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   2018| March  | Volume 66 | Issue 3  
    Online since February 26, 2018

 
 
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REVIEW ARTICLE FOR RESIDENTS
Anterior segment optical coherence tomography for evaluation of cornea and ocular surface
Mittanamalli S Sridhar, Raul Martin
March 2018, 66(3):367-372
DOI:10.4103/ijo.IJO_823_17  PMID:29480245
Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple. Several devices and technologies allow to explore and manage patients better. Optical coherence tomography (OCT) technology has evolved over the years, and hence a detailed evaluation of anterior segment (AS) structures such as cornea, conjunctiva, tear meniscus, anterior chamber, iris, and crystalline lens has been possible in a noncontact and safe procedure. The purpose of this special issue is to present and update in the evaluation of cornea and ocular surface, and this paper reviews a description of the AS-OCT, presenting the technology and common clinical uses of OCT in the management of diseases involving cornea and ocular surface to provide an updated information of the clinical recommendations of this technique in eye care practice.
  7,694 1,048 11
Cornea and anterior eye assessment with placido-disc keratoscopy, slit scanning evaluation topography and scheimpflug imaging tomography
Raul Martin
March 2018, 66(3):360-366
DOI:10.4103/ijo.IJO_850_17  PMID:29480244
Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple and several devices and technologies allow to explore and to manage patients. The purpose of this special issue is to present and also to update in the evaluation of cornea and ocular surface and this second part, reviews a description of the corneal topography and tomography techniques, providing updated information of the clinical recommendations of these techniques in eye care practice. Placido-based topographers started an exciting anterior corneal surface analysis that allows the development of current corneal tomographers that provide a full three-dimensional reconstruction of the cornea including elevation, curvature, and pachymetry data of anterior and posterior corneal surfaces. Although, there is not an accepted reference standard technology for corneal topography description and it is not possible to determine which device produces the most accurate topographic measurements, placido-based topographers are a valuable technology to be used in primary eye care and corneal tomograhers expanding the possibilities to explore cornea and anterior eye facilitating diagnosis and follow-up in several situations, raising patient follow-up, and improving the knowledge regarding to the corneal anatomy. Main disadvantages of placido-based topographers include the absence of information about the posterior corneal surface and limited corneal surface coverage without data from the para-central and/or peripheral corneal surface. However, corneal tomographers show repeatable anterior and posterior corneal surfaces measurements, providing full corneal thickness data improving cornea, and anterior surface assessment. However, differences between devices suggest that they are not interchangeable in clinical practice.
  4,925 808 12
ORIGINAL ARTICLES
The impact of primary open-angle glaucoma: Quality of life in Indian patients
Suresh Kumar, Parul Ichhpujani, Roopali Singh, Sahil Thakur, Madhu Sharma, Nimisha Nagpal
March 2018, 66(3):416-419
DOI:10.4103/ijo.IJO_847_17  PMID:29480254
Purpose: Glaucoma significantly affects the quality of life (QoL) of a patient. Despite the huge number of glaucoma patients in India, not many, QoL studies have been carried out. The purpose of the present study was to evaluate the QoL in Indian patients with varying severity of glaucoma. Methods: This was a hospital-based, cross-sectional, analytical study of 180 patients. The QoL was assessed using orally administered QoL instruments comprising of two glaucoma-specific instruments; Glaucoma Quality of Life-15 (GQL-15) and Viswanathan 10 instrument, and 1 vision-specific instrument; National Eye Institute Visual Function Questionnaire-25 (NEIVFQ25). Results: Using NEIVFQ25, the difference between mean QoL scores among cases (88.34 ± 4.53) and controls (95.32 ± 5.76) was statistically significant. In GQL-15, there was a statistically significant difference between mean scores of cases (22.58 ± 5.23) and controls (16.52 ± 1.24). The difference in mean scores with Viswanathan 10 instrument in cases (7.92 ± 0.54) and controls (9.475 ± 0.505) was also statistically significant. QoL scores also showed moderate correlation with mean deviation, pattern standard deviation, and vertical cup-disc ratio. Conclusion: In our study, all the three instruments showed decrease in QoL in glaucoma patients compared to controls. With the increase in severity of glaucoma, corresponding decrease in QoL was observed. It is important for ophthalmologists to understand about the QoL in glaucoma patients so as to have a more holistic approach to patients and for effective delivery of treatment.
