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  Access statistics : Table of Contents
   2018| July  | Volume 66 | Issue 7  
    Online since June 25, 2018

 
 
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REVIEW ARTICLES
Polypoidal choroidal vasculopathy: Pearls in diagnosis and management
Giridhar Anantharaman, Jay Sheth, Muna Bhende, Raja Narayanan, Sundaram Natarajan, Anand Rajendran, George Manayath, Parveen Sen, Rupak Biswas, Alay Banker, Charu Gupta
July 2018, 66(7):896-908
DOI:10.4103/ijo.IJO_1136_17  PMID:29941728
Polypoidal choroidal vasculopathy (PCV) is increasingly recognized as an important cause of exudative maculopathy in Asians as against Wet age-related macular degeneration in Caucasians. A panel of retinal experts methodically evaluated pertinent updated literature on PCV with thorough PubMed/MEDLINE search. Based on this, the panel agreed upon and proposed the current consensus recommendations in the diagnosis (clinical and imaging), management and follow-up schedule of PCV. Diagnosis of PCV should be based on the gold standard indocyanine green angiography which demonstrates early nodular hyperfluorescence signifying the polyp with additional features such as abnormal vascular network (AVN). Optical coherence tomography is an excellent adjuvant for diagnosing PCV, monitoring disease activity, and decision-making regarding the treatment. Current treatment modalities for PCV include photodynamic therapy, anti-vascular endothelial growth factor agents, and thermal laser. Choice of specific treatment modality and prognosis depends on multiple factors such as the location and size of PCV lesion, presence or absence of polyp with residual AVN, amount of submacular hemorrhage, presence or absence of leakage on fundus fluorescein angiography, visual acuity, and so on. Current recommendations would be invaluable for the treating physician in diagnosing PCV and in formulating the best possible individualized treatment strategy for optimal outcomes in PCV management.
  17,829 2,397 25
Novel techniques in scleral buckling
P Mahesh Shanmugam, Rajesh Ramanjulu, K C Divyansh Mishra, Pradeep Sagar
July 2018, 66(7):909-915
DOI:10.4103/ijo.IJO_136_18  PMID:29941729
Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. With the introduction of pars plana vitrectomy (PPV), there is a growing trend towards the use of PPV for treatment of retinal detachment. There is a reluctance to perform scleral buckling (SB) in RRD due to the perceived steep learning curve, declining mastery over indirect ophthalmoscopy, and poor ergonomics associated with SB. In this article, we discuss the surgical challenges and tips to overcome these in four headings: localization of the break, retinopexy, SB, and subretinal fluid (SRF) drainage. Localization of the break can be performed by the use of forceps or illuminated scleral depressor. It can be facilitated by prior drainage of SRF in cases with bullous RRD. Chandelier with wide-angle viewing system can be used for easier localization of break and cryopexy. Sutureless buckling and suprachoroidal buckling are easier and faster alternatives to the conventional technique. Reshaping the silicone segment helps in accommodating the wider circumferential band. Modified needle drainage, laser choroidotomy, and infusion-assisted drainage can make SRF drainage easier and safer. The above techniques and other practical tips have been explained in detail with the illustrations to make the process of learning the art of SB easier.
  6,213 1,097 7
CASE REPORTS
Culture-positive unilateral panophthalmitis in a serology-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
July 2018, 66(7):1017-1019
DOI:10.4103/ijo.IJO_113_18  PMID:29941760
Dengue fever, a mosquito-borne disease commonly found in the tropics, is one of the most prevalent forms of Flavivirus infection in humans. Symptomatically, it is characterized by fever, arthralgia, headache, and rash. Ophthalmic manifestations can involve both the anterior and posterior segment. Panophthalmitis is rare in dengue hemorrhagic fever, and there is no report of culture-positive panophthalmitis in this setting. Here, we report a case of a serology-positive 33-year-old male patient of dengue hemorrhagic fever who developed sudden onset pain, redness, and proptosis in the right eye. The patient subsequently developed panophthalmitis in his right eye, and Bacillus cereus was isolated from eviscerated sample. This case provides unique insights into pathogenesis of panophthalmitis in dengue and highlights the management options.
  5,661 297 4
EDITORIAL
Pediatric eye screening – Why, when, and how
Santosh G Honavar
July 2018, 66(7):889-892
DOI:10.4103/ijo.IJO_1030_18  PMID:29941725
  4,426 807 9
ORIGINAL ARTICLES
Prevalence and causes of visual impairment among adults aged 15–49 years in a rural area of north India - A population-based study
Sumit Malhotra, Praveen Vashist, Noopur Gupta, Mani Kalaivani, Ramashankar Rath, Sanjeev Kumar Gupta
July 2018, 66(7):951-956
DOI:10.4103/ijo.IJO_1333_17  PMID:29941738
Purpose: Very few studies have been conducted in India and other parts of the world on visual impairment among individuals aged 15–49 years. This study was conducted to determine the prevalence, causes, and associated factors of visual impairment among adults aged 15–49 years in a rural population of Jhajjar district, Haryana, north India. Methods: A population-based cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 15–49 years were selected using compact segment cluster sampling approach. As part of the house-to-house survey, presenting visual acuity using screening chart corresponding to five “E” 6/12 optotypes was measured along with collection of other demographic details. The optometrists performed detailed eye assessment including repeat measurement of visual acuity using retro-illuminated conventional logMAR tumbling “E” charts, torch light examination, and non-cycloplegic refraction at a clinic site within the village to ascertain visual impairment and its cause. Results: Of 5,470 enumerated adults, 5,117 (94%) completed all study procedures. The age- and sex-adjusted prevalence of visual impairment was found to be 1.85% [95% confidence interval (CI): 1.48, 2.23] and blindness was 0.09% (95% CI: 0.01, 0.18). The age- and sex-adjusted prevalence of unilateral visual impairment was 1.11% (95% CI: 0.81, 1.41). Uncorrected refractive errors (84%) contributed maximum to visual impairment in this age group. The visual impairment in study participants was found to be associated with age and educational status. Conclusion: At the community level, uncorrected refractive errors contribute largely to visual impairment in the age group of 15–49 years.
