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   2018| November  | Volume 66 | Issue 11  
    Online since October 25, 2018

 
 
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LETTERS TO THE EDITOR
World diabetes day 2018: Battling the Emerging Epidemic of Diabetic Retinopathy
Suresh K Pandey, Vidushi Sharma
November 2018, 66(11):1652-1653
DOI:10.4103/ijo.IJO_1681_18  PMID:30355895
  140,795 392 52
REVIEW ARTICLES
Lasers in glaucoma
Harsh Kumar, Tarannum Mansoori, Gazella B Warjri, Bindu I Somarajan, Suman Bandil, Viney Gupta
November 2018, 66(11):1539-1553
DOI:10.4103/ijo.IJO_555_18  PMID:30355858
While lasers have been used for many years for the treatment of glaucoma, proper indications and use of the procedures need to be considered before their application. This review summarizes the important laser procedures in Glaucoma.
  8,977 1,285 18
EDITORIAL
Patient–physician relationship – Communication is the key
Santosh G Honavar
November 2018, 66(11):1527-1528
DOI:10.4103/ijo.IJO_1760_18  PMID:30355854
  4,986 740 27
LETTERS TO THE EDITOR
Comment on: Culture-positive unilateral panophthalmitis in a serology-2 positive case of dengue hemorrhagic fever
Chanda Gupta, Manisha Agarwal, Shalini Singh, Rahul Mayor, Vikram Vinayak Koundanya
November 2018, 66(11):1660-1661
DOI:10.4103/ijo.IJO_1301_18  PMID:30355903
  4,583 140 -
REVIEW ARTICLES
Imagining eye care in India (2018 Lalit Prakash Agarwal lecture)
Taraprasad Das, Lapam Panda
November 2018, 66(11):1532-1538
DOI:10.4103/ijo.IJO_872_18  PMID:30355857
India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995–2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the “old” tradition of empathy and the “new” technology of analytics, is required to imagine the future of eye care in India.
  4,004 582 7
GUEST EDITORIAL
Withering trust: Redefining the doctor patient relationship
Amitava Ray, Vanita Pathak-Ray
November 2018, 66(11):1529-1530
DOI:10.4103/ijo.IJO_821_18  PMID:30355855
  3,403 523 1
CASE REPORTS
Paracetamol-induced fixed drug eruption presenting as eyelid skin necrosis
Prajakta Kimmatkaar, Sima Das, Arpan Gandhi, Vidya Taneja
November 2018, 66(11):1627-1629
DOI:10.4103/ijo.IJO_448_18  PMID:30355885
Fixed drug eruption (FDE) is a type of drug-induced cutaneous disorder that characteristically presents with recurrence of similar lesion at the same skin or mucosal site as a result of systemic exposure to a drug. Paracetamol is commonly prescribed analgesic-antipyretic agent in all age group of patients. FDE due to paracetamol is not very common but it is well reported in literature for all age groups. We report a case of a 7-year-old male with FDE due to paracetamol involving upper eyelid and presenting as an eyelid skin necrosis.
  3,502 353 2
ORIGINAL ARTICLES
A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study
Shweta G Rathi, Natasha G Seth, Savleen Kaur, Faisal Thattaruthody, Sushmita Kaushik, Srishti Raj, Surinder S Pandav, Jagat Ram
November 2018, 66(11):1580-1585
DOI:10.4103/ijo.IJO_427_18  PMID:30355865
Purpose: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. Methods: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ≥5–≤18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. Results: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). Conclusion: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.
  3,341 416 20
Low-cost three-dimensional printed orbital template-assisted patient-specific implants for the correction of spherical orbital implant migration
Tarjani Vivek Dave, Sweety Tiple, Sandeep Vempati, Mansha Palo, Mohammad Javed Ali, Swathi Kaliki, Milind N Naik
November 2018, 66(11):1600-1607
DOI:10.4103/ijo.IJO_472_18  PMID:30355870
Purpose: To describe the outcomes of a patient-specific implant (PSI), fabricated using a three-dimensional (3D) printed orbital template and placed in the basin of the inferior orbital fissure to correct inferotemporally migrated spherical orbital implant. Methods: This is a single-center, prospective, consecutive, interventional, case series of six patients, with non-porous, spherical, orbital implant migration that underwent implant recentration surgically with a novel technique. Migration was subclassified either as decentration that did not affect the prosthetic retention or as displacement that affected the prosthetic retention in the eye socket. Only implant displacements were treated. The primary outcome measure was centration of the implant clinically and radiologically, with ability to retain the prosthesis. Results: At a mean follow-up of 21 months, all six orbital spherical implants remained centered. There were no cases of extrusion, exposure, or migration of either implants. There were no cases of PSI displacement. Additional procedures to optimize the aesthetic outcome of the customized ocular prosthesis (COP) required were simultaneous fornix formation suture in three patients, subsequent fornix formation with mucus membrane graft in two patients, and levator resection and sulcus hyaluronic acid gel injection in one patient each. The mean PSI implant weight was 2.66 ± 0.53 g. The mean COP weight was 2.2 ± 0.88 g postoperatively. The median patient satisfaction with the procedure was 9 on 10. Conclusion: A 3D printing-assisted PSI placed in the basin of the inferior orbital fissure allows recentration of the migrated implant over a follow-up of 21 months without complications.
