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   2019| May  | Volume 67 | Issue 5  
    Online since April 22, 2019

 
 
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ORIGINAL ARTICLE
Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review
Sethu Sheeladevi, Bharani Seelam, Phanindra B Nukella, Rishi R Borah, Rahul Ali, Lisa Keay
May 2019, 67(5):583-592
DOI:10.4103/ijo.IJO_1235_18  PMID:31007213
Purpose: The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ≥30 years in India. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision Results: Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2–68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9–14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0). Conclusion: This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.
  3,565 659 -
ORIGINAL ARTICLES
Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis
Rahul Bhargava, Prachi Kumar
May 2019, 67(5):594-598
DOI:10.4103/ijo.IJO_1352_18  PMID:31007215
Purpose: To compare the safety and efficacy of tacrolimus 0.03% ointment with dexamethasone 0.05% ointment for subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis (AK). Methods: A randomized, double blind trial was done. Eligibility criteria was corrected distance visual acuity of 6/9 Snellen or worse for at least 4 weeks with corneal SEIs following AK. The grading of SEIs was done on a scale of 0 to 3; 0, no infiltrates, 1 mild infiltration, 2 moderate infiltration and 3, severe infiltration. Consecutive patients with SEIs following AK were randomized to receive either topical tacrolimus 0.03% or dexamethasone 0.05% ointment twice daily for 6 months. Treatment was successful if there was reduction of SEIs and improvement in vision. Results: A total of 45 patients each were assigned to the Tacro and Dexa groups, respectively. Baseline characteristics of patients did not differ significantly (P > 0.001). There was a significant change in symptoms, vision and SEIs in both the groups. However, the magnitude was greater in tacro group. Treatment was successful in 37 (92.5%) patients in Tacro and 34 (85%) patients in dexa group. In dexa group, after a period of 1.24 ± 0.24 months, 7 (15.6%) patients developed a significant rise in intraocular pressure (IOP). Three (7.5%) eyes in tacro and 6 (15%) eyes in dexa group had recurrence of SEIs after cessation of therapy. Conclusion: Tacrolimus 0.03% is an effective alternative to dexamethasone 0.05% with low recurrence rate, no significant rise in IOP but may cause burning and foreign body sensation in some patients.
  2,805 585 -
EDITORIAL
The burden of uncorrected refractive error
Santosh G Honavar
May 2019, 67(5):577-578
DOI:10.4103/ijo.IJO_762_19  PMID:31007210
  1,629 459 -
SURGICAL TECHNIQUES
Glue-assisted retinopexy for rhegmatogenous retinal detachments (GuARD): A novel surgical technique for closing retinal breaks
Mudit Tyagi, Sayan Basu
May 2019, 67(5):677-680
DOI:10.4103/ijo.IJO_1943_18  PMID:31007238
Purpose: This study describes a novel surgical technique of fibrin glue-assisted retinopexy for rhegmatogenous retinal detachment (GuARD) without oil or gas tamponade after pars plana vitrectomy (PPV). Methods: This pilot clinical trial included five eyes of five patients with rhegmatogenous retinal detachments (RD). A complete PPV was done in all cases followed by fluid–air exchange, laser photocoagulation around the break/s, and application of 0.1–0.2 mL of fibrin glue. No air, long-acting gas or silicone oil was used subsequently. No specific postoperative positioning was prescribed. The primary outcome measure was efficacy of the procedure defined as successful anatomical retinal reattachment. Secondary outcome measures were postoperative improvement in best corrected visual acuity (BCVA) and complications. Results: The median age of patients was 55 (range: 36–61 years) years and median duration of symptoms was 15 (range: 7–60) days. All eyes were pseudophakic, four eyes had inferior and one eye had total RD. Successful retinal reattachment was achieved in all (100%) cases and was maintained at the end of 3–8 months of follow-up. The median BCVA improved from 20/100 preoperatively to 20/80 at 1-week and 20/50 at 1-month postoperatively. None of the eyes had any postoperative complications such as elevated intraocular pressures or unexpected inflammation. Conclusion: The findings of this study suggest that GuARD is a promising technique for treatment of rhegmatogenous RD that may allow early visual recovery while avoiding the problems of gas or oil tamponade and obviating the need of postoperative positioning.
