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   Table of Contents - Current issue
Coverpage
October 2020
Volume 68 | Issue 10
Page Nos. 2059-2331

Online since Wednesday, September 23, 2020

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EDITORIAL  

Nosocomial COVID-19 transmission in routine ophthalmic practice—Is there new evidence? Highly accessed article p. 2059
Santosh G Honavar
DOI:10.4103/ijo.IJO_3046_20  PMID:32971606
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GUEST EDITORIALS Top

Innate human resilience and COVID-19: Help from an old friend to beat the new enemy Highly accessed article p. 2061
Mohammad Javed Ali
DOI:10.4103/ijo.IJO_2372_20  PMID:32971607
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COVID-19 prophylaxis in ophthalmology Highly accessed article p. 2062
Paul T Finger, Anthony Fam, Ankit S Tomar, Gaurav Garg, Kimberly J Chin
DOI:10.4103/ijo.IJO_2459_20  PMID:32971608
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TALES OF YORE Top

Dr Raynold Berke of Old Lids and New Laws Highly accessed article p. 2064
Mrittika Sen
DOI:10.4103/ijo.IJO_2804_20  PMID:32971609
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ONE MINUTE OPHTHALMOLOGY Top

Lava cake sans ice-cream p. 2066
Janani Sreenivasan, Pukhraj Rishi
DOI:10.4103/ijo.IJO_722_20  PMID:32971610
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REVIEW ARTICLES Top

Relevance of IgE, allergy and eye rubbing in the pathogenesis and management of Keratoconus Highly accessed article p. 2067
Prerna Ahuja, Zelda Dadachanji, Rohit Shetty, Sowmya Arudi Nagarajan, Pooja Khamar, Swaminathan Sethu, Sharon D'Souza
DOI:10.4103/ijo.IJO_1191_19  PMID:32971611
Keratoconus (KC) is an ectatic disease of the cornea characterized by localized thinning and protrusion causing irregular astigmatism, which can lead to significant visual impairment. KC has often been associated with allergy and/or atopy, which are immune-mediated inflammatory reactions primarily driven by IgE. A higher proportion of KC patients were reported to have history or suffer from systemic and/or ocular allergy with elevated allergen-specific IgE and/or total serum IgE. Eye rubbing, one of the risk factors for worsening of the disease and developing related complications in KC, is associated with IgE driven conditions. The current review enumerates and contextualizes the evidence related to IgE in mediating KC pathogenesis, including aberrant extra-cellular matrix remodeling. This review also discusses clinical strategies directed at modulating IgE-mediated responses in the management of KC, and the emerging academic and plausible clinical relevance of assessing serum and tear IgE (allergen-specific and total) status in improving the understanding of disease pathobiology, treatment planning, and prognosis.
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Lower eyelid blepharoplasty: An overview p. 2075
Kasturi Bhattacharjee, Sripurna Ghosh, Shoaib Ugradar, Ariel M Azhdam
DOI:10.4103/ijo.IJO_2265_19  PMID:32971612
Of the two common techniques of lower blepharoplasty, the transconjunctival approach is limited to young patients with prominent herniation of lower fat pad without skin excess and the transcutaneous approach to patients requiring skin excision. However, the current trends not only highlight the traditional sculpting of the three orbital fat pads in lower lid blepharoplasty but also additional relocation of the intraorbital fats for correcting the inferior orbital hollowing. The purpose of this review is to analyze the published literature on common types, techniques, indications, and outcomes of the multiple surgical variants of lower lid blepharoplasty often aimed at treating the redundant skin, steatoblepharon, tear trough deformity, lid laxity, and dermatochalasis, thereby to correct the negative vector and inferior orbital hollowing along with effacement of the lid cheek junction. An extensive survey of peer-reviewed literature published in English in electronic databases, as well as bibliographies from cited articles, was conducted. Databases such as MEDLINE PubMed, the Cochrane Library, and Embase were scanned using relevant medical subject heading (MeSH) terms. Clinical studies with a minimum of five study cases were included. Level III evidence, case reports, letters, editorials, and case series with fewer than five eyes were excluded. This article provides a concise overview of available literature and as such no meta-analysis was done due to the narrowed scope of the involved studies and the variety in surgical approaches and techniques of lower lid blepharoplasty.
