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   2019| April  | Volume 67 | Issue 4  
    Online since March 22, 2019

 
 
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REVIEW ARTICLE
Techniques of anterior capsulotomy in cataract surgery
Bhavana Sharma, Robin G Abell, Tarun Arora, Tom Antony, Rasik B Vajpayee
April 2019, 67(4):450-460
DOI:10.4103/ijo.IJO_1728_18  PMID:30900573
Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.
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ORIGINAL ARTICLES
Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series
Giacomo De Benedetti, Agostino S Vaiano
April 2019, 67(4):464-471
DOI:10.4103/ijo.IJO_1244_17  PMID:30900575
Purpose: To compare the efficacy and safety profile of oral azithromycin with that of doxycycline over 9 months in patients experiencing failure with conservative and topical treatment for Meibomian gland dysfunction (MGD), to assess recurrence of MGD, and to determine the number of treatments required. Methods: This is a randomized controlled trial with a cross-over design at a tertiary care center. In all, 115 consecutive patients underwent a complete ophthalmological examination before being randomly assigned to oral treatment with doxycline (4 g for 30 days) or azithromycin (1.25 g for 5 days). Patients were evaluated at 3, 6, and 9 months. Therapy was switched or conservative management maintained according to signs and symptoms. Results: In the azithromycin group, 83.25% of the patients were stable after one treatment, 16.5% needed a further one or two treatments (some had previously been switched to doxycycline), and 5.77% did not improve despite treatment. In the doxycycline group, 33.79% of patients were stable after one treatment, 66.21% needed a further one or two treatments (some had previously switched to azithromycin), and 29.41% did not improve despite treatment (P < 0.05). Minimal gastrointestinal adverse effects (nausea, diarrhea, abdominal cramp, and decreased appetite) were reported, mostly unchanged at the follow-up visits. At the first visit, more adverse effects were reported in the doxycycline group (14/51, 24%) than in the azithromycin group (3/52, 6%; P < 0.005). Conclusion: Both antibiotics were effective and safe for treating patients with persistent MGD, although azithromycin was superior when the reduced dose and the shorter course of therapy (5 days vs. 4 weeks) were taken into consideration. Given the chronic nature of the disease and the improvement in some signs with minimal adverse effects, a shorter therapy seems a safer and more logical alternative to longer regimens.
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CONSENSUS CRITERIA
Consensus statement and guidelines for use of dilute atropine sulphate in myopia control
Siddharth S Kesarwani, Mumbai Group of Paediatric Ophthalmologists and Strabismologists
April 2019, 67(4):461-463
DOI:10.4103/ijo.IJO_1457_18  PMID:30900574
Purpose: To develop a consensus statement for use of dilute atropine in control of myopia progression in children based on review of existing literature, opinions and suggestions of the members of the Group of Paediatric Ophthalmologist and Strabismologists, Mumbai (GPOS). Methods: Literature review, group discussions, questionnaire study and consensus building by supermajority voting. Results: About 65% of paediatric ophthalmologists in Mumbai have started prescribing atropine sulphate 0.01% as routine in their patients showing myopia progression. Majority of the respondents who have used it for >1 year in their patient population are extremely happy with the results. About 47% respondents expressed concerns regarding some yet unknown side effects of long-term use in our patient population. Majority of the respondents agree that it is safe and have rarely encountered side effects with its use. Conclusion: Atropine sulphate 0.01% is a safe and effective treatment for myopia control. Most trained paediatric ophthalmologists recommend its use in children with progressive simple myopia.