  2,458 411 10
EDITORIAL
Universal screening versus universal precautions in ophthalmic surgery
Santosh G Honavar
March 2018, 66(3):355-356
DOI:10.4103/ijo.IJO_253_18  PMID:29480241
  2,319 513 -
ORIGINAL ARTICLES
Ultrasound biomicroscopy image patterns in normal upper eyelid and congenital ptosis in the Indian population
Abhidnya Surve, Rachna Meel, Neelam Pushker, MS Bajaj
March 2018, 66(3):383-388
DOI:10.4103/ijo.IJO_915_17  PMID:29480247
Purpose: To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM). Methods: This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenital ptosis (n = 33) cases; Marcus Gunn jaw-winking ptosis (MGJWP, n = 7) cases, and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES, n = 20) cases were studied on a vertical UBM scan using 50-MHz probe. Lid-thickness, tarsal-thickness, orbicularis oculi and levator-Muller-orbital septum-conjunctival (LMSC) complex were measured in primary gaze. Comparison was made between four groups and results were statistically analyzed using ANOVA test. In normal individuals, LMSC measurements were repeated in down-gaze imaging. Results: Skin with subcutaneous tissue, LMSC complex and pre-aponeurotic fat-pad appeared echodense while orbicularis oculi and tarsus appeared echolucent. In primary gaze, mean thickness (± standard deviation) of the eyelid, tarsus, orbicularis oculi and LMSC, respectively, were: 1.612 ± 0.205, 0.907 ± 0.098, 0.336 ± 0.083, and 0.785 ± 0.135 mm in normal individual. LMSC showed 46.64% increase in thickness on down-gaze. The mean eyelid thickness and LMSC were thicker in MGJWP and BPES as compared to normal. In different types of congenital ptosis cases, various patterns of UBM imaging were observed. Conclusion: UBM allows noninvasive imaging of eyelid structures with good anatomical correspondence in normal eyelids and study the structural alterations of eyelids in different types of congenital ptosis. UBM can be used to highlight the anatomical difference in normal eyelids that may help modify the surgery for better cosmetic outcomes. Furthermore, it has the potential to be used in preoperative evaluation and operative planning in certain types of acquired ptosis, which needs to be evaluated.
  2,444 348 5
Comparative evaluation of rotational stability and visual outcome of toric intraocular lenses with and without a capsular tension ring
Anju Rastogi, Samreen Khanam, Yashpal Goel, Kamlesh , Prolima Thacker, Prateek Kumar
March 2018, 66(3):411-415
DOI:10.4103/ijo.IJO_875_17  PMID:29480253
Purpose: To evaluate the rotational stability of toric intraocular lens (IOL) when co-implanted with a capsular tension ring (CTR) as compared to that of a toric IOL without a CTR. Methods: This was a prospective randomized clinical trial performed in a tertiary care centre in India. Fifty adult human eyes with visually significant cataract and regular corneal astigmatism ≥1.5D divided into two groups of 25 eyes each, A and B by simple randomization. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count <2000/mm2 were excluded from the study. The eyes in both the groups underwent standard phacoemulsification and were implanted with a toric IOL. In Group A, a CTR was put in the bag before IOL implantation. The groups were called for follow-up on day 1, 1 week, 1 month, and 3 months, postoperatively. The axis of the toric IOL on each visit was measured by slit lamp imaging in retroillumination and analyzed digitally. Results: Mean rotation of toric IOL at 3 months postoperatively was 1.85 ± 1.72° in Group A and 4.02 ± 2.04° in Group B. The difference was statistically significant (P = 0.003). Conclusion: Coimplantation of a CTR is a safe and effective technique for ensuring better rotational stability of toric IOLs.
