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   2015| February  | Volume 63 | Issue 2  
    Online since April 1, 2015

 
 
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SYMPOSIUMS
Vascular tumors of the choroid and retina
P Mahesh Shanmugam, Rajesh Ramanjulu
February 2015, 63(2):133-140
DOI:10.4103/0301-4738.154387  PMID:25827544
Vascular tumors of the retina and choroid can be seen occasionally. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.
  4,945 729 -
Retinoblastoma: Achieving new standards with methods of chemotherapy
Swathi Kaliki, Carol L Shields
February 2015, 63(2):103-109
DOI:10.4103/0301-4738.154369  PMID:25827539
The management of retinoblastoma (RB) has dramatically changed over the past two decades from previous radiotherapy methods to current chemotherapy strategies. RB is a remarkably chemotherapy-sensitive tumor. Chemotherapy is currently used as a first-line approach for children with this malignancy and can be delivered by intravenous, intra-arterial, periocular, and intravitreal routes. The choice of route for chemotherapy administration depends upon the tumor laterality and tumor staging. Intravenous chemotherapy (IVC) is used most often in bilateral cases, orbital RB, and as an adjuvant treatment in high-risk RB. Intra-arterial chemotherapy (IAC) is used in cases with group C or D RB and selected cases of group E tumor. Periocular chemotherapy is used as an adjunct treatment in eyes with group D and E RB and those with persistent/recurrent vitreous seeds. Intravitreal chemotherapy is reserved for eyes with persistent/recurrent vitreous seeds. In this review, we describe the various forms of chemotherapy used in the management of RB. A database search was performed on PubMed, using the terms "RB," and "treatment," "chemotherapy," "systemic chemotherapy," "IVC," "IAC," "periocular chemotherapy," or "intravitreal chemotherapy." Relevant English language articles were extracted, reviewed, and referenced appropriately.
  4,429 772 -
Review of spectral domain-enhanced depth imaging optical coherence tomography of tumors of the retina and retinal pigment epithelium in children and adults
Carol L Shields, Janet Manalac, Chandana Das, Jarin Saktanasate, Jerry A Shields
February 2015, 63(2):128-132
DOI:10.4103/0301-4738.154384  PMID:25827543
Background: Spectral domain (SD) enhanced depth imaging optical coherence tomography (EDI-OCT) is a useful tool for anatomic, cross-sectional imaging of retinal conditions. Aims: The aim was to identify characteristic patterns of retinal and retinal pigment epithelial tumors on EDI-OCT in children and adults. Settings and Design: Retrospective review. Materials and Methods: Analysis of published reports and personal observations using office-based EDI-OCT for adults and portable hand-held SD OCT for infants and children. Results: Using EDI-OCT, retinal tumors such as small retinoblastoma, astrocytic hamartoma, and hemangioblastoma arose abruptly from the retina, immediately adjacent to normal retina. Small exophytic retinoblastoma and retinal hemangioblastoma showed the full-thickness, homogeneous retinal disorganization with surrounding normal retina "draping" over the margins. Retinoblastoma occasionally had intralesional cavities and surrounding subretinal fluid. Hemangioblastoma often had adjacent intraretinal edema and subretinal fluid. Astrocytic hamartoma arose within the nerve fiber layer and sometimes with a "moth-eaten" or cavitary appearance. Retinal pigment epithelial (RPE) lesions such as congenital hypertrophy of RPE appeared flat with shadowing, occasional subretinal cleft, and abrupt photoreceptor loss. Congenital simple hamartoma showed an abrupt elevation from the inner retina with crisp, dark posterior shadowing. Combined hamartoma of the retina/RPE showed vitreoretinal traction causing "sawtooth mini-peak" or gently "maxi-peak" folding of the retina. RPE adenoma often produces remote macular edema or epiretinal membrane and the tumor has an irregular, "rugged" surface with deep shadowing. Conclusions: Enhanced depth imaging optical coherence tomography shows characteristic patterns that are suggestive of certain retinal and RPE tumors.
