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   2020| April  | Volume 68 | Issue 4  
    Online since March 16, 2020

 
 
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EDITORIAL
All eyes on Coronavirus—What do we need to know as ophthalmologists
Rohit C Khanna, Santosh G Honavar
April 2020, 68(4):549-553
DOI:10.4103/ijo.IJO_516_20  PMID:32174565
  13,893 2,255 22
REVIEW ARTICLE
Use of ocular biomarkers as a potential tool for early diagnosis of Alzheimer's disease
Ajay K Singh, Shilpa Verma
April 2020, 68(4):555-561
DOI:10.4103/ijo.IJO_999_19  PMID:32174567
Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide which unfortunately has no known effective cure to date. Despite many clinical trials indicating the effectiveness of preclinical treatment, a sensitive tool for screening of AD is yet to be developed. Due to multiple similarities between ocular and the brain tissue, the eye is being explored by researchers for this purpose, with utmost attention focused on the retinal tissue. Besides visual functional impairment, neuronal degeneration and apoptosis, retinal nerve fiber degeneration, increase in the cup-to-disc ratio, and retinal vascular thinning and tortuosity are the changes observed in the retinal tissue which are related to AD. Studies have shown that targeting these changes in the retina is an effective way of reducing the degeneration of retinal neuronal tissue. Similar mechanisms of neurodegeneration have been demonstrated in the brain and the eyes of AD patients. Multiple studies are underway to investigate the potential of diagnosing AD and detection of amyloid-β (Aβ) levels in the retinal tissue. Since the tissues in the anterior segment of the eye are more accessible for in vivo imaging and examination, they have more potential as screening biomarkers. This article provides a concise review of available literature on the ocular biomarkers in anterior and posterior segments of the eye including the cornea, aqueous humour (AH), crystalline lens, and retina in AD. This review will also highlight the newer technological tools available for the detection of potential biomarkers in the eye for early diagnosis of AD.
  5,337 789 19
ORIGINAL ARTICLES
Retropupillary iris-claw intraocular lens implantation in aphakic patients
CV Sumitha, Vijay Pai, Mithun Thulasidas
April 2020, 68(4):597-602
DOI:10.4103/ijo.IJO_1043_19  PMID:32174577
Purpose: To evaluate the outcomes of implantation of an iris-claw intraocular lens (IC-IOL) in retropupillary position in aphakic patients. Methods: We conducted a prospective interventional study, including 36 aphakic eyes with inadequate capsular support. The postoperative examination included best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, central corneal thickness (CCT), and anterior segment examination with emphasis on the anterior chamber reaction and shape of pupil. Follow-up was done for 3 months. Results: Thirty-six eyes of 34 patients, including 22 right eyes and 14 left eyes were included. Indications for surgery were complicated cataract surgery in 38.9% (n = 14), aphakia in 27.8% (n = 10), pseudophakic bullous keratopathy in 16.7% (n = 6), dislocated posterior chamber IOL (PCIOL) in 11.1% (n = 4), IC drop in 2.8% (n = 1), and subluxated PCIOL in 2.8% (n = 1). Postoperatively, the visual acuity improved by at least two lines in 32 (88.9%) and worsened in four (11.1%) eyes at the end of three months. Mean postoperative IOP at the end of the third month was 12.42 mmHg (standard deviation [SD] 2.57; range 11.55–13.29 mmHg). The mean postoperative CCT at the end of the third month was 542.42 microns (SD 13.77; range 537.76–547.07 microns). Sixteen eyes (44.4%) had horizontally oval pupil, eleven eyes (30.6%) had round pupil, and nine eyes (25%) had irregular pupil. Twenty-three eyes (63.9%) presented with significant anterior chamber reaction and seven eyes (19.4%) had corneal stromal edema on postoperative day 1. Conclusion: Our study demonstrated that retropupillary IC-IOL implantation in eyes without adequate capsular support is an effective and safe procedure with a good visual outcome and fewer complications.