  2,160 415 20
LETTERS TO THE EDITOR
Preloaded injectable intraocular lenses: The way forward
Sanjay Chaudhary
March 2018, 66(3):477-477
DOI:10.4103/ijo.IJO_1049_17  PMID:29480276
  2,299 188 -
ORIGINAL ARTICLES
Seroprevalence, risk associations, and cost analysis of screening for viral infections among patients of cataract surgery
Parveen Rewri, Madhavi Sharma, DP Vats, Aparna Singhal
March 2018, 66(3):394-399
DOI:10.4103/ijo.IJO_726_17  PMID:29480249
Purpose: The purpose of this study was to estimate the prevalence of blood-borne viral infections (triple H: HBV-hepatitis B virus, HCV-hepatitis C virus, and HIV-human immunodeficiency virus) among cataract patients, sought possible risk associations and discuss feasibility of universal preoperative screening. Methods: This prospective, cross-sectional study enrolled consecutive patients of senile cataract. They were screened by immunoassay-based rapid diagnostic card tests for blood-borne viral infections. Positive cases were confirmed with confirmatory ELISA tests. Seropositive patients were enquired about the exposure to possible risk associations for acquiring these infections. Cost of card test per patient was calculated. Results: The prevalence of seropositivity for triple H viral infections (HBV, HCV, and HIV) among patients of senile cataract was 5.9% (95% confidence interval [CI]: 5.3–6.6), and HCV was most common viral infection. The dental extraction was most common (54%; 95% CI:48-60) possible risk association. The total cost of primary screening per patient for triple H infections(HBV, HCV, and HIV) was $0.93. Conclusion: The prevalence of blood-borne viral infection among cataract patients is high in this area. Awareness of the prevalence of blood-borne viral infections in service area, along with knowledge of rate of accidental exposure and risk of transmission would help to understand cost-effectiveness of universal preoperative screening before cataract surgery.
  2,116 328 9
Pneumatic retinopexy outcomes as primary or secondary surgical option for treating rhegmatogenous retinal detachment
Abhinav Dhami, Kunal Kaushik Shah, Dhanashree Ratra
March 2018, 66(3):420-425
DOI:10.4103/ijo.IJO_999_17  PMID:29480255
Purpose: To report the outcomes of pneumatic retinopexy (PR) performed as a primary surgical procedure for rhegmatogenous retinal detachment (RRD) or as a secondary procedure for recurrent RRD. Methods: We retrospectively analyzed case records of 54 patients (54 eyes) who underwent PR for RRD by injecting 0.3 ml of perfluoropropane (C3F8) in the vitreous cavity and cryopexy to break in the same sitting, followed by positioning. Results: A total 54 eyes of 54 patients aged between 17 and 84 years (mean - 51.3, median - 53 years) were included in the study. Except five eyes, all had breaks in the superior quadrants. The RRD ranged from 1 quadrant to 4 quadrants. Twenty-eight eyes (51.8%) were phakic and 26 (48.1%) were pseudophakic. The follow-up ranged from 6 to 144 months. In 25 eyes (46.2%), PR was the primary intervention and was successful in 15 (60%) eyes with a significant visual improvement (P = 0.023). Twenty-nine eyes (52.7%) with failed scleral buckle or failed pars plana vitrectomy underwent PR with a success rate of 65.5% and significant visual improvement (P = 0.0017). Progression of proliferative vitreoretinopathy changes (40%) was the most common cause of failure. The success rate was higher in phakic eyes, eyes with attached macula, superior breaks, superior RRD, and RRD limited to 3 quadrants or less. Conclusion: PR remains a minimally invasive procedure which can be used primarily or as a salvage procedure in failed surgery with moderately good success rate and minimal complications. One-step procedure reduces patient visits and ensures adequate treatment of the break.
  2,078 314 5
Comparison of anterior segment measurements using Sirius Topographer® and Nidek Axial Length-Scan® with assessing repeatability in patients with cataracts
Resat Duman, Ersan Çetinkaya, Rahmi Duman, Mustafa Dogan, Mehmet Cem Sabaner
March 2018, 66(3):402-406
DOI:10.4103/ijo.IJO_859_17  PMID:29480251
Purpose: The purpose of this study is to evaluate anterior segment measurements obtained using CSO Sirius Topographer® (CSO, Firenze, Italy) and Nidek Axial Length (AL)-Scan® (Nidek CO., Gamagori, Japan). Methods: A total of 43 eyes of 43 patients were included in this prospective study. The central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white distance (WTW), flat keratometry (K1), steep keratometry (K2), and mean keratometry (K) values were randomly measured three times with each device by the same examiner. The intraclass correlation coefficient of repeatability was analyzed. The compatibility of both devices was evaluated using the 95% limits of the agreement proposed by Bland and Altman. Results: Examiner achieved high repeatability for all parameters on each device except the WTW measured by Sirius. All measurements except WTW and K1 taken with the Sirius were higher than that taken with the Nidek AL-Scan®. The difference in CCT, ACD, and WTW values was statistically significant. Conclusion: High repeatability of the measurements was achieved on both devices. Although Km, K1, and K2 measurements of the Sirius and the AL-Scan® showed good agreement, WTW, CCT, and ACD measurements significantly differed between two devices. Thus, anterior segment measurements except for Km, K1, and K2 cannot be used interchangeably between Sirius and Nidek AL-Scan® devices.