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ORIGINAL ARTICLES Top

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis p. 2084
Shreesha Kumar Kodavoor, B Soundarya, Ramamurthy Dandapani
DOI:10.4103/ijo.IJO_2164_19  PMID:32971613
Purpose: This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects. Methods: One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months. Results: Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant. Conclusion: In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.
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Clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis p. 2088
Ashi Khurana, Sanjay Chanda, Preeti Bhagat, Swati Aggarwal, Mohit Sharma, Lokesh Chauhan
DOI:10.4103/ijo.IJO_90_20  PMID:32971614
Purpose: To report clinical characteristics, predisposing factors, and treatment outcome of Curvularia keratitis. Methods: Retrospective chart review of consecutive culture-proven Curvularia keratitis patients who presented to a tertiary eye care center in north India. Patients with mixed infections with Curvularia as one of the pathogens were also included. Standard case report form was developed to capture demographic information, clinical features, etiology, treatment, and outcome. Binary logistic regression was done to ascertain the effect of identified variables on final visual acuity. Results: Medical records of 97 patients of Curvularia keratitis were reviewed. Median age of patients was 45.3 years. Seventy-nine (79.4%) patients presented during the months of September to November. History of corneal trauma was present in 69.1%. Trauma from sugarcane leaf was identified in 66.1% of cases with corneal trauma with vegetative matter. Presenting visual acuity was worse than 20/60 in 57.8% of patients. Hypopyon and pigmented plaque-like infiltrate was present in 16.5% and 28.8% of patients, respectively. Mixed infection was reported in 14.4% of cases. Median time of antifungal therapy was 24.5 days. Surgical intervention was required in 18.5% cases. Of all, 11.1% patients achieved final VA of more than 20/200 who were managed surgically as compared to 68 (86%) patients who were managed medically. Younger age, absence of comorbidities, and lesser infiltrate size were found associated with good final visual acuity. Conclusion: Working males were most affected by Curvularia keratitis. Corneal trauma with sugarcane leave was the most common predisposing factor in the study area. Most of the cases presented with worse visual acuity but could be managed medically.
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Making the decision to donate eyes: Perspectives from the families of the deceased in Madurai, India p. 2094
Ganesh-Babu B Subburaman, John H Kempen, Saravanan Durairaj, Vijayakumar Balakrishnan, Vijayakumar Valaguru, Venkatesh Prajna Namperumalsamy, Ravilla Duraisamy Thulasiraj, Sachin Gupta
DOI:10.4103/ijo.IJO_2324_19  PMID:32971615
Purpose: To identify factors affecting family members' decision whether to donate eye organs. Methods: A community-based case-control study based on in-home interviews with families of deceased individuals who had or had not donated eye organs, in Madurai district, Tamil Nadu, India. Data collected were knowledge and awareness of eye donations, whether the deceased individual had expressed or pledged willingness to donate, and family members' attitudes and willingness to donate their own eye organs. Results: Seventy-six families of donors and 256 families of non-donors completed the survey. Multivariable analysis showed that the following variables were significantly associated with a donation: age, whether the deceased had registered for eye donation, pre-expressed willingness of deceased to donate, whether family members personally know beneficiaries of eye donations, and higher score on a scale evaluating knowledge and awareness about eye donation. The majority of donors' families (71%) had been encouraged by someone to donate. Among non-donor families, a substantially larger fraction (52.8%) indicated they would have donated had someone reminded or encouraged them to do so, in comparison with those who indicated lack of awareness or knowledge (14.5%). Conclusion: Community programs are likely to be effective if they encourage individuals to pledge their eyes or express their willingness to donate their eyes to family members in advance of death; they increase public awareness of the value of eye donation. A friend, family member, neighbor or counselor approaching bereaved families and having a dialogue about eye donation would substantially increase the probability of a decision to donate.
