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   2015| June  | Volume 63 | Issue 6  
    Online since August 11, 2015

 
 
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ORIGINAL ARTICLES
Manuel's asteroid disruption technique
Manuel John, Abraham Ipe, Ivan Jacob
June 2015, 63(6):524-527
DOI:10.4103/0301-4738.99867  PMID:23571244
A seventy-year-old male presented with dense asteroid hyalosis in both eyes. He had undergone cataract extraction in one eye 3 years ago, and the other eye had immature cataract. Both the autorefractor and dilated streak retinoscopy did not give readings and subjective visual improvement could not be achieved. Immediately following YAG posterior capsulotomy and anterior vitreous asteroid disruption, the vision improved to 20/20 with recordable auto refractor and streak retinoscopy values. Our initial experience indicates that the treatment is simple, safe and effective but needs controlled and prospective studies to confirm its long-term safety.
  5,341 250 -
Outcome of different techniques of pterygium excision with conjunctival autografting in pediatric population: Our experience in central India
Amit R Yadav, Khushbu Ramesh Bhattad, Pradhnya Alok Sen, Elesh Budhendra Jain, Alok Sen, Budhendra K Jain
June 2015, 63(6):491-495
DOI:10.4103/0301-4738.162599  PMID:26265638
Aim: To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years. Settings and Design: Retrospective case series. Materials and Methods: A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence. Results: Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7-16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically. Conclusions: Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.
  4,173 402 -
Personal and practice profile of male and female ophthalmologists in India
Kumar Saurabh, Krishnendu Sarkar, Rupak Roy, Parthopratim Dutta Majumder
June 2015, 63(6):482-486
DOI:10.4103/0301-4738.162579  PMID:26265636
Background: The aim of this study was to study the practice pattern, personal profile, and work-family balance of male and female ophthalmologists in India. Materials and Methods: This study was conducted through 41 point questionnaire sent to the members of All India Ophthalmological Society dealing with practice profile and personal circumstances of ophthalmologists. Results: Six hundred and twenty-two (8%) responses were obtained out of 7723 invitations sent. A total of 452 were male and 170 were female ophthalmologists. Age group of 30-39 years was most common age of respondents (male 155; 35.3%; female 81; 47.6%). Larger number of male ophthalmologists (157; 34.7%) worked for more than 9 h a day than female ophthalmologists (41; 24.1%) (P = 0.01). Larger number of male ophthalmologists (229; 50.7%) earned more than Rs. 1 lakh/month than female ophthalmologists (55; 32.4%) (P = 0.00001) More female ophthalmologists (21; 12.4%) than males (26; 5.8%) said that they faced cultural, ethnic or gender bias at work place (P = 0.002). Forty-four (25.9%) female and 54 (12%) male ophthalmologists said that they often curtailed their work for family needs (P = 0.0001). Two hundred and fifty-two (55.8%) male ophthalmologists and 78 (45.9%) female ophthalmologists considered their profession rewarding (P = 0.02). Conclusion: Ophthalmology as a profession was considered rewarding by both male and female ophthalmologists. However, female ophthalmologists were curtailing their work for family needs and earning less than male ophthalmologists. Female ophthalmologists were also subject to gender bias at workplace. These issues need to be tackled to improve the work satisfaction of ophthalmology workforce.
  3,917 343 -
BRIEF COMMUNICATIONS
An innovative impression technique for fabrication of a custom made ocular prosthesis
Sunil Chandra Tripuraneni, Sriharsha Babu Vadapalli, P Ravikiran, N Nirupama
June 2015, 63(6):545-547
DOI:10.4103/0301-4738.162626  PMID:26265651
Various impression and fitting techniques have been described in the past for restoring ocular defects. The present article describes a new direct impression technique for recording and rehabilitating ocular defects, by custom-made ocular prosthesis. All the techniques described in the history, mainly concentrated in recording the tissue surface of the defect, which made it difficult to contour the palpebral surface resulting in the poor esthetics of the prosthesis. The present impression technique uses heavy bodied polyvinyl siloxane impression material, which facilitates accurate recording of the tissue surface and the palpebral surface of the defect, resulting in the fabrication of functionally and esthetically acceptable prosthesis.