  1,657 330 -
ORIGINAL ARTICLES
A cluster of central retinal artery occlusions following cataract surgery
Alok Sen, Ashish Mitra, Shubhi Tripathi, Megha Sharma, Pratik Shenoy
May 2019, 67(5):630-633
DOI:10.4103/ijo.IJO_1070_18  PMID:31007223
Purpose: To report a series of central retinal artery occlusions (CRAO) following cataract surgery complicated by posterior capsular rupture (PCR). Methods: Data from 14 patients with acute CRAO following cataract surgery was collected for this study including subject demographics, initial and final best-corrected visual acuity, systemic investigations, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings. Results: Mean subject age was 59.9 ± 12.1 years. Male: Female ratio was 1:1. All patients were operated between October and November 2015 and presented with acute vision loss 1 to 4 days after surgery. All the patients underwent cataract surgery under peribulbar anesthesia and had PCR for which anterior vitrectomy (AV) was done. In all the cases Ethylene oxide (ETO) sterilized vitrectomy probe was used for AV. Clinical picture of CRAO was noted in all the cases during the immediate postoperative period. OCT showed inner retinal layer hyperreflectivity while FFA was normal in all the cases. The final visual acuity was poor in all the eyes. This paper discusses the possible mechanisms of CRAO in these cases. Conclusion: CRAO is a potential complication of peribulbar anesthesia for intraocular surgery in patients with vascular risk factors and hence any substance that can aggravate the vasospasm in such patients should be used cautiously. Vasospasm could be caused by ETO as residual ETO could be present in the vitrectomy machine tubing causing toxicity. It is recommended to be cautious while using ETO sterilized instruments for cataract surgery.
  1,217 311 -
GUEST EDITORIAL
Radiation therapy for exudative choroidal hemangioma
Paul T Finger
May 2019, 67(5):579-581
DOI:10.4103/ijo.IJO_707_19  PMID:31007211
  1,128 319 -
ORIGINAL ARTICLE
Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: A cross-sectional study
Chujin Qiu, Xianqiong Feng, Jihong Zeng, Hongmei Luo, Zhifeng Lai
May 2019, 67(5):612-617
DOI:10.4103/ijo.IJO_1116_18  PMID:31007219
Purpose: To investigate the quality of discharge teaching, readiness for hospital discharge (RHD), and post-discharge outcomes (PDO) of cataract patients in a day ward and to explore the relationships among these three variables. Methods: This cross-sectional study used an opportunistic sample from the ophthalmic day ward in a general hospital in Sichuan province, China. Data were collected using four questionnaires. Results: The total average score on the Quality of Discharge Teaching Scale was 192.95, and the dimension with the lowest score was “guidance obtained practically.” The total average score on the Readiness for Hospital Discharge Scale was 175.51, and the dimension with the lowest score was “knowledge of disease.” The total average score on the Post-Discharge Outcome Questionnaire was 77.08, and the four dimensions with the lowest scores were “compliance behaviors,” “avoiding excessive use of eye,” “avoiding strenuous exercise,” and “regular check-up.” Pearson correlation coefficients indicated low to moderate correlations between discharge teaching quality and PDO (0.245, P < 0.01), RHD and PDO (0.271, P < 0.01), and discharge teaching quality and PDO (0.559, P < 0.01). Conclusion: The quality of discharge teaching among cataract patients who underwent day surgery was relatively high, and patient preparation for discharge and PDO were good. However, medical staff should focus more attention on patients' individualized needs for discharge teaching while emphasizing the importance of compliance behavior.