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ORIGINAL ARTICLES
The prevalence and risk factors for cataract in rural and urban India
Sumeer Singh, Shahina Pardhan, Vaitheeswaran Kulothungan, Gayathri Swaminathan, Janani Surya Ravichandran, Suganeswari Ganesan, Tarun Sharma, Rajiv Raman
April 2019, 67(4):477-483
DOI:10.4103/ijo.IJO_1127_17  PMID:30900578
Purpose: To report the prevalence and risk factors of cataract and its subtypes in older age group. Methods: A total of 6617 subjects were recruited from both rural and urban areas. A detailed history including data on demographic, socioeconomic and ocular history was obtained. Lens opacity was graded according to the Lens Opacity Classification System III (LOCS III). Results: Cataract was present in 1094 of the rural and 649 subjects in the urban population. Monotype subtype cataracts were found in 32% and 25% in rural and urban population and 12.68% and 18.6% were mixed cataracts in the rural and urban groups. In baseline characteristics history of diabetes, alcohol intake and presence of age-related macular degeneration were the risk factors in urban group. On multivariate analysis, the only significant risk factors for any cataract in subjects ≥60 years were increasing age in both rural [odds ratio (OR), 1.07] and urban (OR, 1.08) population, and HbA1c (OR, 1.14) in rural population. Overweight (OR, 0.6) was found to be a protective factor, and lower social economic status (OR, 1.52) a risk factor for cataract in urban population. A significant urban–rural difference was found in the prevalence of cataract and its subtypes (P ≤ 0.05). Conclusion: We found the risk factors for any cataract in older age group to be increasing age and HbA1c in rural group. Age and lower social economic status were found to be the risk factors in urban arm. A statistically significant difference was found on comparison of the prevalence of cataract and its subtypes between the rural and urban population.
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Accuracy of the refractive prediction determined by intraocular lens power calculation formulas in high myopia
Dong Zhou, Zhuo Sun, Guohua Deng
April 2019, 67(4):484-489
DOI:10.4103/ijo.IJO_937_18  PMID:30900579
Purpose: Our study was conducted to evaluate and compare the accuracy of the refractive prediction determined by the calculation formulas for different intraocular lens (IOL) powers for high myopia. Methods: This study reviewed 217 eyes from 135 patients who had received cataract aspiration treatment and IOL implantation. The refractive mean numerical error (MNE) and mean absolute error (MAE) of the IOL power calculation formulas (SRK/T, Haigis, Holladay, Hoffer Q, and Barrett Universal II) were examined and compared. The MNE and MAE at different axial lengths (AL) were compared, and the percentage of every refractive error absolute value for each formula was calculated at ±0.25D, ±0.50D, ±1.00D, and ±2.00D. Results: In all, 98 patients were recruited into this study and 98 eyes of them were analyzed. We found that Barrett Universal II formula had the lowest MNE and MAE, SRK/T and Haigis formulas arrived at similar MNE and MAE, and the MNE and MAE calculated by Holladay and Hoffer Q formula were the highest. Barrett Universal II formulas have the lowest MAE among different AL patients, whereas it reached the highest percentage of refractive error absolute value within 0.5D in this study. The MAE of each formula is positively correlated with AL. Conclusion: Barrett Universal II formula rendered the lowest predictive error compared with SRK/T, Haigis, Holladay, and Hoffer Q formulas. Thus, Barrett Universal II formula may be regarded as a more reliable formula for high myopia.
  1,785 392 -
ONE MINUTE OPHTHALMOLOGY
Papilledema or pseudopapilledema?
Lin Liu, Michael D Yu, Carol L Shields
April 2019, 67(4):449-449
DOI:10.4103/ijo.IJO_2013_18  PMID:30900572
  1,560 593 -
INNOVATIONS IN OPHTHALMOLOGY
Trash to treasure Retcam
Prithvi Chandrakanth, Ramya Ravichandran, Naveen G Nischal, M Subhashini
April 2019, 67(4):541-544
DOI:10.4103/ijo.IJO_1524_18  PMID:30900590
Digital fundus imaging is being used in diagnosis, documentation, and sharing of many retinal diseases and hence forms an essential part of ophthalmology. The use of smartphones for the same has been ever increasing. There is a need for simpler devices to couple the 20D lens and smartphone so as to take fundus photographs which can help in fundus documentation. This article describes a simple inexpensive technique of preparing a smartphone fundus photography device (Trash To Treasure (T3) Retcam) from the used materials in the clinics within minutes. This article will also review the optical principles of the T3 Retcam and describe the step–by–step method to record good-quality retinal image/videos. This inexpensive device is made by recycling and modifying the plastic hand sanitizer bottle in the clinics/hospitals which can be used for documenting, diagnosing, screening, and academic purposes.
