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   2018| April  | Volume 66 | Issue 4  
    Online since March 26, 2018

 
 
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REVIEW ARTICLE
Simplifying “target” intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma
Ramanjit Sihota, Dewang Angmo, Deepa Ramaswamy, Tanuj Dada
April 2018, 66(4):495-505
DOI:10.4103/ijo.IJO_1130_17  PMID:29582808
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target” IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having – mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. “Target” IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a “Target” IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
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EDITORIAL
Brace up or burnout
Santosh G Honavar
April 2018, 66(4):489-490
DOI:10.4103/ijo.IJO_424_18  PMID:29582805
  1,552 367 -
ORIGINAL ARTICLES
Concomitant use of conjunctival tissue graft from the pterygium itself without rotation in pterygium surgery: A full circle in conjunctival autografting
Shreesha Kumar Kodavoor, Nitin Narendra Tiwari, Dandapani Ramamurthy
April 2018, 66(4):506-510
DOI:10.4103/ijo.IJO_890_17  PMID:29582809
Purpose: The aim of this study is to describe a modified technique of using conjunctival tissue from the pterygium itself without any rotation of graft for the primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium using fibrin glue. Methods: In this retrospective, noncomparative, interventional case series, 98 eyes of 98 patients with primary pterygium operated between July 2011 to July 2016 were included. They underwent this technique from the pterygium tissue itself. There was no rotation of this graft, and it was adhered to the bare scleral defect with fibrin glue. Histopathological analysis of pterygium tissue was done to look for morphology and thickness of this thin conjunctival tissue obtained from pterygium tissue itself. The primary outcome measure was recurrence rate. Other outcome measures studied was graft retraction and graft edema. Results: The mean age was 52 ± 10.04 years. Mean follow-up was 14 ± 8.24 months. The only significant complication was recurrence rate of 4.08% (4 eyes out of 98). The most come secondary outcome was graft edema, 52.04% (51 eyes out of 98) which resolved without any intervention. Other outcome such as graft retraction, 32.65% was also recorded. Conclusion: Conjunctival tissue from the pterygium tissue itself without actual rotation appears to be a successful technique with lower recurrence rate for treating primary pterygium in eyes with glaucoma filtering bleb, glaucoma suspects, and in primary double-head pterygium.
  1,444 335 -
GUEST EDITORIAL
Evaluation of macular ganglion cell analysis compared to retinal nerve fiber layer thickness for pre-perimetric glaucoma diagnosis
Ramanjit Sihota, Shikha Gupta, Dewang Angmo
April 2018, 66(4):491-493
DOI:10.4103/ijo.IJO_235_18  PMID:29582806
  1,053 377 -
ORIGINAL ARTICLES
Evaluation of macular ganglion cell analysis compared to retinal nerve fiber layer thickness for preperimetric glaucoma diagnosis
Sushmita Kaushik, Pankaj Kataria, Vaibhav Jain, Gunjan Joshi, Srishti Raj, Surinder Singh Pandav
April 2018, 66(4):511-516
DOI:10.4103/ijo.IJO_1039_17  PMID:29582810
Purpose: To compare the diagnostic ability of the ganglion cell analysis (GCA) and retinal nerve fiber layer (RNFL) protocol on optical coherence tomography (OCT), to diagnose preperimetric glaucoma. Methods: A prospective, cross-sectional study of 275 adult patients including 47 early glaucoma (mean deviation better than -6.0 D), 150 glaucoma suspects (106 with suspicious discs and 44 ocular hypertensive (OHT), and 78 normal controls was done. Eligible participants were scanned with the spectral domain CirrusTM OCT (Carl Zeiss Meditec, Dublin, CA). Average peripapillary RNFL thickness and GCA measurements were obtained. Area under receiver operating characteristic (AROC) curves were used to evaluate discriminant value of both protocols to diagnose likely preperimetric glaucoma among glaucoma suspects. Results: Average RNFL and GCA were significantly thinner in glaucoma patients compared to glaucoma suspects and normal controls (P < 0.001). The RNFL was 92.26 ± 8.8 μ in normal controls, 87.9 ± 12.12 μ in glaucoma suspects and significantly thinner in POAG (70.29 ± 10.18 μ; P < 0.001). The GCA was 81.94 ± 6.17 μ in normal controls, 77.69 ± 9.03 μ in glaucoma suspects, and significantly thinner in POAG (69.36 ± 11.06 μ; P < 0.001). AROCs for discriminating glaucoma suspects from normal were modest, with no difference in AROC of average RNFL or GCA measurements (DeLong; P = 0.93). Average RNFL thickness had significantly greater AROC values than average GCA for discriminating glaucoma suspects (both suspicious discs and OHT) from glaucoma (P = 0.03 and 0.05, respectively. AROC for diagnosing glaucoma was significantly better (P = 0.02) for RNFL (0.88 ± 0.03) than GCA (0.77 ± 0.04). Conclusion: In the present time, GCA measurements, as provided by the SD-OCT, do not appear to outperform RNFL measurements in the diagnosis of preperimetric glaucoma.