  1,132 291 -
ORIGINAL ARTICLES
Coping strategy in persons with low vision or blindness – an exploratory study
Puja Rai, Jolly Rohatgi, Upreet Dhaliwal
May 2019, 67(5):669-676
DOI:10.4103/ijo.IJO_1655_18  PMID:31007237
Purpose: Coping strategies employed by people with visual disability can influence their quality of life (QoL). We aimed to assess coping in patients with low vision or blindness. Methods: In this descriptive cross sectional study, 60 patients (25–65 years) with <6/18 best-corrected vision (BCVA) in the better eye and vision loss since ≥6 months were recruited after the institutional ethics clearance and written informed consent. Age, gender, presence of other chronic illness, BCVA, coping strategies (Proactive Coping Inventory, Hindi version), and vision-related quality of life (VRQoL; Hindi version of IND-VFQ33) were recorded. Range, mean (standard deviation) for continuous and proportion for categorical variables. Pearson correlation looked at how coping varied with age and with VRQoL. The analysis of variance (ANOVA) and t-test compared coping scores across categorical variables. Statistical significance was taken at P < 0.05. Results: Sixty patients fulfilled inclusion criteria. There were 33 (55%) women; 25 (41.7%) had low vision, 5 (8.3%) had economic blindness, and 30 (50.0%) had social blindness; 27 (45.0%) had a co-morbid chronic illness. Total coping score was 142 ± 26.43 (maximum 217). VRQoL score (maximum 100) was 41.9 ± 15.98 for general functioning; 32.1 ± 12.15 for psychosocial impact, and 41.1 ± 17.30 for visual symptoms. Proactive coping, reflective coping, strategic planning, and preventive coping scores correlated positively with VRQoL in general functioning and psychosocial impact. Conclusion: Positive coping strategies are associated with a better QoL. Ophthalmologists who evaluate visual disability should consider coping mechanisms that their patients employ and should refer them for counseling and training in more positive ways of coping.
  1,257 151 -
Objective optical assessment of tear-film quality dynamics in patients with meibomian gland dysfunction and aqueous-deficient dry eye optical quality changes in different dry eye subtypes
Fen Ye, Feng Jiang, Yan Lu, Chun Yan Xue, Xiao Min Zhu, Yan Wu, Zhen Ping Huang
May 2019, 67(5):599-603
DOI:10.4103/ijo.IJO_1278_18  PMID:31007216
Purpose: To evaluate the optical quality and tear-film dynamics in patients with aqueous-deficient or evaporative subtype of dry eye disease (DED). Methods: Twenty-five aqueous-deficient dry eye (ADDE) patients, 25 DED patients with meibomian gland dysfunction (MGD), and 25 healthy subjects were included in this study. Vision-related health-targeted quality of life was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Dynamic recording with a double-pass system (Optical Quality Analysis System [OQAS]) was performed in right eyes. Scattered light was measured as the objective scatter index (OSI) at 0.5-second intervals over 20 seconds without blinking. Then, we recorded OSI every 0.5 seconds within a 20-second period with the subjects asked to blink freely. Several parameters were established to evaluate the dynamic alterations of optical quality and the effects of blinks: OSI, OSI standard deviation (SD), ΔOSI, ΔOSI/time, blinking change (BC), and blinking frequency (BF). Additional clinical examination included tear film break-up time (BUT), Schirmer I test (SIT), fluorescein staining grade (FL), meibomian gland quality, meibomian gland expressibility, and meibomian gland drop-out. Results: The OSI, SD, ΔOSI, ΔOSI/time, BC, and BF were significantly higher in DED patients than controls (P < 0.01, respectively). The OSI, SD, ΔOSI, ΔOSI/time, BC, and BF were significantly higher in patients with MGD than patients with ADDE (P < 0.01). In the MGD group, BUT, FL staining score, lid abnormality, meibomian gland expressibility, and meibomian gland drop-out were correlated with Δ OSI and Δ OSI/time. Conclusion: Dry eye patients with MGD had significant alterations of optical quality compared with ADDE patients. The double-pass system has potential to be a useful quantitative method to evaluate the optical quality and tear-film dynamics in patients with dry eye.
  1,105 277 -
Iridocorneal endothelial syndrome: Evaluation of patient demographics and endothelial morphology by in vivo confocal microscopy in an Indian cohort
Chintan Malhotra, Natasha G Seth, Surinder S Pandav, Arun K Jain, Sushmita Kaushik, Amit Gupta, Srishti Raj, Deepika Dhingra
May 2019, 67(5):604-610
DOI:10.4103/ijo.IJO_1237_18  PMID:31007217
Purpose: To evaluate the patient demographics and morphological characteristics of corneal endothelium by in vivo confocal microscopy (IVCM), in patients with Iridocorneal Endothelial (ICE) Syndrome. Methods: In this retrospective observational series, IVCM acquired endothelial images of patients with ICE syndrome were evaluated. 'ICE cells' morphology was classified as “−” or “+” if they were larger or smaller than contralateral normal endothelium. It was correlated with patient demographics and clinical manifestations. Results: IVCM was performed on 41 eyes of 21 patients, with 13 males (62%) and 8 females (38%). The disease was unilateral in 19 (90.5%) and bilateral but asymmetric in two (9.5%) patients. Total ICE was seen in 91% eyes. Eighty percent patients (12 out of 15) with ICE—cells were males while 83.3% (5 out of 6) patients with ICE + cells were females. Mean age of patients with ICE- cell type and ICE + cell type was 45.8 ± 17.8 years and 40.3 ± 9.2 years respectively (P = 0.02). Both ICE – and ICE + eyes had similar incidence (33.3%) of corneal edema. ICE + eyes had more severe (grades 2/3) glaucoma (n = 5/6 eyes, 83.3%) compared to ICE – eyes (n = 8/15 eyes, 53.3%). Conclusion: A male preponderance, predilection of ICE – and + cell variants for male and female gender respectively, lack of association of the endothelial cell morphology with corneal edema, and apparent association of ICE + phenotype with more severe glaucoma occurring at a relatively younger age, are some novel findings of the present study. In the clinical setting correlation of patient demographics with these IVCM findings may help in better long-term prognostication of eyes with ICE syndrome.