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EDITORIAL
“Indovation” in ophthalmology – The potential power of frugal innovations
Santosh G Honavar
April 2019, 67(4):447-448
DOI:10.4103/ijo.IJO_550_19  PMID:30900571
  1,359 472 -
LETTER TO THE EDITOR
A tribute to Dr. Babu Rajendran
Suresh K Pandey, Vidushi Sharma
April 2019, 67(4):571-572
DOI:10.4103/ijo.IJO_320_19  PMID:30900605
  1,693 108 -
CASE REPORTS
Systemic toxicity of topical corticosteroids
Jitender Jinagal, Parul Chawla Gupta, Rakesh Kumar Pilania, Jagat Ram
April 2019, 67(4):559-561
DOI:10.4103/ijo.IJO_1091_18  PMID:30900600
Corticosteroids are known to cause many ocular and systemic side effects when administered by oral or parenteral routes. Corticosteroid induced systemic toxicity secondary to topical steroid eye drops is rare. A 6-week-old, male infant was brought to our tertiary eye care center with bilateral congenital cataracts. The child underwent phacoaspiration with primary posterior capsulotomy without intraocular lens implantation in both eyes at an interval of 6 weeks. Child was initiated on topical betamethsone 0.1% eight times a day, tobramycin 0.3% six times a day, homatropine 2% twice a day, and carboxymethylcellulose 0.5% four times a day. Two and four weeks later he underwent surgical membranectomy in the right and left eye respectively followed by frequent use of topical steroids, initially given 1 hourly and then tapered weekly in the follow-up period. The patient showed increase in intraocular pressure and gain in body weight along with development of cushingoid habitus nearly 6 to 8 weeks after starting topical steroids. These side effects started weaning off following the reduction in dose of topical steroids, suggesting the role of the corticosteroid-related systemic side effects. This case highlights the serious systemic side effects secondary to increased frequency and duration of topical corticosteroid use in infancy. Hence, dosage of topical steroids should be adjusted in its therapeutic range to prevent their ocular and systemic side effects. Therefore, close monitoring is advocated for children using topical corticosteroids to prevent serious ocular and systemic side effects.
  1,138 298 -
ORIGINAL ARTICLES
Enhanced S-cone syndrome: Clinical spectrum in Indian population
Anmol Naik, Dhanashree Ratra, Aniruddha Banerjee, Daleena Dalan, Sourabh Jandyal, Girish Rao, Parveen Sen, Muna Bhende, V Jayaprakash, Pradeep Susvar, Jaydeep Walinjkar, Chetan Rao
April 2019, 67(4):523-529
DOI:10.4103/ijo.IJO_1480_18  PMID:30900587
Purpose: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders. Methods: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings. Results: We included 14 patients (age range 4–39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1st decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years. Conclusion: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.
  1,110 232 -
CASE REPORTS
Primary orbital low-grade fibromyxoid sarcoma – A case report
Raksha Rao, Santosh G Honavar, Kaustubh Mulay, Vijay Anand P Reddy
April 2019, 67(4):568-570
DOI:10.4103/ijo.IJO_633_18  PMID:30900604
An 18-year-old female presented with rapidly progressive proptosis of the left eye for one month and grade II relative afferent pupillary defect. Orbital imaging showed a well-defined homogenous extraconal mass in close relation to the lateral rectus muscle and extending up to the superior orbital fissure, associated with bony erosion. An incisional biopsy was performed, with the histopathology demonstrating stellate to spindle-shaped tumor cells (fibroblasts) embedded in a richly myxoid matrix. A diagnosis of low-grade fibromyxoid sarcoma (LGFS) was made. The patient was treated by stereotactic external beam radiotherapy. Here, we report a case of LGFS which, to the best of our knowledge, is the first at an orbital location.
