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   2016| February  | Volume 64 | Issue 2  
    Online since April 5, 2016

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Systematic approach to managing vernal keratoconjunctivitis in clinical practice: Severity grading system and a treatment algorithm
Nikhil S Gokhale
February 2016, 64(2):145-148
DOI:10.4103/0301-4738.179727  PMID:27050351
Vernal keratoconjunctivitis is an ocular allergy that is common in the pediatric age group. It is often chronic, severe, and nonresponsive to the available treatment options. Management of these children is difficult and often a dilemma for the practitioner. There is a need to simplify and standardize its management. To achieve this goal, we require a grading system to judge the severity of inflammation and an algorithm to select the appropriate medications. This article provides a simple and practically useful grading system and a stepladder algorithm for systematic treatment of these patients. Use of appropriate treatment modalities can reduce treatment and disease-related complications.
  5,411 1,173 -
Brinzolamide/timolol versus dorzolamide/timolol fixed combinations: A hospital-based, prospective, randomized study
Mary S Galose, Heba M Elsaied, Tamer A Macky, Pakinam H Fouad
February 2016, 64(2):127-131
DOI:10.4103/0301-4738.179718  PMID:27050347
Purpose: To compare the efficacy and tolerability of brinzolamide/timolol (BT) and dorzolamide/timolol (DT) fixed combinations on intraocular pressure (IOP) reduction. Methods: Patients with primary open angle glaucoma or normal tension glaucoma were randomized to receive either BT or DT. IOPs were measured at baseline, 2 weeks, and 1, 2, and 3 months. The primary outcome measures were the mean change in IOP from baseline at each visit. Secondary outcome measures included the tolerability of each fixed combination. Results: Seventy-three patients (73 eyes) were included; 37 eyes in BT group and 36 eyes in DT group. Baseline mean IOP were 24.14 ± 4.5 and 29.53 ± 6 mmHg for BT and DT, respectively (P < 0.001). Both BT and DT provided statistically significant mean IOP reductions from baseline values within each group at all study visits (P < 0.001). DT provided greater mean IOP reductions from baseline than BT at each visit which was statistically significant at 2 weeks (P = 0.037). Mean percentage of IOP reduction was 24.35% and 46.33% at 2 weeks (P < 0.001), and 24.65% and 47% at 3 months (P < 0.001) for BT and DT, respectively. Patients' tolerability appeared to be better for DT than for BT with complete ocular comfort without any ocular adverse effects in 31 patients (81.1%) in DT group and 11 patients (29.7%) in BT group (P < 0.001). Conclusion: Both drops provide effective IOP reduction which was greater, and patients were more likely to achieve lower target pressures with DT than with BT.
  2,681 572 -
Multi-drug resistant Pseudomonas aeruginosa keratitis and its effective treatment with topical colistimethate
Samrat Chatterjee, Deepshikha Agrawal
February 2016, 64(2):153-157
DOI:10.4103/0301-4738.179721  PMID:27050354
The purpose was to evaluate the clinical outcome in multi-drug resistant Pseudomonas aeruginosa (MDR-PA) bacterial keratitis and report the successful use of an alternative antibiotic, topical colistimethate in some of them. The medical records of 12 culture-proven MDR-PA keratitis patients, all exhibiting in vitro resistance by Kirby–Bauer disc diffusion method to ≥ three classes of routinely used topical antibiotics were reviewed. Eight patients were treated with 0.3% ciprofloxacin or ofloxacin, 1 patient with 5% imipenem/cilastatin and 3 patients with 1.6% colistimethate. The outcomes in 8 eyes treated with only fluoroquinolones were evisceration in 4 eyes, therapeutic corneal graft in 1 eye, phthisis bulbi in 1 eye, and no improvement in 2 eyes. The eye treated with imipenem/cilastin required a therapeutic corneal graft. All the three eyes treated with 1.6% colistimethate healed. Colistimethate may prove to be an effective alternative antibiotic in the treatment of MDR-PA keratitis.