  4,554 518 -
Review of spectral domain enhanced depth imaging optical coherence tomography of tumors of the choroid
Carol L Shields, Janet Manalac, Chandana Das, Jarin Saktanasate, Jerry A Shields
February 2015, 63(2):117-121
DOI:10.4103/0301-4738.154377  PMID:25827541
Background: Spectral domain enhanced depth imaging optical coherence tomography (EDI-OCT) can provide anatomic localization of intraocular tumors. Aims: The aim was to identify topographical and intrinsic patterns of choroidal tumors on EDI-OCT. Settings and Design: Retrospective review. Materials and Methods: Analysis of published reports and personal observations using office based EDI-OCT. Results: Using EDI-OCT, choroidal nevus displayed a smooth, dome-shaped topography with overlying retinal pigment epithelium alterations, drusen, and occasional subretinal cleft demonstrating photoreceptor loss. Small choroidal melanoma showed smooth, moderately dome-shaped topography, commonly with overlying shallow subretinal fluid that often depicted "shaggy" photoreceptors. Choroidal metastasis showed a minimally "lumpy, bumpy" surface topography and with overlying subretinal fluid and shaggy photoreceptors. Choroidal hemangioma showed a smooth, dome-shaped topography, with expansion of the affected small, medium, and large choroidal vessels. Choroidal lymphoma showed varying topography with increasing tumor thickness as "flat, rippled, or undulating (seasick)" surface. Choroidal osteoma displayed a smooth undulating surface with visible intralesional horizontal lines suggestive of bone lamellae and occasional horizontal and vertical tubules with intralesional "spongy" flecks. Choroidal melanocytosis appeared as uniformly thickened choroid with increased stromal density surrounding the normal choroidal vascular structures. Conclusions: Enhanced depth imaging-OCT can depict characteristic patterns that are suggestive of various choroidal tumors.
  4,336 659 -
Uveal melanoma: Estimating prognosis
Swathi Kaliki, Carol L Shields, Jerry A Shields
February 2015, 63(2):93-102
DOI:10.4103/0301-4738.154367  PMID:25827538
Uveal melanoma is the most common primary malignant tumor of the eye in adults, predominantly found in Caucasians. Local tumor control of uveal melanoma is excellent, yet this malignancy is associated with relatively high mortality secondary to metastasis. Various clinical, histopathological, cytogenetic features and gene expression features help in estimating the prognosis of uveal melanoma. The clinical features associated with poor prognosis in patients with uveal melanoma include older age at presentation, male gender, larger tumor basal diameter and thickness, ciliary body location, diffuse tumor configuration, association with ocular/oculodermal melanocytosis, extraocular tumor extension, and advanced tumor staging by American Joint Committee on Cancer classification. Histopathological features suggestive of poor prognosis include epithelioid cell type, high mitotic activity, higher values of mean diameter of ten largest nucleoli, higher microvascular density, extravascular matrix patterns, tumor-infiltrating lymphocytes, tumor-infiltrating macrophages, higher expression of insulin-like growth factor-1 receptor, and higher expression of human leukocyte antigen Class I and II. Monosomy 3, 1p loss, 6q loss, and 8q and those classified as Class II by gene expression are predictive of poor prognosis of uveal melanoma. In this review, we discuss the prognostic factors of uveal melanoma. A database search was performed on PubMed, using the terms "uvea," "iris," "ciliary body," "choroid," "melanoma," "uveal melanoma" and "prognosis," "metastasis," "genetic testing," "gene expression profiling." Relevant English language articles were extracted, reviewed, and referenced appropriately.
  4,143 656 -
Choroidal metastases: Origin, features, and therapy
Sruthi Arepalli, Swathi Kaliki, Carol L Shields
February 2015, 63(2):122-127
DOI:10.4103/0301-4738.154380  PMID:25827542
The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms "choroidal metastasis," or "choroidal metastases," in combination with terms such as "treatment," "features," or "diagnosis." Relevant articles were extracted and reviewed.
