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   2016| January  | Volume 64 | Issue 1  
    Online since March 7, 2016

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Prevalence of diabetic retinopathy in India: The All India Ophthalmological Society Diabetic Retinopathy Eye Screening Study 2014
Salil S Gadkari, Quresh B Maskati, Barun Kumar Nayak
January 2016, 64(1):38-44
DOI:10.4103/0301-4738.178144  PMID:26953022
Aim: The aim of this study is to ascertain the prevalence of diabetic retinopathy (DR) in diabetic patients across the nation and attempt to establish history-based risk factors. Materials and Methods: A cross-sectional study of diabetic patients was conducted as an initiative of the All India Ophthalmological Society from 14th November to 21st November 2014. Known diabetics were evaluated voluntarily by members of the society at 194 centers using a structured protocol provided by the society for examination. The results were evaluated to ascertain the prevalence of DR in the population studied and to establish relation with gender, age, and history-based risk factors such as duration of diabetes, insulin use, and other end-organ disease using the Chi-square test. Results: A total of 6218 known diabetics were screened. Totally, 5130 data entry forms were considered suitable for further evaluation. About 61.2% were males, 88.6% were between 40 and 80 years of age, almost two-thirds of the patients were from the west and south zones, and over half had diabetes more than 5 years. The data set was predominantly urban 84.7% and 46.1% had no family history. DR prevalence in the entire data set was 21.7%. Prevalence was more in males (P = 0.007), diabetics more than 5 years (P = 0.001), those above 40 years (P = 0.01), insulin users (P = 0.001), and history of vascular accidents (P = 0.0014). Significantly 22.18% of patients detected with DR had a vision of 6/18 or better in the worse eye. Conclusion: The study reiterated the findings of earlier regional studies on a pan Indian scale and put data in perspective.
  14,410 1,787 -
Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines
Taraprasad Das, Ajay Aurora, Jay Chhablani, Anantharaman Giridhar, Atul Kumar, Rajiv Raman, Manish Nagpal, Raja Narayanan, Sundaram Natarajan, Kim Ramasamay, Mudit Tyagi, Lalit Verma
January 2016, 64(1):14-25
DOI:10.4103/0301-4738.178142  PMID:26953019
The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians.
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Iris-claw intraocular lens implantation: Anterior chamber versus retropupillary implantation
Sezer Helvaci, Selahaddin Demirduzen, Huseyin Oksuz
January 2016, 64(1):45-49
DOI:10.4103/0301-4738.178139  PMID:26953023
Purpose: To compare the outcomes of anterior chamber and retropupillary implantation of iris-claw Artisan intraocular lenses (IOL). Design: Prospective, randomized, single-blinded study. Patients and Methods: Forty eyes of forty aphakic patients were enrolled. Patients were randomized into two groups. Each group includes twenty patients. Group 1 received anterior chamber Artisan IOL implantation. Group 2 received retropupillary Artisan IOL implantation. Preoperative and postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and all complications were noted and compared at 6 months follow-up. Results: Each two groups obtained a significant improvement in CDVA (P < 0.05). Four patients in Group 1 and five patients in Group 2 had significant but nonpermanent increase at IOP values. There were one and two pupillary irregularity in Group 1 and Group 2, respectively. In one patient, a shallow and inferior located retinal detachment were encountered in anterior chamber group. Conclusions: The results were not significantly different between the two fixation techniques for iris-claw lens. The surgery procedure is dependent to surgeon experience and eye's conditions.
  7,370 748 -
Novel pharmacotherapies in diabetic retinopathy: Current status and what's in the horizon?
Arup Das, Paul G McGuire, Finny Monickaraj
January 2016, 64(1):4-13
DOI:10.4103/0301-4738.178154  PMID:26953018
The blood–retinal barrier (BRB) alteration is the hallmark feature of diabetic retinopathy. Vascular endothelial growth factor (VEGF) is a potent vasopermeability factor that has been implicated in the pathogenesis of BRB alteration. Inflammation also plays a crucial role in this process with involvement of several chemokines and cytokines. Multiple anti-VEGF drugs are widely used as in the treatment of diabetic macular edema (DME) as well as proliferative diabetic retinopathy. Several clinical trials have proved the beneficial effects of these drugs in improvement of vision and prevention of vision loss. However, the response to anti-VEGF drugs in DME is not complete in a significant number of patients. The effect seems transient in this latter group, and many patients do not show complete resolution of fluid. Potential novel therapies targeting molecules beyond VEGF are being developed and examined in clinical trials.