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Intralenticular changes in eyes with mature senile cataract on modified posterior segment optical coherence tomography p. 2099
Amar Pujari, Harathy Selvan, Jayanand Urkude, Rashmi Singh, Ritika Mukhija, Saumya Yadav, Tarjani Makwana, Namrata Sharma
DOI:10.4103/ijo.IJO_1650_19  PMID:32971616
Purpose: To study the morphological changes within mature senile cataracts on modified posterior segment optical coherence tomography (OCT). Methods: A cross-sectional observational study recruiting patients of mature cataracts admitted for elective cataract surgery in tertiary eye care. A modified OCT imaging of the lens was done and lenticular findings were noted by a single observer. Corresponding slit-lamp biomicroscopic findings and intraoperative experiences were also noted by a second observer and respective surgeons. Results: Forty-four eyes of 44 patients were included. The mean age of patients was 65 ± 5.7 years. The intralenticular findings were uniform in groups of eyes, and they were characterized into three stages. First was a stage of early lamellar separation where small intralenticular clefts were noted superficially. Second was the stage of established lamellar separation where crescentic fluid clefts appeared interspersed between the lens fibers, and the depth increased as a function of severity. Both these stages did not show any distinct slit-lamp or intraoperative findings. A third stage of liquefaction identified as extensive lamellar separation with subcapsular fluid pockets. This was also reflected in slit-lamp biomicroscopy, showing the hydrated cortex with intraoperative challenges. Two cases showed peculiar changes, one of a hyperreflective subcapsular sheath and another of superficial nuclear lamellar separation. Conclusion: Mature cataracts may also show graded progression, which could be delineated on lenticular OCT. This could be of immense help in pre-operative planning and optimal management of these high-risk cases.
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Decoding fluid droplet generation during phacoemulsification and pars plana procedures in the COVID-19 era—An experimental study p. 2103
Samaresh Srivastava, Abhishek Kothari, Vaishali Vasavada, Abhay R Vasavada, Shail Vasavada, Viraj Vasavada, Aditya Sudhalkar
DOI:10.4103/ijo.IJO_1883_20  PMID:32971617
Purpose: The purpose of this study is to evaluate fluid droplet spray generation during phacoemulsification (PE), pars plana vitrectomy (PPV), and fragmatome lensectomy (FL) and assess factors affecting these. Methods: This is an experimental study. PE through 2.2 and 2.8 mm incisions was performed in six goat eyes and four simulator eyes using both continuous and interrupted ultrasound (U/S). PPV and FL were performed in three goat eyes. Generation of visible fluid droplet spray was analyzed from video recordings through the microscope camera and an external digital camera. Hydroxypropylmethylcellulose (HPMC) was applied over the incision site during PE and FL. Results: When PE was performed through both incision sizes, there was no visible fluid droplet spray if the phaco tip was centered in the incision, without sleeve compression. When there was phaco tip movement with the phaco sleeve sandwiched between the tip and the incision wall, there was visible fluid droplet spray generation. It was more difficult to induce fluid droplet spray with 2.8 mm incision, and spray was lesser with interrupted U/S. During PPV, there was no droplet spray. During FL, fluid droplet spray was only seen when U/S was delivered with the fragmatome tip close to the sclerotomy. HPMC impeded droplet spray. Conclusion: Fluid droplet generation during PE can be minimized to a large extent by keeping the phaco tip centered within the incision, avoiding sleeve compression. Smaller incision and continuous U/S were more prone to droplet generation. FL should be performed away from sclerotomy. HPMC over incision is recommended.
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Minimizing surgically induced astigmatism in non-phaco manual small incision cataract surgery by U-shaped modification of scleral incision p. 2107
Suresha Anepla Rajappa, Hima Bhatt
DOI:10.4103/ijo.IJO_1696_19  PMID:32971618
Purpose: To evaluate the amount and type of surgically induced astigmatism (SIA) in manual small incision cataract surgery (SICS) with a 4.5 mm U-shaped scleral incision. Methods: A prospective cross-sectional study was done on a total of 61 patients above 40 years of age with senile cataract. All patients underwent complete examination including preoperative uncorrected visual acuity (UCVA), refraction, best-corrected visual acuity (BCVA), and keratometry using a manual keratometer (Bausch and Lomb). All 61 patients underwent manual SICS with a 4.5 mm U-shaped scleral incision within the astigmatic neutral incisional funnel. Patients were thoroughly examined on immediate postoperative day 1 and findings of UCVA, BCVA, refraction, and keratometry were noted at the end of the 1st week, 4th week, and 6th week follow-up visits. SIA was calculated for all the follow-ups using the SIA calculator version 2.1, a free software program. The changes in the amount and type of postoperative SIA were tested for statistical significance using Fischer's exact test. Variance was tested using intraclass score effect. The threshold for statistical significance was set to P < 0.001. Results: Postoperatively, the average SIA was 0.43 ± 0.13 D at the end of 1st week, 0.29 ± 0.20 D at the end of the 4th week, and remained the same 0.29 ± 0.21 D at the end of 6th week. The type of astigmatism shifted more towards against-the-rule (ATR) type in 45.9% of cases during the final postoperative follow-up. Conclusion: In our study, we conclude that the incision within the funnel of astigmatic neutralization is one of the major determinants of SIA in manual SICS. We were able to achieve phacocomparable SIA in our study mainly because of our type of incision.