  3,189 368 16
Intraoperative injection versus sponge-applied mitomycin C during trabeculectomy: One-year study
Devendra Maheshwari, Swathi Kanduri, Ramakrishnan Rengappa, Mohideen Abdul Kadar
April 2020, 68(4):615-619
DOI:10.4103/ijo.IJO_963_19  PMID:32174581
Purpose: To determine the safety and efficacy of mitomycin C (MMC) injection versus sponge during trabeculectomy. Methods: It is a prospective analysis of patients who underwent trabeculectomy with MMC and followed up for 1 year, divided into two groups, namely, group 1- injection (n = 21), group 2-> sponge (n = 21). The same concentration of MMC was used for both groups. Inclusion criteria were trabeculectomies with MMC for intraocular pressure (IOP) control in eyes with glaucoma (primary + secondary) with a follow-up of 1 year. Results: Mean preoperative IOP in group 1 was 29.00 ± 11.92 mmHg and group 2 was 25.87 ± 11.09 mmHg, which reduced to 12.19 ± 4.03 and 15.56 ± 10.72 mmHg at final visit with P value of 0.0002 and 0.001, respectively. Mean preoperative number of antiglaucoma medications was 2.4 ± 0.87 in group 1 and 2.3 ± 0.96 in group 2, which reduced to 0.38 ± 0.5 and 0.91 ± 0.85 with P value of 0.001 and 0.0003, respectively. The complete success rate was 52.4% in the injection group and 26.1% in the sponge group at end of 1 year. Overall, success rate (complete + qualified) was 90.5% and 87% in group 1 and group 2 at final visit. All major complications were encountered in sponge group. 1 (11.1%) patient developed choroidal detachment and one had malignant glaucoma which got resolved by medical management. 33.3% cases had encapsulated bleb which received bleb needling. 44.4% cases underwent Argon laser suture lysis postoperatively. Conclusion: The MMC injection may be as safe and as effective as conventional sponge application with comparable estimated complete treatment success.
  3,190 349 16
ORIGINAL ARTICLE
Phacoemulsification in posterior polar cataract: Experience from a tertiary eye care Centre in North India
Chintan Malhotra, Deepika Dhingra, Nishant Nawani, Partha Chakma, Arun K Jain
April 2020, 68(4):589-594
DOI:10.4103/ijo.IJO_932_19  PMID:32174575
Purpose: To determine the rate of posterior capsular rupture (PCR) and assess the postoperative outcomes in patients of posterior polar cataract (PPC) undergoing phacoemulsification using a combination of “V” or “λ” nucleofractis and viscodissection. Methods: It was a retrospective study of 80 eyes of 64 patients undergoing surgery for PPC. All surgeries were performed by a single surgeon. After completion of the continuous curvilinear capsulorrhexis (CCC), controlled hydrodelineation was used to separate the endonucleus from the epinuclear shell with limited viscodissection. Phacoemulsification was then carried out by making a “V” or lambda-shaped nucleofractis with the phaco tip followed by multiple chopping of the nucleus, ensuring the integrity of the epinuclear part of the lens. The epinuclear plate was removed after viscodissection. Results: The overall rate of PCR was 7.5% (6 out of 80 eyes). Of the 6 eyes, 4 eyes had been documented to have a pre-existing posterior capsular defect on slit-lamp examination. The rate of “on table” PCR, that is, PCR occurring intraoperatively was only 2.6% (2 of 76 eyes). Nucleus drop was not encountered in any case. Overall 87.5% eyes achieved a final visual acuity of 20/40 or better with 68.75% being 20/20 or better. Of the eyes developing PCR, two-third achieved a visual acuity of 20/30 or better. Conclusion: Using a combination of surgical techniques of V groove or lambda technique for nucleofractis and removal of epinucleus by viscodissection can result in a low rate of PCR and extremely good postoperative outcomes in cases of PPC.