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Changing uveitis patterns in South India - Comparison between two decades
Jyotirmay Biswas, Ranju Kharel (Sitaula), Priyansha Multani
April 2018, 66(4):524-527
DOI:10.4103/ijo.IJO_851_17  PMID:29582812
Purpose: Changing pattern of uveitis in a subset of a population is an important ocular health indicator. Methods: A comparative study was done between uveitis patients of 2013 and 1995 using two proportions Z-test. Results: In 2013, 352 new uveitis cases were examined. Males 56%, females 44%; unilateral 30.4%; bilateral in 69.6%. A specific diagnosis achieved in 66.2%. Anterior uveitis was seen in 35.22%, intermediate uveitis in 30.11%, posterior uveitis in 25%, and panuveitis in 9.65%. There was no significant difference in the incidence of new uveitic cases (1.04% vs. 1.8%). A decline in male preponderance from 64% to 56% (P = 0.0187) was observed. In both studies, anterior uveitis was the most common but human leukocyte antigen-B27 positivity uveitis had increased (29.83% vs. 14.5%; P < 0.05). Intermediate uveitis was the second-most common type instead of posterior uveitis (P = 0.0006). In posterior uveitis cases, etiology was established in 88.6% versus 56.06% cases (P < 0.05). The most common cause of posterior uveitis was tuberculosis (TB) (35.2%). Viral retinitis had increased to 6.81% from 0.76% (P < 0.05). However, a declining trend in cases of toxoplasmosis was observed (P = 0.0545). The cause of panuveitis was comparable in both studies. The prevalence of TB has significantly increased in the present era (22.5% vs. 0.64%; P < 0.0001) and was the proven etiological cause of uveitis in overall 22.5% of which 4.8% cases were of anterior uveitis cases, 7.1% cases of intermediate uveitis cases, 8.8% cases of posterior uveitis cases, and 1.8% of panuveitis cases. Conclusion: A shifting paradigm of uveitis over the past two decades was observed.