  4,322 404 13
Community outreach: An indicator for assessment of prevalence of amblyopia
Damaris Magdalene, Harsha Bhattacharjee, Mitalee Choudhury, Prabhjot Kaur Multani, Anshul Singh, Saurabh Deshmukh, Krati Gupta
July 2018, 66(7):940-944
DOI:10.4103/ijo.IJO_1335_17  PMID:29941736
Purpose: To study the prevalence, determine the magnitude, and cause of amblyopia among the children aged 6 months to 16 years in Kamrup district, Assam, India. Methods: Among a total of 39,651 children between 6 months and 16 years of age, door-to-door screening was conducted by trained workers. For children above 5 years of age who failed to read the 6/9 line, camps were conducted in the nearby schools. Children below 5 years of age were directly referred to the tertiary eye care institute. After visual acuity assessment at the institute, cycloplegic refraction and complete ophthalmic examination were done to rule out other causes of diminution of vision. Axial length measurement and corneal topography were performed in children with high refractive errors. Results: Of the total 39,651 children screened, 469 were diagnosed to have amblyopia at the camp and 223 were diagnosed at the institute. The prevalence of amblyopia was 1.75%. Amblyopia was more common among the males (52.50%) as compared to females. Maximum number of patients were found in the age group of 11–16 (63.58%). Refractive amblyopia was found to be the most common cause of amblyopia (45.29%). In children below 5 years, deprivation amblyopia and strabismic amblyopia were more common. Conclusion: Awareness of amblyopia among the parents is essential for early detection and treatment of the disease, which will, in turn, reduce the burden of childhood visual impairment.
  3,945 352 4
Assessing the inclusion of primary school children in vision screening for refractive error program of India
Pallavi Shukla, Praveen Vashist, Suraj Senjam Singh, Vivek Gupta, Noopur Gupta, Meenakshi Wadhwani, Amit Bharadwaj, Lakshya Arora
July 2018, 66(7):935-939
DOI:10.4103/ijo.IJO_1036_17  PMID:29941735
Purpose: In India, teachers screen middle school children using the 6/9 Snellen's optotype. Recently, the National Program for Control of Blindness included primary school students also. The present cross-sectional study was planned to assess the inclusion of primary school students. Compliance to spectacles was ascertained after 6 months follow-up. Methods: Randomly selected 23 Government primary schools. A total of 30 teachers were nominated and given hands-on training in vision screening and recording formats. Teachers conducted vision screening of primary school students of their respective schools using the 6/12 Snellen's chart and referred students with subnormal vision to optometrist. Optometrist also validated the screening done by teachers. Optometrist screened the vision of 5% randomly selected children screened by teachers as having normal vision. Descriptive statistics used STATA version 13.0. Results: A total of 6056 students screened by the teachers. Sensitivity and specificity of teacher screening were 92.3% (confidence interval [CI] 88.6–95.0) and 72.6% (CI 68.2–76.6)), respectively. About 277 students underwent refraction and 186 prescribed spectacles. The prevalence of myopia, hypermetropia, and astigmatism is 2.5% (2.1–2.9), 0.6% (0.4–0.8), and 1.3% (1.0–1.6), respectively. Compliance to spectacles usage is 36%. Conclusion: Burden of refractive error in primary school is very low. Trained teachers can identify children with subnormal vision, but the false-positive rate is very high. Compliance to spectacle use among primary school children is also less. Vision screening by teachers prioritized in secondary schools and preschool screening should be done by more skilled eye care workers preferably optometrist.
  3,675 420 6
CASE REPORTS
Intercalary membrane as the inner wall overlying optic and chorio-retinal colobomas. Deep penetration Swept Source-OCT study
Jorge Ruiz-Medrano, Ignacio Flores-Moreno, Javier A Montero, Jose M Ruiz-Moreno
July 2018, 66(7):1027-1030
DOI:10.4103/ijo.IJO_892_17  PMID:29941764
Five eyes of four patients were studied to analyze the structure of the inner wall of optic and chorioretinal colobomas using swept-source optical coherence tomography (SS-OCT). The colobomatous cavities and their relationship with adjacent structures were examined. SS-OCT permitted the study of the colobomatous cavities in all cases. In four of those cases, a Y-shaped intercalary membrane (ICM) was identified, with an origin in the retinal nerve fiber layer (RNFL), which covered the coloboma and in one case the coloboma was in contact with the vitreous cavity. Vitreous adhesion to the internal wall of the coloboma was found in three cases. No clinical or tomographic maculopathy was observed in any patient. High-resolution deep penetration SS-OCT allows in vivo study of optic and chorioretinal colobomas, identifying the RNFL as the main component of the ICM overlying the colobomatous cavities.