  3,000 407 5
CASE REPORT
Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia
Mihir Kothari, Mohini Modak, Heena Khan, Shairin Jahan, Meghna Solanki, Vivek Rathod
April 2020, 68(4):653-656
DOI:10.4103/ijo.IJO_1243_19  PMID:32174596
To report convergence excess esotropia (CEET) following 0.01% atropine eye drops (Low dose atropine [LDA]). Children who developed CEET that resolved promptly after discontinuation of LDA are described. Three myopes aged 5.3 ± 1.2 years and mean sphere -4.5D were included. All were operated for intermittent exotropia earlier. Mean esotropia was +28.3PD for near and 10.6PD for distance. LDA induced high AC/A ratio and fusion normalized in 3 weeks after discontinuation of LDA. LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia. Any evidence of the emergence of a CEET should warrant discontinuation of LDA.
  3,020 314 2
SURGICAL TECHNIQUE
Intraocular lens-sling technique: A safe approach for lens implantation in complicated cataract surgery and secondary intraocular lens implantation
Manas Nath, Ashish M Khodifad, Annamalai Odayappan, Josephine S Christy, Subhashini Manoharan
April 2020, 68(4):632-635
DOI:10.4103/ijo.IJO_1112_19  PMID:32174584
Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.
  2,504 318 2
ORIGINAL ARTICLES
Comparison of the corrected intraocular pressure by tonopachy with that of Goldmann applanation tonometry in normal and glaucomatous patients
Girish Velis, Srinivasan Kavitha, Nazlee Zebardast, Sabyasachi Sengupta, Rengaraj Venkatesh
April 2020, 68(4):620-626
DOI:10.4103/ijo.IJO_570_19  PMID:32174582
Purpose: To compare corrected intraocular pressure (IOP) by tonopachy with that of Goldmann applanation tonometry (GAT) in normal and glaucomatous patients. Methods: In this cross-sectional study, IOP and central corneal thickness (CCT) were measured in 426 eyes (213 normal eyes and 213 glaucomatous eyes) of 426 patients by tonopachy followed by GAT and ultrasound pachymetry. IOP was corrected for CCT by in-built formula in tonopachy and Ehlers correction factor for Goldmann tonometer. Limits of agreements were assessed using Bland–Altman plots. Intraclass correlation coefficient was calculated to estimate the absolute agreement between single and average measurements of IOP and CCT of tonopachy with that of Goldmann tonometer and ultrasound pachymetry respectively. Results: Mean corrected IOP measured with tonopachy and GAT in glaucomatous eyes was 17.63 ± 5.04 mmHg and 19.42 ± 5.83 mmHg, and in controls it was 13.4 ± 2.5 mmHg and 16.2 ± 3.1 mmHg, respectively. Limits of agreement ranged from –4.63 to +9.25 mmHg for total population (mean = 2.31), —6.01 to +9.59 mmHg (mean = 1.79) for glaucoma group and —2.99 to +8.65 mmHg (mean = 2.83) for controls. Intraclass correlation coefficient for IOP measurement between tonopachy and Goldmann tonometer was 0.84 for total population, 0.85 for glaucoma group, and 0.63 for controls, respectively. Conclusion: Corrected IOP obtained by tonopachy showed moderate agreement with GAT and it is more in glaucoma patients than controls. Thus, tonopachy can be used as a screening tool, but cannot replace GAT.
  2,474 256 2
ONE MINUTE OPHTHALMOLOGY
Bilateral lacrimal sac swellings in the elderly: Not always a mucocele
Manpreet Singh, Manpreet Kaur, Shakeen Singh
April 2020, 68(4):554-554
DOI:10.4103/ijo.IJO_1490_19  PMID:32174566
  2,241 444 -
ORIGINAL ARTICLES
Comparative clinical trial of intracameral ropivacaine vs. lignocaine in subjects undergoing phacoemulsification under augmented topical anesthesia
Arun K Sharma, Shalini Singh, Sanjeev Hansraj, Ajai K Gupta, Siddharth Agrawal, Vishal Katiyar, Sanjiv K Gupta
April 2020, 68(4):577-582
DOI:10.4103/ijo.IJO_1388_19  PMID:32174572
Purpose: To compare intracameral Ropivacaine to Lignocaine during phacoemulsification under augmented topical anesthesia, in terms of efficacy and safety. Methods: This prospective, randomized, double-masked clinical trial included subjects planned for phacoemulsification with posterior chamber intraocular lens implantation for visually significant uncomplicated senile cataract, under augmented topical anesthesia. Cases were randomized into two groups, Group A (Ropivacaine 0.1%) or Group B (Lignocaine 1.0%). The pain experienced by the patients during the surgery, mydriasis, post-op inflammation and endothelial cell change at six weeks after the procedure was evaluated. Surgeon's feedback was recorded to evaluate the cooperation of the patient during surgery. Results: A total of 210 subjects were screened and 184 were randomized to have 92 subjects in each group. There was no statistically significant difference seen on comparing Group A and B with respect to Age (P = 0.05), painful surgical steps (P = 0.85), visual analog scale scores (P = 0.65), surgeon's score (P = 0.11), postoperative inflammation (P = 0.90) and average ultrasound time during phacoemulsification (P = 0.10). Subjects in Group A fared better when compared to Group B with respect to endothelial cell loss (P = 0.0008), and augmentation in mydriasis (P < 0.001). Conclusion: Intracameral Ropivacaine and Lignocaine, both are equally effective in providing analgesia during phacoemulsification. However, intracameral Ropivacaine is superior to Lignocaine with regards to corneal endothelial cell safety, and augmenting mydriasis.