  1,065 234 -
ONE MINUTE OPHTHALMOLOGY
Rings on the eyes, matters of the heart
Su Mae Ang, Basil K Williams, Carol L Shields
April 2018, 66(4):494-494
DOI:10.4103/ijo.IJO_296_18  PMID:29582807
  951 319 -
ORIGINAL ARTICLES
Prevalence, progression, and outcomes of diabetic retinopathy during pregnancy in Indian scenario
Tarjani Makwana, Brijesh Takkar, Pradeep Venkatesh, Jai Bhagwan Sharma, Yashdeep Gupta, Rohan Chawla, Rajpal Vohra, Alka Kriplani, Nikhil Tandon
April 2018, 66(4):541-546
DOI:10.4103/ijo.IJO_1062_17  PMID:29582816
Purpose: The objective of this study is to evaluate pattern of diabetic retinopathy (DR) during pregnancy in females with pregestational diabetes mellitus (DM). Methods: This is an ambispective observational cohort study conducted at an Indian tertiary care centre. A total of 50 pregnant females with pregestational DM were included while those with gestational DM were excluded from the study. Ocular examination (inclusive of fundus photography) was conducted and systemic parameters (inclusive of Glycated hemoglobin) were assessed during each of the 3 trimesters and 3 months postpartum. The prevalence and progression of DR during pregnancy in the study cohort were the main outcome measures. Results: Three of the 50 patients had type 1 DM while 47 had type II DM. All the patients with type I DM were insulin dependent while 19 patients with type II DM were insulin dependent. Overall prevalence of DR was 8% (4/50); 2 cases had nonproliferative DR (NPDR), and 2 had proliferative DR (PDR). During the study period, worsening was seen in both the patients with PDR and one required vitrectomy. Mean visual acuity in patients with PDR decreased from 0.77 logMAR units at presentation to 1.23 logMAR at final follow-up. There was no change in the mean visual acuity of patients with NPDR. None of the patients with NPDR converted to PDR. There was no new onset DR in the patients without DR at presentation. Assessment of risk factors for DR revealed significantly higher duration of DM (14 ± 6.32 years vs. 3.43 ± 1.43 years, P = 0.0008). The median age was also higher in the DR patients (31 years vs. 29 years, P = 0.32). Conclusion: No new onset cases were seen during the course of pregnancy and no conversion from NPDR to PDR was seen; however, a worsening of the two PDR cases was observed. No cases of DR were seen in noninsulin-dependent DM. None of the four participants with DR showed a spontaneous resolution of DR postpartum. Patients with PDR and long-standing DM require careful observation during pregnancy. A registry of diabetic mothers should be set up for development of guidelines for managing such cases.
  976 233 -
CASE REPORTS
Successful treatment of allergic conjunctival granuloma by topical tacrolimus: A clinicopathologic case report
Alireza Foroutan, Abdolhossein Ghafourian, Abbas Habibi, Pooria Foroutan, Maryam Ashrafkhorasani, Sayyed Amirpooya Alemzadeh
April 2018, 66(4):578-580
DOI:10.4103/ijo.IJO_490_16  PMID:29582827
Allergic conjunctival granuloma is a rare cause of conjunctival ocular lesions. The aim of this case report was to present a successful treatment of an allergic conjunctival granuloma with topical tacrolimus eye drops. A 20-year-old female presented with bilateral multiple yellow nodules of the bulbar conjunctival epithelium and conjunctival injection. The patient had tearing, photophobia, itching, foreign body sensation, and red eye. The patient's signs and symptoms progressed despite the use of topical steroids. The patient was treated by application of tacrolimus eye drop (0.005%) in her right eye every 6 h while the left eye was put on placebo. Her signs and symptoms were recorded at each visit. After 3 weeks' therapy with topical tacrolimus eye drop, the patient became asymptomatic in her right eye and conjunctival granulomas fully resolved. Topical tacrolimus seems to be an effective therapeutic option for the treatment of allergic conjunctival granulomas.
  1,074 123 -
ORIGINAL ARTICLES
Biochemical scenario behind initiation of diabetic retinopathy in type 2 diabetes mellitus
Lakshmi Kanta Mondal, Gautam Bhaduri, Basudev Bhattacharya
April 2018, 66(4):535-540
DOI:10.4103/ijo.IJO_1121_17  PMID:29582815
Purpose: Despite the disease having similar glycemic status and duration microangiopathy in some patients develop within few years whereas it doesn't appear as a health complication in some diabetics for a considerable period. This study is undertaken to assess the hyperglycemia-induced biochemical background behind the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (DM). Methods: Following proper diagnosis, 100 patients of type 2 DM of 10–12 years duration having no DR, and 42 patients of type 2 DM of the same duration and glycemic status as the second group, with mild retinopathy were recruited in the study. Lactic acid, glutamate, malondialdehyde (MDA), nitrate, advanced glycation end-products (AGEs), peripheral blood mononuclear cell reactive oxygen species (ROS), vascular endothelial growth factor (VEGF), and its receptor 2 (VEGFR2) in these two groups were produced in an assay following standard methodology. Results: Biochemical markers of anaerobic glycolysis, lipid peroxidation, AGEs, glutamate concentration, oxidative stress, and expression of VEGF and its VEGFR2 with significantly elevated markings were found in them who developed earliest stage of DR rather than them who had not. Conclusion: Hyperglycemia-induced anomalous glucose metabolism, lipid peroxidation, advanced glycation, glutamate toxicity, and oxidative stress create a background where apoptosis of retinal capillary endothelial cells invite increased expression of VEGF and VEGFR2, these being the crucial factors behind the development of diabetic microangiopathy.