  3,946 697 -
The role of intravitreal chemotherapy for retinoblastoma
Fairooz P Manjandavida, Carol L Shields
February 2015, 63(2):141-145
DOI:10.4103/0301-4738.154390  PMID:25827545
Targeted therapy in retinoblastoma (RB) is widely accepted as the current management tool with an aim of increasing drug availability at the tumor location. Inevitably the effect is several times higher compared to systemic delivery of chemotherapeutic drugs and carries less systemic toxicity. Despite tremendous advancement in saving life, eye salvage in advanced RB especially with active vitreous seeds remains a challenge. The hypoxic environment of the vitreous and reduced vitreous concentration of the drugs delivered makes these tumor seeds resistant to chemotherapy. Direct delivery of chemotherapeutic drugs into the vitreous cavity aids to overcome these challenges and is progressively being accepted worldwide. However, intraocular procedure in RB was abandoned due to high risk of extraocular tumor dissemination. Recently, the forbidden therapeutic technique was re-explored and modified for safe use. Although eye salvage rate has tremendously improved after intravitreal chemotherapy (IVitC), retinal toxicity, and vision salvage are yet to be validated. In our preliminary report of intravitreal melphalan in 11 eyes, we reported 100% eye salvage and 0% recurrence with an extended 15 months mean follow-up. In this review, we analyzed published reports on IVitC in RB via PubMed, Medline, and conference proceedings citation index, electronic database search, without language restriction that included case series and reports of humans and experimental animal eyes with RB receiving IVitC.
  2,884 559 -
Using risk factors for detection and prognostication of uveal melanoma
Pukhraj Rishi, Vikram V Koundanya, Carol L Shields
February 2015, 63(2):110-116
DOI:10.4103/0301-4738.154373  PMID:25827540
The early detection of malignancy, particularly uveal melanoma, is crucial in protecting visual acuity, salvaging the eye, and preventing metastasis. Risk factors for early detection of uveal melanoma have been clearly delineated in the literature and allow identification of melanoma when it is tiny and simulates a nevus. These factors include thickness >2 mm, presence of subretinal fluid (SRF), symptoms, the orange pigment, margin near optic disc, acoustic hollowness, surrounding halo, and absence of drusen. The importance of early detection is realized when one considers melanoma thickness, as each millimeter increase in melanoma thickness imparts 5% increased risk for metastatic disease. Newer imaging modalities like enhanced depth imaging optical coherence tomography and fundus autoflouroscence facilitate in detection of SRF and orange pigment. Additional molecular biomarkers and cytological features have been identified which can predict the clinical behavior of a small melanocytic lesion. Features that suggest a poor prognosis include higher blood levels of tyrosinase m-RNA, vascular endothelial growth factor, insulin-like growth factor; monosomy 3 and gains in chromosome 8. Management of uveal melanoma includes enucleation (for large), local eye wall resection, brachytherapy, charged particle irradiation, and thermotherapy (for small to medium tumors). Although the role of a good clinical evaluation cannot be underestimated, it is advisable to evaluate the various radiological, molecular, and cytological features, to enhance the accuracy of early diagnosis and improved prognosis.
  2,893 370 -
LETTERS TO THE EDITOR
Regarding fundus imaging with a mobile phone: A review of techniques
Biju Raju, N S D Raju
February 2015, 63(2):170-171
DOI:10.4103/0301-4738.154407  PMID:25827552
  2,507 307 -
BRIEF COMMUNICATIONS
Human papillomavirus 52 positive squamous cell carcinoma of the conjunctiva
Silvia Olivia Salceanu, Catalin Constantin, Ion Cijevschi, Ramona Gabriela Ursu, Mirela Grigorovici, Luminita Smaranda Iancu
February 2015, 63(2):166-169
DOI:10.4103/0301-4738.154406  PMID:25827551
Human papillomavirus (HPV) infection is strongly associated with several human cancers; the most known genotypes involved being HPV 16 and HPV 18. We report the detection of HPV 52 in a sample taken from a 47-year-old patient with squamous cell carcinoma of the conjunctiva of the left eye. The method used for the detection of HPV was real time polymerase chain reaction. The evolution was favorable after surgical removal of the tumor and the patient was explained that long-term follow-up is essential to avoid recurrence.