  2,012 234 6
CASE REPORTS
Isolated neurofibroma of the eyelid mimicking recurrent chalazion
H Vijaya Pai, Surabhi Abbagani, Padma Priya Jaishankar
March 2018, 66(3):451-453
DOI:10.4103/ijo.IJO_852_17  PMID:29480265
Neurofibroma is a peripheral nerve sheath tumor which is seen in neurofibromatosis type 1 and is characterized by various ophthalmic manifestations. Solitary neurofibroma of the eyelid is rare. We report a case of a 53-year-old female patient who presented with a painless swelling in the left upper lid of 4 years' duration. She had undergone surgery for the same lesion twice. The lesion was excised and histopathological examination revealed a solitary neurofibroma. She did not have any other features of generalized neurofibromatosis.
  1,814 232 3
ORIGINAL ARTICLES
Quality indicators for eye bank
Manisha Acharya, Saurabh Biswas, Animesh Das, Umang Mathur, Abhishek Dave, Ashok Singh, Suneeta Dubey
March 2018, 66(3):389-393
DOI:10.4103/ijo.IJO_861_17  PMID:29480248
Purpose: The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. Methods: Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions – “result quality” and “process quality.” The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011–2016. Results: Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. Conclusion: These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.
  1,665 313 8
CASE REPORTS
An unusual case of corneal lipoma
Praveen Subudhi, Zahiruddin Khan, Sweta Patro, B Nageswar Rao Subudhi, Silla Sitaram
March 2018, 66(3):455-456
DOI:10.4103/ijo.IJO_912_17  PMID:29480267
A 24-year-old male presented with a painless yellowish lesion on the nasal part of his cornea that extended to the paracentral area. Without a confirmed clinical diagnosis, the patient was advised surgical removal of the lesion. The lesion showed a smooth, elevated anterior surface without any signs of inflammation. On making a small incision over the lesion, we found yellowish material being extruded from the lesion. Cytological evaluation of the material revealed clear vacuolated cells suggestive of lipocytes, based on which we diagnosed it a rare case of corneal lipoma.
  1,736 172 -
Bilateral central retinal artery occlusion as presenting manifestation of human immunodeficiency virus infection
Reema Bansal, Sahil Jain, Vishali Gupta, Aman Sharma, Amanjit Bal, Sanjay Jain
March 2018, 66(3):466-468
DOI:10.4103/ijo.IJO_906_17  PMID:29480272
A 30-year-old male with bilateral acute visual loss presented with retinal edema in the posterior pole and peripapillary region with extensive retinal hemorrhages. Fluorescein angiography revealed delayed arterial filling in the right eye and absent arterial filling in the left eye, suggesting bilateral central retinal artery occlusion. Systemic evaluation revealed a history of chronic low-grade fever and generalized lymphadenopathy. HIV (ELISA) was positive, and other systemic comorbidities were ruled out. Cervical lymph node biopsy stained positive for acid-fast bacilli, with large areas of necrosis, palisaded by epithelioid cell granulomas, macrophages, and multinucleated giant cells, suggesting lymph node tuberculosis. Despite antiretroviral and antitubercular therapy, he developed optic atrophy at 4 weeks.