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Visual outcomes of binocular implantation of a new extended depth of focus intraocular lens p. 2111
Rajesh Sinha, Pranita Sahay, Rohit Saxena, Nidhi Kalra, Vinay Gupta, Jeewan S Titiyal
DOI:10.4103/ijo.IJO_2139_19  PMID:32971619
Purpose: To evaluate the visual outcomes of bilateral implantation of a new hydrophobic foldable extended depth of focus (EDOF) IOL. Methods: All cases undergoing phacoemulsification with bilateral implantation of Supraphob Infocus IOL between December 2017 and July 2018 at a tertiary eye care center were recruited in this prospective interventional study. The primary outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Postoperative follow-up was done on day 1, 1 week, 1 month, and 3 months. Results: One hundred and four eyes of 52 patients with a mean age of 58.4 ± 9.3 years were included. The mean UDVA improved from 0.84 ± 0.32 logMAR preoperatively to 0.11 ± 0.08 logMAR at 3 months following surgery. At the final follow-up, the binocular UDVA, UIVA, and UNVA was 0.03 ± 0.07, 0.14 ± 0.06, and 0.36 ± 0.05 logMAR, respectively. The mean CS was 1.47 ± 0.06 logCS. The distance and near stereopsis was 90.2 ± 24.8 s of arc (arcsec) and 62.5 ± 19.4 arcsec, respectively. The mean total higher-order aberration (HOA), point spread function, and modulation transfer function were 0.30 ± 0.13, 0.07 ± 0.08, and 0.26 ± 0.07, respectively. Conclusion: The Supraphob Infocus EDOF IOL provides good unaided visual acuity for distance, intermediate, and near along with a high quality of vision as assessed by contrast sensitivity, HOAs, and stereoacuity. It may be a potential alternative to the currently available EDOF IOLs in providing good visual acuity at variable distances.
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The distribution of relaxin receptors in the anterior segment of primary open-angle glaucoma patients p. 2117
Ofira Zloto, Alon Skaat, Ido Didi Fabian, Mordechai Rosner, Hana Ziv, Ari Leshno, Shlomo Melamed
DOI:10.4103/ijo.IJO_2008_19  PMID:32971620
Purpose: Relaxin is a polypeptide hormone produced by the corpus luteum and the decidua in females and by the prostate in males. It has vasodilatory and antifibrotic effects. In the past, it has been reported that injection of relaxin hormone has caused a reduction in the intraocular pressure although its mechanism has not yet been fully understood and the expression of relaxin receptors has not yet been evident in the human eye. Therefore, the purpose of this current study was to examine the presence of relaxin receptors in the human eye anterior segment. Methods: This is an interventional non-randomized study. Patients with primary open-angle glaucoma who underwent trabeculectomy were recruited. During the surgery, a punch biopsy (including the cornea, sclera, trabecular meshwork, and Schlemm's canal) was taken and stained with hematoxylin-eosin, and immunohistochemistry staining for relaxin/insulin-like family peptide receptor 1 (RXFP1). Results: A positive staining was noted for RXFP1 in the inner uveal, corneoscleral, and cribriform meshwork and Schlemm's canal's endothelium. Negative staining for RXFP1 was noted in the cornea and sclera. Conclusion: RXFP1 is present in the anterior segment drainage system of the human eye. Therefore, this receptor may have an active role in regulating the outflow facility and in the reduction of intraocular pressure.