  2,592 560 -
A retrospective survey of childhood glaucoma prevalence according to Childhood Glaucoma Research Network classification
Ambika Hoguet, Alana Grajewski, Elizabeth Hodapp, Ta Chen Peter Chang
February 2016, 64(2):118-123
DOI:10.4103/0301-4738.179716  PMID:27050345
Purpose: To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification. Materials and Methods: Retrospectively, the medical records of 205 consecutive childhood glaucoma and glaucoma suspect patients at an urban tertiary care center were reviewed. The initial diagnosis and new diagnosis according to CGRN classification were recorded. Results: All patients fit one of the seven categories of the new classification. Seventy-one percent of diagnoses were changed upon reclassification. Twenty-three percent of patients had primary glaucoma (juvenile open-angle glaucoma and primary congenital glaucoma [PCG]); 36% had secondary glaucoma (glaucoma associated with nonacquired ocular anomalies; glaucoma associated with nonacquired systemic disease or syndrome; glaucoma associated with acquired condition; and glaucoma following cataract surgery); and 39% were glaucoma suspect. Of the patients diagnosed with glaucoma, PCG was the most common diagnosis, seen in 32% of patients. Conclusion: The CGRN classification provides a useful method of classifying childhood glaucoma.
  2,230 453 -
”FakeBooks” - predatory journals: The dark side of publishing
Sundaram Natarajan, Akshay Gopinathan Nair
February 2016, 64(2):107-108
DOI:10.4103/0301-4738.179733  PMID:27050342
  1,960 383 -
Hyaluronidase hypersensitivity: A rare complication of peribulbar block
AR Rajalakshmi, M Ashok Kumar
February 2016, 64(2):160-162
DOI:10.4103/0301-4738.179717  PMID:27050356
Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight-threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.
  1,896 257 -
Detection of the early keratoconus based on corneal biomechanical properties in the refractive surgery candidates
Zofia Pniakowska, Piotr Jurowski
February 2016, 64(2):109-113
DOI:10.4103/0301-4738.179725  PMID:27050343
Context: Subclinical keratoconus is contraindication to refractive surgery. The currently used methods of preoperative screening do not always allow differentiating between healthy eyes and those with subclinical keratoconus. Aim: To evaluate biomechanical parameters of the cornea, waveform score (WS), and intraocular pressure (IOP) as potentially useful adjuncts to the diagnostic algorithm for precise detection of the early keratoconus stages and selection of refractive surgery candidates. Settings and Design: Department of Ophthalmology and prospective cross-sectional study. Patients and Methods: Patients enrolled in the study were diagnosed with refractive disorders. We assessed parameters of corneal biomechanics such as corneal hysteresis (CH), corneal resistance factor (CRF), Goldman-correlated IOP (IOPg), corneal compensated IOP, WS, and keratoconus match index (KMI). They were classified into one of three groups based on the predefined KMI range: Group 1 (from 0.352 to 0.757) – 45 eyes, Group 2 (from −0.08 to 0.313) – 52 eyes, and Group 0 - control group (from 0.761 to 1.642) – 80 eyes. Results: In both study groups, IOPg, CRF, and CH were decreased when compared to control (P < 0.0001). In control group, there was positive correlation between CH and KMI (P < 0.05), with no correlations in any of the two study groups. CRF correlated positively with KMI in control (P < 0.0001) and in Group 2 (P < 0.05). Conclusions: CH and CRF, together with WS and IOPg, consist a clinically useful adjunct to detect subclinical keratoconus in patients referred for refractive surgery when based on KMI staging.
  1,681 462 -
Bilateral macular hemorrhage due to megaloblastic anemia: A rare case report
Sree Kumar Vaggu, Preethi Bhogadi
February 2016, 64(2):157-159
DOI:10.4103/0301-4738.179720  PMID:27050355
We report a case of a 17-year-old female patient who presented with sudden, painless, nonprogressive diminished vision in both eyes (best corrected visual acuity in right eye - 6/60 and left eye - 6/36). An ophthalmological evaluation revealed bilateral pale tarsal conjunctiva and bilateral macular hemorrhage. Hematological evaluation revealed the presence of megalocytic anemia (with hemoglobin - 4.9 g%). General examination showed severe pallor. On systemic examination, no abnormality was detected, confirmed by ultrasonography abdomen. Other causes of severe anemia have been ruled out. Intraocular pressure in both eyes was 12 mmHg. This case documents the rare occurrence of bilateral subinternal limiting membrane macular hemorrhage with megaloblastic anemia without thrombocytopenia and other retinal features of anemic retinopathy.