  2,107 294 4
Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy
Sirisha Senthil, Sanket Deshmukh, Kiranmaye Turaga, Veerendranath Pesala, Praveen K Bandela, Jonnadula Ganesh, Chandrasekhar Garudadri, Shrikant Bharadwaj
April 2020, 68(4):609-614
DOI:10.4103/ijo.IJO_588_19  PMID:32174580
Purpose: To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies. Methods: Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery. Results: Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months. Conclusion: The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups.
  2,059 281 2
COMMENTARIES
Commentary: Viewing Alzheimer's disease from an ophthalmologist's eyes
Shikha T Bassi
April 2020, 68(4):562-563
DOI:10.4103/ijo.IJO_2132_19  PMID:32174568
  1,909 339 -
ORIGINAL ARTICLES
Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study
Utsab Pan, Aarti Jain, Joseph Gubert, Bibha Kumari, Manavi D Sindal
April 2020, 68(4):627-631
DOI:10.4103/ijo.IJO_1145_19  PMID:32174583
Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.
  1,989 239 7
Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India
Pradhnya Sen, Namrata Gupta, Amit Mohan, Chintan Shah, Alok Sen, Elesh Jain
April 2020, 68(4):603-607
DOI:10.4103/ijo.IJO_872_19  PMID:32174578
Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0–16 years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 ± 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1–6 months, 11 (7%) had delay of 6–12 months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.
  1,848 233 9
PHOTO ESSAY
A cute bilateral conjunctivitis with nasooral involvement: A rare manifestation of tuberculosis
Suresh Palanisamy, Anita D Mathews, Somasheila I Murthy
April 2020, 68(4):639-640
DOI:10.4103/ijo.IJO_566_19  PMID:32174588
  1,858 200 -
ORIGINAL ARTICLES
Comparison of vertical split conjunctival autograft with and without limbus to limbus orientation in cases of double-head pterygium—A retrospective analysis
Shreesha K Kodavoor, B Soundarya, Ramamurthy Dandapani
April 2020, 68(4):573-576
DOI:10.4103/ijo.IJO_1079_19  PMID:32174571
Purpose: The aim of this study is to compare the outcome and complications in patients who underwent double-head pterygium excision with split conjunctival autograft with and without limbus to limbus orientation. Methods: In this retrospective, comparative study, 99 eyes with double-head pterygium which underwent split conjunctival autograft with limbus to limbus orientation (Group 1) and 93 eyes which underwent without limbus to limbus orientation (Group 2) during the period of 2011–2016 were included in this study. The primary outcome compared was the recurrence rate. Other complications were included as secondary outcomes. Results: Mean age in group 1 and group 2 were 46.84 +/- 10.78 years and 54.38 +/- 11.44 years respectively. M:F was 36:63 in group 1 and 45:48 in group 2 with a mean follow up of 18.30 +/- 7.48 months in group 1 and 17.04 +/- 9.98 months in group 2. Recurrence was seen in 4 cases in each of the 2 groups with the mean time of recurrence being 7 +/- 2.34 months in group 1 and 6 +/- 2.01 months in group 2. Other complications included graft edema, SCH, graft retraction, granuloma, dellen and graft loss with only graft loss being statistically significant between 2 groups. Conclusion: This study provides data that recurrence rates are not different among patients who undergo split conjunctival graft with and without limbal orientation. The strict adherence to maintaining limbus to limbus orientation while managing double-headed pterygia may not be necessary in all cases, especially in those with large defects following excision.