  856 261 -
SURGICAL TECHNIQUE
Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries
Thomas Kuriakose, Smitha Jasper, Sherina Thomas
April 2018, 66(4):565-567
DOI:10.4103/ijo.IJO_939_17  PMID:29582821
Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC) before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure. This technique, used in 12 eyes, seems to be effective in patients with angle-closure glaucoma, malignant glaucoma, and per-operative sudden increase in vitreous pressure during surgery. Small-incision surgeries are ideally suited for this procedure. This minimally invasive technique is simple to perform and complications are unlikely to be more than what is seen with intravitreal injections.
  942 157 -
ORIGINAL ARTICLES
Application of high intensity focused ultrasound for treatment of open-angle glaucoma in Indian patients
Nilanjana Deb-Joardar, Kasu Prasad Reddy
April 2018, 66(4):517-523
DOI:10.4103/ijo.IJO_1024_17  PMID:29582811
Purpose: The aim of this study is to assess the efficacy of ultrasound cycloplasty (UCP) in Indian patients with open angle glaucoma (OAG). Methods: A prospective interventional study was designed to treat 73 eyes of 73 patients with OAG with the EyeOP1 device equipped with six miniaturized cylindrical piezoelectric transducers. Two treatment protocols of ultrasound delivery depending on exposure time (8 s and 10 s of shot per transducer) were used. Complete ophthalmic examination, ocular biometry and anterior segment optical coherence tomography were performed preoperatively and patients were followed up at day 1, day 7 and months 1, 2, 3, 6, and 12. The primary outcome measure was “successful” intraocular pressure (IOP) control defined as IOP reduction ≥20% from baseline and IOP value >5 mm Hg at the last follow-up visit. Secondary outcomes were the occurrence of complications and mean IOP during the follow-up period. Results: In all patients, the mean IOP reduced from 23.5 ± 3.0 mmHg before treatment to 15.7 ± 5.4 mmHg at 12 months (P < 0.05). Successful IOP control after a single procedure was 78.3% (79% and 78% in the 8 s and 10 s groups, respectively) at 12 months. Overall, the mean IOP reduction achieved in responding patients was 41% (standard deviation = 12%). Notwithstanding minor side effects such as transient pain, anterior chamber reaction, and refractive error changes, no major intraoperative or postoperative complications (severe hypotony or phthisis) were observed during the follow-up. Conclusion: Our short-term results reveal that UCP is a simple, safe, and noninvasive procedure which enables to significantly reduce the IOP in patients with OAG. The study results in Indian eyes corroborate findings in earlier studies on Caucasian eyes.
  818 203 -
Diabetic retinopathy in patients with diabetic foot syndrome in South India
Thoiba Karam, Yogish Subraya Kamath, Lavanya G Rao, Krishna Addoor Rao, Shailaja Bhat Shenoy, Sulatha V Bhandary
April 2018, 66(4):547-550
DOI:10.4103/ijo.IJO_1000_17  PMID:29582817
Purpose: The purpose was to study the retinopathy status in diabetic patients with a risk of diabetic foot (DF) syndrome visiting a tertiary care hospital in South India. Methods: In this cross sectional study all patients with diabetes mellitus (DM) with a risk of DF syndrome, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and eighty-two patients diagnosed to have a risk profile for DF syndrome were included in the study. Their mean age was 59.28 years and 75.27% were males. The mean duration of Type 1 and Type 2 variants of DM was 14.9 years and 10.9 years, respectively. Of the 182 patients, 67.58% had retinopathy changes. Proliferative diabetic retinopathy (DR) constituted 17.88% of the total patients with retinopathy. An increased presence of retinopathy in patients with an increased risk grade of DF was found significant by the Chi-square test (P < 0.001). Conclusion: Our study found an increased presence of DR in a South Indian cohort with DF syndrome. The severity of retinopathy was greater in patients with higher grades of risk for DF. The establishment of an association between DR and DF syndrome will help in developing an integrated management strategy for these two debilitating consequences of diabetes.