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COMMENTARY Top

Commentary: Pregnancy hormone to control intraocular pressure? p. 2121
John D Akkara, Anju Kuriakose
DOI:10.4103/ijo.IJO_709_20  PMID:32971621
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ORIGINAL ARTICLES Top

Agreement and repeatability of Icare ic100 tonometer p. 2122
Judy Jose, Ramesh S Ve, H Vijaya Pai, Sayantan Biswas, Vamsi Parimi, Paresh Poojary, T Nagarajan
DOI:10.4103/ijo.IJO_546_19  PMID:32971622
Purpose: To find the agreement and repeatability of Icare ic100 tonometer. Methods: We included 150 subjects above the age of 18 years for this cross-sectional, multicenter study with intraocular pressure (IOP) ≥7 mmHg. After the initial ophthalmic examination, two masked examiners took five IOP measurements using three different instruments; Icare ic100, Icare TA01i, and Goldmann applanation tonometer (GAT) in only one eye of the participants. Comparison of agreement of IOP using different instruments was quantified with intraclass correlation coefficient (ICC) using the two-way random effects models of absolute agreement and Cronbach's alpha. The test-retest variability of the instruments was assessed by deriving repeatability coefficient (RC) and coefficient of variation (CV). Results: Agreement between the tonometers across the different IOP groups had no statistically significant difference in their mean IOP. Icare ic100 was found to have good reliability across all IOP groups (ICC value >0.78) when compared with Icare TA01i. In comparison with GAT, Icare ic100 showed good reliability across all IOP groups (ICC >0.87) except >16 to <23 mmHg group where it showed moderate reliability (ICC = 0.52). Icare ic100 showed good repeatability with RC and CV of 2.67 and 4.89, respectively. Conclusion: Icare ic100 rebound tonometer can measure IOP with relatively small measurement error and can provide a reliable and repeatable reading in comparison with GAT across a wide pressure range without hampering corneal health.
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Managing vitreoretinal surgeries during COVID-19 lockdown in India: Experiences and future implications Highly accessed article p. 2126
Divya Agarwal, Rohan Chawla, Toshit Varshney, Nawazish Shaikh, Parijat Chandra, Atul Kumar
DOI:10.4103/ijo.IJO_2140_20  PMID:32971623
Purpose: The study aims to describe the clinical and demographic profile of patients who required vitreoretinal surgeries during the novel coronavirus disease-2019 (COVID-19) lockdown in India. It also reports our operating protocols and initial experience while performing vitreoretinal surgeries during COVID-19 times at a government tertiary eye care hospital. Methods: This is a retrospective cross-sectional observational study of patients requiring emergent/urgent vitreoretinal surgeries between March 25, 2020 and May 31, 2020. A modified working protocol focussing on the enforcement of standard COVID-19 precautions, OT sterilization, and formation of dedicated infection control and disease surveillance committee was adopted. Patients underwent standard vitreoretinal procedures under general/local anesthesia. Relevant demographic and clinical data were recorded and analyzed. Surveillance data of healthcare workers (HCW) was also analyzed. Results: Eighty six patients were considered for vitreoretinal surgery in this period. Finally, 83 patients underwent surgery. The mean age of the patients was 38.4 ± 20.1 years (Range, 1 month - 75 years). Majority of them were males (66%) and adults (82.6%). Majority of them came from nearby hotspot areas. Most common indications were acute retinal detachment (38.5%) and diabetic vitrectomies (22.9%). Trauma-related cases (14.4%) were less. Surgery was deferred in 3 patients who turned out to be COVID-19 positive. 4 HCWs were quarantined but none of them developed COVID-19 disease. Conclusion: During COVID-19 lockdown, vitreoretinal surgeries were most commonly performed for retinal detachment and diabetic complications. Proper implementation of infection control protocols helps in delivering adequate patient care while ensuring the safety of caregivers during this pandemic.