  2,931 426 -
ORIGINAL ARTICLES
Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective, randomized comparative study
Seemant Raizada, Jamal Al Kandari, Fahad Al Diab, Khalid Al Sabah, Niranjan Kumar, Sebastian Mathew
June 2015, 63(6):504-510
DOI:10.4103/0301-4738.162602  PMID:26265641
Background: The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema. Materials and Methods: This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis. Results: In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group. Conclusion: Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.
  2,727 420 -
SYMPOSIUMS - RETINOCHOROIDAL IMAGING
Choroidal thickness profile in healthy Indian children
Jay Kumar Chhablani, Riddhima Deshpande, Virender Sachdeva, Sagar Vidya, P Srinivasa Rao, Anand Panigati, Birendra Mahat, Rajeev Reddy Pappuru, Niranjan Pehere, Avinash Pathengay
June 2015, 63(6):474-477
DOI:10.4103/0301-4738.162577  PMID:26265634
Purpose: The purpose was to study choroidal thickness and its profile based on location in healthy Indian children using enhanced depth spectral-domain-optical coherence tomography (SD-OCT). Methods: In this cross-sectional observational study 255 eyes of 136 children with no retinal or choroidal disease were consecutively scanned using enhanced depth SD-OCT. Eyes with any ocular disease or axial length (AXL) >25 mm or < 20 mm were excluded. A single observer measured choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-microns intervals up to 2500 microns temporal and nasal to the fovea. Generalized estimating equations were used to evaluate the correlation between choroidal thickness at various locations and age, AXL, gender and spherical equivalent (SEq). Results: Mean age of the subjects was 11.9 ± 3.4 years (range: 5-18 years). There were 62 Females and 74 males. The mean AXL was 23.55 ± 0.74 mm. Mean subfoveal choroidal thickness was 312.1 ± 45.40 μm. Choroid was found to be thickest subfoveally, then temporally. Age, AXL and SEq showed a significant correlation with choroidal thickness, whereas gender did not affect choroidal thickness. Conclusion: Our study provides a valid normative database of choroidal thickness in healthy Indian children. This database could be useful for further studies evaluating choroidal changes in various chorioretinal disorders. Age and AXL are critical factors, which negatively correlated with choroidal thickness.
  2,684 307 -
ORIGINAL ARTICLES
Foveal slope measurements in diabetic retinopathy: Can it predict development of sight-threatening retinopathy? Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS II, Report no 8)
Laxmi Gella, Swakshyar Saumya Pal, Suganeswari Ganesan, Tarun Sharma, Rajiv Raman
June 2015, 63(6):478-481
DOI:10.4103/0301-4738.162578  PMID:26265635
Aim: The aim was to assess the foveal slope configuration in subjects with type 2 diabetes in a population-based study. Materials and Methods: A subset of 668 subjects from Sankara Nethralaya Diabetic Retinopathy (DR) Epidemiology and Molecular Genetics Study II, a population-based study, were included in the current study. All the subjects underwent comprehensive ophthalmic evaluation including spectral domain optical coherence tomography. Foveal thickness was assessed in five central early treatment DR study quadrants from the three-dimensional scan and foveal slope was calculated in all the four quadrants. Results: Subjects with sight-threatening DR (STDR) had significantly shallow foveal slope in inferior quadrant (STDR: 7.33 ± 6.26 vs. controls: 10.31 ± 3.44; P = 0.021) when compared to controls and in superior (STDR: 7.62 ± 5.81 vs. no DR: 9.11 ± 2.82; P = 0.033), inferior (STDR: 7.33 ± 6.26 vs. no DR: 8.81 ± 2.81; P = 0.048), and temporal quadrants (STDR: 6.69 ± 5.70 vs. no DR: 7.97 ± 2.33; P = 0.030) when compared to subjects with no DR. Foveal slope was significantly shallow among the older age groups in subjects with no DR (P < 0.001) and non-STDR (P = 0.027). Average foveal slope in the diabetic subjects was independently and significantly correlated with increase in age (r = −0.241; P < 0.001) and central subfield thickness (r = −0.542; P < 0.001). Conclusion: Changes in foveal slope were seen with increasing age; however, in diabetes these segmental slope changes can be seen in late DR (STDR).