  3,379 352 8
OPHTHALMIC IMAGES
Epicapsular stars
Saurabh Deshmukh, Harsha Bhattacharjee, Krati Gupta
November 2018, 66(11):1624-1625
DOI:10.4103/ijo.IJO_578_18  PMID:30355883
  3,009 189 6
ORIGINAL ARTICLES
Comparison of changes in refractive error and corneal curvature following small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis surgery
Ya L Zhang, Li J Cao, Hong W Chen, Xiang H Xu, Zhao N Li, Lei Liu
November 2018, 66(11):1562-1567
DOI:10.4103/ijo.IJO_366_18  PMID:30355861
Purpose: To compare visual acuity, refractive error, corneal curvature, and the stability of these parameters during the early postoperative period following small-incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) surgery. Methods: One hundred and five eyes and 110 eyes were enrolled in SMILE and FS-LASIK group, respectively. Uncorrected and best-corrected distance visual acuity (UCVA and BCVA), manifest refraction, corneal curvature, intraocular pressure, and slit-lamp examinations were performed preoperatively, 1 day, 1 week, 1 month, and 3 months postoperatively. Results: No significant differences in postoperative UCVA or BCVA were observed between the SMILE and FS-LASIK groups at any time point. SMILE group had significant better postoperative spherical equivalent (SE) values than FS-LASIK group at 1 day, 1 week, and 1-month follow-up. However, there was no significant difference in postoperative SE values at 3-month follow-up. Significant differences in mean postoperative corneal curvature were observed during all follow-up examinations. Conclusion: SMILE surgery was associated with more accurate postoperative refractive correction up to 1 month following surgery. SMILE surgery also resulted in less significant corneal curvature changes than FS-LASIK. Furthermore, FS-LASIK was associated with decreased stability of postoperative refractive error and corneal curvature relative to SMILE.
  2,476 394 6
Primary limbal stem cell transplantation in the surgical management of extensive ocular surface squamous neoplasia involving the limbus
Purvasha Narang, Vikas Mittal, Vikas Menon, Anirban Bhaduri, Bhaskar Roy Chaudhuri, Santosh G Honavar
November 2018, 66(11):1569-1573
DOI:10.4103/ijo.IJO_348_18  PMID:30355863
Purpose: To determine the role of primary limbal stem cell transplantation (LSCT) in managing extensive ocular surface squamous neoplasia (OSSN) with more than 3 quadrants of limbal involvement to prevent manifestations of limbal stem cell deficiency. Methods: A multi-center, comparative, and interventional clinical study of cases and historical controls was done. Patients with a limbal mass suggestive of OSSN involving more than 3 quadrants of limbus (> 9 clock hours) and no local, regional or systemic metastasis, who underwent primary surgical excision with or without adjuvant chemotherapy and had a minimum follow-up of 12 months were included in this study. Two historical controls underwent tumor excision with only amniotic membrane grafting. Three cases underwent tumor excision along with LSCT in the form of conjunctival limbal autograft (CLAG) or simple limbal epithelial transplant (SLET). Results: None of the eyes had any recurrences of OSSN during the follow-up period. Cases with primary LSCT with tumor excision showed better ocular surface stability in the long term. Conclusion: Concomitant LSCT either in the form of CLAG or SLET appears to provide better long-term outcomes and is advocated while excision of extensive OSSN involving the limbus.