  4,886 889 -
Advances in retinal imaging for diabetic retinopathy and diabetic macular edema
Colin Siang Hui Tan, Milton Cher Yong Chew, Louis Wei Yi Lim, Srinivas R Sadda
January 2016, 64(1):76-83
DOI:10.4103/0301-4738.178145  PMID:26953028
Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonperfusion, as well as leakage from both microaneurysms and neovascularization. Recent advances in retinal imaging modalities complement traditional fundus photography and provide invaluable new information for clinicians. Ultra-widefield imaging, which can be used to produce both color fundus photographs and FAs, now allows unprecedented views of the posterior pole. The pathologies that are detected in the periphery of the retina have the potential to change the grading of disease severity, and may be of prognostic significance to disease progression. Studies have shown that peripheral ischemia may be related to the presence and severity of DME. Optical coherence tomography (OCT) provides structural detail of the retina, and the quantitative and qualitative features are useful in the monitoring of diabetic eye disease. A relatively recent innovation, OCT angiography, produces images of the fine blood vessels at the macula and optic disc, without the need for contrast agents. This paper will review the roles of each of these imaging modalities for diabetic eye disease.
  4,206 669 -
Automated detection of diabetic retinopathy in retinal images
Carmen Valverde, Maria Garcia, Roberto Hornero, Maria I Lopez-Galvez
January 2016, 64(1):26-32
DOI:10.4103/0301-4738.178140  PMID:26953020
Diabetic retinopathy (DR) is a disease with an increasing prevalence and the main cause of blindness among working-age population. The risk of severe vision loss can be significantly reduced by timely diagnosis and treatment. Systematic screening for DR has been identified as a cost-effective way to save health services resources. Automatic retinal image analysis is emerging as an important screening tool for early DR detection, which can reduce the workload associated to manual grading as well as save diagnosis costs and time. Many research efforts in the last years have been devoted to developing automatic tools to help in the detection and evaluation of DR lesions. However, there is a large variability in the databases and evaluation criteria used in the literature, which hampers a direct comparison of the different studies. This work is aimed at summarizing the results of the available algorithms for the detection and classification of DR pathology. A detailed literature search was conducted using PubMed. Selected relevant studies in the last 10 years were scrutinized and included in the review. Furthermore, we will try to give an overview of the available commercial software for automatic retinal image analysis.
  3,725 675 -
Diabetic retinopathy: An epidemic at home and around the world
Rajiv Raman, Laxmi Gella, Sangeetha Srinivasan, Tarun Sharma
January 2016, 64(1):69-75
DOI:10.4103/0301-4738.178150  PMID:26953027
Prevention of blindness due to diabetic retinopathy (DR) requires effective screening strategies, for which eye care providers need to know the magnitude of the burden and the risk factors pertinent in their geographical location. It is estimated that around 72 million of the global adult population (around 8.2%) has diabetes and about one-fifth of all adults with diabetes lives in the South-East Asia. In India, around 65 million people have diabetes. As the global prevalence of diabetes increases, so will the number of people with diabetes-related complications, such as DR; nearly one-third of them are likely to develop this complication. This article reviews the present status of diabetes and DR in India, the current situation of DR services and the projections on the load of morbidity associated with retinopathy. The article compiles the Indian studies elucidating the risk factors for DR.
  3,634 521 -
Genetic components in diabetic retinopathy
Bibhudatta Mishra, Anand Swaroop, Raj P Kandpal
January 2016, 64(1):55-61
DOI:10.4103/0301-4738.178153  PMID:26953025
Diabetic retinopathy (DR) is a serious complication of diabetes, which is fast reaching epidemic proportions worldwide. While tight glycemic control remains the standard of care for preventing the progression of DR, better insights into DR etiology require understanding its genetic basis, which in turn may assist in the design of novel treatments. During the last decade, genomic medicine is increasingly being applied to common multifactorial diseases such as diabetes and age-related macular degeneration. The contribution of genetics to the initiation and progression of DR has been recognized for some time, but the involvement of specific genes and genetic variants remains elusive. Several investigations are currently underway for identifying DR susceptibility loci through linkage studies, candidate gene approaches, and genome-wide association studies. Advent of next generation sequencing and high throughput genomic technologies, development of novel bioinformatics tools and collaborations among research teams should facilitate such investigations. Here, we review the current state of genetic studies in DR and discuss reported findings in the context of biochemical, cell biological and therapeutic advances. We propose the development of a consortium in India for genetic studies with large cohorts of patients and controls from limited geographical areas to stratify the impact of the environment. Uniform guidelines should be established for clinical phenotyping and data collection. These studies would permit identification of genetic loci for DR susceptibility in the Indian population and should be valuable for better diagnosis and prognosis, and for clinical management of this blinding disease.