  1,096 235 -
ONE MINUTE OPHTHALMOLOGY
Bilateral pale posterior pole sans pain: A “hard” sell
Ramya Appanraj, Vinay S Kumar, Pukhraj Rishi, Jyotirmay Biswas
May 2019, 67(5):582-582
DOI:10.4103/ijo.IJO_1949_18  PMID:31007212
  932 332 -
CASE REPORTS
Focal choroidal excavation: Cause or effect?
Raj C Shah, Mahesh Gopalakrishnan, Anubhav Goyal, Giridhar Anantharaman, Abhishek Sethia
May 2019, 67(5):696-698
DOI:10.4103/ijo.IJO_1263_18  PMID:31007249
We report the imaging characteristics of focal choroidal excavation (FCE) and associated choroidal neovascular membrane (CNVM) and interpret the probable etiopathogenesis of FCE through findings in four patients detected by spectral-domain optical coherence tomography (SD-OCT). FCE was found as an acquired entity in two of our cases subsequent to treatment of CNVM, whereas in the two other cases FCE was pre-existing. Furthermore, association of FCE with pachychoroid spectrum is reaffirmed through this case series.
  936 220 -
ORIGINAL ARTICLES
Computed tomography imaging-based normative orbital measurement in Indian population
Vivek Gupta, Anuj Prabhakar, Mukesh Yadav, Niranjan Khandelwal
May 2019, 67(5):659-663
DOI:10.4103/ijo.IJO_1187_18  PMID:31007233
Purpose: This study aims to evaluate normal orbital structures with nonenhanced computed tomography (NCCT) and determine normative data for the Indian population. Methods: CT images of the orbits of 100 patients were retrospectively reviewed on a work station to record the normative data of the orbits. Clinical details of all patients were reviewed to ensure that they did not have ocular/orbital diseases. Both axial and coronal images were utilized to record the data. Results: The mean age of the population evaluated was 34.07 years, with male to female ratio of 1.77. The average orbital index for the left orbit was 97 and for the right side was 103. The mean thickness of left inferior rectus, lateral rectus, medial rectus, and the superior rectus was 3.36 mm, 3.14 mm, 3.80 mm, and 3.75 mm, respectively. The right inferior rectus, lateral rectus, medial rectus, and the superior rectus measured 3.46 mm, 3.14 mm, 3.83 mm, and 3.78 mm, respectively. The optic nerve sheath complex diameter varied between 3.05 mm and 7.17 mm for the left eye and 3.05 mm and 7.0 mm for the right eye. Conclusion: The study provides normative data on various orbital structures in an Indian population. This data is likely to be useful for diagnosing various orbital pathologies and in planning surgical orbital procedures.
  899 141 -
Refractive outcomes of a single-step and a two-step approach for silicone oil removal and cataract surgery
VG Madanagopalan, Pradeep Susvar, M Arthi
May 2019, 67(5):625-629
DOI:10.4103/ijo.IJO_1380_18  PMID:31007222
Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ≤±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (−1.73 ± 2.04 vs. −0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ≤±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.