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A reappraisal of indirect choroidal rupture using swept-source optical coherence tomography in-vivo pathology images in patients with blunt eye trauma p. 2131
Anupriya Arthur, Nancy Magdalene Rajasekaran, Thomas Kuriakose
DOI:10.4103/ijo.IJO_2192_19  PMID:32971624
Purpose: To describe the in-vivo pathology of indirect choroidal rupture (ICR) in patients with recent ocular trauma using swept-source optical coherence tomography (SSOCT). Methods: Retrospective observational study of the presenting and follow-up OCT images of four consecutive Asian patients with blunt trauma presenting over a period of 6 months and review of OCT descriptions in the literature. Results: The three patients who presented within 2 weeks of injury showed a gap in the Bruch's membrane (BM)/retinal pigment epithelial complex at the site of the ICR. The distance of the gap ranged from 103 to 465 μm. Blood from associated tear in the choriocapillary layer dissected under the photoreceptor layer to lift it off the retinal pigment epithelium (RPE) layer. The Sattler's and Haller's layers of the choroid were not affected. Fibro-vascular proliferation occurring in the reparative phase bridges the gap in the BM, RPE complex. Late fibrous tissue proliferation extends into the Sattler's layer in the choroid and goes up to the outer nuclear layer in the retina disrupting its architecture. Conclusion: SSOCT is a useful tool to study the pathology of recent onset ICR as it is capable of imaging through blood. The primary injury in ICR seems to be a break in the Bruch's membrane. The RPE layer and choriocapillaries get disrupted secondary to the break in the BM as their basement membranes are part of the BM. Scarring during the reparative phase disrupts the adjacent layers of the choroid and retina.
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Combined retinal vascular occlusion: Demography, clinical features, visual outcome, systemic co-morbidities, and literature review p. 2136
Vishal Raval, Sameera Nayak, Merlin Saldanha, Subhadra Jalali, Rajeev Reddy Pappuru, Raja Narayanan, Taraprasad Das
DOI:10.4103/ijo.IJO_2116_19  PMID:32971625
Purpose: To document the clinical features, systemic association, and treatment outcome of patients with a combined retinal vein and artery occlusion (CRVAO) and review of literature. Methods: A retrospective chart review of patients diagnosed with CRVAO at a tertiary eye care center. Patient's demographic details and associated ocular and systemic factors were recorded. Treatment included laser photocoagulation, anti-vascular endothelial growth factor (VEGF) intravitreal injection or transscleral cyclophotocoagulation (TSCPC), alone or in combination. At last, follow- up treatment response was measured in visual acuity status, regression of neovascularization, and control of intraocular pressure (IOP). All cases reported in the current decade were analyzed and compared with this study. Results: Seventeen eyes with CRVAO accounted for 0.3% of total vascular occlusion (total 5151 patients were seen in this period). The mean age was 48.12 ± 17.5 years (range: 12-87 years) and there were 9 females. Nine eyes had CRVO + CRAO; 6 eyes had BRVO + BRAO, and one patient each had CRVO + BRAO and CRAO + BRVO. Fluorescein angiography (FA) showed delayed 'arm to retina' time (>20 seconds) in all 10 eyes and delayed arteriovenous transit time in 9 out of 10 eyes. Optical coherence tomography (OCT) showed hypereflective inner retinal layers (16 eyes) and neurosensory detachment (7 eyes). The most common systemic associations were hypertension and dyslipidemia (n = 7 people; 41.18%) each. Four patients (23.5%) had a plaque in carotid arteries with normal 2D echocardiography. Ten (59%) eyes were treated with intravitreal bevacizumab + laser; four (23.5%) eyes were treated with laser only, and three (17.6%) eyes were treated with laser + anti-VEGF + TSCPC. At last follow up, vision improved in 9 (52.9%) eyes; stable in 3 (17.7%) eyes, and reduced to perception of light in 5 (29.4%) eyes. Conclusion: Combined CRVAO is a rare emergency leading to acute vision loss. Early diagnosis and treatment for ocular complications and systemic evaluation for cardiovascular risk factors are needed.