  2,518 305 -
BRIEF COMMUNICATIONS
Traumatic central serous chorioretinopathy
Laura Steeples, Vinod Sharma, Karl Mercieca
June 2015, 63(6):536-538
DOI:10.4103/0301-4738.162610  PMID:26265647
Central serous chorioretinopathy (CSR) is well described in the literature, with recognized associations such as systemic steroid therapy and stress; the association of blunt trauma with CSR is highly unusual. A 44-year-old male developed CSR rapidly after blunt trauma to his left eye with a significant reduction in visual acuity to hand movements. Serial optical coherence tomography and fundus fluorescein angiography images are presented. The patient was managed conservatively and spontaneous resolution occurred by 2 months with an excellent visual outcome. There was no evidence of an alternative underlying pathology for the presentation and particularly no signs of posterior uveitis. Investigations for an underlying vascular, inflammatory or infectious cause were all negative. The patient had previously had CSR in his other eye, and this may indicate a potential predisposition to developing the condition, triggered by blunt trauma.
  2,352 230 -
Mirtazapine-induced acute angle closure
Nilay Kahraman, Onur Durmaz, Mehmet Murat Durna
June 2015, 63(6):539-540
DOI:10.4103/0301-4738.162612  PMID:26265648
Acute angle closure (AAC) is an ocular emergency with symptoms including blurred vision, eye pain, headache, nausea, vomiting and reddening of the eye those results from increased intraocular pressure. This clinical condition can lead to permanent damage in vision, thus causing blindness by generating progressive and irreversible optic neuropathy if left untreated. There are several reasons of AAC, including several types of local and systemic medications; mainly sympathomimetics, cholinergics, anti-cholinergics, mydriatics, anti-histamines, antiepileptics like topiramate, tricyclic and tetracyclic antidepressants, serotonin reuptake inhibitors, antipsychotics, sulfa-based drugs and anticoagulants. Mirtazapine, a noradrenergic and specific serotonergic antidepressant, is an atypical antidepressant with a complex pharmacological profile. This case report describes a patient with major depressive disorder, who experienced AAC after the first dosage of mirtazapine treatment, and highlights the importance of close monitoring of individuals under antidepressant treatment particularly immediately after initiation of the drug.
  2,294 263 -
EDITORIAL
Burning bright or burning out?
Sundaram Natarajan
June 2015, 63(6):473-473
DOI:10.4103/0301-4738.162576  PMID:26265633
  2,278 263 -
ORIGINAL ARTICLES
Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma
Vishal Arora, Shveta Jindal Bali, Sanjeev Kumar Gupta, Praveen Vashisht, Tushar Agarwal, Vishnubhatla Sreenivas, Tanuj Dada
June 2015, 63(6):511-515
DOI:10.4103/0301-4738.162603  PMID:26265642
Purpose: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). Patients and Methods: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. Results: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40-77 years) and controls (mean age: 54.9 ± 6.7 years, 42-73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). Conclusions: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.
  2,220 288 -
Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery
Ashiya Khan, Abadan Khan Amitava, Syed Ali Raza Rizvi, Ziya Siddiqui, Namita Kumari, Shivani Grover
June 2015, 63(6):496-500
DOI:10.4103/0301-4738.162600  PMID:26265639
Context : Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA), visual function-14 (VF-14) score and their quality-adjusted life years (QALYs) were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student's t-test. Significance set at P < 0.05; 95% confidence interval (CI) quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI]) in LogMAR VA (0.03 [−0.05−0.11]), VF-14 score (7.92 [−1.03−16.86]) and QALYs (1.14 [−0.89−3.16]). However, with significantly lower costs (INR 3228 [2700-3756]), MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30]) than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.