  845 193 -
ORIGINAL ARTICLE
Evaluation of the effect and safety of dexmedetomidine as an additive to local anesthesia in peribulbar block for vitreoretinal surgery
Gaganjeet S Gujral, Manisha Agarwal, Preety Gautam, Ankita Shrivastav, Shalini Singh
May 2019, 67(5):636-640
DOI:10.4103/ijo.IJO_1386_18  PMID:31007226
Purpose: We conducted a prospective, randomized study to evaluate the efficacy of dexmedetomidine as an additive to peribulbar block for vitreoretinal surgery in terms of onset time of block, hemodynamic stability profile, patient comfort, and surgeon satisfaction. Methods: One hundred patients of American Society of Anesthesiologists grade 1 and 2 scheduled for vitreoretinal surgery were randomly assigned into two groups: control group (n = 50) received lignocaine bupivacaine block, and Dex group (n = 50) received lignocaine bupivacaine plus 20 μg dexmedetomidine peribulbar block. Information regarding time for onset of block, hemodynamic data, visual analog scale for pain, sedation levels, total duration of surgery, and surgeon satisfaction levels were collected. Results: All the demographic characteristics including age, gender, American Society of Anesthesiologists grade, onset of anesthesia, and duration of surgery were comparable in both groups. At the baseline, there was no statistically significant difference in heart rate, mean arterial pressure, diastolic blood pressure, and respiratory rate between the two groups, with a difference noted in systolic blood pressure at the baseline. There was significant difference noted in the systolic blood pressure and mean arterial pressure at different time intervals with a decreasing trend as time progressed. The mean sedation score was significantly higher in the Dex group than that in the control group. The surgeon satisfaction was higher in the Dex group than that in the control group. Conclusion: Dexmedetomidine is a useful and safe drug in combination with lignocaine bupivacaine in peribulbar for vitreoretinal surgery as it maintains hemodynamic stability and provides sedation, which enables full cooperation and potentially better operating conditions.
  798 224 -
CASE REPORTS
Treatment of circumscribed choroidal hemangioma using CyberKnife: A viable alternative
Aditi Agarwal, Venkatavaradan Raghavan, Ramadas Rathnadevi, Pukhraj Rishi
May 2019, 67(5):704-706
DOI:10.4103/ijo.IJO_1410_18  PMID:31007252
Circumscribed choroidal hemangioma is a benign vascular hamartoma without systemic associations. For symptomatic cases, treatment options are photodynamic therapy (PDT), transpupillary thermotherapy (TTT), intravitreal injection of anti-vascular endothelial growth factor (VEGF), or radiation therapy. CyberKnife radiosurgery is an image-guided radiation therapy that delivers radiation to lesions anywhere in the body with an accuracy of 0.5 mm without damage to surrounding structures. We report a case of circumscribed choroidal hemangioma which was successfully treated with CyberKnife therapy. The literature search reveals cases of uveal melanoma, intraocular, and periocular lymphoma successfully treated with CyberKnife therapy. To the best of our knowledge, this is the first report on such treatment for choroidal hemangioma.
  796 149 -
COMMENTARY
Commentary: Discharge planning in day-care cataract patients
Anup K Goswami
May 2019, 67(5):617-618
DOI:10.4103/ijo.IJO_158_19  PMID:31007220
  663 131 -
ORIGINAL ARTICLES
Macular ganglion cell complex parameters by optical coherence tomography in cases of multiple sclerosis without optic neuritis compared to healthy eyes
Nancy M Lotfy, Tariq Alasbali, Rajiv Khandekar
May 2019, 67(5):648-653
DOI:10.4103/ijo.IJO_1378_18  PMID:31007230
Purpose: To compare different macular thickness parameters and peripapillary retinal nerve fiber layer (RNFL) thickness between recently diagnosed cases of multiple sclerosis (MS) without optic neuropathy (ON) and healthy individuals. Methods: This cross-sectional study was performed between June 2014 and June 2015. All subjects underwent ocular and retinal examination. Spectral domain optical coherence tomography (SD-OCT) was used to measure the thickness of different layers of the retina at macular and peripapillary regions and at different quadrants. Between groups comparison was performed with P < 0.05 indicating statistical significance. Results: There were 32 eyes in the MS group and 74 eyes in the control group. The MS group was significantly younger than the control group (P < 0.001). The mean ganglion cell complex (GCL++) thickness in superior macular area was 64.1 ± 8.9 μ in the MS group and 71.1 ± 5.9 μ in the control group. The thickness of the RNFL did not statistically differ in each of the quadrants between groups. Despite controlling for age, the macular thickness parameters were significantly thinner in eyes with MS compared to healthy eyes (P < 0.01). Conclusion: The macular ganglion cell complex (mGCC) parameters were significantly reduced in recently diagnosed cases of MS as compared to healthy individuals.
