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   2016| August  | Volume 64 | Issue 8  
    Online since September 30, 2016

 
 
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BRIEF COMMUNICATIONS
Ocular toxicity by seeds of Annona squamosa (custard apple)
Harsha Nagaraja, Thungappa Kugar, Yathish Shivanna, Archita Agrawal, Rohit Shetty
August 2016, 64(8):611-613
DOI:10.4103/0301-4738.191514  PMID:27688289
Custard apple seeds have been used in native medicine from time immemorial for the management of head lice and skin exfoliation. We report six consecutive patients who developed toxic keratoconjunctivitis within 6-12 h of ocular exposure to custard apple seeds. The use of topical steroid worsens the toxicity and predisposes to the development of microbial keratitis in such cases. Patients showed a good response to primary treatment with topical fortified antibiotics and lubricants. This case series highlights the need to educate the patients regarding the potential toxic effects of the custard seeds and the treating physicians about possible deleterious effects on using topical steroid.
  4,119 263 -
ORIGINAL ARTICLES
Repair of 50-75% full-thickness lower eyelid defects: Lateral stabilization as a guiding principle
C Blake Perry, Richard C Allen
August 2016, 64(8):563-567
DOI:10.4103/0301-4738.191488  PMID:27688276
Introduction: Repair of large defects of the lower eyelid can be difficult. A common procedure performed to address these defects is a Hughes flap. This procedure has a number of disadvantages: The eye is closed postoperatively, a second stage is required, and the edge of the flap is often erythematous. The purpose of this paper is to describe a one-stage procedure for the repair of large full-thickness defects of the lower lid as an alternative to a Hughes flap. Materials and Methods: This is a retrospective study of patients who underwent the described procedure. The procedure employs lateral stabilization of the posterior lamella with a periosteal strip, medial transposition of the lateral posterior lamella for central and medial defects, and a myocutaneous advancement flap to stabilize the anterior lamella. Results: A total of 38 patients underwent the procedure to reconstruct full-thickness defects of the lower lid ranging from 50% to 75%. All patients underwent previous Mohs excision of a skin cancer. The average follow-up was 5.6 months. Eleven patients (29%) had postoperative sequelae, but only two patients (5%) required additional treatment. Conclusion: Lateral stabilization with a periosteal strip and myocutaneous advancement flap is an excellent one-step procedure that avoids many of the complications seen with the Hughes procedure and is comparable to other techniques used for the reconstruction of subtotal, full-thickness lower lid defects.
  3,304 399 -
Prevalence of glaucoma in Eastern India: The Hooghly River Glaucoma Study
Chandrima Paul, Subhrangshu Sengupta, Sumit Choudhury, Souvik Banerjee, Betsy L Sleath
August 2016, 64(8):578-583
DOI:10.4103/0301-4738.191497  PMID:27688279
Context: Glaucoma is the leading cause of global irreversible blindness. No recent study with adequate sample size has been carried out to estimate glaucoma prevalence in Eastern India. Aims: The aim of this study was to assess and compare the prevalence and types of glaucoma in a rural and urban East Indian population. Settings and Design: The Hooghly River Glaucoma Study (HRGS) is a population-based cross-sectional study from West Bengal. A tertiary hospital in Kolkata was our urban study center. Our rural study area included 28 contiguous villages from the district of Hooghly surrounding the rural base hospital located at Dhobapara in village Bakulia. Individuals aged 40 years and above were included in this study. Subjects and Methods: All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. Glaucoma was defined using modified International Society of Geographical and Epidemiological Ophthalmology criteria. Statistical Analysis Used: Analysis was performed using Chi-square test and multiple logistic regression using SPSS. Results: Totally, 14,092 individuals participated; 2.7% were detected to have glaucoma in rural arm and 3.23% in urban arm (P < 0.001). In urban population, 2.10% had primary open angle glaucoma (POAG), 0.97% had primary angle closure glaucoma (PACG), and 0.15% had secondary glaucoma. In rural population, 1.45% had POAG, 1.15% had ACG, and 0.10% had secondary glaucoma. Conclusions: HRGS is the largest population-based glaucoma study in India to date with glaucoma prevalence comparable to other landmark Indian studies. POAG was the most common form of glaucoma in our study population as well. PACG was more common in this region than previously thought.