  1,211 121 -
ORIGINAL ARTICLES
Long-term outcomes of cataract surgery in children with uveitis
Sonam Yangzes, Natasha Gautam Seth, Ramandeep Singh, Parul Chawla Gupta, Jitender Jinagal, Surinder Singh Pandav, Vishali Gupta, Amod Gupta, Jagat Ram
April 2019, 67(4):490-495
DOI:10.4103/ijo.IJO_846_18  PMID:30900580
Purpose: To evaluate the long-term outcomes of cataract surgery in children with uveitis. Methods: Retrospective, noncomparative review of medical records of children (≤16 years) with uveitic cataract who had undergone cataract surgery between January 2001 and December 2014 at a tertiary care center was done. The main outcome measures were visual acuity and postoperative complications. Results: We recruited 37 children (58 eyes) who were diagnosed with uveitic cataract and underwent cataract surgery. The etiology of uveitis included juvenile idiopathic arthritis (n = 19), presumed intraocular tuberculosis (n = 8), idiopathic (n = 4), Behçet's disease (n = 2), Vogt–Koyanagi–Harada syndrome (n = 2), human leukocyte antigen B-27 associated uveitis (n = 1), and toxocariasis (n = 1). Phacoemulsification with intraocular lens (IOL) implantation was performed in 17 patients (27 eyes; 46.55%), while 20 patients (31 eyes; 53.44%) were left aphakic after pars plan lensectomy and vitrectomy. At an average follow-up of 3.69 ± 7.2 (SD) years, all cases had significant improvement in corrected distance visual acuity post cataract extraction; visual acuity of 20/40 or more was achieved in 32 eyes (55.17%). The most common complication was capsular opacification (37.93%). Incidence of secondary procedures as well as glaucoma was not statistically different in patients undergoing IOL implantation from those who were aphakic. Conclusion: Even though number of secondary procedures was more in pseudophakic group, meticulous choice of surgical technique and adequate immunosuppression lead to a modest gain of visual acuity in children undergoing IOL implantation in uveitis. However, scrupulous case selection and aggressive control of pre- and postoperative intraocular inflammation are the key factors in the postoperative success of these patients.
  1,034 288 -
Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes
Charudutt Kalamkar, Amrita Mukherjee
April 2019, 67(4):509-514
DOI:10.4103/ijo.IJO_655_18  PMID:30900584
Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.
  1,102 210 -
Evaluation of anterior segment parameters with two anterior segment optical coherence tomography systems: Visante and Casia, in primary angle closure disease
Dewang Angmo, Reena Singh, Shweta Chaurasia, Suresh Yadav, Tanuj Dada
April 2019, 67(4):500-504
DOI:10.4103/ijo.IJO_641_18  PMID:30900582
Purpose: To determine the comparability of anterior chamber biometric measurements in primary angle closure disease (PACD) patients using two commercially available anterior segment optical coherence tomography machines (ASOCT): Visante and Casia. Methods: This was a cross-sectional observational study, which included clinically, diagnosed cases of PACD. Anterior segment biometric measurements were done using Casia and Visante ASOCT. Parameters studied were central corneal thickness (CCT), anterior chamber depth (ACD), nasal (N) and temporal (T) angle opening distance at 500 μm (AOD500) and 750 μm (AOD750), and N and T trabecular iris space area at 500 μm (TISA500) and 750 μm (TISA750). Results: Total 36 PACD patients (72 eyes) with average age of 59.48 ± 7.95 years were recruited, out of which 25 were females (69.44%) and 11 males (30.56%). The mean measurements of CCT, ACD, AOD500, and TISA on Casia and Visante machines were 522.5 ± 34.75 μm and 539.55 ± 29.56 μm (P = 0.00); ACD- 2.144 ± 0.38 mm and 2.133 ± 0.39 mm (P = 0.487); AOD500-0.27 ± 0.16 μm and 0.21 ± 0.10 μm (P = 0.04); and TISA500-0.100 ± 0.07 μm and 0.063 ± 0.03 μm (P = 0.00), respectively. A statistically significant difference was noted in CCT, N and T AOD, and TISA. A good corelation for ACD and CCT (ACD = 0.9816 and CCT = 0.772) only were noted between the two machines. The Bland-Altman plot analysis of different parameters between two machines has revealed good agreement of measurement of ACD and CCT but poor agreement for rest of the parameters. Conclusion: It is advisable not use the two machines interchangeably because of the wide limits of agreement and poor correlation of angle measurement values of Casia and Visante ASOCT.