  647 145 -
CASE REPORTS
Optical coherence tomography angiography in assessment of response to therapy in retinal capillary hemangioblastoma and diffuse choroidal hemangioma
Pradeep Sagar, P Mahesh Shanmugam, Vinaya K Konana, Rajesh Ramanjulu, K C Divyansh Mishra, Sriram Simakurthy
May 2019, 67(5):701-703
DOI:10.4103/ijo.IJO_1429_18  PMID:31007251
In this series, we discuss the role of optical coherence tomography angiography (OCTA) in assessing response to treatment in intraocular vascular tumors. This is a series of two cases: Multiple retinal capillary hemangioblastoma (RCH) treated with laser photocoagulation and diffuse choroidal hemangioma (DCH) with radiotherapy. In large RCH and DCH, optical coherence tomography (OCT) showed significant reduction of subretinal and intraretinal fluid. But post-treatment mean tumor vascular density (MTVD) was slightly reduced. In one small RCH, vascular loop was seen suggesting minimal residual disease. So, OCTA helps in identifying treatment inadequacy and understanding alternate mechanism involved in treatment response in vascular tumors.
  655 136 -
ORIGINAL ARTICLES
Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study
Sudarshan Khokhar, Sagnik Sen, Chirakshi Dhull
May 2019, 67(5):619-624
DOI:10.4103/ijo.IJO_1146_18  PMID:31007221
Purpose: To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip. Methods: Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively. Results: Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05). Conclusion: Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.
  637 145 -
External dacryocystorhinostomy for isolated lacrimal sac rhinosporidiosis – A suitable alternative to dacryocystectomy
Nandini Bothra, Suryasnata Rath, Ruchi Mittal, Devjyoti Tripathy
May 2019, 67(5):665-668
DOI:10.4103/ijo.IJO_1136_18  PMID:31007236
Purpose: To describe the outcome of external dacryocystorhinostomy (DCR) as a suitable alternative to dacryocystectomy (DCT) in cases of isolated lacrimal sac rhinosporidiosis. Methods: This was a retrospective, interventional case series. Institutional review board approval was obtained for the study. The chart review of 13 patients who underwent external DCR surgery for isolated lacrimal sac rhinosporidiosis between July 2012 and May 2018 was performed. Demographic details, clinical presentation, preoperative and intraoperative findings, surgical technique used, postoperative management, surgical outcome and duration of follow up were reviewed for each patient. Results: Thirteen patients were included in the study. Nine (69.2%) were male and four (30.8%) were female. The mean age was 22.1 years (range: 8–46 years). Involvement was unilateral in all cases. The commonest presenting complaint was epiphora with discharge seen in 10 cases (76.9%). An intrasac granuloma was grossly identified intraoperatively in 12 out of the 13 patients. Mean follow up was 26.9 months (range: 1.5–68 months). Till the last follow up, all cases were symptom free and did not have any evidence of recurrence of infection. Conclusion: From this series of cases reported by the authors, external DCR with appropriate precautions to prevent recurrence appears to be a suitable alternative to conventional DCT with excellent long-term outcomes without disease recurrence.
  568 130 -
Comparison of torsional amplitudes between emmetropes and myopes using after-image slides
Antony Arokiadass Baskaran, Tanuja Britto, Sundaresan Rajkumar, Philip A Thomas, C A Nelson Jesudasan
May 2019, 67(5):655-658
DOI:10.4103/ijo.IJO_1663_18  PMID:31007232
Purpose: To describe the influence of corrected refractive error on measured torsional fusional amplitudes (TA) by comparing the TA between emmetropes and spectacle corrected myopes, using the after-image slides of the synoptophore, as targets. Methods: Fifty emmetropes (Group I) and 50 myopes (Group II) with best-corrected acuity of 6/6 in each eye were included in the study. Near point of convergence (NPC), near point of accommodation (NPA), and horizontal fusional amplitudes (HFA) were assessed in all the subjects. After-image slides, both horizontally aligned, were used as targets (without the bright flashes). One of the slides was rotated inwards, till cyclo-diplopia was reported by the subject; the procedure was repeated with the slide rotated outwards. The sum of the two readings was taken as TA. NPC, NPA, HFA, and TA were analyzed. Results: There was no significant difference in the NPC, NPA, and HFA between the two groups. The emmetropic subjects had significantly better torsional amplitude (8.4 ± 1.4 degrees) compared to myopes (7.7 ± 1.5 degrees, P = 0.03). We postulate that this difference may be due to perceived image minification, which brings the edges of retinal image of the targets closer to the fovea, thus rendering the myopes lesser tolerant to cyclodiplopia than emmetropes. Conclusion: Refractive error, corrected with spectacles, influences the measured TA. Myopic subjects have lesser torsional fusional amplitude than emmetropes.