  2,066 321 -
OPHTHALMOLOGY PRACTICE
A treatment method for chronic suppurative lacrimal canaliculitis using chalazion forceps
Xiuming Jin, Fangli Fan, Fan Zhang, Yingying Zhao, Renjian Hu
August 2016, 64(8):589-592
DOI:10.4103/0301-4738.191506  PMID:27688281
Purpose: The purpose of this study is to evaluate the effectiveness of chronic suppurative lacrimal canaliculitis treatment using chalazion forceps. Patients and Methods: A prospective study was performed on consecutive patients who accepted the aid of chalazion forceps to treat chronic suppurative lacrimal canaliculitis. Two different treatment methods using chalazion forceps were performed according to the degree of lacrimal canaliculitis. Postoperatively, the patients received 0.5% levofloxacin eye drops four times per day and 0.5 g oral levofloxacin tablets once per day for 4 days. The follow-up period was more than 3 months. Lacrimal irrigation, the condition of the lacrimal punctum, and patients' symptoms were carefully evaluated. Results: In total, 32 patients met the criteria for chronic suppurative lacrimal canaliculitis. Included were 6 males and 26 females. Their average age was 51.7 ± 14.9 years (range; 19-80 years), and all had unilateral canaliculitis. The mean duration of the symptoms was 18.9 ± 9.8 months (range; 3-48 months). The mean follow-up time was 14.7 ± 7.8 months. The signs and symptoms resolved completely in all patients within 15 days, and no recurrence was observed. No patients reported epiphora after the treatment. Conclusions: The use of chalazion forceps is effective in treating chronic suppurative lacrimal canaliculitis. The forceps may offer an alternative treatment technology in the management of suppurative lacrimal canaliculitis.
  2,154 214 -
ORIGINAL ARTICLES
Anterior stromal puncture with staining: A modified technique for preoperative reference corneal marking for toric lenses and its retrospective analyses
Sahil Bhandari, Manas Nath
August 2016, 64(8):559-562
DOI:10.4103/0301-4738.191486  PMID:27688275
Introduction: Toric intraocular lenses (IOLs) are an effective way of compensating preexisting corneal astigmatism during cataract surgery. To achieve success, it is imperative to align the toric IOLs in desired position and preoperative reference marking is one among the three important steps for accurate alignment. To make the marking procedure simpler and effective, we have modified the conventional three-step slit lamp-based technique. Materials and Methods: Patient is seated in front of the slit lamp and asked to keep the chin over chin rest. A 26-gauge bent needle with tip stained by sterile blue ink marker is used to make anterior stromal puncture (ASP) at the edges of horizontal 180° axis near the limbus. Results: A total of 58 eyes were retrospectively evaluated. Mean (+/-SD) IOL deviation on day 1 and day 30 was 5.7 ± 6.5° and 4.7 ± 5.6°, respectively. Median IOL misalignment on day 1 and day 30 was 3°. Redialing of IOL was required in 2 (3.4%) eyes only, all of which were performed within 1 week of surgery. In total, 2 (3.7%) eyes had a residual astigmatism of − 0.5 Dcyl and − 1.0 Dcyl, respectively. Conclusion: ASP is an effective technique for reference marking, technically simpler and can be practiced by most of the surgeons. It avoids the necessity of high-end sophisticated machinery and gives a better platform for the reference corneal marking along with the benefit of reproducibility and simplicity.
  2,005 257 -
Clinical spectrum, diagnostic criteria, and polymerase chain reaction of aqueous humor in viral and toxoplasma detection in Fuchs' uveitis syndrome
Swapnali Sabhapandit, Somasheila I Murthy, Praveen K Balne, Virender Singh Sangwan, V Sumanth, Ashok K Reddy
August 2016, 64(8):555-558
DOI:10.4103/0301-4738.191485  PMID:27688274
Aim : The aim of this study is to describe the clinical features and diagnostic criteria of Fuchs' uveitis (FU) and to determine whether it has an association with virus and toxoplasma in the aqueous humor during cataract surgery. Setting and Design : This is a prospective, case-control study. Materials and Methods : Patients with FU (n = 25), anterior uveitis (n = 15), and no uveitis (normal) (n = 50) were included based on predefined inclusion and exclusion criteria for all three groups. Polymerase chain reaction (PCR) of aqueous humor and serum for rubella, herpes simplex virus (HSV), cytomegalovirus (CMV), varicella-zoster virus (VZV), and toxoplasma was done using conventional uniplex PCR. Statistical Analysis : It was done using SPSS software using Chi-square test for categorical variables, and P < 0.05 was considered statistically significant. Results : Ninety patients were enrolled in the study in three groups, comparable for age, gender, and laterality of ocular involvement. All patients had diffuse keratic precipitates in FU group (P = 0001) with none having posterior synechiae (P = 0.046) which was statistically significant when compared to anterior uveitis patients. Iris nodules were noted in one case in both groups. Serum and aqueous PCR was negative for detection of VZV, CMV, toxoplasma, and rubella in all groups. PCR for HSV was positive in one patient in "normal" group but was not statistically significant. Conclusion: Our study shows that diagnosis of FU is mainly clinical. There appears to be no role of aqueous humor testing for viruses by PCR to aid in etiological diagnosis.