  1,636 306 2
PHOTO ESSAY
Retinochoroidal fold with severe discedema in a case of posterior scleritis
Devesh Kumawat, Rohan Chawla, Nasiq Hasan
April 2020, 68(4):647-649
DOI:10.4103/ijo.IJO_1013_19  PMID:32174593
  1,680 202 1
COMMENTARY
Commentary: Pearls in posterior polar cataract
Manas Nath, Annamalai Odayappan
April 2020, 68(4):595-596
DOI:10.4103/ijo.IJO_2049_19  PMID:32174576
  1,507 356 1
CASE REPORTS
Advanced keratoconus in a child with juvenile scleroderma
Abhinav Biala, Mohd Kazi, Sunita Chaurasia
April 2020, 68(4):658-660
DOI:10.4103/ijo.IJO_1227_19  PMID:32174598
An 18-year-old male presented with complaints of gradually decreasing vision in both eyes for 6 years. He was a diagnosed with juvenile scleroderma at the age of 11 years by a pediatric rheumatologist. Clinical slit lamp examination showed features of ectasia, thinning, Vogt's striae, and apical scarring in both eyes. Bulbar and tarsal conjunctiva was quiet and normal. Corneal tomography revealed mean keratometry 65.8 and 65.4 diopters, thinnest pachymetry of 351 and 224 microns in the right and left eye, respectively. There was no history of itching and eye rubbing in the past. Patients of juvenile scleroderma may have associated keratoconus. The management of advanced keratoconus presents challenges related to handling and insertion of contact lenses in this condition. Keratoplasty is an option in those patients when contact lenses are not acceptable.
  1,656 192 1
Management of double optic disc pit complicated by maculopathy
Naresh Babu, Girish Baliga, Piyush Kohli, Kim Ramasamy
April 2020, 68(4):663-665
DOI:10.4103/ijo.IJO_1114_19  PMID:32174600
Optic disc pit (ODP) is a rare, congenital, cavitary anomaly of the optic disc. Usually, single ODP occurs in an eye and only eleven cases of double ODP have been reported so far in the literature. In the present study, we report a case of unilateral double ODP, with both the pits present in opposite disc segments. They were associated with serous retinal detachment at the macula and retinal pigment epithelium degeneration nasal to disc. The case was managed successfully with vitrectomy, internal limiting membrane peeling, plugging the pits with homologous partial-thickness scleral flaps, and gas tamponade.
  1,632 139 1
Recurrent unintentional filtering blebs after vitrectomy: A case report
P Mahesh Shanmugam, Pradeep Sagar, Vinaya K Konana, Sriram Simakurthy, Rajesh Ramanjulu, Abhishek Sheemar, KC Divyansh Mishra
April 2020, 68(4):660-662
DOI:10.4103/ijo.IJO_1249_19  PMID:32174599
A lady who underwent lensectomy for microspherophakia and pars plana vitrectomy for retinal detachment in her left eye developed recurrent filtering blebs at the site of sclerotomies. Filtering blebs were managed by suturing the sclerotomies. Targeted gene sequencing identified a variant of ASPH gene (p.Arg688Gln) which is not known to be associated with Traboulsi syndrome. But considering the paucity of cases with genetic analysis, it would be possible that p.Arg688Gln is a pathogenic variant. This is the first case report of Traboulsi syndrome due to an ASPH variant not reported earlier that can lead to recurrent filtering blebs.