  1,655 221 2
GUEST EDITORIAL
Good quality pays rich dividends
Venkatesh N Prajna, Manisha Shah
March 2018, 66(3):357-358
DOI:10.4103/ijo.IJO_1246_17  PMID:29480242
  1,532 337 2
ORIGINAL ARTICLES
Visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens: A prospective study
Gitansha Shreyas Sachdev, Shreyas Ramamurthy, Umesh Sharma, Ramamurthy Dandapani
March 2018, 66(3):407-410
DOI:10.4103/ijo.IJO_813_17  PMID:29480252
Purpose: The aim of this study was to analyze the objective and subjective visual outcomes of patients bilaterally implanted with the extended range of vision intraocular lens (EROV IOL), the Tecnis Symfony. Methods: This was a prospective interventional case series conducted at a tertiary eye care hospital in South India. The study included patients with bilateral implantation of EROV IOLs. The uncorrected and corrected visual acuity for distance, intermediate, and near vision was recorded at 6 weeks and 6 months' postoperative visit. A subjective questionnaire was administered to assess spectacle independence, photic phenomenon, and overall satisfaction. All data were recorded using Microsoft Excel worksheet. The analyses were performed using SPSS for windows software. Results: Our study included fifty patients with bilateral implantation of EROV IOLs. The mean age was 59.84 ± 11.68 years. The mean uncorrected binocular distance, intermediate, and near visual acuity (in standard decimal equivalent) was 0.89,0.99 and 0.99 respectively, at 6 months' postoperative visit. Ninety-six percent of the patients did not require spectacles for distance and 98% of the patients were free from spectacles for intermediate and near vision. 94% of our patients perceived no or minimal photic phenomena such as glare and halos. The mean subjective patient satisfaction score (out of 10) for distance, intermediate, and near was 9, 10, and 9, respectively. Conclusion: The EROV IOLs demonstrated high levels of spectacle independence for distance, intermediate, and near vision. The incidence of photic phenomena observed was minimal with a high level of patient satisfaction.
  1,524 343 31
ONE MINUTE OPHTHALMOLOGY
Possible retinoblastoma?
Carol L Shields, Elizabeth B Elimimian
March 2018, 66(3):359-359
DOI:10.4103/ijo.IJO_1310_17  PMID:29480243
  1,438 364 -
PHOTO ESSAY
Retinal pigment epithelium rip following single intravitreal ziv-aflibercept injection
Sumit Randhir Singh, Jay Chhablani
March 2018, 66(3):445-446
DOI:10.4103/ijo.IJO_797_17  PMID:29480261
  1,553 245 1
SURGICAL TECHNIQUE
Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: A minimally invasive approach revisited
Abhijit Naik, Anamika Patel, Nandini Bothra, Lapam Panda, Milind N Naik, Suryasnata Rath
March 2018, 66(3):440-444
DOI:10.4103/ijo.IJO_819_17  PMID:29480260
Purpose: To report endoscope-assisted fascia lata harvest (EAFH) as a minimally-invasive technique for correction of severe blepharoptosis. Methods: This was a retrospective case series between January 2013 and April 2017. Medical records of all consecutive patients who underwent frontalis suspension by EAFH in the study period were reviewed and outcome was analyzed. Results: Fourteen patients (10 males) were included in the study. Mean age of the group was 18.14 + 17.03 years (range 4-65 years) and 11 patients had simple congenital blepharoptosis. Blepharophimosis syndrome was seen in 3 patients. Eleven patients had bilateral blepharoptosis. The mean preoperative and postoperative MRD1 was –1.60 ± 0.87 mm and +2.12 ± 1.37 mm respectively. Mean lengths of the incision and fascial harvest were 2.25 ± 0.43 cm and 13.0 ± 2.35 cm (range 10-17 cm) respectively. The median follow-up of patients was 4.57 + 4.03 months (range 1-15 months). Complications included a wound dehiscence in two patients and these were resutured. The donor sites healed well in all patients leaving a small thigh scar and none needed scar revision. Conclusion: EAFH is a promising minimally-invasive technique performed with a small incision and achieved adequate length of fascial harvest.
  1,500 215 5
ORIGINAL ARTICLES
Spectral domain optical coherence tomography evaluation of macular changes in Eales disease
Neha Goel, Vinod Kumar, Supriya Arora, Pooja Jain, Basudeb Ghosh
March 2018, 66(3):433-438
DOI:10.4103/ijo.IJO_845_17  PMID:29480258
Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed. Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 μm) in eyes with macular involvement than those without it (243.8 ± 19.3 μm). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively. Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.