  810 192 -
CASE REPORTS
Optical coherence tomography angiography features of choroidal hemangioma
Vinaya Kumar Konana, P Mahesh Shanmugam, Rajesh Ramanjulu, K C Divyansh Mishra, Pradeep Sagar
April 2018, 66(4):581-583
DOI:10.4103/ijo.IJO_955_17  PMID:29582828
This is an observational case series of four cases of choroidal hemangioma. All cases underwent OCT angiography with swept source OCTA (Topcon DRI OCT Triton plus) 6 mm * 6 mm protocol. OCTA at the level of large choroidal vessels demonstrated peculiar vascular pattern in all four eyes. Patterns observed were bag of worms, spaghetti like and vessels with terminal bulbs. In eye with diffuse choroidal hemangioma comparison of choroidal vascular pattern with the contralateral eyes showed significant difference in the vascular architecture. OCTA is an excellent non invasive tool in assessing the choroidal vascular pattern in eyes with choroidal hemangioma.
  807 192 -
ORIGINAL ARTICLES
Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors
Prabhushanker Mahalingam, Tasneem Tameem Topiwalla, Geetha Ganesan
April 2018, 66(4):558-561
DOI:10.4103/ijo.IJO_770_17  PMID:29582819
Purpose: This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy. Methods: A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks. Results: Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05). Conclusion: The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.
  808 155 -
Change in choroidal vascularity in acute central serous chorioretinopathy
Mohammed Abdul Rasheed, Abhilash Goud, Ashik Mohamed, Kiran Kumar Vupparaboina, Jay Chhablani
April 2018, 66(4):530-534
DOI:10.4103/ijo.IJO_1160_17  PMID:29582814
Purpose: This study aims to compare the effect of laser photocoagulation or observation on choroidal vascularity in acute central serous chorioretinopathy (CSCR). Methods: A retrospective analysis of 30 patients with acute CSCR treated either with laser photocoagulation (16 eyes) or sham laser (14 eyes) was performed. Demographic details, visual acuity (VA) assessment, and other relevant clinical data were considered from baseline to the 3rd and 6th month follow-up visits. Participants with chronic CSCR and missing follow-up or inadequate data were excluded. Choroidal analysis including choroidal thickness and choroidal vascularity index (CVI) assessment was done for each visit using Spectral Domain (SD) Optical Coherence Tomography (OCT) images. Results: In laser arm group, there was a statistically significant change in VA, contrast sensitivity and central macular thickness (CMT) and neurosensory detachment (NSD) (P < 0.05) at the 3rd and 6th month visits. However, there was no statistically significant difference in subfoveal choroidal thickens (SFCT) and CVI (P > 0.05) at both the visits. In sham laser group, similarly, there was a significant improvement in VA, contrast sensitivity, CMT, and CVI (P < 0.05) at the 3rd and 6th month visits. There was significant reduction in NSD at the 3rd month; however, it was not statistically significant at the 6th month visit. SFCT did not change significantly at both the visits. There was no significant difference for the changes in parameters between the groups at the 6th month. Regression analysis showed no significant correlation with final VA with any of the baseline parameters. Conclusion: Early laser photocoagulation does lead to change in choroidal morphology, though insignificant, in comparison to observation. The present data, yet again, support no additional benefit of early laser photocoagulation in acute CSCR.