  2,277 392 -
A thousand splendid suns
Sundaram Natarajan
January 2016, 64(1):1-1
DOI:10.4103/0301-4738.178160  PMID:26953016
  2,219 428 -
Does tight control of systemic factors help in the management ofdiabetic retinopathy?
Ramachandran Rajalakshmi, Vijayaraghavan Prathiba, Viswanathan Mohan
January 2016, 64(1):62-68
DOI:10.4103/0301-4738.178146  PMID:26953026
Diabetic retinopathy (DR), one of the leading causes of preventable blindness, is associated with many systemic factors that contribute to the development and progression of this microvascular complication of diabetes. While the duration of diabetes is the major risk factor for the development of DR, the main modifiable systemic risk factors for development and progression of DR are hyperglycemia, hypertension, and dyslipidemia. This review article looks at the evidence that control of these systemic factors has significant benefits in delaying the onset and progression of DR.
  1,779 387 -
Diabetic retinopathy: Battling the global epidemic
Arup Das
January 2016, 64(1):2-3
DOI:10.4103/0301-4738.178155  PMID:26953017
  1,697 363 -
Telemedicine in diabetic retinopathy: Access to rural India
Taraprasad Das, Rajeev Reddy Pappuru
January 2016, 64(1):84-86
DOI:10.4103/0301-4738.178151  PMID:26953029
Diabetic retinopathy (DR) is a growing concern in India. The first step in management of DR is timely screening. With 10% prevalence in rural India, 11 million people are likely to have DR by the year 2030. With limited resources and skilled manpower, it will not be possible to have routine eye examination to identify and treat these patients on a regular basis. Telemedicine is a possible answer in these situations where patients could be remotely screened and appropriately advised. With the advent of several technological advances such as low cost hand-held nonmydriatic camera, increased capabilities of the smartphones to take external eye and retinal photographs coupled with improving broadband connectivity; teleophthalmology in the management of DR could be a reality in the not too distant future.
  1,636 304 -
Rehabilitation of orbital defect with silicone orbital prosthesis retained by dental implants
Satyabodh Shesharaj Guttal, Jhanvi Desai, Adarsh Kudva, Basavaraj R Patil
January 2016, 64(1):93-95
DOI:10.4103/0301-4738.178137  PMID:26953033
Orbital defects can result from cancer, birth anomalies, or trauma leading to an onslaught of problems in the function and psyche of the patient. These defects are restored by surgical reconstruction and followed by placement of orbital prosthesis for cosmetic makeup. The use of dental implants in retaining orbital prosthesis improves patient acceptance of the prosthesis owing to better retention and stability than conventional adhesive retained prosthesis. This case report describes a custom-made magnetic retentive assembly anchored by a dental implant which offers the orbital prosthesis the simplicity of self-alignment and ease of use.
  1,607 306 -
Diabetic care initiatives to prevent blindness from diabetic retinopathy in India
GVS Murthy, Taraprasad Das
January 2016, 64(1):50-54
DOI:10.4103/0301-4738.178152  PMID:26953024
It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20–50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.
  1,504 355 -
The effect of anterior transposition of the inferior oblique muscle on eyelid configuration and function
Tugba Goncu, Sevim Cakmak, Ali Akal, Halit Oguz
January 2016, 64(1):33-37
DOI:10.4103/0301-4738.178138  PMID:26953021
Purpose: To evaluate the alteration of lower lid configuration and function with anterior transposition surgery of the inferior oblique (IO) muscle. Patients and Methods: A prospective clinical trial was conducted on a consecutive series of patients underwent anterior transposition of the IO as a sole operation. All patients received a thorough ophthalmic examination 1 day before and 3 months after surgery. Output parameters were consisted of palpebral fissure, margin reflex distance 1–2, lower lid function, hertel value, and lower lid crease. The differences of the collected data were calculated for statistical significance by using the Wilcoxon test. Results: A total of 19 eyes of 16 consecutive patients were included. The median preoperative grade of IO overaction was 3.5 (ranging from 3 to 4), which decreased to 0 (ranging from 0 to 2) postoperatively (P < 0.05). No significant change was observed in all parameters 3 months postoperatively (P > 0.05). Conclusion: In this study, no significant effect on lower lid configuration and function was observed following IO anterior transposition in which the disinserted muscle was placed posterior to inferior rectus insertion.