  1,421 242 5
CASE REPORTS
Encephalocele presenting as lower lid swelling: A rare case report
Vaibhav Kumar Jain, Vikas Kanaujia, Priyadarshini Mishra, Kumudini Sharma
March 2018, 66(3):453-454
DOI:10.4103/ijo.IJO_894_17  PMID:29480266
Encephalocele is a rare congenital abnormality characterized by abnormal protrusion of brain and meninges through an opening in the skull. We report an 8-year-old girl who presented with a swelling in the right lower lid for the last 6 years. In her infancy, she had undergone surgery for a very small swelling located in the right nasolacrimal area. On further clinicoradiological evaluation, anterior encephalocele was diagnosed. This case highlights the uncommon site of anterior encephalocele; misdiagnosis and mismanagement of which could result in dreaded complications such as meningitis and cerebrospinal fluid leaking fistula formation.
  1,478 182 2
Successful management of bee sting induced Aspergillus fumigatus endophthalmitis and scleritis
Mohit Dogra, Subina Narang, Sunandan Sood, Panchmi Gupta
March 2018, 66(3):461-463
DOI:10.4103/ijo.IJO_889_17  PMID:29480270
Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.
  1,370 228 3
COMMENTARY
Pneumatic retinopexy: A cost-effective alternative
Ritesh Narula
March 2018, 66(3):426-427
DOI:10.4103/ijo.IJO_69_18  PMID:29480256
  1,325 212 4
CASE REPORTS
To laser or not?
Vishal Govindhari, Jay Chhablani
March 2018, 66(3):463-466
DOI:10.4103/ijo.IJO_837_17  PMID:29480271
A 64-year-old male patient presented to the clinic with diminished vision in his right eye for the past 2 years. Examination revealed a best-corrected visual acuity (BCVA) of counting fingers at 1 m with a scarred choroidal neovascular membrane (CNVM) in the right eye while the left eye had a BCVA of 20/20 with a small peripapillary subretinal hemorrhage along with angioid streaks in both eyes. Multimodal imaging revealed the presence of a CNVM in the left eye which was treated with focal thermal laser. Regression was noted on optical coherence tomography angiography at 1 month post-laser, but at 3-month follow-up, exacerbation of the CNVM was observed. Subsequently, four intravitreal ziv-aflibercept injections were given, and scarring of CNVM was noted on OCT. Thermal laser in the background of angioid streaks has worsened the breaks in the Bruch's membrane leading to worsening of the CNVM.
  1,344 188 1
REVIEW ARTICLE FOR RESIDENTS
Dynamic corneal deformation response and integrated corneal tomography
Marcella Q Salomão, Ana Luisa Hofling-Lima, Fernando Faria-Correia, Bernardo Teixeira Lopes, Sandra Rodrigues-Barros, Cynthia J Roberts, Renato Ambrósio
March 2018, 66(3):373-382
DOI:10.4103/ijo.IJO_831_17  PMID:29480246
Measuring corneal biomechanical properties is still challenging. There are several clinical applications for biomechanical measurements, including the detection of mild or early forms of ectatic corneal diseases. This article reviews clinical applications for biomechanical measurements provided by the Corvis ST dynamic non contact tonometer
  1,099 427 18
PHOTO ESSAY
Multimodal imaging in a case of retinocytoma
Shreyas Temkar, Amar Pujari, Rohan Chawla, Atul Kumar
March 2018, 66(3):447-448
DOI:10.4103/ijo.IJO_908_17  PMID:29480262
  1,310 195 2
CASE REPORTS
Subretinal tissue plasminogen-assisted vitrectomy for posttraumatic full-thickness macular hole with submacular hemorrhage
Pradeep Kumar, Vinod Kumar, Raghav Ravani, Sahil Agarwal
March 2018, 66(3):474-476
DOI:10.4103/ijo.IJO_815_17  PMID:29480275
A young male presented with diminution of vision left eye, attributable to full-thickness macular hole, and submacular hemorrhage, following closed globe injury 2 weeks ago. The patient was managed successfully with 25-gauge vitrectomy, subretinal injection of tissue plasminogen activator and aspiration of liquefied blood through the macular hole, internal limiting membrane peeling, short-acting gas tamponade, and prone positioning. This resulted in good visual improvement, type 1 macular hole closure, and restoration of foveal architecture. The outcome and rationale of treatment in this unique scenario is discussed.