  1,075 216 -
Barriers and enablers to low vision care services in a tertiary eye care hospital: A mixed method study
Gopalakrishnan Sarika, Dinesh Venugopal, M V S Sailaja, Sheela Evangeline, Ramani Krishna Kumar
April 2019, 67(4):536-540
DOI:10.4103/ijo.IJO_1215_18  PMID:30900589
Purpose: Visual impairment is a major health concern all over the world. Globally, it has been studied that utilization of low vision care (LVC) services varies from 3% to 15%. This study describes barriers to access the LVC services and suggest enablers to improve the uptake of services in a tertiary eye care hospital. Methods: A snapshot qualitative research design with purposive sampling was adopted. Qualitative part of the study involved 13 eye care practitioners (ECPs) and 7 patients with low vision participated in one to one in-depth interviews. The interviews were audio recorded, transcribed, inductively coded, and analyzed. The barriers to access LVC services were identified and enablers to improve the uptake of services were implemented. The referral rate and utilization of LVC services were analyzed in the quantitative part. Results: Themes emerged out of qualitative part of the study were barriers, perceived benefits, and enablers to improve the uptake of LVC services. Barriers among ECPs included lack of awareness on referral criteria and available LVC. Barriers among patients were lack of knowledge and understanding about the need for services. The enablers included development of referral criteria and referral pathway to LVC services, creating awareness of LVC services to patients and ECPs, stratification levels of LVC services, and implementation of LVC counseling chamber. Referral rate improved from 25.6% to 51.2% and the utilization of services increased from 67.9% to 81.7% after implementation of the recommended enablers. Conclusion: Execution of stratified enablers increased the uptake of LVC services benefiting more number of people with low vision in this study.
  1,080 193 -
Human amniotic membrane as a drug carrier – An in-vitro study using fortified cefazolin ophthalmic solution
Sajeev Hitha Sara, Namperumalsamy Venkatesh Prajna, Srinivasan Senthilkumari
April 2019, 67(4):472-475
DOI:10.4103/ijo.IJO_1336_18  PMID:30900576
Purpose: Our previous study demonstrated the drug reservoir function of human amniotic membrane (HAM) using stable moxifloxacin as a model drug. The purpose of the present study is to evaluate whether HAM can be used as a drug carrier for extended release of extemporaneous preparation of cefazolin. Methods: HAM Buttons (1 Control, 5 Test) were incubated in a freshly prepared (1 ml) sterile topical solution of cefazolin 5% (w/v) for 3 h and 24 h at two different temperatures. The groups were designated as follows: Group IA: Soaking duration 3 h at 4°C; Group IB: Soaking duration 3 h at room temperature; Group IIA: Soaking duration 24 h at 4°C; and Group IIB: Soaking duration 24 h at room temperature. The release kinetics of cefazolin from different groups of drug-laden HAM was studied for a period of 5 days. Samples were assayed for estimation of cefazolin content at different time intervals by High Performance Liquid Chromatography (HPLC) with Photodiode array (PDA) detector. Results: Three-hour cefazolin treatment with HAM at 4°C caused high drug entrapment (24%) compared to room temperature (11%; P < 0.005); however, the release kinetics was not significantly different between Group IA and IB as well as Group IIA and IIB up to the study period. Increase in drug treatment duration did not show increase in entrapment, but caused two-fold (IA Vs IIA) and 1.6-fold (IB Vs IIB) less drug entrapment at 4°C and room temperature, respectively. Conclusion: The results reveal that HAM may be a suitable drug carrier for extended delivery of fortified formulations without compromising stability.
  914 244 -
Comparison of central corneal thickness measurements using different imaging devices and ultrasound pachymetry
Ertugrul Can, Hilal Eser-Ozturk, Mustafa Duran, Tugba Cetinkaya, Nursen Arıturk
April 2019, 67(4):496-499
DOI:10.4103/ijo.IJO_960_18  PMID:30900581
Purpose: To compare central corneal thickness (CCT) measurements obtained by the AL-Scan, Lenstar LS900, Galilei, and ultrasound pachymetry (UP) in normal and cataractous eyes. Methods: Eighty eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measurements using the AL-Scan, Lenstar LS900, Galilei, and UP by a single examiner. To assess the intraobserver repeatability, three consecutive measurements were taken for the AL-Scan. Results: The mean CCT [± standard deviation (SD)] for the AL-Scan, Lenstar LS900, Galilei, and UP were 554.6 ± 30.9 μm, 542.9 ± 31.3 μm, 570.7 ± 30 μm, and 552.7 ± 32.8 μm, respectively. The differences between pairs of mean CCT for the methods are statistically significant for the pairs of Galilei–UP, AL-Scan–Galilei, and Lenstar LS900–Galilei. Bland–Altman plots showed that AL-Scan–UP have the closest agreement, followed by Lenstar–UP and AL-Scan–Lenstar. Galilei was found to have the poorest agreement with the other three methods. The intraobserver repeatability of the AL-Scan was very good with an intraclass correlation coefficient (ICC) of 0.980. Conclusion: We found that CCT measurements between the AL-Scan–UP, Lenstar LS900–UP, and AL-Scan–Lenstar LS900 showed very strong correlation and comparable agreement. AL-Scan–UP showed the closest agreement and these devices can be used interchangeably in clinical practice. Galilei significantly showed higher value of CCT compared to other methods. It was also observed that the Al-Scan had excellent intraobserver repeatability.