  3,685 253 4
Validating the pachychoroid disease spectrum using multimodal imaging
Guruprasad Ayachit, Apoorva Ayachit, Harsha Nadgir, Shrinivas Joshi
July 2018, 66(7):1022-1024
DOI:10.4103/ijo.IJO_180_18  PMID:29941762
Pachychoroid disease spectrum has garnered considerable interest and has been discussed in detail in recent literature. It refers to a group of retinal and choroidal disorders, namely pigment epitheliopathy, central serous chorioretinopathy, neovasculopathy, and polypoid choroidal vasculopathy, all arising from a thickened choroid and hyperpermeable large choroidal vessels. We describe a case which had simultaneous presentation of multiple disorders on the pachychoroid spectrum. Multimodal findings in this patient have been described in this report. The presence of pachychoroid should prompt thorough imaging since coexistence of multiple disorders can potentially change the management and follow-up schedule of these patients.
  3,421 446 6
ORIGINAL ARTICLES
Comparison of the efficacy of Lea Symbol chart and Sheridan Gardiner chart for preschool vision screening
Cigi M Paul, Sanitha Sathyan
July 2018, 66(7):924-928
DOI:10.4103/ijo.IJO_1078_17  PMID:29941732
Purpose: To compare the efficacy of Lea symbols (LS) chart and Sheridan Gardiner (SG) chart for vision screening among preschool children, in a semi-urban district of South India. Methods: Vision screening was conducted among 260 preschool children aged 3–5 years in cluster sampled kindergartens using LS chart and SG chart. Pass/fail scores and time taken for visual acuity (VA) estimation were compared. VA scores and time taken were compared using unpaired t-test. Sensitivity, specificity, and positive and negative predictive values were compared between the charts. Results: There was a significant difference between LS and SG charts in the VA score in both the eyes (P = 0.04). LS showed 76.09% pass score and 23.90% fail score, whereas SG showed 87.65% pass score and 12.35% fail score with a cutoff value of > 0.3 log MAR. Time for screening using LS was higher, when compared to SG, both for the right eyes (P < 0.001) and the left eyes (P < 0.001). The sensitivity of the LS was 94.74% (95% confidence interval [CI]: 70.13%–81.06%) and that of SG was 52.63% (95% CI: 45.29%–59.8%). The specificity of LS was 66.67% (95% CI: 90.26%–97.30%) and SG was 83.33% (95% CI: 70.12%–91.30%). Conclusion: LS chart showed better sensitivity and negative predictive value when compared to SG chart. However, SG chart showed better specificity and positive predictive value, and screening was less time-consuming. Considering the high sensitivity and negative predictive value, LS is the preferred tool, when compared to SG chart in preschool vision screening in our population.
  3,327 387 4
ORIGINAL ARTICLE
Association of obesity and age-related macular degeneration in Indian population
Durgasri Jaisankar, Gayathri Swaminathan, Rupak Roy, Vaitheeswaran Kulothungan, Tarun Sharma, Rajiv Raman
July 2018, 66(7):976-983
DOI:10.4103/ijo.IJO_1265_17  PMID:29941743
Purpose: The aim of this study was to establish the prevalence and association of age-related macular degeneration (AMD) and obesity which was not studied extensively in Indian population over 60 years of age. Methods: This was a cross-sectional, population-based study. A total of 4791 patients with gradable fundus photography were included. All patients underwent detailed ophthalmic examination and AMD was graded with retinal photographs. Grading of AMD was done according to the International ARM Epidemiological Study Group and staged based on grading in worse eye. The association of AMD severity and obesity (based on body mass index, waist–hip ratio, waist circumference, isolated abdominal obesity, isolated generalized obesity, and combined obesity) was assessed. The main outcome variable was an association between the presence and severity of AMD with different grades of obesity. Results: No direct significant association was noted between the presence and severity of AMD and any obesity indices. Subgroup analyses based on lifestyle patterns and common systemic pathologies in AMD population were done. Late AMD was significantly associated with tobacco consumption in population with combined obesity (P = 0.033 and odds ratio = 2.998). Conclusion: No direct association was noted between the presence or severity of AMD and obesity in South Indian population. However, indirect associations between the severity of AMD and combined obesity were found.
  3,131 405 5
ORIGINAL ARTICLES
Factors limiting the Northeast Indian elderly population from seeking cataract surgical treatment: Evidence from Kolasib district, Mizoram, India
S G Prem Kumar, Amit Mondal, Pankaj Vishwakarma, Sabitra Kundu, Ralte Lalrindiki, Elizabeth Kurian
July 2018, 66(7):969-974
DOI:10.4103/ijo.IJO_1184_17  PMID:29941741
Purpose: Reliable data on the barriers to the uptake of cataract surgical services in the Northeast Indian states are scanty. The purpose of this study was to assess the barriers to uptake of cataract surgical services among elderly patients and suggest appropriate strategies to reduce these. Methods: A cross-sectional study was conducted among patients who failed to avail cataract surgical services, 6–12 months' postinitial diagnosis at a community eye health camp. Validated questionnaire was used to collect information through face-to-face interviews at the residence of the participants. Descriptive statistics and Chi-square tests were conducted to assess the association between the barriers quoted and sociodemographic variables. Results: A total of 140 (89.2%) individuals participated in the study, of whom 56 (40%) were aged between 71 and 80 years. The median age for men and women was 73.5 and 72.5 years, respectively. About 57% of participants were female patients. A total of 66 (47.1%) participants had borderline visual acuity followed by those with poor vision (41.4%, n = 58). “Bad roads/difficult terrain” (P = 0.009), “witnessed bad surgical outcomes in others” and “did not feel important” (P < 0.024), “poor overall health status” (P < 0.001), “lack of information” (P = 0.025) and “no escort” (P = 0.025) were significant barriers reported by this population. Conclusion: Most of the barriers reported in this study seem to be endogenous in nature and appear to be within the purview of the local eye care service provider to remedy. Counseling and targeted awareness and information, education, and communication strategies could nullify many of the barriers reported in this study.