  1,268 181 -
Small lens for a big eye: Successful management of anterior megalophthalmos
Jyoti Himanshu Matalia, Sushma Tejwani, Vimal Krishna Rajput, Himanshu Matalia
March 2018, 66(3):457-459
DOI:10.4103/ijo.IJO_678_17  PMID:29480268
We report a case of anterior megalophthalmos and complicated cataract, with apparently smaller lens in both eyes. The right eye had spontaneous retinal detachment. The child underwent cataract surgery in both the eyes with retinal detachment surgery in the right eye. Due to small size of the lenticular bag, a downsized customized intraocular lens (IOL) was implanted. Postoperatively, the IOL was well centered with ambulatory vision till 3 years of follow-up. This case describes this rare disorder and its association with apparently small-sized lens and discusses the course of its management, highlighting the visual rehabilitation with customization of IOLs.
  1,274 170 2
ORIGINAL ARTICLES
Choroidal thickness in patients with fibromyalgia and correlation with disease severity
Mahmut Oguz Ulusoy, Ali Kal, Selen Işik-Ulusoy, Öznur Kal
March 2018, 66(3):428-432
DOI:10.4103/ijo.IJO_877_17  PMID:29480257
Purpose: To evaluate and compare choroidal thickness in patients with fibromyalgia (FM) and healthy controls. Methods: In this prospective, cross-sectional study, forty eyes of 40 patients with FM and 40 eyes of 40 age- and sex-matched healthy subjects were enrolled. FM was diagnosed according to the American College of Rheumatology criteria. The choroidal thickness measurements of the subjects were obtained using spectral-domain optical coherence tomography (RTVue-100, Optovue). Widespread pain index (WPI), symptom severity scale (SSS), and fibromyalgia impact questionnaire (FIQ) scores were recorded. The choroidal thickness measurements of the groups were compared, and correlations among the WPI, SSS, and FIQ scores and these measurements were calculated. Results: Choroidal thicknesses at 1500 μm nasally were 198.5 ± 46.7 μm and 306.3 ± 85.4 μm; at 1000 μm nasally were 211.7 ± 50.2 μm and 310.05 ± 87.26 μm; at 500 μm nasally were 216 ± 55.05 μm and 311.5 ± 83.4 μm; at subfoveal region were 230.9 ± 58.4 μm and 332.4 ± 91.3 μm; at 500 μm temporally 227.5 ± 58.1 μm and 318.15 ± 92.3 μm; at 1000 μm temporally 224.5 ± 57.07 μm and 315.1 ± 84.2 μm; at 1500 μm temporally 212.5 ± 56.08 μm and 312.9 ± 87.8 μm in the FM and control groups, respectively (P < 0.001). Choroidal thicknesses were thinner at all measurement location, except temporal 1000 and 1500 in patients with FIQ score ≥50 than in FIQ score <50. Conclusion: The results of this study demonstrated that choroidal thickness decreases in patients with FM and correlated with disease activity. This choroidal changes might be related with the alterations in autonomic nervous system functioning. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and FM.
  1,233 211 11
CASE REPORTS
Transient reversal of macular ischemia with intravitreal steroid implant injection in a case of radiation maculopathy
Aditya Verma, Vikas Khetan
March 2018, 66(3):468-471
DOI:10.4103/ijo.IJO_782_17  PMID:29480273
Diabetic retinopathy (DR) is a well-known risk factor in the development of radiation maculopathy (RM). Steroids have been shown to improve the vision and reduce the macular thickness in patients with RM. This observational case report highlights altered course of DR after a course of radiotherapy for orbital lymphoma, after a single dose of intravitreal dexamethasone implant showed a dramatic revascularization of the ischemic macula, with a significant reduction in the size of ischemic area. This appears to be the first case in literature corroborating the favorable effect on steroids on retinal vasculature, seen angiographically.