  2,218 257 -
BRIEF COMMUNICATIONS
Anterior segment ischemia following Hummelsheim procedure in a case of sixth nerve palsy
Rakesh K Bansal, Ravi K Bamotra
June 2015, 63(6):543-544
DOI:10.4103/0301-4738.162619  PMID:26265650
A, 46-year-old Indian male, known hypertensive presented with left esotropia of 25  prism diopters (PD) after head injury in a roadside accident 9 months back. The deviation was constant in nature and was associated with complaints of diplopia in left lateral gaze. Traumatic sixth nerve palsy was diagnosed. The patient underwent left medial rectus recession of 5 mm and a split-tendon transposition of the left superior and inferior recti to the lateral rectus insertion (Hummelsheim procedure). On the first postoperative day, the patient developed corneal edema and anterior chamber reaction of flare 2+ and cells 2+. The pupil was semi-dilated and was sluggishly reacting to light. Anterior segment ischemia was diagnosed, which was managed with topical and systemic steroids.
  2,261 171 -
PHOTO ESSAY
Giant nevus of Ota
Pukhraj Rishi, Ekta Rishi, Deepak Bhojwani
June 2015, 63(6):532-533
DOI:10.4103/0301-4738.162607  PMID:26265645
  2,218 206 -
ORIGINAL ARTICLES
Effect of biaxial versus coaxial microincision cataract surgery on optical quality of the cornea
Tamer Fahmy Eliwa, Mahmoud A Elsamkary, Ismail Hamza
June 2015, 63(6):487-490
DOI:10.4103/0301-4738.162598  PMID:26265637
Context: Visual function is determined by a combination of the cornea, which has a larger effect and internal aberrations generated by the intraocular lens and those induced by the surgery. These corneal refractive changes are related to the location and size of the corneal incision. The smaller the incision, the lower the aberrations and the better the optical quality. Aims: To compare the effect of uneventful coaxial versus biaxial microincision cataract surgery (MICS) on the corneal aberrations. Settings and Design: Retrospective interventional nonrandomized comparative case study comprised 40 eyes of 36 patients with primary senile cataract. Subjects and Methods: They were divided into two groups: Group I (20 eyes) had operated by biaxial MICS and Group II (20 eyes) had operated by coaxial MICS. Each group were assessed by corneal topography and wavefront analysis over 6 mm pupil size preoperatively and 1-month postoperatively. Statistical Analysis Used: Statistical analysis was performed using SPSS for Windows (version 17.0.1, SPSS, Inc.). The paired t-test was used to compare the mean values of corneal aberrations preoperatively and 1-month postoperatively in each group. Results: There was a significant increase in trefoil and quatrefoil in biaxial MICS (P = 0.063, 0.032 respectively) while other aberrations insignificantly changed. The coaxial MICS showed a significant increase in root mean square (RMS) of total high order aberrations (HOAs) (P = 0.02) and coma (0.028), but not the others. In comparison to each other, there was the insignificant difference as regards astigmatism, RMS of individual and total HOAs. Conclusions: Coaxial and biaxial MICS are neutral on corneal astigmatism and aberrations.