  3,226 275 8
CONSENSUS
Community care for diabetic retinopathy and glaucoma in India: A panel discussion
Padmaja Kumari Rani, Vinay Nangia, Krishna R Murthy, Rohit C Khanna, Taraprasad Das
July 2018, 66(7):916-920
DOI:10.4103/ijo.IJO_910_17  PMID:29941730
Diabetic retinopathy (DR) and glaucoma are emerging causes of blindness and visual impairment in India and the world. Both diseases do not have any early warning symptoms, and once the symptoms appear, the diseases are reasonably advanced. Because of the long-standing nature of the diseases, one cannot adopt the cataract detection and treatment model so successfully developed in India. It requires an altogether different approach for screening and related infrastructure including human capital development. The solutions developed to reduce the burden of DR/glaucoma should be customized to urban, semi-urban, and rural areas. Greater advocacy, improving the health-seeking behavior, development of infrastructure and skilled personnel appropriate for the points of care, and an emphasis in comprehensive eye care are some of the solutions.
  3,045 363 5
ORIGINAL ARTICLES
Tribal Odisha Eye Disease Study # 4: Accuracy and utility of photorefraction for refractive error correction in tribal Odisha (India) school screening
Sandeep Reddy, Lapam Panda, Anjul Kumar, Suryasmita Nayak, Taraprasad Das
July 2018, 66(7):929-933
DOI:10.4103/ijo.IJO_74_18  PMID:29941733
Purpose: To compare the photorefraction system (Welch Allyn Spot™) performance with subjective refraction in school sight program in one Odisha (India) tribal district. Methods: In a cross-sectional study school students, aged 5–15 years, referred after the preliminary screening by trained school teachers received photoscreening and subjective correction. The photoscreener was compared to subjective refraction in the range of +2D to −7.5D. Statistical analysis included Friedman nonparametric test, Wilcoxon signed-rank test, linear regression, and Bland–Altman plotting. Results: The photoscreener was used in 5990 children. This analysis included 443 children (187 males, 256 females, and the mean age was 12.43 ± 2.5 years) who received both photorefraction and subjective correction, and vision improved to 6/6 in either eye. The median spherical equivalent (SE) with spot photorefraction was 0.00 D (minimum −5.0D; maximum +1.6 D), and with subjective correction was 0.00D (minimum −6.00 D; maximum +1.5 D). The difference in the SE between the two methods was statistically significant (P < 0.001) using Friedman nonparametric test; it was not significant for J 45 and J 180 (P = 0.39 and P = 0.17, respectively). There was a good correlation in linear regression analysis (R2 = 0.84) and Bland–Altman showed a good agreement between photorefraction and subjective correction in the tested range. Conclusion: Photorefraction may be recommended for autorefraction in school screening with reasonable accuracy if verified with a satisfactory subjective correction. The added advantages include its speed, need of less expensive eye care personnel, ability to refract both eyes together, and examination possibility in the native surrounding.
  3,154 254 1
Facilitating factors in overcoming barriers to cataract surgical services among the bilaterally cataract blind in Southern India: A cross-sectional study
Anika Amritanand, Smitha Jasper, Padma Paul, Thomas Kuriakose
July 2018, 66(7):963-968
DOI:10.4103/ijo.IJO_216_18  PMID:29941740
Purpose: To effectively address cataract blindness, increasing sight-restoring surgeries among the bilaterally blind are essential. To improve uptake of surgical services among this group, evidence regarding the problems of access is vital. Barriers in accessing eye care services have previously been reported but not specific to bilaterally cataract blind patients. Further, there is a gap in knowledge regarding factors facilitating access to eye care. Our aims were to (1) report proportion of bilaterally cataract blind patients undergoing surgery and sight restoration rate (SRR) and (2) analyze barriers and factors enabling access to eye care services among bilaterally cataract blind patients. Methods: Retrospective analysis of interview and clinical data of bilaterally cataract blind patients undergoing surgery through outreach services at the base hospital, from June 2015 to May 2016, was performed. Demographic data, vision, postoperative visual outcomes, barriers, and facilitating factors in accessing cataract surgical services were obtained. Results: Bilateral cataract blindness was present in 196/3178 (6.2%, 95% confidence interval 5.4–7.06) patients. SRR was 6.5%. Fear of surgery (24.2%) and lack of family support/escort (22.9%) were the most common barriers. Neighbors and acquaintances (28.6%), general health workers (20.2%), and persons who had undergone cataract surgery (19.6%) were the most common facilitating factors. Conclusion: Proportion of bilaterally cataract blind people undergoing surgery and consequently SRR were low. The most common barriers were at the individual level while facilitating factors at the community level were instrumental in promoting uptake of services. Interventions involving community-based support for the blind may be useful in overcoming barriers to eye care.