  747 189 -
PHOTO ESSAY
Bilateral multifocal retinal pigment epithelium detachment and pachychoroidopathy
Chokkahalli K Nagesha, Emmanuel O Megbelayin
April 2018, 66(4):570-571
DOI:10.4103/ijo.IJO_1070_17  PMID:29582823
  713 147 -
CASE REPORTS
A rare case of unilateral diffuse melanocytic proliferation
Guruprasad Ayachit, Apoorva Ayachit, Shrinivas Joshi, Sameera V Vasudevan
April 2018, 66(4):588-590
DOI:10.4103/ijo.IJO_979_17  PMID:29582831
A 67-year-old woman presented with metamorphopsia in the right eye. Leopard mottling was seen temporal to the fovea oculus dexter with corresponding hyper- and hypo-autofluorescent lesions on fundus autofluorescence. Spectral domain-optical coherence tomography revealed hyperreflective dots in the retinal pigment epithelium and choroid with subretinal fluid (SRF). Intravitreal bevacizumab was administered with which SRF resolved, albeit with increase in the areas of mottling. The patient was diagnosed to have metastatic ductal carcinoma of the right breast. It is important to bear in mind that the well-known entity of bilateral diffuse uveal melanocytic proliferation can rarely present unilaterally.
  734 125 -
Progressive outer retinal necrosis after rituximab and cyclophosphamide therapy
Mohit Dogra, Priya Bajgai, Ashok Kumar, Aman Sharma
April 2018, 66(4):591-593
DOI:10.4103/ijo.IJO_811_17  PMID:29582832
We report a case of progressive outer retinal necrosis (PORN) in a patient of microscopic polyangitis (MPA), being treated with immunosuppressive drugs such as cyclophosphamide and rituximab. Her aqueous tap was positive for Varicella Zoster virus and she was treated with oral and intravitreal antivirals, along with discontinuation of one of the immunosuppressive agents, i.e. rituximab, which might have led to reactivation of the virus causing necrotizing retinitis lesions. Rituximab and cyclophosphamide are extremely potent drugs, which are necessary to manage immunological disorders such as MPA. However, they may predispose the patient to serious complications like viral infections, including PORN.
  715 141 -
Actinomycetes canaliculitis complicating congenital nasolacrimal duct obstruction in an infant
Akshay Gopinathan Nair, Nayana A Potdar, Swaranjali S Gore, Amol Y Ganvir, Monisha K Apte, Trupti R Marathe, Chaya A Kumar, Chhaya A Shinde
April 2018, 66(4):574-577
DOI:10.4103/ijo.IJO_1075_17  PMID:29582826
Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.
  677 116 -
Management of multi drug resistant endogenous Klebsiella pneumoniae endophthalmitis with intravitreal and systemic colistin
Mohit Dogra, Mansi Sharma, Deeksha Katoch, Mangat Dogra
April 2018, 66(4):596-597
DOI:10.4103/ijo.IJO_809_17  PMID:29582834
We report a case of a 35-year-old male with a pancreatic pseudocyst, who developed bilateral endogenous endophthalmitis, 4 days after surgical drainage of the pseudocyst. Bacterial cultures of the pancreatic drain fluid and the vitreous tap showed the growth of Klebsiella pneumoniae. The cultured organism was resistant to all the tested antibiotics except colistin. Intravenous colistin was instituted and three injections of intravitreal colistin were given in the left eye of the patient. Complete resolution of infection was seen and visual acuity of 6/6 was regained in both eyes, which was maintained at 4-month follow-up.