  2,467 355 8
Comparative analysis of visual outcomes and ocular aberrations following wavefront optimized and topography-guided customized femtosecond laser in situ keratomileusis for myopia and myopic astigmatism: A contralateral eye study
Nitin N Tiwari, Gitansha S Sachdev, Shreyas Ramamurthy, Ramamurthy Dandapani
November 2018, 66(11):1558-1561
DOI:10.4103/ijo.IJO_507_18  PMID:30355860
Purpose: To compare the visual outcomes and higher order aberrations (HOAs) following wavefront optimized (WFO) laser in situ keratomileusis (LASIK) versus topography-guided customized ablation (TCAT) LASIK for myopia and myopic astigmatism. Methods: Patients who underwent femtosecond-assisted LASIK for myopic correction between August 2016 and October 2017 were included in this interventional prospective case series. The following parameters were evaluated preoperatively and at 3 months' postoperative visit: uncorrected distance vision acuity (UDVA) and corrected distance vision acuity (CDVA), manifest refraction, and HOAs. Results: Two hundred eyes of 100 patients were included in the study. At 3 months' postoperative visit, 92% and 90% eyes in the TCAT and WFO groups, respectively, demonstrated a UDVA of 20/20 or better (P = 0.90). A residual manifest spherical equivalent within 0.5 D was achieved in 100% and 95% of the eyes in the TCAT and WFO groups, respectively (P = 0.10). No significant difference was observed in the HOAs induced in both the groups, with slightly lower induction of trefoil and horizontal coma in the TCAT group. Conclusion: Both groups demonstrated similar refractive efficacy and predictability, with greater gain of CDVA following TCAT ablation. HOAs induced were not significantly different between the two groups. Further studies are needed to validate the superiority of one procedure over the other.
  2,418 311 23
ONE MINUTE OPHTHALMOLOGY
Unilateral macular drusen in a young female
Kareem Sioufi, Katherine E Talcott, Marc J Spirn
November 2018, 66(11):1531-1531
DOI:10.4103/ijo.IJO_1349_18  PMID:30355856
  2,149 449 1
CASE REPORTS
Conjunctival myxoma: A case report with unique high frequency ultrasound (UBM) findings
Puneet Jain, Paul T Finger, Codrin E Iacob
November 2018, 66(11):1629-1631
DOI:10.4103/ijo.IJO_518_18  PMID:30355886
A 39-year-old female presented with a painless yellow-pink tumor on her right eye. High-frequency ultrasound imaging revealed an epibulbar lesion with homogenous low internal reflectivity and no evidence of intraocular invasion. The patient underwent excisional biopsy leading to a pathology diagnosis of myxoma. Additional surgical margins as well as adjuvant cryotherapy margins were followed by extensive conjunctival repair. Herein, we report on a conjunctival myxoma with unique ultrasonographic findings.
  2,253 234 3
Real-time polymerase chain reaction for diagnosis and management of HIV-induced uveitis
Jayapratha R Selvaraj, S Sudharshan, Lily K Therese, MK Janani, Poongulali Selvamuthu, Parveen Rewri, Jyotirmay Biswas
November 2018, 66(11):1634-1636
DOI:10.4103/ijo.IJO_509_18  PMID:30355888
Intraocular (IO) inflammation in patients with Human immune deficiency virus (HIV) infection can be due to opportunistic infections, immune recovery uveitis, drugs used in the management or a primary manifestation of HIV itself. We studied the role of RT-PCR for HIV RNA in confirming the diagnosis of HIV induced uveitis and its useful in the management and follow-up of these patients.
  2,187 216 -
ORIGINAL ARTICLES
Outcome of deep anterior lamellar keratoplasty patients with intraoperative Descemet's membrane perforation: A retrospective cross-sectional study
Shreesha Kumar Kodavoor, Bijita Deb, Dandapani Ramamurthy
November 2018, 66(11):1574-1579
DOI:10.4103/ijo.IJO_282_18  PMID:30355864
Purpose: To evaluate functional and anatomical outcome in patients undergoing deep anterior lamellar keratoplasty (DALK) with intraoperative Descemet's membrane (DM) perforation (macro and micro). Methods: A retrospective cross sectional study (January 2009 to December 2015) of sixteen eyes of sixteen patients which included nine patients of advanced keratoconus (KC), two patients with paracentral DM scarring post hydrops, KC with Bowman's membrane scarring, macular corneal dystrophy and one patient of advanced Pellucid Marginal Degeneration (PMD). All underwent DALK with intraoperative DM perforation. Big bubble technique was attempted in all except in the two patients with post hydrops DM scar. Preoperative and postoperative best corrected visual acuity (BCVA), astigmatism and endothelial count (EC) were compared. Results: Postoperative BCVA and astigmatism were found to be better and statistically significant ('p value' 0.00 and 0.003 respectively). BCVA preoperative and postoperative was 1.07± 0.3 and 0.28 ± 0.09 in LogMAR respectively and astigmatism pre and postoperative 4.14 ± 1.5 D and 2.7 ± 0.97 D respectively. Percentage decrease in EC at sixth postoperative week was 7.48% and at sixth month and 1 year postoperative was 15.1%. Two patients developed postoperative double anterior chamber and two patients developed pupillary block glaucoma and all were successfully managed. Conclusion: Not all patients of intraoperative DM perforation (including macro perforation) needs to be converted to penetrating keratoplasty. DALK can be successfully done if the perforation is identified early and managed adequately. This is the only known study which has shown a large series of successful DALK even with macro perforations.
