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   2015| July  | Volume 63 | Issue 7  
    Online since October 12, 2015

 
 
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REVIEW ARTICLES
Intermittent exotropia: Surgical treatment strategies
Jai Aditya Kelkar, Santhan Gopal, Rachana B Shah, Aditya S Kelkar
July 2015, 63(7):566-569
DOI:10.4103/0301-4738.167109  PMID:26458472
Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.
  5,571 538 -
Hydroxychloroquine retinopathy: A review of imaging
Hemang K Pandya, Mark Robinson, Nawajes Mandal, Vinay A Shah
July 2015, 63(7):570-574
DOI:10.4103/0301-4738.167120  PMID:26458473
Hydroxychloroquine (HCQ) retinopathy can result in permanent vision loss. In early stages of HCQ retinopathy, patients are usually asymptomatic with preservation of visual acuity. We aspire that our review, in conjunction with the American Academy of Ophthalmology screening guidelines, shall shed light on effective screening measures utilizing multimodal imaging techniques to detect early signs of HCQ retinopathy before advanced changes manifest clinically.
  4,972 612 -
SYMPOSIUMS - RETINOCHOROIDAL IMAGING
Update on wide- and ultra-widefield retinal imaging
Samir S Shoughy, J Fernando Arevalo, Igor Kozak
July 2015, 63(7):575-581
DOI:10.4103/0301-4738.167122  PMID:26458474
The peripheral retina is the site of pathology in many ocular diseases and ultra-widefield (UWF) imaging is one of the new technologies available to ophthalmologists to manage some of these diseases. Currently, there are several imaging systems used in practice for the purpose of diagnostic, monitoring disease progression or response to therapy, and telemedicine. These include modalities for both adults and pediatric patients. The current systems are capable of producing wide- and UWF color fundus photographs, fluorescein and indocyanine green angiograms, and autofluorescence images. Using this technology, important clinical observations have been made in diseases such as diabetic retinopathy, uveitides, retinal vascular occlusions and tumors, intraocular tumors, retinopathy of prematurity, and age-related macular degeneration. Widefield imaging offers excellent postoperative documentation of retinal detachment surgery. New applications will soon be available to integrate this technology into large volume routine clinical practice.
  4,314 423 -
ORIGINAL ARTICLES
The use of handheld spectral domain optical coherence tomography in pediatric ophthalmology practice: Our experience of 975 infants and children
Ashwin Mallipatna, Anand Vinekar, Chaitra Jayadev, Supriya Dabir, Munsusamy Sivakumar, Narasimha Krishnan, Pooja Mehta, Tos Berendschot, Naresh Kumar Yadav
July 2015, 63(7):586-593
DOI:10.4103/0301-4738.167108  PMID:26458476
Purpose: Optical coherence tomography (OCT) is an important imaging tool assessing retinal architecture. In this article, we report a single centers experience of using handheld spectral domain (SD)-OCT in a pediatric population using the Envisu 2300 (Bioptigen Inc., Research Triangle Park, NC, USA). Methods: We studied SD-OCT images from 975 patients imaged from January 2011 to December 2014. The variety of cases that underwent an SD-OCT was analyzed. Cases examples from different case scenarios were selected to showcase unique examples of many diseases. Results: Three hundred and sixty-eight infants (37.7%) were imaged for retinopathy of prematurity, 362 children (37.1%) underwent the test for evaluation of suboptimal vision or an unexplained vision loss, 126 children (12.9%) for evaluation of nystagmus or night blindness, 54 children (5.5%) for an intraocular tumor or a mass lesion such as retinoblastoma, and 65 children (6.7%) for other diseases of the pediatric retina. The unique findings in the retinal morphology seen with some of these diseases are discussed. Conclusion: The handheld SD-OCT is useful in the evaluation of the pediatric retinal diseases. The test is useful in the assessment of vision development in premature children, evaluation of unexplained vision loss and amblyopia, nystagmus and night blindness, and intraocular tumors (including retinoblastoma).
  3,807 264 -
SYMPOSIUMS - RETINOCHOROIDAL IMAGING
Unconventional techniques of fundus imaging: A review
Mahesh P Shanmugam, Divyansh Kailash Chandra Mishra, R Rajesh, R Madhukumar
July 2015, 63(7):582-585
DOI:10.4103/0301-4738.167123  PMID:26458475
The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand-held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost-effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist's armamentarium.