  1,218 184 4
COMMENTARY
Universal screening: To do or not to do
Samrat Chatterjee
March 2018, 66(3):400-401
DOI:10.4103/ijo.IJO_84_18  PMID:29480250
  1,194 191 -
LETTERS TO THE EDITOR
Response to: Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment naive eyes undergoing vitrectomy
Salil Gadkari, Madan Deshpande
March 2018, 66(3):483-484
DOI:10.4103/ijo.IJO_1086_17  PMID:29480283
  1,191 133 -
OPHTHALMIC IMAGES
Photophobia accompanied by painful plantar punctate hyperkeratotic patches: Tyrosinemia type 2
Ajay Anand Mohite, Joseph Abbott
March 2018, 66(3):449-449
DOI:10.4103/ijo.IJO_820_17  PMID:29480263
  1,132 188 -
Acorea: A rare congenital anomaly
Srikanth Ramasubramanian, Parthopratim Dutta Majumder
March 2018, 66(3):450-450
DOI:10.4103/ijo.IJO_900_17  PMID:29480264
  1,097 213 3
CASE REPORTS
Concurrent management of myopic choroidal neovascularization and rhegmatogenous retinal detachment with intravitreal antivascular endothelial growth factor during primary retinal detachment repair
Kumar Saurabh, Rupak Roy, Nicey Roy Thomas, Maitreyi Chowdhury
March 2018, 66(3):472-474
DOI:10.4103/ijo.IJO_856_17  PMID:29480274
We report concurrent management of rhegmatogenous retinal detachment and myopic choroidal neovascularization in the left eye of a 24-year-old female who presented with sudden dimness of vision due to retinal detachment and choroidal neovascularization. Intravitreal antivascular endothelial growth factor was injected during primary vitrectomy for retinal detachment. At final follow-up, the retina was attached with scarring of choroidal neovascularization. Ours is the first report of the use of intravitreal antivascular endothelial growth factor during vitrectomy for retinal detachment.
  1,113 183 1
COMMENTARY
Macular changes in retinal vasculitis
Kumar Saurabh, Rupak Roy
March 2018, 66(3):439-439
DOI:10.4103/ijo.IJO_1232_17  PMID:29480259
  952 198 1
ERRATUM
Erratum: Optical coherence tomography: A guide to interpretation of common macular diseases

March 2018, 66(3):485-485
DOI:10.4103/0301-4738.226132  PMID:29480284
  965 182 -
LETTERS TO THE EDITOR
Pediatric ophthalmology training in India
Parikshit Gogate, Partha Biswas, Vijayalakshmi Perumalsamy
March 2018, 66(3):478-479
DOI:10.4103/ijo.IJO_1147_17  PMID:29480278
  995 144 1
Calibrated Bowman's lacrimal probe
Amar Pujari, Mandeep S Bajaj, Pradeep Sharma
March 2018, 66(3):478-478
DOI:10.4103/ijo.IJO_1063_17  PMID:29480277
  986 151 -
CASE REPORTS
Commentary: One size does not fit all
Jitendra Jethani
March 2018, 66(3):460-460
DOI:10.4103/ijo.IJO_1209_17  PMID:29480269
  977 148 2
LETTERS TO THE EDITOR
Response to: Pediatric ophthalmology training in India
Sucheta Parija, Preetam Mahajan
March 2018, 66(3):480-480
DOI:10.4103/ijo.IJO_1215_17  PMID:29480279
  885 124 -
Comment on: Surgical treatment of superior oblique palsy: Predictors of outcome
Veenu Maan, Pradeep Agarwal, Mohd Masjood
March 2018, 66(3):481-481
DOI:10.4103/ijo.IJO_1022_17  PMID:29480280
  847 125 -
Comment on: Variation in the vitreoretinal configuration of Stage 4 retinopathy of prematurity in photocoagulated and treatment-naive eyes undergoing vitrectomy
Gaurav Sanghi, Rajeev Gupta
March 2018, 66(3):482-483
DOI:10.4103/ijo.IJO_1011_17  PMID:29480282
  770 147 -
Response to: Surgical treatment of superior oblique palsy: Predictors of outcome
Pilar Merino Sanz, José Escribano, Pilar Gómez De Liaño, Rubén Yela
March 2018, 66(3):481-482
DOI:10.4103/ijo.IJO_1157_17  PMID:29480281
  792 117 -