  575 104 -
COMMENTARIES
Commentary: Fibrin glue in rhegmatogenous retinal detachment repair—Are we there yet?
Kumar Anshuman, Dhanashree Ratra
May 2019, 67(5):683-684
DOI:10.4103/ijo.IJO_104_19  PMID:31007241
  552 113 -
OPHTHALMIC IMAGES
Double dialysis of the iris
Sonam Yangzes, Simar Rajan Singh, Jagat Ram
May 2019, 67(5):691-691
DOI:10.4103/ijo.IJO_1965_18  PMID:31007245
  524 137 -
COMMENTARY
Commentary: Uncorrected refractive errors in Indian adults: An unrecognized problem
Ronnie George
May 2019, 67(5):592-593
DOI:10.4103/ijo.IJO_645_19  PMID:31007214
  540 114 -
CASE REPORTS
A rare case of bilateral choroidal coloboma within deep posterior staphyloma associated with macular hole retinal detachment
Kadri Venkatesh, Neha Khanna, S Sivaranjani, Sri Ganesh
May 2019, 67(5):699-700
DOI:10.4103/ijo.IJO_729_18  PMID:31007250
To report case of bilaterally symmetrical choroidal coloboma within posterior staphyloma with MHRD. This is a case report of a 50year old female presented with diminished vision in both eyes. On examination, she had Bilateral High Myopia with recent onset MHRD associated with symmetrically bilateral Choroidal Coloboma within posterior staphyloma and was operated for MHRD in left eye. Presence of choroidal coloboma within posterior staphyloma is rare and with coexisting macular hole makes pathophysiology of RD challenging to understand.
  543 106 -
ORIGINAL ARTICLES
Microbiological profile and antibiotic susceptibility of scleral buckle infections in North India
Ankita Shrivastav, Sumit Kumar, Shalini Singh, Manisha Agarwal, Neelam Sapra, Arpan Gandhi
May 2019, 67(5):644-647
DOI:10.4103/ijo.IJO_1094_18  PMID:31007229
Purpose: The aim of this article to study causative organisms for scleral buckle (SB) infections in North India. Methods: A retrospective review of records was done for all patients who have undergone SB removal at our institute between January 2009 and December 2017. The records were analyzed for etiological agent of the infected buckle and its antibiotic sensitivity. Results: A total of 43 samples were analyzed and a positive culture was noted in 35 (81.40%) cases. The buckle infection rate at our institute was noted to be 2.53%. The commonest organism causing SB infections was Staphylococcus – 15 (42.6%) cases, followed by Pseudomonas – 6 (17.14%) cases and Fungi – 6 (17.14%) cases. The median interval between retinal detachment surgery and buckle explantation was 3 years. Conclusion: A large variety of organisms may cause SB infections. The commonest organism found to cause buckle infections in our study was Staphylococcus sp.
  533 113 -
COMMENTARIES
Commentary: Role of alpha-2 agonists in regional ophthalmic anaesthesia
Simar Rajan Singh, Vikas Saini, Avneet Singh, Mohit Dogra
May 2019, 67(5):641-642
DOI:10.4103/ijo.IJO_635_19  PMID:31007227
  544 98 -
CASE REPORTS
A novel simplified method for managing inadvertent tube cut during aurolab aqueous drainage implant surgery for refractory glaucoma
Sachin Mungale, Paaraj Dave
May 2019, 67(5):694-696
DOI:10.4103/ijo.IJO_1708_18  PMID:31007248
We report a novel simplified method for managing inadvertent tube cut in a patient undergoing the Aurolab aqueous drainage implant (AADI) surgery for refractory neovascular glaucoma. Tube cut occurred while applying the polyglactin ligature suture used to avoid early postoperative hypotony. The short end of the cut tube was removed and the long end reinserted into the base plate of AADI. The surgery was then completed as usual. Following the surgery, the intraocular pressure reduced to 20 mmHg which stabilized and was maintained at 10 mmHg till the last follow-up at 12 months without any glaucoma medication.