  3,468 349 -
ORIGINAL ARTICLES
Identification of glaucomatous optic nerve head changes in Indian donor eyes without clinical history
Srinivasan Senthilkumari, Mohan Neethu, Radhakrishnan Santhi, Subbiah Ramaswami Krishnadas, Veerappan Muthukkaruppan
July 2015, 63(7):600-605
DOI:10.4103/0301-4738.167118  PMID:26458478
Purpose: The purpose of this study is to develop methods to identify glaucoma by examining the optic nerve head (ONH) of donor's eyes when information on the preexisting ocular disease is unavailable. Materials and Methods: The ONH of the donor's eyes was evaluated under a stereomicroscope for the cup-disc ratio (CDR) and focal retinal rim thinning. The vertical diameter of the cup and disc was also measured using a precalibrated eyepiece micrometer. The suspect eyes were subjected to histological analysis to confirm the presence of specific glaucomatous changes. Results: A total of 202 eyes from 119 donors (68 males and 51 females, aged 42–96) were evaluated for glaucoma. Among them, 190 (94%) eyes showing vertical CDR in the of 0.0–0.6 range were considered nonglaucomatous and the remaining eyes with >0.6 as glaucoma suspect. The calculated mean CDR of the two groups (0.3 ± 0.16, 0.62 ± 0.27) was highly significant (P = 0.0003). Of 12 eyes suspected of glaucoma, 7 eyes from 5 donors showed specific glaucomatous changes by histology. The prevalence of glaucoma was 4.2% among the donors studied. Conclusions: A simple method of screening fresh donor eyes for selecting those with glaucoma features using CDR and histological analysis was reported. This method helps to obtain biologically active human ocular tissue for glaucoma research on gene expression, ultrastructural/proteome changes, and outflow mechanism.
  3,107 236 -
PHOTO ESSAY
Stickler syndrome
Pukhraj Rishi, Abhilasha Maheshwari, Ekta Rishi
July 2015, 63(7):614-615
DOI:10.4103/0301-4738.167114  PMID:26458481
  2,972 290 -
ORIGINAL ARTICLES
Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery
Yadollah Eslami, Arash Mirmohammadsadeghi
July 2015, 63(7):606-610
DOI:10.4103/0301-4738.167113  PMID:26458479
Background: Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X-pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect. Aims: To compare SIA between horizontal and X-pattern sutures in the scleral tunnel incisions for MSICS. Design: Prospective, nonrandomized comparative trial. Materials and Methods: After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X-pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively. Statistical Analysis: The SIA was calculated by Cartesian coordinates based analysis. Results: Sixty-four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against-the-rule astigmatism. In the X-pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with-the-rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small. Conclusion: In the MSICS, the X-pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.
  2,902 323 -
Economic and social factors that influence households not willing to undergo cataract surgery
Muralikrishnan Radhakrishnan, Rengaraj Venkatesh, Vijayakumar Valaguru, Kevin D Frick
July 2015, 63(7):594-599
DOI:10.4103/0301-4738.167116  PMID:26458477
Purpose: Literature investigating barriers to cataract surgery is mostly done from the patient's point of view. However, many medical decisions are jointly taken by household members, especially in developing countries such as India. We investigated from the household head's (or representative's) perspective, households' view on those not willing to undergo cataract surgery along with the economic and social factors associated with it. Materials and Methods: A cross-sectional survey of four randomly selected village clusters in rural areas of Theni district, Tamil Nadu, India, was conducted to elicit the willingness to pay for cataract surgery by presenting "scenarios" that included having or not having free surgery available. The presentation of scenarios allowed the identification of respondents who were unwilling to undergo surgery. Logistic regression was used to estimate relationships between economic and social factors and unwillingness to undergo cataract surgery. Results: Of the 1271 respondents, 49 (3.85%) were not willing to undergo surgery if they or their family members have cataract even if free surgery were available. In the regression results, those with good understanding of cataract and its treatment were less likely to be unwilling to undergo cataract surgery. Those not reporting household income were more likely to be unwilling to undergo cataract surgery. Conclusions: As a good understanding of cataract was an important predictor of willingness to undergo cataract surgery, health education on cataract and its intervention can improve uptake.
  2,701 264 -
GUEST EDITORIAL
Donate eyes, not patients!
Milind Neilkant Naik
July 2015, 63(7):564-565
DOI:10.4103/0301-4738.167115  PMID:26458471
  2,633 231 -
LETTERS TO THE EDITOR
Methazolamide-induced toxic epidermal necrolysis in a Chinese woman with HLA-B5901
Yonghao Xu, Mengqi Wu, Fang Sheng, Qing Sun
July 2015, 63(7):623-624
DOI:10.4103/0301-4738.167105  PMID:26458485
  2,386 133 -
EDITORIAL
From the book to the bedside: The role of review articles in evidence-based medicine
Sundaram Natarajan
July 2015, 63(7):563-563
DOI:10.4103/0301-4738.167124  PMID:26458470
  2,230 254 -
BRIEF COMMUNICATIONS
Intravitreal aflibercept for management of subfoveal choroidal neovascularization secondary to angioid streaks
Ebru Esen, Selçuk Sizmaz, Nihal Demircan
July 2015, 63(7):616-618
DOI:10.4103/0301-4738.167121  PMID:26458482
In this study, we reported the clinical results of switching from ranibizumab to aflibercept for the treatment of an insufficient responder with choroidal neovascularization (CNV) secondary to angioid streaks (AS). A 39-year-old female patient with CNV secondary to AS had bilateral persistent intraretinal and subretinal fluid on the optical coherence tomography despite prior intravitreal 0.5 mg ranibizumab injections. The therapy was switched to intravitreal injection of aflibercept. The patient received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals for both eyes. Morphological and functional effects were observed as early as 1-week after the first injection. After the third aflibercept injection, her visual acuity improved, intraretinal and subretinal fluid resolved, and central macular thickness reduced in both eyes. This is an early, but encouraging and promising result indicating that aflibercept might be a good alternative management for CNV secondary to AS that is insufficiently responding to prior ranibizumab injections.