  2,258 183 -
PHOTO ESSAY
Angiographic and spectral domain optical coherence tomography features in case of Vogt-Koyanagi-Harada disease
Manish P Nagpal, Kalyani J Bhatt, Navneet S Mehrotra, Sangeeta D Goswami
February 2015, 63(2):162-163
DOI:10.4103/0301-4738.154403  PMID:25827549
  1,778 275 -
EDITORIAL
Ocular oncology - A multidisciplinary specialty
Sundaram Natarajan
February 2015, 63(2):91-91
DOI:10.4103/0301-4738.154364  PMID:25827536
  1,358 308 -
ORIGINAL ARTICLES
Quality of sunglasses available in the Iranian market; a study with emphasis on sellers' license
Nooshin Bazzazi, Samira Heydarian, Reihaneh Vahabi, Siamak Akbarzadeh, Daniel F Fouladi
February 2015, 63(2):152-156
DOI:10.4103/0301-4738.154395  PMID:25827547
Context: Sunglasses should follow minimum requirements to sufficiently protect eyes. It is not known whether all items obtainable from the market are appropriately designed. Aims: To compare ultraviolet (UV)-protective properties of commercially available sunglasses obtained from authorized and unauthorized Iranian sellers. Settings and Study Design: An analytic-descriptive study performed in a metropolitan area (Tehran). Materials and Methods: Using a UV-visible standard spectrophotometer, the percentage transmittance was scanned between 280 and 400 nm in 348 pairs of nonprescription sunglasses (price range: 20-80 US$) obtained anonymously and randomly from authorized (permitted by the Ministry of Health, 189 pairs) and unauthorized (159 pairs) sellers in the Iranian capital city, Tehran. The Australian/New Zealand Standard (AS/NZS) and the American National Standards Institute [ANSI] standards were followed. Statistical Analysis: Chi-square test, independent samples t-test or Mann-Whitney U-test. Results UV-protective properties of the sunglasses obtained from authorized sellers complied with AS/NZS and ANSI guidelines in 92.6% and 95.2% of items, respectively. The corresponding rates for sunglasses obtained from unauthorized sellers were 0% and 8.2%, respectively (P < 0.001 for both). The rate of defective polarizing capability of lenses was 27.4% in sunglasses obtained from authorized sellers versus 90.4% in sunglasses obtained from unauthorized sellers (P < 0.001). Neither brand nor price played significant contributions to UV protection/lens polarizing capability of sunglasses obtained from authorized sellers. Conclusions: Sunglasses provided by unauthorized sellers are alarmingly unreliable and could be potentially hazardous for the eye. Brand and price do not guarantee optimal protection against UV radiation or polarizing performance of the lens.
  1,426 191 -
BRIEF COMMUNICATIONS
A case of subretinal tubercular abscess presenting as disc edema
Sachin Bermu Shetty, Mohammad Abdullah Bawtag, Jyotirmay Biswas
February 2015, 63(2):164-166
DOI:10.4103/0301-4738.154405  PMID:25827550
We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti-tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.
  1,362 254 -
ORIGINAL ARTICLES
Photorefractive keratectomy in mild to moderate keratoconus: Outcomes in over 40-year-old patients
Hamid Khakshoor, Fatemeh Razavi, Alireza Eslampour, Arash Omdtabrizi
February 2015, 63(2):157-161
DOI:10.4103/0301-4738.154400  PMID:25827548
Background: Keratoconus is a contraindication for photorefractive keratectomy (PRK). In the recent decade, some efforts have been made to perform PRK in patients with keratoconus whose corneas are stable naturally or by doing corneal collagen crosslinking. These studies have suggested residual central corneal thickness (CCT) ≥450 μm. Aims: The aim was to evaluate the long-term outcomes of PRK in patients with mild to moderate keratoconus in patients older than 40 with residual CCT ≥ 400 μm. Settings and Design: This prospective study was conducted in our Cornea Research Center, Mashhad, Iran. Materials and Methods: Patients over 40 years old, with a grade I/II keratoconus without progression in the last 2 years were recruited. Patients with a predicted postoperative CCT < 400 μm were excluded. PRK with tissue saving protocol was performed with Tecnolas 217 Z. Mitomycin-C was applied after ablation. The final endpoints were refraction parameters the last follow-up visit (mean: 35 months). Paired t-test and Chi-square were used for analysis. Results: A total of 38 eyes of 21 patients were studied; 20 eyes (52.6%) with a grade I and 18 eyes (47.4%) with grade II keratoconus. The mean uncorrected visual acuity, best corrected visual acuity (BCVA), spherical equivalent, cylindrical power and keratometric readings were significantly improved at the final endpoint compared to preoperation measurements (P < 0.001). Two eyes (5%) lost two lines of BCVA at the final visit. No case of ectasia occurred during the follow-up course. Conclusions: PRK did not induce keratoconus progression in patients older than 40 with a grade I/II keratoconus. Residual CCT ≥ 450 μm seems to be sufficient to prevent the ectasia.