  2,197 209 -
Evaluating the change in central corneal thickness in neonates (term and preterm) in Indian population and the factors affecting it
Jitendra Jethani, Kalpit Shah, Monika Jethani
June 2015, 63(6):501-503
DOI:10.4103/0301-4738.162601  PMID:26265640
Background and Aim: Central corneal thickness (CCT) of term and preterm infants in Indian population is not known. We did a prospective noninterventional study to measure the CCT in term and preterm infants. Materials and Methods: An ultrasonic pachymeter was used. The data regarding the date of birth, expected date of delivery, birth weight were recorded. The preterm and the term infants were followed up at 8 weeks, 20 weeks and at 1-year. Results: A total of 85 (170 eyes) children were included in the study. The mean age was 264.6 ± 21.8 days postconception. The mean birth weight and CCT were 1834.4 ± 512.1 g and 595.8 ± 72.4 μ respectively. A comparison of CCT on the basis postgestational age showed a mean thickness of 620.7 ± 88.8 and 574.4 ± 78.3 μ in the <260 days and >260 days age groups respectively. The difference was statistically significant (Student's test, P = 0.002). The CCT of preterm infants (<260 days) decreased from a mean value of 620.7 ± 88.8 μ to 534.1 ± 57.6 μ at the end of 1-year. Conclusion: We present the data of CCT in term and preterm infants in Indian population. We believe that the premature babies have slightly thicker corneas than mature term babies.
  2,123 178 -
BRIEF COMMUNICATIONS
Microperimetry biofeedback training in a patient with bilateral myopic macular degeneration with central scotoma
Rajiv Raman, Deepali Damkondwar, Srividya Neriyanuri, Tarun Sharma
June 2015, 63(6):534-536
DOI:10.4103/0301-4738.162609  PMID:26265646
Microperimetry-1 (MP-1) evaluation and MP-1 biofeedback training were done in a case of bilateral myopic macular degeneration with a central scotoma. Fixation behavior, location and stability of preferred retinal locus, eye movement speed, and mean sensitivity were assessed. The mean retinal sensitivities before, after and at 1-year after training in the right eye were 2.9 dB, 2.9 dB and 3.7 dB and in the left eye were 3.5 dB, 3.7 dB and 1.8 dB. The fixation point in the 2° gravitation circle, improved from 40% to 50% in the right eye and from 43% to 67% in the left eye. The average eye speed before, after and at 1-year after training in right eye were 0.19°/s, 0.26°/s and 0.25°/s and in left eye were 0.36°/s, 0.25°/s and 0.27°/s. Thus, biofeedback training using MP-1 can improve the visual function in patients with macular diseases and central scotoma.
  2,092 203 -
OPHTHALMOLOGY PRACTICE
Sinonasal carcinoma presenting as chronic sinusitis and sequential bilateral visual loss
Wei-Yu Chiang, Meng-Hsiang Chen, Hsiu-Mei Huang
June 2015, 63(6):528-531
DOI:10.4103/0301-4738.162606  PMID:26265644
Sinonasal undifferentiated carcinoma-related rhinogenic optic neuropathy is rare and may lead to visual loss. To the best of our knowledge, this is the first report of bilateral sequential visual loss induced by this etiology. It is important to differentiate between chronic sinusitis and malignancy on the basis of specific findings on magnetic resonance images. Surgical decompression with multidisciplinary therapy, including steroids, chemotherapy, and radiotherapy, is indicated. However, no visual improvement was noted in this case, emphasizing the rapid disease progression and importance of early diagnosis and treatment.
  1,984 142 -
BRIEF COMMUNICATIONS
A case of syringocystadenoma papilliferum of eyelid with literature review
Madhusmita Behera, Sanhita Chatterjee
June 2015, 63(6):550-551
DOI:10.4103/0301-4738.162634  PMID:26265653
Syringocystadenoma papilliferum can rarely affect eyelid skin. The lesion is frequently misdiagnosed as basal cell carcinoma or cyst or squamous cell carcinoma. We are presenting a case that was clinically diagnosed as basal cell carcinoma of eyelid but was later histologically diagnosed as syringocystadenoma papilliferum.
  1,958 157 -
ORIGINAL ARTICLES
Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective
Nakul Saxena, Pradeep Paul George, Bee Hoon Heng, Tock Han Lim, Shao Onn Yong
June 2015, 63(6):516-523
DOI:10.4103/0301-4738.158533  PMID:26265643
Purpose: To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40-79 years from Singapore is cost-effective in preventing progression to wet AMD. Methods: A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers' perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. Results: Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. Conclusion: Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore.