  1,642 274 -
Ab-interno scleral suture loop fixation with cow-hitch knot in posterior chamber intraocular lens decentration
Ertugrul Can, Nurullah Koçak, Özlem Eski Yücel, Adem Gül, Hilal Eser Öztürk, Osman Sayin
February 2016, 64(2):124-126
DOI:10.4103/0301-4738.179712  PMID:27050346
Aim of Study: To describe a simplified ab-interno cow-hitch suture fixation technique for repositioning decentered posterior chamber intraocular lens (PC IOL). Materials and Methods: Two cases are presented with the surgical correction of decentered and subluxated IOL. Ab-interno scleral suture fixation technique with hitch-cow knot in the eye was performed with a ciliary sulcus guide instrument and 1 year follow-up was completed. Results: Both of the patients had well centered lenses postoperatively. Corrected distant and near visual acuities of the patients were improved. There was no significant postoperative complication. In the follow-up period of 1 year, no evidence of suture erosion was found. Conclusions: Ab-interno scleral suture loop fixation with hitch-cow knot in the eye was effective in repositioning decentered or subluxated PC IOLs with excellent postoperative centered lenses and visual outcomes.
  1,531 213 -
Can higher end tonometers be used interchangeably in routine clinical practice?
Kunjan Jayantilal Patel, Saurabh P Jain, Priti R Kapadia, Nikunj V Patel, Saurabh Patel, Vikas Patel
February 2016, 64(2):132-135
DOI:10.4103/0301-4738.179723  PMID:27050348
Context: Precise intraocular pressure (IOP) measurement is important in glaucoma practise. Various instruments are available today to accurately measure IOP. Thus, the question arises about which instrument to use and whether all of them can be used interchangeably. Aims: To assess the agreement between noncontact tonometer (NCT), rebound tonometer (RBT), Goldmann applanation tonometer (GAT), and dynamic contour tonometer (DCT) in measuring IOP. Subjects and Methods: 499 eyes of 250 patients were evaluated during a period of 24 months from September 2010 to August 2012 and measurement of IOP by NCT, RBT, GAT, and DCT was done in the given sequence. The agreement was assessed by use of the Bland–Altman plot keeping GAT as a gold standard technique. Results: The mean IOP value of NCT, RBT, GAT, and DCT was 15.9 ± 5.5, 15.9 ± 5.8, 15.9 ± 4.9, and 16.0 ± 4.7 mm of Hg, respectively. The limits of agreement of GAT with DCT, NCT, and RBT were found to be +5.4 to −5.2, −4.7 to +4.6, and −5.2 to +5.1 mm of Hg, respectively. Conclusions: A positive and strong correlation was found between newer tonometers and GAT, but the limit of agreement was clinically unacceptable. The use of a single tonometer should be practised at a glaucoma clinic for a patient at each follow-up.
  1,316 308 -
Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes
Varsha M Rathi, Mukesh Taneja, Somasheila I Murthy, Bhupesh Bagga, Pravin Krishna Vaddavalli, Virender S Sangwan
February 2016, 64(2):140-144
DOI:10.4103/0301-4738.179715  PMID:27050350
Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best-corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Pre first PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.
  1,246 231 -
Syphilitic uveitis as the presenting feature of HIV
Ekta Rishi, Madanagopalan V Govindarajan, Jyotirmay Biswas, Mamta Agarwal, S Sudharshan, Pukhraj Rishi
February 2016, 64(2):149-150
DOI:10.4103/0301-4738.179714  PMID:27050352
  1,062 250 -
Spectral analysis of intraocular pressure pulse wave in ocular hypertensive and primary open angle glaucoma patients
Marija M Bozic, Miroslav L Dukic, Milenko Z Stojkovic
February 2016, 64(2):114-117
DOI:10.4103/0301-4738.179719  PMID:27050344
Context: In attempt to find an alternative way to determine conversion from ocular hypertension to primary open angle glaucoma (POAG) (besides visual field and optic disc changes), we analyzed intraocular pressure (IOP) pulse wave in spectral domain. Aims: The aim of this study was to test the potential differences in spectral content of IOP pulse wave between ocular hypertension and POAG patients, which could indicate conversion. Settings and Design: Cross-sectional study designed to test the differences in the spectral content of pressure pulse wave between nontreated ocular hypertensive and nontreated, freshly diagnosed POAG patients. Methods: The total of 40 eyes of 40 subjects was included: 20 previously untreated ocular hypertensive patients, and 20 previously untreated POAG patients. Continuous IOP measuring gained by dynamic contour tonometry was submitted to fast Fourier transform signal analysis and further statistical data processing. Statistics Analysis Used: Ocular and systemic characteristics of the tested subjects were compared by analysis of variance appropriate for this study design. A P < 0.05 was considered to be statistically significant. Results: Higher spectral components of the IOP pulse wave was discerned up to the fifth harmonic in both of the tested groups. No statistically significant differences were found in any of the tested harmonic amplitudes. Conclusions: There are no differences in the spectral content of IOP pulse wave between ocular hypertensive and primary open angle glaucoma patients which could be indicative for conversion.