  1,953 278 6
Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora
Swati Singh, Anu Rajput, Ashik Mohamed, Vikas Mittal
November 2018, 66(11):1592-1594
DOI:10.4103/ijo.IJO_292_18  PMID:30355868
Purpose: To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods: In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal–Wallis test. Results: A total of 38 patients (56 eyes) were included. The mean age was 55 ± 11.1 years with equal distribution of males and females. The mean TMH values were 238 ± 141.3, 396.6 ± 159.5, 707.1 ± 288.8, and 809.5 ± 419.4 μm in grades 1, 2, 3, and 4 of epiphora, respectively. A significant difference in TMH was found among grades 2, 3, and 4 (P = 0.0007). On post hoc analysis, only grade 2 was significantly different from grades 3 and 4 (P = 0.0008 and P = 0.002 respectively), but grades 3 and 4 were comparable (P = 0.62). Conclusion: Levels of TMH were found to increase with increasing severity of epiphora. TMH values were comparable in Munk grades 3 and 4.
  1,913 275 9
Antineutrophil cytoplasmic antibody-positive scleritis: Clinical profile of patients from a tuberculosis-endemic region
Parthopratim Dutta Majumder, Sridharan Sudharshan, Amala Elizabeth George, Sudha K Ganesh, Jyotirmay Biswas
November 2018, 66(11):1587-1591
DOI:10.4103/ijo.IJO_777_18  PMID:30355867
Purpose: To report the clinical profile of a series of antineutrophil cytoplasmic antibody (ANCA)-associated scleritis in Indian population. Methods: We conducted a retrospective review of medical records of 33 eyes of 26 consecutive patients with scleritis, who tested positive for either antibody to proteinase 3 [anti-PR3/cytoplasmic antineutrophil cytoplasmic antibody (cANCA)] or myeloperoxidase [anti-MPO/perinuclear anti-neutrophil cytoplasmic antibody (pANCA)] between 2006 and 2015. Results: The mean age at presentation was 54.1 (11.1) years and 61.5% of the patients were female. Underlying systemic disorder was found in 46.2% of patients and includes granulomatosis with polyangitis (30.8%) and tuberculosis (15.4%). Necrotizing scleritis (48.5%) was the most common scleritis observed, followed by diffuse anterior scleritis (42.4%). Positive cANCA was found in 65.4% of patients and 34.6% was found positive for pANCA. Four of the six patients with positive Mantoux test were started on anti-tuberculosis treatment (ATT) by pulmonologist. Cyclophosphamide was the most common immunosuppressive and 11.5% of the patients required combination of two immunosuppressives. Seventeen eyes developed cataract and four eyes required patch graft. Female gender was more frequently associated with pANCA-associated scleritis than cANCA (P = 0.037). Incidence of necrotizing scleritis was higher in patients with positive cANCA, but this difference was not statistically significant (P = 0.806). cANCA-positive patients had statistically significant higher association with systemic rheumatic diseases (P = 0.021). Conclusion: Necrotizing scleritis is the most common subtype of scleritis in ANCA-positive individuals and even in the absence of systemic involvement. All patients with ANCA positivity should be thoroughly screened to rule out any evidence of tuberculosis, especially in tuberculosis-endemic region before planning aggressive immunomodulatory therapy.