  1,786 289 -
BRIEF COMMUNICATIONS
Exudative retinal detachment following strabismus surgery in Sturge-Weber syndrome
Yu Cheol Kim, Se Yeop Lee, Kwang Soo Kim
June 2015, 63(6):554-555
DOI:10.4103/0301-4738.162641  PMID:26265655
A 15-year-old boy with Sturge-Weber syndrome underwent strabismus surgery (oculus sinister [OS]) for the treatment of exotropia. The patient's visual acuity (OS) decreased to hand motion 10 days after the surgery. One month after the surgery, the patient's visual acuity decreased to light perception, and a fundus examination showed total exudative retinal detachment (OS).
  1,873 173 -
Orbital Chondroma: A rare mesenchymal tumor of orbit
Ruchi S Kabra, Sonal B Patel, Swapna S Shanbhag
June 2015, 63(6):551-554
DOI:10.4103/0301-4738.162638  PMID:26265654
While relatively common in the skeletal system, cartilaginous tumors are rarely seen originating from the orbit. Here, we report a rare case of an orbital chondroma. A 27-year-old male patient presented with a painless hard mass in the superonasal quadrant (SNQ) of left orbit since 3 months. On examination, best-corrected visual acuity of both eyes was 20/20, with normal anterior and posterior segment with full movements of eyeballs and normal intraocular pressure. Computerized tomography scan revealed well defined soft tissue density lesion in SNQ of left orbit. Patient was operated for anteromedial orbitotomy under general anesthesia. Mass was excised intact and sent for histopathological examination (HPE). HPE report showed lobular aggregates of benign cartilaginous cells with mild atypia suggesting of benign cartilaginous tumor - chondroma. Very few cases of orbital chondroma have been reported in literature so far.
  1,899 139 -
Anesthetic dilemma in planning bilateral cataract surgery for an infant associated with congenital cardiac anomaly
Devalina Goswami, Shwetha Seetharamaiah, Sraban Kumar Kedia, Bhagabat Kumar Nayak, Shiv Akshat
June 2015, 63(6):548-549
DOI:10.4103/0301-4738.162630  PMID:26265652
In a patient with tetralogy of Fallot (TOF) and pulmonary atresia, treating the cardiac problem or the associated congenital illness is always a challenge. We describe the challenges and successful initial management of bilateral cataract to prevent visual loss in an infant with TOF with pulmonary atresia.
  1,846 145 -
LETTERS TO THE EDITOR
The muscle transplantation and loop myopexy in so-called heavy eye syndrome
Jitendra Jethani
June 2015, 63(6):558-559
DOI:10.4103/0301-4738.162648  PMID:26265658
  1,792 156 -
Heavy eye syndrome: Role of recessions, resections, loop myopexy, and transplants
Vishaal Bhambhwani, Mandar Kadav, C Aparnaa, Pramod Kumar Pandey
June 2015, 63(6):558-558
DOI:10.4103/0301-4738.162647  PMID:26265657
  1,756 163 -
BRIEF COMMUNICATIONS
Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation
Haresh T Asnani, Vinod C Mehta, Akshay Gopinathan Nair, Vandana Jain
June 2015, 63(6):541-542
DOI:10.4103/0301-4738.162615  PMID:26265649
Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self-resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.
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Unicentric Castleman's disease in the orbit: A case report
Dongwan Kang, Joonsik Lee, Hwa Lee, Sehyun Baek
June 2015, 63(6):555-557
DOI:10.4103/0301-4738.162645  PMID:26265656
A 53-year-old man presented with a palpable mass on the left lower eyelid and occasional diplopia. Under suspicion of orbital lymphoma, an excisional biopsy was performed, and histopathology revealed Castleman's disease. Castleman's disease is a rare disorder of the lymphoid system, and only a few cases of Castleman's disease in the orbit have been reported.
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