  1,036 208 -
Lightning injury of posterior segment of the eye
Ekta Rishi, VP Indu, Pukhraj Rishi
February 2016, 64(2):151-152
DOI:10.4103/0301-4738.179724  PMID:27050353
  1,034 205 -
Anterior and posterior segment parameters measured with Fourier domain optical coherence tomography in photopic and scotopic conditions
Nishanee Rampersad, Rekha Hansraj
February 2016, 64(2):136-139
DOI:10.4103/0301-4738.179726  PMID:27050349
Purpose: To compare anterior and posterior segment parameters measured with the iVue-100 optical coherence tomography (OCT) in photopic and scotopic conditions. Methods: Central and peripheral corneal thickness, retinal nerve fiber layer and macula thickness were measured using the iVue-100 OCT in 47 healthy individuals at a higher education institution in photopic (958 lux) and scotopic (0.03 lux) conditions. Results: As the lighting conditions changed from scotopic to photopic, a significant change in pupil size was noted (P < 0.001). However, there was no significant difference in central corneal thickness measurements with this change in surrounding illumination with only the temporal peripheral corneal area showing a significant difference (3.44 μm thinner). No significant differences were found in the retinal nerve fiber layer thickness. A significant decrease in the reading was noted in only the inferior (P = 0.05) and temporal (P = 0.05) inner macula area. Conclusion: Change in the ambient lighting conditions does not result in a clinically significant difference in corneal, retinal nerve fiber layer, and macula thickness when measured with the iVue-100 OCT,
  952 148 -
Management of Heavy Eyeball Syndrome - our experience
Javed H Farooqui, Huong Thu Tran, Ahmed Gomaa
February 2016, 64(2):169-170
DOI:10.4103/0301-4738.179728  PMID:27050362
  815 180 -
Handheld spectral domain optical coherence tomography seems to be a must-have device for future treatment methods of hereditary maculopathies
Oktay Diner, Yakup Aksoy, Abdullah Kaya, Mehmet Koray Sevinç
February 2016, 64(2):171-172
DOI:10.4103/0301-4738.179730  PMID:27050364
  766 125 -
A case of spontaneously resolved primary congenital glaucoma
Sujata Subbiah, Sophia Louis, Antony Arokiadass Baskaran, Philip A Thomas
February 2016, 64(2):167-168
DOI:10.4103/0301-4738.179732  PMID:27050360
  713 136 -
Traumatic central serous chorioretinopathy in the fellow eye
Seung-Young Yu, Yonguk Kim, Hyung-Woo Kwak, Moosang Kim
February 2016, 64(2):170-171
DOI:10.4103/0301-4738.179731  PMID:27050363
  705 142 -
Comment on: Traumatic central serous chorioretinopathy
Brijesh Takkar, Shorya Azad
February 2016, 64(2):166-167
DOI:10.4103/0301-4738.179729  PMID:27050359
  689 118 -
Two cases of ultrathin Descemet stripping automated endothelial keratoplasty utilizing a graft that had undergone radial keratotomy
Yoav Nahum, Diego Ponzin, Massimo Busin
February 2016, 64(2):162-164
DOI:10.4103/0301-4738.179713  PMID:27050357
This is a report of two cases in which tissue that had undergone radial keratotomy (RK) was utilized for double-pass ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). Postoperative slit-lamp examination, visual acuity, anterior segment optical coherence tomography, and specular microscopy were available 30 months after surgery. Both corneas from a donor, who had undergone RK several years before his demise, and were otherwise suitable for endothelial keratoplasty were prepared for UT-DSAEK using double-pass dissection using first a 300 mm microkeratome head and then a 130μm microkeratome head (ALTK system, Moria, Antony, France). After the second cut, the tissue was punched to 9.0 mm and transplanted in two eyes with endothelial decompensation according to standard technique. As early as 3 months after surgery, both patients had 20/25 best-corrected visual acuity, which remained stable for the following 27 months. Postoperative endothelial cell loss was 34% and 57% at 2.5 years. In conclusion, post-RK donor tissue can be used for UT-DSAEK.
  671 129 -
Macular hole formation and spontaneous closure following neodymium-doped yttrium aluminum garnet capsulotomy in a vitrectomized eye
Jongyeop Park, Yengwoo Son, Seungwoo Lee
February 2016, 64(2):165-166
DOI:10.4103/0301-4738.179722  PMID:27050358
  650 118 -
Author reply
Gaurav Sanghi, Gagandeep S Brar, Rajeev Gupta, Ashish Ahuja
February 2016, 64(2):168-168
  400 83 -