  1,647 346 -
Burden and depression in primary caregivers of persons with visual impairment
Shubhank Khare, Jolly Rohatgi, Manjeet Singh Bhatia, Upreet Dhaliwal
August 2016, 64(8):572-577
DOI:10.4103/0301-4738.191493  PMID:27688278
Context: Caregivers who assist persons with visual impairment often neglect their needs, resulting in burden and depression. Rehabilitation efforts, directed to the disabled, seldom target the caregiver. Aim: To assess burden and depression in persons caring for blind individuals. Settings and Design: This was a cross-sectional study carried out in the outpatient department of a tertiary-level teaching hospital in New Delhi. Materials and Methods : Institutional Ethical Board approval was obtained and written informed consent too was obtained from the participants involved in this study. Persons with best-corrected vision <20/200 in the better eye, and their primary caregivers, were recruited. We recorded demography, other illness/disability, household income, relationship with disabled person, and caregiver burden (Caregiver Burden Scale) and depression (Centre for Epidemiologic Studies Depression Scale). Statistical Analysis: Statistical analysis was carried out using SPSS version 20 (Released 2011. Armonk, NY: IBM Corp.); range, average, and standard deviation were determined for age, burden, and depression. The association between burden and depression was determined using Pearson's correlation; the relationship between degree of disability and caregiver burden and depression was determined using unpaired t-test; using multiple linear regression, factors were found to be statistically significant; significance was taken at P < 0.05. Results: Twenty-seven (53.0%) men and 24 (47.0%) women had visual impairment. Most caregivers (n = 40; 81.6%) were first-degree relatives or a spouse; 32 (65%) had schooling <5 years; and 29 (59%) were unemployed. Depression ranged from 21 to 52 (average 43.2 ± 5.71); it correlated with degree of disability (P = 0.012), household income (r = −0.320; P = 0.025), and burden (r = 0.616; P < 0.001). Burden ranged from 30 to 73 (average 54.5 ± 6.73) and correlated with degree of disability (P = 0.006). On multiple linear regression, burden predicted depression (r = 0.557; P < 0.001). Conclusions: Caregivers merit community support, financial benefit, interventions to diagnose and treat depression, and training in coping. Centers that provide disability certification could offer counseling.
  1,690 271 -
BRIEF COMMUNICATIONS
IgG4-related intraocular inflammation masquerading as ciliary body melanoma in a young girl
Dipankar Das, Panna Deka, Geeta Verma, Ganesh Chandra Kuri, Harsha Bhattacharjee, Gayatri Bharali, Divya Pandey, Akanksha Koul, Bidisha Das, Apurba Deka
August 2016, 64(8):601-603
DOI:10.4103/0301-4738.191510  PMID:27688285
Immunoglobulin G4 (IgG4-related diseases) affects various tissues and organs of the human body. Orbital, adnexal, and scleral inflammations were already reported in the medical literature. To the best of our knowledge, we report the first case of intraocular IgG4-associated inflammatory mass in the ciliary body mimicking as a melanoma in a 23-year-old female from Northeast India. Characteristic histopathology, immunohistochemistry in the tissue, protein chemistry, and raised serum IgG4 were supportive for the diagnosis. As this newly diagnosed disease has multi-organ affection and little is known about its pathogenesis particularly in eye and adnexa, the present case will open many challenges in clinico-pathological diagnosis and research in the future.
  1,656 168 -
A rare case of Enterococcus faecalis-induced orbital cellulitis and myositis
Piyush Kohli, Parul Ichhpujani, Rakesh Kumar Bansal, Suresh Kumar
August 2016, 64(8):609-611
DOI:10.4103/0301-4738.191513  PMID:27688288
Orbital cellulitis is an infection of soft tissue behind the orbital septum. Common pathogens isolated include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. It is a straightforward diagnosis and usually responds to empirical treatment without any sequela. We report a case of orbital cellulitis caused by Enterococcus faecalis, which was complicated by myositis of levator palpebrae superioris. To the best of our knowledge, only one case report exists dating way back to 1986.