  630 152 -
Commentary: Management of endogenous endophthalmitis: Ophthalmologist in the role of a physician
Kumar Saurabh, Rupak Roy, Dhaivat Shah
April 2018, 66(4):598-599
DOI:10.4103/ijo.IJO_1334_17  PMID:29582835
  623 150 -
OPHTHALMIC IMAGES
Rapid regression of retinal neovascularization following intravitreal bevacizumab in branch retinal vein occlusion imaged by optical coherence tomography angiography
Manpreet Brar, Dilraj S Grewal, Mansi Sharma, S P S Grewal
April 2018, 66(4):572-572
DOI:10.4103/ijo.IJO_868_17  PMID:29582824
  549 151 -
SURGICAL TECHNIQUE
Surgical technique for management of isolated lenticular coloboma with high corneal astigmatism
Simar Rajan Singh, Sonam Yangzes, Rohit Gupta, Jagat Ram
April 2018, 66(4):562-564
DOI:10.4103/ijo.IJO_1026_17  PMID:29582820
We describe a surgical technique for the correction of isolated congenital lenticular coloboma associated with high corneal astigmatism. Transscleral fixation of the capsular bag with a single eyelet Cionni capsular tension ring was followed by in-the-bag implantation of a toric intraocular lens (IOL). This lead to complete correction of the lenticular defect and perfect alignment of the toric lens. In this case, the child attained an unaided distance visual acuity of 20/30 following amblyopia therapy and a well-aligned toric IOL at 12 months of follow-up. This technique can be used in cases with concomitant lenticular coloboma and significant corneal astigmatism.
  537 114 -
CASE REPORTS
Unique case of midbrain tuberculoma presenting as isolated inferior rectus palsy with nystagmus
Akkayasamy Kowsalya, Umang Gajarlewar, Namrata G Adulkar, S Mahesh Kumar
April 2018, 66(4):599-602
DOI:10.4103/ijo.IJO_470_17  PMID:29582836
Isolated brain stem tuberculoma constitutes about 5% of all intracranial tuberculomas. A case of isolated inferior rectus palsy with downbeat nystagmus due to presumed midbrain tuberculoma in an immunocompetent patient is described here. This report documents a rare entity of a combination of partial third nerve palsy with pupil involvement along with downbeat nystagmus.
  513 121 -
Multimodal imaging of choroidal nodules in neurofibromatosis type-1
Vinod Kumar, Shilky Singh
April 2018, 66(4):586-588
DOI:10.4103/ijo.IJO_1095_17  PMID:29582830
Choroidal nodules in neurofibromatosis type-1 are common and are best imaged with near-infrared reflectance (NIR) imaging. The authors describe swept-source optical coherence tomography angiography (SSOCTA) of choroidal nodules. These nodules are seen as hyperflow areas on SSOCTA and correlate well to bright patches on NIR imaging. The utility of multicolor scanning laser imaging in detecting these abnormalities is also described.
  509 120 -
COMMENTARY
Changing patterns in uveitis South India: Comparison between two decades
Manohar Babu Balasundaram
April 2018, 66(4):528-529
DOI:10.4103/ijo.IJO_363_18  PMID:29582813
  503 126 -
LETTERS TO THE EDITOR
Comment on: Antibiotic prophylaxis in cataract surgery – An evidence-based approach
Virgilio Galvis, Alejandro Tello, Paul A Camacho, Juan J Rey
April 2018, 66(4):603-603
DOI:10.4103/ijo.IJO_1309_17  PMID:29582837
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CASE REPORTS
Choroidal osteoma in a preterm infant
Yakup Aksoy, Yavuz Çakir, Sükrü Sevinçli, Murat Sönmez, Ali Ayata
April 2018, 66(4):583-585
DOI:10.4103/ijo.IJO_914_17  PMID:29582829
Choroidal osteoma (CO) is a rare, benign, and usually unilateral intraocular tumor composed of mature bone affecting the choroid. It appears as slightly elevated, yellowish-white, or orange choroidal mass with well-defined borders. It is commonly encountered in young female adults. Here, we report findings of a 4-week-old premature baby with CO in her left eye which was detected during a routine examination for “retinopathy of prematurity.” We believe that this case is the youngest patient reported with CO which showing that this pathology can be encountered even in a newborn.