  1,563 193 6
PHOTO ESSAY
Variable clinical profile of foveal hypoplasia in albinism
Kshitiz Kumar, Subhendu K Boral, Deepak Agarwal, Angshuman Goswami, Tushar K Sinha, Debashish Bhattacharya
April 2020, 68(4):649-651
DOI:10.4103/ijo.IJO_905_19  PMID:32174594
  1,549 202 -
COMMENTARY
Commentary: Toric intraocular lens alignment: Going markerless
Mahipal S Sachdev
April 2020, 68(4):587-588
DOI:10.4103/ijo.IJO_1877_19  PMID:32174574
  1,502 215 -
PHOTO ESSAY
Severe acute onset dry eye following presumed Epstein.Barr viral infection
Sumana Chatterjee, Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal, Jayanta Kuila
April 2020, 68(4):642-644
DOI:10.4103/ijo.IJO_1212_19  PMID:32174590
  1,545 165 2
ORIGINAL ARTICLES
Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation
Ajay Sharma, Akanksha Batra
April 2020, 68(4):583-587
DOI:10.4103/ijo.IJO_1253_19  PMID:32174573
Purpose: To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation. Methods: In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement. Results: We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique). Conclusion: Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.
  1,520 187 1
COMMENTARY
Commentary: A drop a day, keeps myopia away?
Nripen Gaur, Pradeep Sharma
April 2020, 68(4):656-657
DOI:10.4103/ijo.IJO_1940_19  PMID:32174597
  1,466 219 -
ORIGINAL ARTICLES
Evaluation of thrombospondin–1 gene polymorphisms in corneal allograft rejection in Asian Indian patients
Murugesan Vanathi, Rashmi Shukla, Prahlad Balakrishnan, Roopa Dwivedi, Noopur Gupta, Radhika Tandon
April 2020, 68(4):565-572
DOI:10.4103/ijo.IJO_552_19  PMID:32174570
Purpose: To evaluate the frequency and the association of Thrombospondin 1 (THBS1) gene single nucleotide polymorphisms (SNPs) in Asian Indian patients with optical full thickness corneal grafting surgery. Methods: Prospective case–control analysis of optical penetrating keratoplasty patients with and without immune rejection and controls for genotyping of 3 THBS1 gene SNPs (rs1478604 A>G; rs2228261 C>T; rs2228262 A>G) by Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS PCR). Results: Among 58 patients [45 with immune allograft rejection (DNA isolation was possible in 38 samples) and 13 without immune corneal allograft rejection] and 65 controls, allele frequencies observed for rs1478604 (A>G) are A: 69.7% and 72.6%, G: 30.2% and 27.3%; for rs2228261 (C>T) are T: 70.2% and 62.3%, C: 29.7% and 37.6%; and for rs2228262 (A>G) A: 97.4% and 98.4%; G 2.5% and 1.5% respectively. Genotype frequencies were rs1478604 (A>G) AA: 57.8% and 59.3%, AG 23.6% and 26.5%; GG 18.4% and 14%; for rs2228261 (C>T) TT: 40.5% and 33.8%, TC: 59% and 56.9%, CC: 0% and 9.2%; for rs2228262 (A>G) AA: 94.8% and 96.8%, AG: 5.1% and 3.1% in rejection and controls respectively. The allele and genotype frequency for the 3 described THSB1 SNPs did not show any difference between the corneal graft immune rejection patients and controls. Conclusion: Asian Indian population evaluated for THBS1 gene SNPs by ARMS PCR genotyping in Asian Indian population did not show any genetic association to immune rejection occurrence in our study.