  1,552 151 -
ORIGINAL ARTICLES
To assess surgical outcomes of combined femtosecond laser-assisted cataract surgery with 25-gauge vitrectomy surgery at a tertiary eye care center
Aditya Kelkar, Jai Kelkar, Sampada Chitale, Rachana Shah, Ashish Jain, Shreekant Kelkar
August 2016, 64(8):584-588
DOI:10.4103/0301-4738.191501  PMID:27688280
Background: The aim of this study was to assess the surgical outcomes of combined femtosecond laser-assisted cataract surgery (FLACS) with 25-gauge vitrectomy surgery. Materials and Methods: A retrospective analysis of 45 patients who underwent combined FLACS with 25-gauge vitrectomy surgery. Results: A total number of 45 eyes of 45 patients were treated with a mean age of 63.27 years (range 45-75). The mean follow-up was 3 months (range 3-12 months). The mean preoperative best-corrected visual acuity was 1.47 ± 0.86. The mean postoperative vision was 0.36 ± 0.36 and 0.275 ± 0.184 at a paired t-test revealed a statistically significant improvement in visual acuity at 1 month (P < 0.001) and 3 months (P < 0.001). The most common indication for surgery was full-thickness macular hole (51.1%), vitreous hemorrhage (24.4%), followed by epiretinal membrane (17.7%) and rhegmatogenous retinal detachment (4.4%). Conclusion: Combining FLACS with vitrectomy may be a step toward achieving better outcomes when combined CS and vitrectomy is performed.
  1,517 178 -
LETTERS TO THE EDITOR
Reply to comment: The effect of anterior transposition of the inferior oblique muscle on eyelid configuration and function
Tugba Göncü, Sevim Çakmak, Ali Akal, Halit Oguz
August 2016, 64(8):615-616
DOI:10.4103/0301-4738.191517  PMID:27688292
  1,587 60 -
EDITORIAL
The emerging battlefront: Infectious diseases
Sundaram Natarajan
August 2016, 64(8):553-554
DOI:10.4103/0301-4738.191482  PMID:27688273
  1,369 227 -
PHOTO ESSAY
Diagnosis and a minimum effective management for nanophthalmic uveal effusion syndrome
Wei Jin, Yaopeng Xu, Wenjun Wang, Anhuai Yang
August 2016, 64(8):593-594
DOI:10.4103/0301-4738.191507  PMID:27688282
  1,019 177 -
BRIEF COMMUNICATIONS
An unusual case of protruding retro-orbital metallic foreign body
Maya Hada, Parijat Chandra, Anil Gangwe
August 2016, 64(8):604-606
DOI:10.4103/0301-4738.191511  PMID:27688286
A 34-year-old female presented with firecracker injury with curved metallic foreign body embedded in the left orbit and protruding out through the upper eyelid. The report highlights notable aspects in diagnosis, decision-making, and successful removal of this unusual case of retro-orbital foreign body.
  987 153 -
Interface infectious keratitis following deep anterior lamellar keratoplasty
Shreesha Kumar Kodavoor, Ramamurthy Dandapani, Ajay Ramesh Kaushik
August 2016, 64(8):597-600
DOI:10.4103/0301-4738.191509  PMID:27688284
A 32-year-old female patient underwent deep anterior lamellar keratoplasty (DALK) in both eyes for advanced keratoconus. She developed an infiltrate in the nasal paracentral interface of the left eye. In view of the paracentral location, localized epithelial removal/stromal scraping was done and the infiltrate was removed using forceps and sent for microbiological assay, which revealed fungal filaments. The patient successfully responded to intensive topical antifungal therapy with the maintenance of visual acuity. Interface keratitis following DALK frequently needs graft lift/interface wash due to deep location, rapid spread and poor penetration and efficacy of topical medications. In view of a paracentral location, modified debulking with topical therapy resulted in a satisfactory outcome in our case thereby avoiding the need for more invasive treatments.
  912 169 -
Choroidal neovascular membrane in a treated choroidal hemangioma
Chokkahalli K Nagesha, Jaydeep Avinash Walinjkar, Vikas Khetan
August 2016, 64(8):606-608
DOI:10.4103/0301-4738.191512  PMID:27688287
Association of choroidal neovascular (CNV) membrane with circumscribed choroidal hemangioma is rare, and the CNV development after photodynamic therapy (PDT) is also rare. Etiopathogenesis of these associations is poorly understood. We noted the development of CNV over choroidal hemangioma after PDT therapy in a young female patient in our hospital. Temporal association of CNV development after PDT treatment points toward the possible side effects of PDT. Repeat injections of antivascular endothelial growth factor (ranibizumab) regressed the CNV resulting in a favorable visual outcome.
