobilizing slit lamp will be of great help for staff and institutes doing regular outreach clinical work.
  2,648 193 -
Nondecussating retinal-fugal fiber syndrome: Clinical and neuroimaging clues to diagnosis
Ankit Balani, Anjani D Kumar, Sapna S Marda, Surendar Alwala
November 2015, 63(11):858-861
DOI:10.4103/0301-4738.171970  PMID:26669340
We report the clinical details and imaging findings for a case of nondecussating retinal-fugal fiber syndrome or isolated achiasma in a 4-year-old female child. Findings included the isolated absence of optic chiasm with unremarkable rest of the optic pathway and midline structures in a child presenting clinically with see-saw nystagmus. Clinically congenital see-saw nystagmus, "mirror reversal" of visual field representation and interocular ipsilateral asymmetry on monocular visual evoked potential point toward achiasma and warrant further evaluation with magnetic resonance imaging (MRI). Isolated achiasma is a rare condition that may remain undiagnosed unless MRI is done.
  2,703 138 -
LETTERS TO THE EDITOR
Comment on: Traumatic central serous chorioretinopathy
Manisha Agarwal, Shalini Singh, Rahul Mayor, Ramesh Venkatesh
November 2015, 63(11):872-873
DOI:10.4103/0301-4738.171978  PMID:26669347
  2,686 121 -
Traumatic central serous chorioretinopathy
Suresh Ramchandani, Prajakta Paritekar, Prachi Shah, Sumedha Sharma
November 2015, 63(11):869-869
DOI:10.4103/0301-4738.171974  PMID:26669344
  2,347 166 -
ERRATUM
Erratum: Effects of dexmedetomidine for retrobulbar anesthesia in orbital ball implants after enucleation surgery

November 2015, 63(11):876-876
DOI:10.4103/0301-4738.171983  PMID:26669350
  2,227 122 -
LETTERS TO THE EDITOR
A survey of the management of vitreoretinal pathology detected prior to laser-assisted in situ keratomileusis
Anil J Singh
November 2015, 63(11):874-874
DOI:10.4103/0301-4738.171980  PMID:26669348
  2,079 120 -
Authors' reply
Arijit Mitra, R Ramkrishanan, Mohideen Abdul Kader
November 2015, 63(11):871-872
  2,019 83 -
Authors' response
Laura Steeples, Vinod Sharma, Karl Mercieca
November 2015, 63(11):869-870
PMID:26669345
  1,940 89 -
Authors' reply
Laura Steeples, Vinod Sharma, Karl Mercieca
November 2015, 63(11):873-873
  1,927 83 -
Response to: Comparison of clinical outcomes, patient, and surgeon satisfaction following topical versus peribulbar anesthesia for phacoemulsification: A randomized controlled trial
Kuldeep Dole, Sucheta Kulkarni, Kavita Shisode, Rahul Deshpande, Nilesh Kakade, Rajiv Khandekar, Madan Deshpande
November 2015, 63(11):875-875
DOI:10.4103/0301-4738.171981  PMID:26669349
  1,572 137 -