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COMMENTARIES
Commentary: Frugal innovations – Path to eye care for all
Ashish Ahuja
April 2019, 67(4):544-545
DOI:10.4103/ijo.IJO_57_19  PMID:30900591
  775 132 -
ORIGINAL ARTICLES
Assessment of macular vascular plexus density using optical coherence tomography angiography in cases of strabismic amblyopia
Amar Pujari, Rohan Chawla, Ritika Mukhija, Hameed Obedulla, Swati Phuljhele, Rohit Saxena, Pradeep Sharma, Atul Kumar
April 2019, 67(4):520-522
DOI:10.4103/ijo.IJO_1069_18  PMID:30900586
Purpose: To evaluate the superficial retinal vascular plexus density using optical coherence tomography angiography (OCTA) in cases of strabismic amblyopia. Methods: Ten eyes of 10 patients with purely strabismic amblyopia underwent detailed ocular evaluation followed by the assessment of the superficial retinal plexus vascular density using OCTA (Topcon DRI OCT Triton, Swept Source OCT, Topcon, Japan). Ten contralateral normal eyes of the same patients were considered as control. All these 20 eyes underwent a 4.5 × 4.5 mm cube scan OCTA centered at the fovea. Using the Topcon propriety software all 20 eyes were assessed for the capillary plexus density of the superficial retinal vascular plexus along the superior, inferior, nasal, and temporal quadrants centered at the fovea. The numerical values were statistically assessed using a paired t-test with respect to each quadrant between the normal and the pathological eyes. Results: The average age of patients was 16 years and eight patients were males. The mean superficial retinal vascular plexus density along the superior, inferior, nasal, and temporal quadrants in normal and pathological eyes were 49.25 ± 30.34 and 48.93 ± 2.85, 47.22 ± 4.11 and 47.37 ± 4.8, 45.54 ± 1.55 and 43.81 ± 4.21, and 46.26 ± 4.63 and 46.38 ± 5.40, respectively. Similarly, the capillary densities along the central were 17.84 ± 3.49 and 17.24 ± 2.44 in normal and pathological eyes. The differences among all these four quadrants and central area were not statistically significant (P-values > 0.05 for all four quadrants and central area) as compared with the normal eyes. Conclusion: The superficial retinal vascular plexus density of a 4.5 × 4.5 mm cube centered at the fovea of eyes of cases of strabismic amblyopia is similar to that of normal eyes.
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Surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy and cataract surgery
Mehmet Baykara, Ceren Poroy, Cansu Erseven
April 2019, 67(4):505-508
DOI:10.4103/ijo.IJO_1007_18  PMID:30900583
Purpose: To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery. Methods: A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications. Results: The average preoperative visual acuity of the patients was logMAR 1.57 ± 1.2, and the average postoperative visual acuity was logMAR 0.39 ± 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 ± 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 ± 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 ± 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 ± 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 ± 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony. Conclusion: Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.
  666 206 -
PHOTO ESSAY
Pediatric keratoconus misdiagnosed as meridional amblyopia
Ritu Arora, Monica Lohchab
April 2019, 67(4):551-552
DOI:10.4103/ijo.IJO_1496_18  PMID:30900595
  712 154 -
CASE REPORTS
Acute macular neuroretinopathy after blunt ocular trauma: A rare association
Samarth Mishra, Sugandha Goel, Purna Nangia, Deepak Senger, Ankit Vinodbhai Shah, Kumar Saurabh, Rupak Roy
April 2019, 67(4):566-568
DOI:10.4103/ijo.IJO_1251_18  PMID:30900603
Acute macular neuroretinopathy (AMN) is a deep retinal ischemic manifestation. It has been reported after the use of sympathomimetics, childbirth, bee sting, oral contraceptives, flu-like illness, intravenous contrast agents and bodily trauma not directly involving the eyes. We report a case of AMN following blunt ocular trauma. An 18-year-old male presented with an acute history of blurring of vision following blunt trauma to the right eye. Spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the outer nuclear layer with ellipsoid layer disruption. This report highlights AMN as a manifestation of blunt trauma, presence of which may be an indicator of poor visual prognosis.