  1,874 271 3
PHOTO ESSAY
Localized scleroderma causing enophthalmos: A rare entity
Anasua Ganguly Kapoor, Sonali Vinay Kumar, Nirupama Bhagyalakshmi
November 2018, 66(11):1611-1612
DOI:10.4103/ijo.IJO_303_18  PMID:30355873
  1,956 182 -
COMMENTARY
Commentary: AADI: New kid on the block
Vanita Pathak-Ray
November 2018, 66(11):1585-1586
DOI:10.4103/ijo.IJO_1118_18  PMID:30355866
  1,932 197 1
CASE REPORTS
Fleck-like deposits and swept source optical coherence tomography characteristics in a case of confirmed ocular chalcosis
Raghav Ravani, Vinod Kumar, Atul Kumar, Pradeep Kumar, Shikha Chawla, Sourabh Ghosh
November 2018, 66(11):1640-1642
DOI:10.4103/ijo.IJO_437_18  PMID:30355890
A 36-year-old male presented with history of injury in the left eye 3 years back with a copper wire. Examination revealed the presence of typical sunflower cataract with golden yellow deposits over the anterior lens capsule with dull glow and old vitreous hemorrhage. Non-contrast computerized tomography revealed retained intraocular foreign body in the pars plana region. The patient underwent phacoemulsification with intraocular lens implantation followed by pars plana vitrectomy and foreign body removal. Intraoperatively, fleck-like deposits were noted on the retinal surface in a circinate manner around the fovea and also over mid-peripheral retina. Postoperative swept source optical coherence tomography (SS-OCT) was performed to document the location of deposits and their characteristics. Limited literature exists regarding SS-OCT characteristics of ocular chalcosis.
  1,939 166 2
An unusual occurrence of stromal keratitis in dengue fever
Pritam Bawankar, Tatyarao Lahane, Ragini Parekh, Sayalee Lahane, Sumeet Lahane, Pooja Pathak, Sayli Sonawane
November 2018, 66(11):1631-1633
DOI:10.4103/ijo.IJO_387_18  PMID:30355887
Dengue is a mosquito-borne infection endemic in the tropical and subtropical regions of the world. Classic dengue fever is a self-limiting, influenza-like illness transmitted by Aedes aegypti mosquito. Ophthalmic manifestations though rare can involve both the anterior and posterior segments and are usually associated with the thrombocytopenic state. However, ophthalmic complications such as anterior uveitis and vasculitis suggest immune-mediated pathogenesis. Herein, we report a rare case of stromal keratitis and an unusual occurrence of simultaneous bilateral blindness following dengue fever in a young girl.
  1,893 203 3
PHOTO ESSAY
Smartphone-based evaluation of the optic nerve head
Amar Pujari, Ritika Mukhija, Rohan Chawla, Swati Phuljhele, Rohit Saxena, Pradeep Sharma
November 2018, 66(11):1617-1618
DOI:10.4103/ijo.IJO_394_18  PMID:30355877
  1,798 263 14
ORIGINAL ARTICLES
Changes in corneal thickness in patients with high-altitude pulmonary edema after systemic oxygen therapy
Sagarika Patyal, Arun Kumar Yadav, Atul Kotwal
November 2018, 66(11):1554-1557
DOI:10.4103/ijo.IJO_642_18  PMID:30355859
Purpose: High-altitude pulmonary edema (HAPO) is an acute medical emergency occurring typically in lowlanders, who ascend rapidly to heights of 3000 m or more. It presents with marked dyspnea on exertion, fatigue with minimal-to-moderate effort, prolonged recovery time, and dry cough with manifestations of cyanosis, tachycardia, tachypnea, and temperature which generally does not increase beyond 38.5°C. The condition may be fatal if not treated in time with supplemental oxygen or hyperbaric oxygen or rapid descent to lower altitude. There is paucity in literature on changes in corneal thickness in HAPO. The effect of continued oxygen therapy on corneal thickness has also not been studied in detail. Hence, this study was conducted at high altitude among physician-confirmed HAPO cases. Methods: A case–control study was conducted at an altitude of 11,400 feet. Cases were patients suffering from HAPO and controls were patients admitted in hospital for low back pain, fractures, and minor surgical procedures. Central corneal thickness (CCT) was measured with an ultrasound pachymeter on day 1 of hospitalization and every day of hospital stay. Systemic oxygen concentration was also measured daily. Results: There was no statistically significant difference in corneal thickness between two groups at the onset of illness, but a significant decrease in CCT was found in both right and left eyes in HAPO cases when oxygen levels were increased by giving supplemental oxygen. Hierarchical modeling showed a decrease in 1.3 μm in CCT with one unit increase in oxygen mmHg in cases. Conclusion: The findings of statistically insignificant difference in CCT between HAPO cases and controls and a decrease in CCT in HAPO cases on being treated with systemic oxygenation are points to ponder about.