  2,993 289 6
PHOTO ESSAY
Multimodal imaging of choroidal tubercles
T Lekha, Ramaraju Karthikeyan
July 2018, 66(7):995-996
DOI:10.4103/ijo.IJO_155_18  PMID:29941748
  2,993 253 3
CASE REPORTS
Endocrine mucin-producing sweat gland carcinoma of the eyelid: A clinical and histological conundrum
Akshay Gopinathan Nair, Ratika Bhargava, Amjad Umer Furniturewala
July 2018, 66(7):1042-1044
DOI:10.4103/ijo.IJO_36_18  PMID:29941769
A 60-year-old male presented with a 6-month-old history of a left upper lid mass. The mass was excised, and histopathological evaluation showed a well-circumscribed, multinodular, intradermal tumor consisting of round-to-oval cells with round nuclei and mucin filled cysts. On immunohistochemical analysis, the tumor cells stained positively for cytokeratin (CK)-7, CK-8, estrogen receptor (ER), progesterone receptor (PR), mucicarmine, synaptophysin, gross cystic disease fluid protein-15 (GCDFP-15), and neuron-specific enolase (NSE). A diagnosis of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid was made and at 6-month follow-up, no recurrence was noted. In this communication, we discuss the pathology and treatment options of EMPSGC of the eyelid. Although an uncommon entity, EMPSGC may be considered as a differential when encountered with a suspicious, potentially malignant eyelid mass.
  2,902 251 6
ORIGINAL ARTICLES
Spectacle compliance among adolescents in Southern India: Perspectives of service providers
Anuradha Narayanan, Shuba Kumar, Krishna Kumar Ramani
July 2018, 66(7):945-949
DOI:10.4103/ijo.IJO_27_18  PMID:29941737
Purpose: Compliance to spectacle wear is vital to elimination of avoidable blindness among schoolchildren. This study aims to understand the barriers to compliance and strategies to overcome the barriers from the perspectives of the service providers of the school vision-screening model. Methods: A snapshot qualitative study using focus group discussions (FGDs) was conducted among the service providers including eye care professionals (ECPs) and social workers that are part of the school screening program. Sessions were audio recorded and transcribed. Themes were formed following inductive coding using a conceptual framework. Results: Out of the three FGDs, two were with ECPs and one with social workers. Four subthemes identified under the barriers were poor awareness, spectacle-related, psychosocial, and financial barriers. Unique barriers according to the service providers included nonuse of spectacles by asymptomatic children, children with unilateral refractive errors and those with emmetropic parents. Service providers also brought out parent's feelings of guilt, doubts about their children's impaired vision, the negative self-image among children, and difficulties in obtaining funding to support the costs of screening. Solutions that emerged included the personal visit of professionals for spectacle distribution and counseling parents, demonstration of improvement in vision for activities that were difficult for the children without spectacles and rewarding, and role modeling of compliant children. Conclusion: This study had identified unique barriers and solutions from the perspectives of the service providers. The suggested strategies would aid in an effective schoolchildren vision screening practice to enhance compliance to spectacle wear.
  2,844 274 3
Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India – An observational study
Anika Amritanand, Padma Paul, Smitha Jasper, Samuel Prasanna Vinoth Kumar, Vinod Abraham
July 2018, 66(7):957-962
DOI:10.4103/ijo.IJO_144_18  PMID:29941739
Purpose: Over 20% of the world's visually impaired and blind populations live in India. Integration of primary eye care (PEC) into existing primary health care by trained personnel could address access-related barriers. We piloted an unreported, modified WHO disability questionnaire-based model for community health workers (CHWs) to screen and refer persons with perceived visual impairment instead of the traditional visual acuity model. The objective of the study was (1) to determine the prevalence of perceived visual impairment, rate of follow-up postreferral, distribution of ocular morbidity, visual impairment, and proportion of appropriate referrals and (2) to compare results of this intervention with those of existing services. Methods: CHWs were trained in administering a questionnaire for identification and referral of persons with perceived visual impairment in 7 rural villages and 22 tribal hamlets from the institutional database. In this cross-sectional study, patients screened and referred to PEC services from September 2014 to March 2015 underwent comprehensive ocular examination by an optometrist and ophthalmologist. Data collected from their records were analyzed retrospectively. Results: Of 18,534 individuals screened, 3082 (16.64%, 95% confidence interval: 16.06–17.14) complained of perceived visual impairment and were referred; 463 (15%) of these followed up for examination. Correct referrals were noted in 452 (97.6%) cases. Cataract (52.3%) and refractive error (15.8%) were the most common morbidities. There was a 39.6% increase in uptake of eye care services from baseline. Conclusion: The questionnaire-based screening tool administered by CHWs can lead to appropriate identification and referral of persons with ocular morbidity impacting uptake of eye care services.
  2,763 303 4
ONE MINUTE OPHTHALMOLOGY
Typical optic neuritis?