  1,285 223 -
A rare case of traumatic posterior phacocele with retinal detachment
Manavi D Sindal, Deepesh Mourya
January 2016, 64(1):89-90
DOI:10.4103/0301-4738.178165  PMID:26953031
Dislocation of crystalline lens into the anterior subconjunctival or subtenon's space is a rare but known complication of blunt trauma. Dislocation into the posterior subtenon's space is even rarer and can be associated with a complication such as occult scleral tear and retinal detachment. We report a case of traumatic posterior subtenon's dislocation of crystalline lens after blunt trauma and its successful surgical management.
  1,261 157 -
An unusual presentation of nonarteritic ischemic optic neuropathy with subretinal fluid treated with intravitreal bevacizumab
Vivek Pravin Dave, Rajeev R Pappuru
January 2016, 64(1):87-88
DOI:10.4103/0301-4738.178143  PMID:26953030
A 62-year-old hypertensive male presented with acute nonarteritic ischemic optic neuropathy (NAION) with contiguous macular edema and subretinal fluid in the right eye. Presenting vision was 20/1000. The patient was treated with intravitreal bevacizumab 1.25 mg/0.05 ml. At 1 month follow-up, the macular edema and the optic nerve head edema completely resolved with a good visual improvement up to 20/40. The visual improvement was maintained at the last follow-up 6 months postinjection. Intravitreal bevacizumab may be a good option for acute NAION especially in an unusual presentation with macular edema and subretinal fluid.
  1,200 204 -
Large exotropia after retrobulbar anesthesia
Chung-Hwan Kim, Ungsoo Samuel Kim
January 2016, 64(1):91-92
DOI:10.4103/0301-4738.178148  PMID:26953032
A 67-year-old woman complained of horizontal diplopia shortly following bilateral cataract surgery with intraocular lens implantation performed under retrobulbar anesthesia. Retrobulbar anesthesia was administered at an inferotemporal injection site using 1 cc lidocaine hydrochloride 2% mixed with bupivacaine hydrochloride 0.5%. The initial ophthalmologic evaluation showed a 12-prism diopter (PD) exotropia, and ocular motility evaluation revealed marked limitation of adduction without vertical limitation. One year after cataract surgery, the exodeviation increased up to 60 PD. The patient underwent an 8.0-mm recession of the right lateral rectus and a 6.0-mm recession of the left lateral rectus. Both lateral rectus muscles were biopsied, and biopsy revealed dense fibrous connective tissue without viable muscular cells. The lateral rectus muscle might be injured by retrobulbar anesthesia, and it could induce large exotropia.
  1,018 187 -
Vogt-Koyanagi-Harada Syndrome following influenza vaccination
Moosang Kim
January 2016, 64(1):98-98
DOI:10.4103/0301-4738.178141  PMID:26953036
  855 168 -
Analyzing the role of intravitreal bevacizumab and pars plana vitrectomy in nontractional refractory diabetic macular edema
Arvind Kumar Dubey, Kaustubh Balwant Harshey
January 2016, 64(1):96-96
DOI:10.4103/0301-4738.178147  PMID:26953034
  783 165 -
Comment on: Choroidal thickness is affected by smoking and mydriatics
Yakup Aksoy, Oktay Diner, Mehmet Koray Sevinc, Abdullah Kaya
January 2016, 64(1):100-101
DOI:10.4103/0301-4738.178156  PMID:26953039
  675 122 -
Comment on: Intraocular pressure and anetrior segment anatomy after phacoemulsification surgery
Yakup Aksoy, Taner Kar, Abdullah Kaya
January 2016, 64(1):99-99
DOI:10.4103/0301-4738.178157  PMID:26953037
  628 147 -
Authors' reply
Seemant Raizada, Jamal Al Kandari, Fahad Al Diab, Khalid Al Sabah, Niranjan Kumar, Sebastian Mathew
January 2016, 64(1):97-97
  332 86 -
Authors' reply
Servet Cetinkaya, Zeynep Dadaci, Halil Ibrahim Yener, Nursen Oncel Acir, Yasemin Fatma Cetinkaya, Faik Saglam
January 2016, 64(1):100-100
  322 96 -
Authors' reply
Jay Chhablani, Riddhima Deshpande, Virender Sachdeva, Sagar Vidya, P Srinivasa Rao, Anand Panigati, Birendra Mahat, Rajeev Reddy Pappuru, Niranjan Pehere, Avinash Pathengay
January 2016, 64(1):101-101
  288 105 -