  1,758 302 -
CASE REPORTS
Acute zonal occult outer retinopathy: Is optical coherence tomography angiography useful?
Anmol U Naik, N Ezhilvathani, Jyotirmay Biswas
November 2018, 66(11):1637-1639
DOI:10.4103/ijo.IJO_966_18  PMID:30355889
A 44-year-old female presented with central vision loss and photopsia in both eyes since 2 months. Multimodal imaging, field defects, electroretinogram abnormalities, and spectral domain optical coherence tomography changes were all suggestive of acute zonal occult outer retinopathy. En-face optical coherence tomography angiography (OCTA) images demonstrated hyper-reflective dots at the level of ellipsoid zone in both eyes in the presence of normal retinochoroidal vasculature. The patient was started on oral azathioprine and prednisolone. On two consecutive monthly follow-ups, en-face OCTA images demonstrated serial changes in the hyper-reflective dot morphology at ellipsoid zone level that have not been previously reported in the literature.
  1,785 249 4
More than meets the eye: Varicella zoster virus-related orbital apex syndrome
Lim Hui Jun, Arvind Gupta, Dan Milea, Fazlur Rehman Jaufeerally
November 2018, 66(11):1647-1649
DOI:10.4103/ijo.IJO_592_18  PMID:30355893
A 67-year-old male patient with poorly controlled type-2 diabetes mellitus developed an orbital apex syndrome and anterior cavernous syndrome secondary to herpetic zoster ophthalmicus (HZO), despite being on oral acyclovir. Urgent treatment with intravenous acyclovir led to improvement of the orbital and ocular inflammation but had no effect on the complete ophthalmoplegia and profound visual loss. At the 9-month follow-up visit, the patient had complete unilateral ophthalmoplegia and monocular blindness due to optic atrophy.
  1,733 251 7
COMMENTARIES
Commentary: Dawn of smartphones in frugal ophthalmic innovation
John Davis Akkara
November 2018, 66(11):1619-1619
DOI:10.4103/ijo.IJO_1002_18  PMID:30355878
  1,790 178 10
SURGICAL TECHNIQUE
Phacoemulsification in phakic iris-claw lens with cataract
Sudarshan Khokhar, Manish Mahabir
November 2018, 66(11):1609-1610
DOI:10.4103/ijo.IJO_423_18  PMID:30355872
In this new technique of cataract surgery in patients with iris-fixated phakic intraocular lens with cataract, phakic IOL is explanted at the end of surgery. Phakic IOL remains stable and securely enclaved to the iris during phacoemulsification which is performed through a small 2.2 mm incision. Endothelial protection is provided by viscodispersive OVD above the phakic IOL and space for surgery is created by high molecular weight viscocohesive OVD beneath the phakic IOL. This technique provides significant advantages from the previously described techniques in terms of chamber stability, endothelial protection, iris trauma and surgical ease.
  1,745 222 4
CASE REPORTS
Bilateral optic neuropathy with central diabetes insipidus in a child
Ambika Selvakumar, M Muthumeena, Olma Veena Noronha, Suresh Bapu
November 2018, 66(11):1642-1644
DOI:10.4103/ijo.IJO_281_18  PMID:30355891
Central nervous system germ cell tumors are rare and they occur in the first two decades of life.[1] Optic nerve germinomas can sometimes mimic optic nerve inflammation.[2] In this case report, we discuss an 11-year-old girl who presented with features of presumed bilateral optic neuritis and developed polyuria and polydipsia, subsequently she was diagnosed to have infiltrative etiology. Her clinical and radiological presentations were initially consistent with inflammatory optic neuropathy. Poor visual recovery to steroid therapy and progressive visual loss warranted the need for optic nerve biopsy which revealed germinoma.