Jyoti Matalia, Shoruba Dinakaran, Hemant Anaspure
July 2018, 66(7):895-895
DOI:10.4103/ijo.IJO_610_18  PMID:29941727
  2,440 579 1
GUEST EDITORIAL
Paradigm shift – For effective management of diabetic retinopathy and glaucoma
Thulasiraj Ravilla
July 2018, 66(7):893-894
DOI:10.4103/ijo.IJO_535_18  PMID:29941726
  2,285 525 -
CASE REPORTS
Multimodal imaging of Bietti's crystalline dystrophy
Vinod Kumar, Amit Gadkar
July 2018, 66(7):1024-1026
DOI:10.4103/ijo.IJO_39_18  PMID:29941763
Bietti's crystalline dystrophy (BCD) is a rare autosomal recessive retinal dystrophy characterized by deposition of crystals in the retina. The purpose of this article is to describe retinal abnormalities in BCD using multimodal imaging. An 18-year-old girl presented with decrease of vision and nyctalopia. She was assessed with color fundus picture, red-free photographs, short-wave autofluorescence, spectral-domain optical coherence tomography (OCT) and en face OCT and was diagnosed to have BCD based on typical presentation. Retinal crystals were better visualized on en face OCT as compared to conventional B scan OCT.
  2,485 268 5
Weber syndrome secondary to brain stem tuberculoma
Sucheta Parija, CS Lalitha, Suprava Naik
July 2018, 66(7):1036-1039
DOI:10.4103/ijo.IJO_1040_17  PMID:29941767
This case report describes a rare presentation of presumed brain stem tuberculoma in a 28-year-old male who presented with acute onset of third cranial nerve palsy with contralateral hemiparesis (Weber syndrome) and upgaze palsy. Isolated midbrain tuberculoma is rare, presenting with varied clinical manifestations and radiological findings posing as a diagnostic dilemma. Weber syndrome is commonly caused by midbrain infarct secondary to occlusion of branches of the posterior cerebral artery and rarely from a tuberculoma. The patient is a case of disseminated tuberculosis with granuloma in midbrain causing pressure effect, thereby presenting with features consistent with Weber syndrome and upgaze palsy. The patient had good recovery with antitubercular treatment and systemic steroids.
  2,460 264 3
SURGICAL TECHNIQUE
Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment
Sumit Randhir Singh, Deven Dhurandhar, Jay Chhablani
July 2018, 66(7):988-990
DOI:10.4103/ijo.IJO_1294_17  PMID:29941745
We report a novel surgical sandwich technique using a combination of intraocular perfluoropropane (C3F8) and silicone oil for inferior retinal detachment (RD). After conventional pars plana vitrectomy and posterior vitreous detachment induction, fluid-gas exchange using 14% C3F8was done. This was followed by silicone oil injection using automated infusion pump to 50% fill of the vitreous cavity under direct visualization to achieve formation of two bubbles – gas bubble superiorly and silicone oil inferiorly. The patient was subsequently asked to maintain upright position. The two immiscible bubbles of C3F8and silicone oil provide tamponade to superior and inferior retina, respectively. With time, gas bubble reduces in size with a gradual superior shift of silicone oil. This novel sandwich technique achieves complete attachment of retina and reduces the risk of retinal redetachment in inferior RDs by adequately tamponading the inferior retina.
  2,254 298 2
CASE REPORTS
Vernal keratoconjunctivitis in human immunodeficiency virus – The possible role of T-helper 1–T-helper 2 shift
Shweta Agarwal, Bhaskar Srinivasan, Geetha Iyer, Sridharan Sudharshan, Kavita Kalaivani
July 2018, 66(7):1004-1006
DOI:10.4103/ijo.IJO_76_18  PMID:29941754
Human immunodeficiency virus infection (HIV) is associated with a reduced T-helper (Th) 1 response, and vernal keratoconjunctivitis (VKC) occurs secondary to a heightened Th2 response. VKC has been reported to occur in patients with HIV. In all probability, a Th1–Th2 shift occurs in the immune response in progressive HIV patients with a decreasing CD4 count. This shift could be the probable cause for the initiation and gradual worsening of the VKC in our patient that corresponded to the dropping CD4 counts. VKC resolved only after a change in antiretroviral therapy for HIV that caused a demonstrable increase in the CD4 counts possibly by reversing the shift.
  2,039 242 5
Optic nerve avulsion associated with central retinal artery occlusion following rotational globe injury
Isha Lohmror, Maya Hada, Vishal Agarwal, Kamlesh Khilnani
July 2018, 66(7):1040-1041
DOI:10.4103/ijo.IJO_149_18  PMID:29941768
Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. Herein, we describe a case of 16-year-old boy, who presented with a rare combination of optic nerve avulsion associated with central retinal artery occlusion, following blunt trauma with a leather ball. This report highlights the potential blinding complication following rotational injury.
  2,080 191 5
Endogenous Cryptococcus neoformans endophthalmitis with subretinal abscess in a HIV-infected man
Joveeta Joseph, Savitri Sharma, Raja Narayanan
July 2018, 66(7):1015-1017
DOI:10.4103/ijo.IJO_60_18  PMID:29941759
To report a rare case of Cryptococcus neoformans endogenous endophthalmitis with subretinal abscess in a 36-year-old HIV-positive man, referred with progressive blurred vision in his right eye for the last 6 months. Vitreous biopsy followed by intravitreal ganciclovir did not result in significant improvement. Microbiology revealed the presence of C. neoformans, and intravitreal amphotericin B was then administered. The patient was treated aggressively with systemic and intravitreal antifungals but had a poor visual and anatomical outcome. A high degree of clinical suspicion combined with microbiological evaluation helped to arrive at an appropriate diagnosis.