  915 143 -
ORIGINAL ARTICLES
Laser intervention on trabeculo-Descemet's membrane after resistant viscocanalostomy: Selective 532 nm gonioreconditioning or conventional 1064 nm neodymium-doped yttrium aluminum garnet laser goniopuncture?
Huri Sabur, Mehmet Baykara, Basak Can
August 2016, 64(8):568-571
DOI:10.4103/0301-4738.191489  PMID:27688277
Purpose: To compare the results of conventional 1064 nm neodymium-doped yttrium-aluminum garnet laser goniopuncture (Nd:YAG-GP) and selective 532 nm Nd:YAG laser (selective laser trabeculoplasty [SLT])  gonioreconditioning (GR) on trabeculo-Descemet's membrane in eyes resistant to viscocanalostomy surgery. Methods: Thirty-eight eyes of 35 patients who underwent laser procedure after successful viscocanalostomy surgery were included in the study. When postoperative intraocular pressure (IOP) was above the individual target, the eyes were scheduled for laser procedure. Nineteen eyes underwent 532 nm SLT-GR (Group 1), and the remaining 19 eyes underwent conventional 1064 nm Nd:YAG-GP (Group 2). IOPs before and after laser (1 week, 1 month, 3 months, 6 months, 1 year, and last visit), follow-up periods, number of glaucoma medications, and complications were recorded for both groups. Results: Mean times from surgery to laser procedures were 17.3 ± 9.6 months in Group 1 and 13.0 ± 11.4 months in Group 2. Mean IOPs before laser procedures were 21.2 ± 1.7 mmHg in Group 1 and 22.8 ± 1.9 mmHg in Group 2 (P = 0.454). Postlaser IOP measurements of Group 1 were 12.1 ± 3.4 mmHg and 13.8 ± 1.7 mmHg in the 1 st week and last visit, respectively; in Group 2, these measurements were 13.6 ± 3.7 mmHg and 14.9 ± 4.8 mmHg, respectively. There were statistically significant differences (P < 0.001) in IOP reduction at all visits in both groups; the results of the two groups were similar (P > 0.05). Mean follow-up was 16.6 ± 6.4 months after SLT-GR and 18.9 ± 11.2 months after Nd:YAG-GP. Conclusions: While conventional Nd:YAG-GP and SLT-GR, a novel procedure, are both effective choices in eyes resistant to viscocanalostomy, there are fewer complications with SLT-GR. SLT-GR can be an alternative to conventional Nd:YAG-GP.
  829 214 -
LETTERS TO THE EDITOR
Comment on: Childhood optic atrophy in biotinidase deficiency
N Venugopal, Sherin Kummararaj
August 2016, 64(8):614-614
DOI:10.4103/0301-4738.191515  PMID:27688290
  911 118 -
BRIEF COMMUNICATIONS
Orbital infarction syndrome after multiple percutaneous sclerotherapy sessions for facial low-flow vascular malformation: A case report and literature review
Weng Sut Sio, Shwu-Huey Lee, I-Chia Liang
August 2016, 64(8):595-597
DOI:10.4103/0301-4738.191508  PMID:27688283
Vision loss following sclerotherapy for facial vascular malformations (VMs) is a rare but detrimental complication. Here, we report a case of an 11-year-old boy with acute onset blepharoptosis, ophthalmoplegia, and blindness in his right eye after the 14 th sclerotherapy session (percutaneous intralesional injection of sodium tetradecyl sulfate) for a right facial low-flow VM without orbital involvement. Computed tomography angiography revealed no contrast enhancement in the right ophthalmic artery, superior ophthalmic vein, or extraocular muscles. He presented with the hallmarks of orbital infarction syndrome: Clear signs of anterior and posterior segment ischemia and disrupted arterial flow to the extraocular muscles. His blepharoptosis and eye movement improved 4 months later; however, he remained blind, and phthisis bulbi developed eventually. Thus, sclerotherapy for facial VM-even without orbital involvement--may result in severe ocular and orbital complications.
  855 159 -
LETTERS TO THE EDITOR
Comment on: Role of subconjunctival bevacizumab in primary pterygium surgery
Siddharudha Shivalli, Soujanya Kaup
August 2016, 64(8):614-615
DOI:10.4103/0301-4738.191516  PMID:27688291
  732 153 -