  2,277 179 -
LETTERS TO THE EDITOR
Atypical optic neuritis due to tuberculosis
Nataraja Pillai Venugopal
July 2015, 63(7):623-623
DOI:10.4103/0301-4738.167110  PMID:26458486
  2,245 201 -
BRIEF COMMUNICATIONS
Epibulbar schwannoma in a 12-year-old boy: A case report and review of literature
Akshay Gopinathan Nair, Swathi Kaliki, Dilip Kumar Mishra, Tarjani Vivek Dave, Milind N Naik
July 2015, 63(7):620-622
DOI:10.4103/0301-4738.167106  PMID:26458484
Schwannomas are benign, encapsulated, primary neurilemmal tumors composed of proliferating Schwann cells. Schwannomas are commonly seen in the orbit, but are rare on the epibulbar surface. Herein, we report a case of a 12-year-old boy who presented to us with a slow-growing painless subconjunctival mass in the left eye. There was no intraocular extension of the mass and intra-operatively, the mass could be clearly delineated and was excised off the underlying sclera. Histopathological examination of the mass showed typical features of schwannoma and immunohistochemistry helped to confirm the diagnosis. There was no recurrence of the lesion observed at follow-up 26 months after surgery. Here, we describe this uncommon tumor and review the available literature. Although rare, an epibulbar schwannoma should be considered in the differential diagnosis of an amelanotic, painless subconjunctival nodular mass. Excision of the lesion is the recommended treatment.
  2,250 151 -
ORIGINAL ARTICLES
Adjustable recessions in horizontal comitant strabismus: A pilot study
Siddharth Agrawal, Vinita Singh, Priyanka Singh
July 2015, 63(7):611-613
DOI:10.4103/0301-4738.167117  PMID:26458480
Aim: To compare the surgical outcome of adjustable with the conventional recession in patients with horizontal comitant strabismus. Patients and Methods: A prospective comparative nonrandomized interventional pilot study was performed on patients with horizontal comitant strabismus. Fifty-four patients (27 in each group) were allocated into 2 groups to undergo either adjustable suture (AS) recession or non-AS (NAS) recession along with conventional resection. The patients were followed up for 6 months. A successful outcome was defined as deviation ±10 prism diopters at 6 months. The results were statistically analyzed by Chi-square test, Fisher's exact test, and Student's t-test. Results: A successful outcome was found in 24 (88.8%) patients in AS and 17 (62.9%) in NAS group (P = 0.02). The postoperative adjustment was done in 13 (48.1%) patients in AS group. There was one complication (tenon's cyst) in AS group. Conclusion: AS recession may be considered in all cooperative patients undergoing strabismus surgery for comitant deviations.
  2,226 167 -
LETTERS TO THE EDITOR
Query to the author of retinoblastoma: Achieving new standards with methods of chemotherapy
Sanjiv Kumar Gupta, Ajai Kumar, Arun Sharma, Vishal Katiyar, Siddharth Agrawal
July 2015, 63(7):625-625
DOI:10.4103/0301-4738.167111  PMID:26458487
  1,954 163 -
BRIEF COMMUNICATIONS
A case of spontaneously resolved primary congenital glaucoma
Gaurav Sanghi, Gagandeep Singh Brar, Rajeev Gupta, Ashish Ahuja
July 2015, 63(7):618-620
DOI:10.4103/0301-4738.167107  PMID:26458483
Primary congenital glaucoma usually presents as enlarged and hazy cornea at birth or early childhood. The diagnosis is based on a thorough clinical examination under anesthesia. Most cases require surgical intervention as the definitive treatment. In very rare instances, primary congenital glaucoma may arrest and resolve spontaneously. We describe a case of spontaneously arrested and resolved primary congenital glaucoma in a 37-year-old male presenting with large cornea, Haab's striae, and normal intraocular pressure in one eye. Such a case has not been previously described from the Indian subcontinent.
  1,861 165 -
LETTERS TO THE EDITOR
Photograph query
Swathi Kaliki
July 2015, 63(7):625-626
DOI:10.4103/0301-4738.167112  PMID:26458488
  1,845 132 -