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ORIGINAL ARTICLES
Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope: A modified technique of ciliary body photocoagulation
Quan-Yong Yi, Bin Cai, Jiang Huang, Li-Shuang Chen, Yin Han, Zhi-Sha Bai
April 2019, 67(4):515-519
DOI:10.4103/ijo.IJO_65_18  PMID:30900585
Purpose: This study aimed to investigate the efficacy of cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope in treating refractory glaucoma. Methods: Eleven patients (11 eyes) with refractory neovascular glaucoma were treated with ciliary body photocoagulation. Preoperative and postoperative corrected visual acuity, intraocular pressure (IOP), ophthalmofundoscopy, B-ultrasound and ultrasound biomicroscopy, optical coherence tomography, and fundus fluorescein angiography were performed. Results: Preoperative IOP ranged from 45 to 58 mmHg (mean 51.9 mmHg). At postoperative 1, 3, and 6 months, the IOPs ranged between 16 and 33 mmHg (mean 27.1 mmHg), 14–28 mmHg (mean 20.6 mmHg), and 14–28 mmHg (mean 18.5 mmHg), respectively. IOP at the last follow-up (range 7–12 months) was 15–24 mmHg (mean 18.8 mmHg). An average of 63.8% decrease in postoperative IOP was found in these patients with no associated complications. The postoperative fibrotic exudate, anterior chamber hyphema, and exudative choroidal detachment were all well-managed and resolved. No patients experienced intraocular lens deviation or dislocation, hypotonia oculi, atrophy of eyeball, retinal detachment, endophthalmitis, or sympathetic ophthalmia. Conclusion: Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope is a safe and effective technique for the treatment of neovascular glaucoma.
  661 150 -
OPHTHALMIC IMAGES
Archipelago keratitis
Himanshu P Matalia, Chinnappaiah Nandini, Majji Saishree, Jyoti Matalia
April 2019, 67(4):555-555
DOI:10.4103/ijo.IJO_1354_18  PMID:30900597
  629 180 -
COMMENTARIES
Commentary: Tsunami of grassroot innovations from makers
John Davis Akkara, Anju Kuriakose
April 2019, 67(4):545-546
DOI:10.4103/ijo.IJO_96_19  PMID:30900592
  651 130 -
ORIGINAL ARTICLES
Prevalence of ophthalmic disorders among hearing-impaired school children in Guntur district of Andhra Pradesh
Niranjan K Pehere, Rohit C Khanna, Ramakrishna Marlapati, Krishnaiah Sannapaneni
April 2019, 67(4):530-535
DOI:10.4103/ijo.IJO_995_18  PMID:30900588
Purpose: To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India. Methods: Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done. Results: In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%–16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%–10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89–16.8). Conclusion: The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools.
  641 140 -
CASE REPORTS
Ocular coherence tomography angiography features of congenital hypertrophy of retinal pigment epithelium
P Mahesh Shanmugam, Vinaya Kumar Konana, Rajesh Ramanjulu, K C Divyansh Mishra, Pradeep Sagar, Sriram Simakurthy
April 2019, 67(4):563-566
DOI:10.4103/ijo.IJO_801_18  PMID:30900602
Congenital hypertrophy of retinal pigment epithelium (CHRPE) is a benign, pigmented, flat lesion arising from the retinal pigment epithelium (RPE). In this study, we describe optical coherence tomography angiography (OCTA) features of two eyes with solitary CHRPE. We found that the retinal vasculature over CHRPE was normal in both cases. We observed that in solitary CHRPE, segmentation artifacts can interfere in the interpretation of retinal vasculature due to thinning of the outer retina. Visualization of the underlying choroidal vasculature was obscured to some extent by masking effect of the hyperpigmented RPE. The choroidal vasculature was better appreciated on en face OCTA. On OCTA, the retinal and choroidal vasculature associated with CHRPE was found to be normal in our study.