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Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in Indian patients with retinal vein occlusion, age-related macular degeneration, and diabetic macular edema Highly accessed article p. 2143
Aditya Kelkar, Caroll Webers, Rohit Shetty, Jai Kelkar, Nikhil Labhsetwar, Abhishek Pandit, Madhulika Malode, Sayali Tidke
DOI:10.4103/ijo.IJO_1866_19  PMID:32971626
Purpose: To evaluate the rate of compliance and the reasons for loss to follow-up in Indian patients with diabetic macular edema (DME), age-related macular degeneration (AMD), and retinal vein occlusion (RVO) being treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods: This was a retrospective single-center study. Patients with DME, AMD, or RVO were eligible if they initiated anti-VEGF therapy between January 2013 and December 2017. Patients' data were obtained from hospital electronic records, including the number of injections received, visits, details of follow-up, missed appointments, and reasons for loss to follow-up (>365 days). Results: A total of 648 patients were eligible for the study, of which 334 (51.54%) patients were lost to follow-up. Overall, 343 (64.96%) were males and the overall mean (SD) age was 66.40 (7.44) years. A total of 376 (58.0%) patients had a history of diabetes and 364 (56.2%) patients had a history of hypertension. Further, 127 (38.0), 112 (33.5), and 95 (28.4) had DME, AMD, and RVO, respectively and were lost to follow-up. The most commonly reported reason for loss to follow-up was “non-affordability” (n = 120; 41.1%) followed by “no improvement in vision” (n = 83; 28.4%). “No improvement in vision” (42.2%) and “non-affordability” (37.5%) were higher among patients with DME. No association was found in gender- and treatment-wise distribution of reasons for loss to follow-up. Conclusion: The results showed that around half of the patients with DME, AMD, and RVO were lost to follow-up to intravitreal anti-VEGF therapy, and the most common factors were “non-affordability” and “no improvement in vision.”
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Long-term clinical outcomes of submacular blood removal with isolated autologous retinal pigment epithelium-choroid patch graft transplantation in long-standing large-sized submacular hematomas: An Indian experience p. 2148
Subhendu Kumar Boral, Deepak Agarwal, Arnab Das, Tushar Kanti Sinha
DOI:10.4103/ijo.IJO_1729_19  PMID:32971627
Purpose: To study the outcomes of submacular blood removal with isolated autologous full-thickness retinal pigment epithelial (RPE)-choroid patch graft transplantation in long-standing large-sized submacular hematomas in Indian population. Methods: A retrospective study was done on eight consecutive patients of long-standing large-sized submacular hematoma from east India. In all cases, 23G vitrectomy was performed with the induction of retinal detachment (performed with or without 38G or 41G subretinal cannula) and a temporal 180° retinectomy was done. Submacular blood along with choroidal neovascular tissue was removed. A full-thickness RPE-choroid autologous patch graft was taken from a relatively healthy quadrant at the mid periphery and then the graft transferred under perfluorocarbon liquid (PFCL) to place it in the subfoveal area. Then, retina was re-attached using PFCL and laser completed. Silicone oil (5000 cst) was used as a tamponade. Post-operatively, wide-field fundus photographs (Optos), serial optical coherence tomography (OCT), indocyanine green angiography (ICGA), and multifocal electroretinography (ERG) were done. Results: The mean age of the patients at presentation was 67.88 ± 10.03 years. Mean pre-operative best corrected visual acquity (BCVA) was 2.64 ± 0.3 log MAR and mean postoperative BCVA was 1.095 ± 0.27 log MAR (P < 0.05). The mean follow-up was 20 ± 16.57 months. ICG showed re-vascularization of translocated graft in all at 2 months. Multifocal ERG (after 6 months) showed some waveform in all. None of the cases developed re-bleed. Conclusion: Removal of submacular blood and neovascular membrane with autologous RPE-choroid graft is a viable option in cases with long-standing large submacular hematomas.
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Commentary: Retinal pigment epithelium–choroid patch graft for large submacular hemorrhage p. 2153
Dhanashree Ratra
DOI:10.4103/ijo.IJO_774_20  PMID:32971628
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Tug of war: A bimanual technique for anterior circumferential proliferative vitreoretinopathy in recurrent retinal detachment p. 2155
Daraius Shroff, Indranil Saha, Gagan Bhatia, Ranjan Dutta, Charu Gupta, Cyrus M Shroff
DOI:10.4103/ijo.IJO_2179_19  PMID:32971629
Purpose: To describe a bimanual technique, “tug of war” for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD). Methods: We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped. Results: Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3–8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04). Conclusion: The 'tug of war' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.