  523 115 -
COMMENTARY
Commentary: In vivo confocal microscopy in iridocorneal endothelial syndrome
Vineet Ratra
May 2019, 67(5):610-611
DOI:10.4103/ijo.IJO_154_19  PMID:31007218
  512 106 -
PHOTO ESSAY
Retinal capillary hemangioblastoma associated with retinochoroidal coloboma in Von Hippel-Lindau disease
Priyadarshini Mishra, Shabari Pal, Vikas Kanaujia, Kumudini Sharma
May 2019, 67(5):688-690
DOI:10.4103/ijo.IJO_1564_18  PMID:31007244
  513 105 -
COMMENTARIES
Commentary: Central retinal arterial occlusions after phacoemulsification: Our perspective
Rashmi Deshmukh, Ritesh Narula
May 2019, 67(5):633-634
DOI:10.4103/ijo.IJO_280_19  PMID:31007224
  499 103 -
PHOTO ESSAY
Double decker endothelial keratoplasty
Arjun Srirampur, Kavya Reddy Katta, Sritha Vemuganti, Anupama Kalwad
May 2019, 67(5):686-688
DOI:10.4103/ijo.IJO_1758_18  PMID:31007243
  492 104 -
COMMENTARIES
Commentary: A cluster of central retinal artery occlusions following cataract surgery
Atul Kumar, Divya Agarwal, Akshaya Balaji
May 2019, 67(5):635-635
DOI:10.4103/ijo.IJO_50_19  PMID:31007225
  468 109 -
Commentary: Fibrin sealant for temporary retinopexy
P Mahesh Shanmugam
May 2019, 67(5):682-683
DOI:10.4103/ijo.IJO_67_19  PMID:31007240
  441 111 -
Commentary: Sealing breaks comfortably— A novel approach to retinopexy without positioning
Manavi D Sindal, M Arthi
May 2019, 67(5):681-681
DOI:10.4103/ijo.IJO_269_19  PMID:31007239
  461 82 -
Commentary: Adjunctive agents in peribulbar anesthesia: Role of dexmedetomidine in vitreo-retinal surgeries
Sahil Bhandari
May 2019, 67(5):642-643
DOI:10.4103/ijo.IJO_176_19  PMID:31007228
  449 84 -
OPHTHALMIC IMAGES
Operating microscope and endoilluminator-induced retinal phototoxic maculopathy after trans-scleral sutured posterior chamber intraocular lens
Mohit Dogra, Simar R Singh, Mangat R Dogra
May 2019, 67(5):692-692
DOI:10.4103/ijo.IJO_1233_18  PMID:31007246
  411 118 -
PHOTO ESSAY
Keratoprosthesis optic and carrier corneal graft “noncontact” as a cause of sterile stromal necrosis in a case of Auro KPro implantation
Chintan Malhotra, Deepika Dhingra, Arun Kumar Jain
May 2019, 67(5):685-686
DOI:10.4103/ijo.IJO_1713_18  PMID:31007242
  397 94 -
COMMENTARIES
Commentary: Normative orbital measurement in Indian population
Suryasnata Rath
May 2019, 67(5):663-664
DOI:10.4103/ijo.IJO_434_19  PMID:31007234
  407 68 -
COMMENTARY
Commentary: Retinal phototoxicity with operating microscope and endoilluminator light
Ekta Rishi, Smriti Jain
May 2019, 67(5):693-693
DOI:10.4103/ijo.IJO_97_19  PMID:31007247
  377 88 -
Commentary: Ganglion cell complex of retinal layer thickness by optical coherence tomography in cases of multiple sclerosis without optic neuritis compared to healthy eyes
Padmaja Sudhakar
May 2019, 67(5):653-654
DOI:10.4103/ijo.IJO_175_19  PMID:31007231
  340 116 -
COMMENTARIES
Commentary: Relevance of orbital measurements for the orbit surgeon
Lakshmi Mahesh
May 2019, 67(5):664-664
DOI:10.4103/ijo.IJO_690_19  PMID:31007235
  374 64 -