  630 149 -
COMMENTARY
Commentary: The human amniotic membrane: Fortifying nature's gift to ophthalmology
Swapna S Shanbhag, Pragnya Rao Donthineni, Vivek Singh, Sayan Basu
April 2019, 67(4):476-476
DOI:10.4103/ijo.IJO_2062_18  PMID:30900577
  616 156 -
CASE REPORTS
Corneal staining during cataract surgery: Natural course, ASOCT features, and preventive measures
Chinnappaiah Nandini, Himanshu Matalia, Lubna Zameer, Jyoti Matalia
April 2019, 67(4):557-559
DOI:10.4103/ijo.IJO_1216_18  PMID:30900599
We report the natural course of the accidental injection of trypan blue into the corneal stroma while performing a routine cataract surgery by a resident during a training session. The corneal staining resolved with conservative medical treatment over 7 weeks. This case describes the anterior segment optical coherence tomography (ASOCT) features of corneal staining. It emphasizes on the relatively benign nature of this dye and the follow-up course. Causes that may be responsible for this untoward complication are highlighted with the necessary preventive measures that need to be taken care are also discussed.
  599 150 -
SURGICAL TECHNIQUE
Optimal refinement of residents' surgical skills by training on induced goat's eye corneoscleral perforation
Amar Pujari, Namrata Sharma, Manthan Hasmukhbhai Chaniyara, Jayanand Urkude, Rashmi Singh, Saumya Yadav, Ritika Mukhija, Mohamed Ibrahime Asif, Navneet Sidhu
April 2019, 67(4):547-548
DOI:10.4103/ijo.IJO_1474_18  PMID:30900593
Surgical skill enhancement for the residents under training can be performed through various efforts. Here in this report, the authors describe a technique of corneoscleral perforation repair on goat's eye, as the tissue resemblance and the reality of experience while performing crucial steps are similar to human eyes. Beginning from tissue handling, optimal suture placement was taught with an intention to impart quality techniques of traumatic globe injury repair. Therefore, rather than training on expensive artificial eye model, training budding surgeons on goat's eye gives much more realistic tissue handling experiences in the presence of constant challenges almost similar to human eyes.
  580 131 -
CASE REPORTS
A case of retinal cavernous hemangioma analyzed with optical coherence tomography angiography
Ekta Singh, Alok Sen
April 2019, 67(4):561-563
DOI:10.4103/ijo.IJO_1478_18  PMID:30900601
Retinal cavernous hemangiomas is a rare vascular tumor, isolated and non-progressive. This tumor is incidentally diagnosed on fundus examination and visual impairment can be rare presentation from vitreous hemorrhage, pre-retinal traction, hyphema, or macular scarring. The tumor has typical appearance of grape-like clusters of dilated vascular sacs with variable surface gliosis. Characteristic imaging findings aids in diagnosis. Newly emerged imaging tool is optical coherence tomography angiography (OCT A) which obtains high-resolution visualization of retinal vasculature in non-invasive fashion. In the present case report, we analyzed various diagnostic tool available for retinal cavernous hemangiomas; illustrating on the OCT A features.
  560 144 -
OPHTHALMIC IMAGES
Management of retinal artery macroaneurysm exudation in Wyburn-Mason syndrome with intravitreal ranibizumab
Anmol U Naik, Muna Bhende, Ambika Selvakumar, Vikas Khetan
April 2019, 67(4):556-556
DOI:10.4103/ijo.IJO_1497_18  PMID:30900598
  417 170 -
PHOTO ESSAY
Valsalva retinopathy following transesophageal echocardiography
Amber A Bhayana, Vinod Kumar
April 2019, 67(4):553-554
DOI:10.4103/ijo.IJO_1565_18  PMID:30900596
  441 131 -
COMMENTARY
Commentary: Training in wet labs and on surgical simulators: Need of the hour
Manisha Acharya, Javed Hussain Farooqui, Abhishek Dave
April 2019, 67(4):549-550
DOI:10.4103/ijo.IJO_1940_18  PMID:30900594
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