  2,003 223 3
PHOTO ESSAY
Ultra-widefield imaging in Coats'-type retinitis pigmentosa
Shreyans Jain, Sonali Gupta, Vinod Kumar
July 2018, 66(7):997-998
DOI:10.4103/ijo.IJO_1109_17  PMID:29941749
  1,900 241 1
LETTERS TO THE EDITOR
July 1 is National Doctors' Day: How to regain the lost public trust in healthcare?
Suresh K Pandey, Vidushi Sharma
July 2018, 66(7):1045-1046
DOI:10.4103/ijo.IJO_976_18  PMID:29941770
  1,812 320 2
CASE REPORTS
Management of Candida glabrata infectious crystalline keratopathy with endophthalmitis following penetrating keratoplasty
Ritu Nagpal, Sunita Chaurasia, Joveeta Joseph, Mudit Tyagi, Padmaja Kumari Rani, Muralidhar Ramappa, Rikin Shah
July 2018, 66(7):1012-1014
DOI:10.4103/ijo.IJO_1106_17  PMID:29941758
A 33-year-old male underwent an optical keratoplasty elsewhere in the right eye following which he developed endophthalmitis and subsequently underwent a pars plana vitrectomy and lensectomy. At presentation, he had a deep stromal crystalline infiltration along the graft–host junction. A large therapeutic keratoplasty was performed, and the excised corneal button was evaluated. Histopathology revealed gram-positive round-to-oval budding structures and microbiology identified the organism as Candida glabrata. He was treated with antifungals in the postoperative period. At 4 months after therapeutic keratoplasty, the patient developed recurrent endophthalmitis, following stoppage of antifungals. The treatment was reinstituted for another year, and the patient did well with a clear graft at 18-month-follow-up period after the recurrence episode. Management of infectious crystalline keratopathy with endophthalmitis is a challenging situation and requires long-term treatment.
  1,904 219 1
OPHTHALMIC IMAGES
Traumatic optic nerve head avulsion: Multimodal imaging
Prashant Jain, Mahesh Gopalakrishnan, Giridhar Anantharaman
July 2018, 66(7):1003-1003
DOI:10.4103/ijo.IJO_147_18  PMID:29941753
  1,835 255 2
Intralenticular foreign body
Jitender Jinagal, Gaurav Gupta, Parul Chawla Gupta, Jagat Ram
July 2018, 66(7):1001-1001
DOI:10.4103/ijo.IJO_148_18  PMID:29941751
  1,851 239 1
CASE REPORTS
A case of human leukocyte antigen B-27-associated ocular hypotony successfully treated with golimumab
Parthopratim Dutta Majumder, Ruchika Lakra, G Yamuna, Anindya Kishore Majumder, Viswanath Kaushik
July 2018, 66(7):1006-1008
DOI:10.4103/ijo.IJO_120_18  PMID:29941755
A 42-year-old male presented to us after an episode of acute anterior human leukocyte antigen (HLA)-B27-associated uveitis, and intraocular pressure (IOP) in the right eye was 4 mmHg. Ultrasound biomicroscopy revealed ciliary body edema with supraciliary effusion. He was on a frequent topical corticosteroid, and oral steroid in addition to receiving a periocular injection depot corticosteroid 20 days back. He was started on treatment with subcutaneous golimumab (GLM). After a month, his IOP in the right eye was 14 mm of Hg with UBM showing resolution of ciliary body edema. GLM can be useful in the management of steroid-resistant cases of HLA B-27-associated ocular hypotony.
  1,861 188 -
Pars plana vitrectomy and re-directing a dexamethasone implant into vitreous cavity following misdirected entry into the crystalline lens
Partha Biswas, Krishnendu Nandi, Sneha Batra, Aniket Ginodia, Preeyam Biswas
July 2018, 66(7):1033-1036
DOI:10.4103/ijo.IJO_1179_17  PMID:29941766
A known diabetic patient presented with diabetic macular edema (DME) and nonproliferative diabetic retinopathy in both eyes with a vision of 6/18, N12in the right eye and 4/60, N36in the left eye (LE). The patient had undergone injection of dexamethasone implant in the LE which got misdirected into the crystalline lens. The patient was taken up for phacoemulsification with intraocular lens implantation along with vitrectomy and posterior vitreous detachment induction, and redirection of the dexamethasone implant into the vitreous cavity. The DME resolved over the next 3 months.
  1,821 212 -
SURGICAL TECHNIQUE
Management of late-onset flocculent after-cataract with capsular bag lavage and posterior continuous curvilinear capsulorhexis
Jeewan Singh Titiyal, Ruchita Falera, Manpreet Kaur, Tarun Arora
July 2018, 66(7):984-987
DOI:10.4103/ijo.IJO_1324_17  PMID:29941744
We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.