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PHOTO ESSAY
Floating venous loop in regressed retinopathy of prematurity
Shreyas Temkar, Sourav Damodaran, Rohan Chawla, Shashwat Behera, Rahul Kumar Bafna, Kumar Parmanand
April 2018, 66(4):568-569
DOI:10.4103/ijo.IJO_1017_17  PMID:29582822
  466 117 -
OPHTHALMIC IMAGES
Mud-splattered fundus
R Joel Welch, Xintong Li, Carol L Shields
April 2018, 66(4):573-573
DOI:10.4103/ijo.IJO_1003_17  PMID:29582825
  446 132 -
CASE REPORTS
Presumably contaminated intravenous infusion-induced Aspergillus terreus endogenous endophthalmitis presenting with posterior hypopyon
Mohit Dogra, Madhuri Akella, Mangat R Dogra, Amod Gupta
April 2018, 66(4):593-595
DOI:10.4103/ijo.IJO_695_17  PMID:29582833
A 36-year-old immunocompetent man developed endogenous endophthalmitis 1 week after intravenous fluid infusion in a rural setting. Large submacular abscess with posterior hypopyon warranted urgent vitrectomy which revealed Aspergillus terreus on fungal culture. Intravitreal and oral antifungals lead to resolution of inflammation with satisfactory anatomic outcome but poor visual outcome due to submacular scar.
  456 100 -
ORIGINAL ARTICLES
Association of exudative age-related macular degeneration with matrix metalloproteinases-2 (-1306 C/T) rs243865 gene polymorphism
Rasa Liutkeviciene, Alvita Vilkeviciute, Dominyka Borisovaite, Goda Miniauskiene
April 2018, 66(4):551-557
DOI:10.4103/ijo.IJO_1050_17  PMID:29582818
Purpose: Age-related macular degeneration (AMD) is a disease of the macula that significantly affects eyesight and leads to irreversible central vision loss. Recent studies have demonstrated that angiogenesis is the most important mechanism of AMD development. It is associated with extracellular remodeling involving different proteolytic systems, among them matrix metalloproteinases (MMPs), which play an essential role in the etiopathogenesis of AMD. The main objective of the present study was to determine the relationship between exudative AMD and MMP-2 (-1306 C/T) rs243865 polymorphism. Methods: The study enrolled 267 patients with exudative AMD and 318 controls. DNA was extracted from peripheral venous blood leukocytes by commercial kits. Genotyping of MMP-2 (-1306 C/T) rs243865 was carried out using real-time polymerase chain reaction method. Results: The analysis of MMP-2 (-1306 C/T) polymorphism did not reveal any differences in the distribution of CC, CT, and TT genotypes between the exudative AMD and control groups: 58.8%, 31.5% and 9.7% vs. 59.75%, 33.96% and 6.29%, respectively, P = 0.287). When the study population was subdivided into age groups, MMP-2 (-1306 C/T) rs243865 CT genotype showed 5.7-fold increased the risk of exudative AMD development compared to CC and TT genotypes together in younger (<65 years) males group (P = 0.05). Conclusion: MMP-2 (-1306 C/T) polymorphism is associated with exudative AMD development in younger males.
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LETTERS TO THE EDITOR
Response to comment on: Bilateral idiopathic spontaneous filtering bleb with ectopia lentis: A case report and review of literature
Premanand Chandran, Anjali S Khairnar, Nabeed Aboobacker, Ganesh V Raman
April 2018, 66(4):605-606
DOI:10.4103/ijo.IJO_249_18  PMID:29582840
  432 71 -
Comment on: Bilateral idiopathic spontaneous filtering bleb with ectopia lentis: A case report and review of literature
Sirisha Senthil
April 2018, 66(4):604-605
DOI:10.4103/ijo.IJO_160_18  PMID:29582838
  364 76 -
Comment on: Viscoelastic-augmented trabeculectomy – A newer concept
Sanjay Kumar Daulat Thakur
April 2018, 66(4):604-604
DOI:10.4103/ijo.IJO_865_17  PMID:29582839
  365 72 -
ERRATUM
Erratum: Age and myopia associated optical coherence tomography of retina and choroid in pediatric eyes

April 2018, 66(4):606-606
DOI:10.4103/0301-4738.228581  PMID:29582841
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