  1,651 195 1
ORIGINAL ARTICLES
Lysosomal enzymes and mannose 6-phosphate receptors in the lacrimal drainage system: Evidence and its potential implications
Mohammad Javed Ali, Ashapogu Venugopal, Kavyashree Sakharayapatna Ranganath, Nadimpalli Siva Kumar
November 2018, 66(11):1595-1599
DOI:10.4103/ijo.IJO_286_18  PMID:30355869
Purpose: To investigate the presence and patterns of lysosomal enzymes and mannose 6-phosophate receptor (MPRs) in human lacrimal drainage system. Methods: The study was performed on healthy lacrimal sacs and nasolacrimal ducts obtained from exenteration samples immediately after surgery and frozen at −80°C for subsequent analysis. Soluble proteins' extract was used for enzyme assays, sodium dodecyl sulfate–polyacrylamide gel electrophoresis (PAGE), native PAGE, activity staining, and western blot analysis. Membrane proteins were separately assessed for detection of mannose 6-phosphate receptors, MPR 46. Sepharose gels, 4-methylumbelliferyl substrates, and antibodies against common lysosomal enzymes and MPRs were used. Enzyme assays were carried out in triplicate to ascertain the results. Results: Differential lysosomal enzyme activities were documented, and among them acid phosphatase and β-hexosaminidase were found to be high. Western blot analysis using enzyme antibodies and subsequent activity staining confirmed strong signals for moderately expressed enzymes such as fucosidase, glucuronidase, and mannosidase. Membrane extracts demonstrated the presence of MPR 46, which indicates the possible roles of cation-dependent MPRs in lysosomal targeting in human lacrimal drainage system. Conclusion: This study provides a proof of principle for the presence of differential lysosomal activity and mannose 6-phosphate ligand transport receptors in human lacrimal drainage system and hypothesizes the potential implications of their dysfunctions.
  1,655 190 4
CASE REPORTS
Morning glory disc anomaly and facial hemangiomas in a girl with moyamoya syndrome
Sanitha Sathyan, Mariea Chackochan
November 2018, 66(11):1644-1646
DOI:10.4103/ijo.IJO_538_18  PMID:30355892
Moyamoya disease (MMD) is a chronic progressive, occlusive cerebrovascular disease in the circle of Willis and the feeding arteries. Morning glory disc anomaly (MGDA) is characterized by an abnormal excavated optic disc with radial emergence of blood vessels from the rim of the disc. We describe a case of moyamoya syndrome (MMS), a rare entity among Indian ethnicity, associated with MGDA and regressed facial capillary hemangiomas, which are relatively less reported presentations of MMD. This report emphasizes on the role of neuroimaging in MGDA, so as to facilitate early detection and management of life-threatening intracranial pathologies such as MMS.
  1,608 209 6
Cerebral venous thrombosis with auto-immune hyperthyroidism
Siddharth Madan, Zia Chaudhuri
November 2018, 66(11):1649-1651
DOI:10.4103/ijo.IJO_23_18  PMID:30355894
Sudden deterioration of visual functions warrants comprehensive ophthalmic examination with evaluation for systemic association. Cerebral venous thrombosis (CVT) is an uncommon disorder that can present with neurological deficits. We report a young female patient aged 28 years who presented with severe headache and sudden diminution of vision and was subsequently diagnosed with hyperthyroidism and CVT. Management of CVT and hyperthyroidism hastened full recovery of visual functions.
  1,405 185 2
PHOTO ESSAY
Unilateral corneal edema in young: A diagnostic dilemma
Dewang Angmo, Harathy Selvan, Aswini Kumar Behera, Pramod Kumar Suman
November 2018, 66(11):1612-1614
DOI:10.4103/ijo.IJO_564_18  PMID:30355874
  1,397 183 1
OPHTHALMIC IMAGES
Differential corneal involvement in xeroderma pigmentosum
Sunita Chaurasia
November 2018, 66(11):1623-1623
DOI:10.4103/ijo.IJO_667_18  PMID:30355881
  1,344 167 1
COMMENTARIES
Commentary: Change in trends of imaging the retina
Ashish Arjun Ahuja, Ashish Kamble
November 2018, 66(11):1620-1621
DOI:10.4103/ijo.IJO_1011_18  PMID:30355879
  1,315 160 -
OPHTHALMIC IMAGES