  1,483 194 -
PHOTO ESSAY
Uncontrolled systemic hypertension and haemolacria
G Seethapathy, Jitendra Jethani
April 2020, 68(4):638-639
DOI:10.4103/ijo.IJO_1619_19  PMID:32174587
  1,458 211 3
A case of cutaneous candidiasis of upper eyelid in association with facial paralysis
Hasan Aytogan
April 2020, 68(4):637-638
DOI:10.4103/ijo.IJO_1381_19  PMID:32174586
  1,442 207 -
LETTERS TO THE EDITOR
Comment on: Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed.onset endophthalmitis
Naresh B Kannan, Sagnik Sen, Chitaranjan Mishra, Obuli Ramachandran, Renu P Rajan, Karthik Kumar
April 2020, 68(4):669-670
DOI:10.4103/ijo.IJO_1994_19  PMID:32174604
  1,340 141 -
Extraocular use of sodium hyaluronate 1% for preventing air/gas escape during descemetopexy
Rajesh Sinha, Rinky Agarwal, Jeewan S Titiyal
April 2020, 68(4):667-668
DOI:10.4103/ijo.IJO_1481_19  PMID:32174602
  1,326 153 -
COMMENTARIES
Commentary: Eye as a window to the brain
Satya Karna
April 2020, 68(4):563-564
DOI:10.4103/ijo.IJO_2069_19  PMID:32174569
  1,248 205 1
COMMENTARY
Commentary: Approachand alternatives to position the intraocular lens in deficient support
Bhavana Sharma, Samendra Karkhur, Deepak Soni
April 2020, 68(4):635-636
DOI:10.4103/ijo.IJO_2014_19  PMID:32174585
  1,298 153 1
PHOTO ESSAY
Early anterior capsular fibrosis and formation of secondary cataract with in.the.bag intraocular lens decentration in a patient with retinitis pigmentosa
Madhu Bhoot, Suneeta Dubey
April 2020, 68(4):646-647
DOI:10.4103/ijo.IJO_977_19  PMID:32174592
  1,247 176 1
An unusual case of orbital myositis in a patient with HLA B-27-associated uveitis
Parthopratim Dutta Majumder, Kirthi Koka, Veena Noronha
April 2020, 68(4):641-642
DOI:10.4103/ijo.IJO_1360_19  PMID:32174589
  1,247 163 -
LETTERS TO THE EDITOR
Comment on: Flat irregular pigment epithelium detachment in central serous chorioretinopathy: Correlation with choroidal neovascular membrane
Preetkanwar Singh Sodhi
April 2020, 68(4):671-671
DOI:10.4103/ijo.IJO_1795_19  PMID:32174606
  1,266 141 1
PHOTO ESSAY
Thermo-cauterization and amniotic membrane grafting for extensive hydrops in a child with vernal keratoconjunctivitis
Rashmi Mittal, Hitendra Ahooja
April 2020, 68(4):644-645
DOI:10.4103/ijo.IJO_1297_19  PMID:32174591
  1,227 161 1
OPHTHALMIC IMAGE
Bilateral macular hole in gyrate atrophy: A rare association
Deepika C Parameswarappa, Komal Agarwal
April 2020, 68(4):652-652
DOI:10.4103/ijo.IJO_984_19  PMID:32174595
  1,151 205 2
COMMENTARY
Commentary: Causes of delayed presentation of pediatric cataract: A questionnaire.based prospective study at a tertiary eye care center in central rural India
Lav Kochgaway, Sneha Jain, Merina Mandal, Rupak Roy, Sagar Bhargava, Maneesh Singh
April 2020, 68(4):607-610
DOI:10.4103/ijo.IJO_2156_19  PMID:32174579
  1,207 146 1
LETTERS TO THE EDITOR
Comment: Doctor heal thyself- Addressing the shorter life expectancy of doctors in India
Mahesh Agrawal, Teena Agrawal
April 2020, 68(4):668-669
DOI:10.4103/ijo.IJO_1793_19  PMID:32174603
  1,133 121 -
Response to comment on: Flat irregular pigment epithelium detachment in central serous chorioretinopathy: A correlation with choroidal neovascular membrane
Rajan Gupta, Jay Chhablani
April 2020, 68(4):672-672
DOI:10.4103/ijo.IJO_2044_19  PMID:32174607
  1,041 163 -
Response to comment on: Comment on: Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed.onset endophthalmitis
Vivek Pravin Dave
April 2020, 68(4):670-671
DOI:10.4103/ijo.IJO_2202_19  PMID:32174605
  961 140 1
COMMENTARY
Commentary: Current trends in the management of optic disc pit maculopathy
Alok C Sen, Gaurav M Kohli, Shubhi Tripathi
April 2020, 68(4):665-666
DOI:10.4103/ijo.IJO_1911_19  PMID:32174601
  857 0 1