  1,310 219 -
GUEST EDITORIAL
Trends in the management of intraocular tumors over 40 years
Jerry A Shields, Carol L Shields
February 2015, 63(2):92-92
DOI:10.4103/0301-4738.154366  PMID:25827537
  1,131 244 -
ORIGINAL ARTICLES
Chromatic-achromatic perimetry in four clinic cases: Glaucoma and diabetes
Inmaculada Cabezos, Maria Josť Luque, Dolores de Fez, Vicenta Moncho, Vicente Camps
February 2015, 63(2):146-151
DOI:10.4103/0301-4738.154392  PMID:25827546
Background: Some diseases that affect the visual system may show loss of chromatic-achromatic sensitivity before obvious physical signs appear in the usual examination of the eye's posterior segment. A perimetric study has been conducted with four typical patients with glaucoma and diabetes, at different stages of the disease. Materials and Methods: In addition to the standard white-on-white (standard automated perimetry [SAP]), a test battery has been used to study patient's contrast sensitivity, using stimuli with different chromatic, spatial, and temporal content (multichannel perimetry). The choice of stimuli tries to maximize the response of different visual mechanisms: Achromatic (parvocellular and magnocellular origin); chromatic red-green (parvocellular origin); and chromatic blue-yellow (koniocellular origin). Results: The results seem to indicate losses in the achromatic-parvocellular perimetry and both chromatic perimetry tests, undetected by conventional SAP. Conclusions: Our results illustrate that our patients without visible retinal alterations show signs of suspicion in multichannel perimetry.
  1,115 176 -
LETTERS TO THE EDITOR
Water drinking test and angle closure glaucoma
N Venugopal
February 2015, 63(2):172-172
DOI:10.4103/0301-4738.154410  PMID:25827553
  1,073 202 -
GUEST EDITORIAL
Ocular oncology in India
Vikas Khetan
February 2015, 63(2):177-177
DOI:10.4103/0301-4738.154814  PMID:25850417
  806 159 -
LETTERS TO THE EDITOR
Comment on: Central corneal thickness and intraocular pressure in premature and full-term newborns
‹mit Yolcu, Fatih Cakir Gundogan
February 2015, 63(2):172-173
DOI:10.4103/0301-4738.154413  PMID:25827554
  647 151 -
Human ocular thelaziasis in Karnataka
ML Pandey, RL Sharma, A Sharma
February 2015, 63(2):173-173
DOI:10.4103/0301-4738.154415  PMID:25827555
  610 131 -
Authors' reply
Mahesh P Shanmugam, Divyansh K Mishra, R Madhukumar, Rajesh Ramanjulu, Srinivas Y Reddy, Gladys Rodrigues
February 2015, 63(2):171-171
  604 103 -
Authors' reply
Varun Gogia, Pradeep Venkatesh, Shikha Gupta, Ashish Kakkar, Satpal Garg
February 2015, 63(2):174-174
  574 116 -
Comment on: Endoilluminator-assisted scleral buckling: Our results
Suresh Ramchandani, Sushama Ramchandani
February 2015, 63(2):174-174
DOI:10.4103/0301-4738.154416  PMID:25827556
  545 118 -
Comment on: Refractive outcome analyses in myopes
Christos Pitsas, Vasiliki Zygoura, Nikolaos Kopsachilis, Gianluca Carifi
February 2015, 63(2):175-175
DOI:10.4103/0301-4738.154419  PMID:25827557
  518 121 -
ERRATUM
Automated diabetic retinopathy imaging in Indian eyes: A pilot study: Erratum

February 2015, 63(2):176-176
DOI:10.4103/0301-4738.154420  PMID:25827558
  405 116 -