  1,792 221 7
LETTERS TO THE EDITOR
5% cefuroxime as an alternative to 5% cefazolin in the treatment of Gram-positive bacterial keratitis
Samrat Chatterjee, Deepshikha Agrawal
July 2018, 66(7):1046-1048
DOI:10.4103/ijo.IJO_329_18  PMID:29941771
  1,769 210 1
PHOTO ESSAY
Conjunctival vegetative foreign body in a child mimicking shield ulcer
Jitender Jinagal, Parul Chawla Gupta, Neha Jain, Avinash Negi, Archana Angrup, Jagat Ram
July 2018, 66(7):991-992
DOI:10.4103/ijo.IJO_26_18  PMID:29941746
  1,691 204 -
CASE REPORTS
Misplaced capsule tension ring in anterior chamber: A unique way of explantation
Jignesh Manshibhai Gala, Rohit C Khanna
July 2018, 66(7):1009-1011
DOI:10.4103/ijo.IJO_1207_17  PMID:29941756
We report a patient who presented with endocapsular capsule tension ring (CTR) in iridocorneal angle leading to secondary angle closure glaucoma (ACG) and subsequent removal of the CTR from trabeculectomy ostium. Secondary ACG was diagnosed 2 years and 6 months after cataract surgery in which a CTR was used for zonular instability. CTR removal with trabeculectomy was performed, after which there was the resolution of symptoms. To the best of our knowledge, this is the first case report in which CTR was removed from trabeculectomy ostium. We describe a surgical technique to explant CTR and combining with trabeculectomy.
  1,660 212 1
LETTERS TO THE EDITOR
Comments on “Bilateral medial rectus palsy due to midbrain infarction following concussion head injury”
Pramod Kumar Pandey, Annu Joon, Divya Kishore, Mainak Bhattacharyya
July 2018, 66(7):1049-1050
DOI:10.4103/ijo.IJO_184_18  PMID:29941773
  1,644 182 -
PHOTO ESSAY
Foveolar simple retinal pigment epithelial hamartoma
Amar Pujari, Shreyas Temkar, Sahil Agarwal, Gaurav Garg, Rohan Chawla, Atul Kumar
July 2018, 66(7):999-1000
DOI:10.4103/ijo.IJO_54_18  PMID:29941750
  1,624 189 -
LETTERS TO THE EDITOR
Commentary on “Intravitreal dexamethasone implant for management of treatment-naïve retinal vein occlusion”
Mayank Bansal
July 2018, 66(7):1048-1049
DOI:10.4103/ijo.IJO_498_18  PMID:29941772
  1,596 204 -
COMMENTARY
Commentary on: “Tribal Odisha Eye Disease Study # 4: Accuracy and utility of photorefraction for refractive error correction in tribal Odisha (India) school screening”
Arvind K Morya
July 2018, 66(7):934-934
DOI:10.4103/ijo.IJO_812_18  PMID:29941734
  1,611 185 1
CASE REPORTS
Central retinal arterial occlusion in a patient with pyoderma gangrenosum
Koushik Tripathy, Shahana Mazumdar, Barsha Sarma
July 2018, 66(7):1019-1021
DOI:10.4103/ijo.IJO_1229_17  PMID:29941761
A 74-year-old male presented to us with a history of vision loss for 36 hours in the right eye (RE). The RE had a visual acuity of hand movements. The fundus revealed a pale retina, cattle tracking in the retinal vessels, and a cherry-red spot at the macula. The patient was a known case of pyoderma gangrenosum (PG) and had received intravenous methylprednisolone and cyclophosphamide at the onset of visual symptoms. An emergency anterior chamber paracentesis was performed following unsuccessful attempts of ocular massage. The patient improved to 6/9 in the RE 4 months after paracentesis. The patient had an aggressive course of PG, for which he needed a combination of oral steroid, immunomodulator therapy and biologicals. An association between central retinal arterial occlusion and PG has not been reported before, according to the best of authors' knowledge.
  1,595 198 -
Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body
VG Madanagopalan, CK Nagesha, Girish Velis, Santosh Devulapally, S Balamurugan
July 2018, 66(7):1031-1033
DOI:10.4103/ijo.IJO_1276_17  PMID:29941765
A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade under steroid cover. With continued use of systemic and topical steroids after surgery, complete resolution of FBA and improvement in vision were noted in a week. Prompt resolution of FBA after IOFB removal points toward a strong association between the presence of IOFB and FBA.
  1,586 204 4
COMMENTARY
Commentary on “Community care for diabetic retinopathy and glaucoma in India: A panel discussion”
Atul Kumar, Vineet Mutha, Yogita Gupta, R Karthikeya, Aswini Behera
July 2018, 66(7):921-923
DOI:10.4103/ijo.IJO_309_18  PMID:29941731
  1,575 201 -
PHOTO ESSAY
Clinical presentation following photorefractive intrastromal cross-linking for myopic correction
Gitansha Shreyas Sachdev, Shreyas Ramamurthy
July 2018, 66(7):993-994
DOI:10.4103/ijo.IJO_1227_17  PMID:29941747
  1,498 210 3
COMMENTARY
Ophthalmic problems in remote areas of India
Atul Kumar Singh
July 2018, 66(7):975-975
DOI:10.4103/ijo.IJO_658_18  PMID:29941742
  1,503 174 1
Gear up for work!
Kunwar Vikram Singh Dhaliwal
July 2018, 66(7):1002-1002
DOI:10.4103/ijo.IJO_503_18  PMID:29941752
  1,418 151 -
CASE REPORTS
Commentary on “Misplaced capsule tension ring in anterior chamber: A unique way of explantation”
Sagar Bhargava, Maneesh Singh, Lav Kochgaway
July 2018, 66(7):1011-1012
DOI:10.4103/ijo.IJO_460_18  PMID:29941757
  1,274 176 -