Corneal “Plaque” formation after anti-acanthamoeba therapy in acanthamoeba keratitis
Rashmi Mittal, Hitendra Ahooja, Neelam Sapra
November 2018, 66(11):1623-1624
DOI:10.4103/ijo.IJO_734_18  PMID:30355882
  1,263 181 3
PHOTO ESSAY
Intraoperative assessment of corneal injuries using microscope-integrated optical coherence tomography
Amar Pujari, Ritika Mukhija, Jayanand Urkude, Rashmi Singh, Divya Agarwal, Namrata Sharma
November 2018, 66(11):1614-1615
DOI:10.4103/ijo.IJO_546_18  PMID:30355875
  1,197 138 2
LETTERS TO THE EDITOR
Intraoperative optical coherence tomography-guided scleral suture passage while performing surgery on extraocular muscles
Amar Pujari, Pradeep Sharma, Swati Phuljhele, Saloni Kapoor, Rohan Chawla, Rohit Saxena, Namrata Sharma
November 2018, 66(11):1654-1655
DOI:10.4103/ijo.IJO_769_18  PMID:30355896
  1,176 156 4
COMMENTARY
Commentary: Comparison of changes in refractive error and corneal curvature following small-incision lenticule extraction and femtosecond laser-assisted in situ keratomileusis surgery
Gitansha Shreyas Sachdev
November 2018, 66(11):1567-1568
DOI:10.4103/ijo.IJO_1184_18  PMID:30355862
  1,153 177 -
OPHTHALMIC IMAGES
Corneal edema in xeroderma pigmentosa
Sunita Chaurasia
November 2018, 66(11):1622-1622
DOI:10.4103/ijo.IJO_469_18  PMID:30355880
  1,130 183 2
PHOTO ESSAY
Thin posterior capsule in persistent fetal vasculature causing an appearance of spontaneous posterior capsular rupture
Koushik Tripathy, Vivek Sharma
November 2018, 66(11):1616-1617
DOI:10.4103/ijo.IJO_590_18  PMID:30355876
  1,109 148 -
OPHTHALMIC IMAGES
Intraocular intrusion in vitreous cavity of encirclage band following retinal detachment surgery
Ashish Mitra, Alok Sen, Tina Agrawal, Gaurav Kohli
November 2018, 66(11):1625-1626
DOI:10.4103/ijo.IJO_360_18  PMID:30355884
  1,082 147 1
LETTERS TO THE EDITOR
Comment on: Unique case of midbrain tuberculoma presenting as isolated inferior rectus palsy with nystagmus
Pramod K Pandey, Annu Joon, Mainak Bhattacharyya, Divya Kishore, Monika Yadav, Sumit Kumar
November 2018, 66(11):1662-1663
DOI:10.4103/ijo.IJO_654_18  PMID:30355905
  1,017 133 1
Reply to comment on: Sandwich technique using combination of perfluoropropane and silicone oil for inferior retinal detachment
Sumit Randhir Singh, Deven Dhurandhar, Jay Chhablani
November 2018, 66(11):1658-1658
DOI:10.4103/ijo.IJO_1415_18  PMID:30355900
  998 132 -
Comment on: Evaluation of retinal nerve fiber layer thickness after optic canal decompression
Sagnik Sen, Pallavi Singh, Pragya Saini, Arjun Desai
November 2018, 66(11):1658-1659
DOI:10.4103/ijo.IJO_876_18  PMID:30355901
  989 129 2
Response to comment on: Culture-positive unilateral panophthalmitis in a serology-2 positive case of dengue hemorrhagic fever
Richa Kamal, Dhaivat Shah, Satish Sharma, Madharuvasal Krishnan Janani, Arindam Kar, Kumar Saurabh, Rupak Roy, Hajib Narahari Rao Madhavan
November 2018, 66(11):1661-1661
DOI:10.4103/ijo.IJO_1373_18  PMID:30355904
  986 121 -
Comment on: Diagnostic positron emission tomography–computed tomography in clinically elusive giant cell arteritis
Sonali Gupta, Shreyans Jain
November 2018, 66(11):1655-1656
DOI:10.4103/ijo.IJO_1185_18  PMID:30355897
  972 109 1
Comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment
Navneet Mehrotra
November 2018, 66(11):1657-1657
DOI:10.4103/ijo.IJO_1356_18  PMID:30355899
  938 117 1
Response to comment on: Diagnostic positron emission tomography-computed tomography in clinically elusive giant cell arteritis
Ryian Mohamed
November 2018, 66(11):1656-1657
DOI:10.4103/ijo.IJO_1469_18  PMID:30355898
  897 119 -
COMMENTARY
Commentary: Using newer technology for an unresolved clinical dilemma
Raj Anand
November 2018, 66(11):1607-1608
DOI:10.4103/ijo.IJO_1127_18  PMID:30355871
  878 127 -
LETTERS TO THE EDITOR
Response to comment on: Evaluation of retinal nerve fiber layer thickness after optic canal decompression
Kasturi Bhattacharjee, Samir Serasiya, Deepika Kapoor, Harsha Bhattacharjee
November 2018, 66(11):1659-1660
DOI:10.4103/ijo.IJO_1194_18  PMID:30355902
  861 111 -