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Commentary: Management of proliferative vitreoretinopathy in recurrent retinal detachment p. 2158
Naresh Babu, Piyush Kohli
DOI:10.4103/ijo.IJO_641_20  PMID:32971630
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MYD88 L265P mutation in intraocular lymphoma: A potential diagnostic marker Highly accessed article p. 2160
Sandhya Narasimhan, Mayur Joshi, Sowmya Parameswaran, Pukhraj Rishi, Vikas Khetan, Suganeswari Ganesan, Jyotirmay Biswas, Natarajan Sundaram, Janani Sreenivasan, Sonali Verma, Vanitha Krishnamurthy, Krishnakumar Subramanian
DOI:10.4103/ijo.IJO_1712_19  PMID:32971631
Purpose: Vitreoretinal lymphoma (VRL) is the most common intraocular lymphoma (IOL). This can be either primary or secondary to the central nervous system lymphoma. The diagnosis of primary intraocular lymphoma (PIOL) currently relies on clinical diagnosis and cytological analysis of the vitreous or subretinal biopsy. Although most cases are diagnosed without much issue, the limited amount of vitreous fluid, subjectivity in cytological reporting, and special expertise in ocular pathology make the diagnosis challenging. MYD88 L265P mutation has been implicated to have diagnostic utility in PIOL. In this study, we screened consecutive vitreous biopsies for the presence of MYD88 L265P mutation to understand its diagnostic utility compared to conventional cytological analysis. Methods: Cytological analysis and MYD88 L265P mutation by PCR-based sequencing and restriction fragment length polymorphism (RFLP) were carried out on consecutive vitreous and subretinal biopsies collected from 21 patients. The diagnostic utility of the cytology and MYD88 L265P mutation analysis were compared. Results: Out of the 21 patients, 15 had clinical suspicion of having PIOL. Out of these suspected cases of PIOL, nine were confirmed on follow-up, while six were diagnosed as other intraocular pathologies. Diagnostic utility of MYD88 L265P mutation analysis revealed a sensitivity of 88.9%, specificity of 91.6%, positive and negative predictive value of 88.9% and 91.7%, respectively. Diagnostic accuracy of 90.5% was achieved with the mutation analysis that shows the superiority of MYD88 in both ruling in and ruling out PIOL. The diagnostic utility of MYD88 L265P mutation was superior to conventional cytological analysis. Conclusion: The analysis of MYD88 L265P mutation is reliable and efficient in the diagnosis of PIOL.
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Annular intubation with pigtail probe for canalicular lacerations p. 2166
Rajat D Maheshwari, Maanvi Maheshwari
DOI:10.4103/ijo.IJO_8_20  PMID:32971632
Purpose: Pigtail probe as a procedure of choice for canalicular laceration. Methods: Retrospective, consecutive interventional case series of patients with eyelid laceration involving the canaliculus undergoing repair. All patients were subjected to repair with pigtail probe as first choice and only if this was not possible, they were repaired by other method. Outcome was analyzed in terms of cosmetic, functional, and anatomic success. Results: A total of 35 patients (mean age, 10.88 years) underwent eyelid and canaliculus repair by a single surgeon (RM). In all, 32 (91.42%) canalicular lacerations were repaired by annular intubation using a pigtail probe, while the remaining 3 (8.58%) lacerations in which pigtail probe intubation was not possible, were repaired by an alternative method. Upper canaliculus was involved in 6 (17.14%) and lower canaliculus in 29 (82.86%) eyes. Mean follow-up was 8.2 months (range 3–13 months). Intubation tubes were removed after at least 3 months (range 12–20 weeks). None of the patients had complaints of epiphora. All the patients had good cosmesis, anatomic alignment and functional success as assessed by dye disappearance test in younger children and lacrimal irrigation in older children and adults. Conclusion: Bicanalicular annular repair with pigtail probe achieved excellent functional and cosmetic results. The loop minimizes the chances of extrusion of the tube, maintains natural anatomic alignment of the cut ends of the canaliculus and thus retains the integrity of the delicate canalicular system. Pigtail probe intubation can be considered as the first choice in canalicular lacerations.
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Topical timolol for the treatment of conjunctival pyogenic granulomas: Outcomes and effect on intraocular pressure p. 2170
Akshay Gopinathan Nair, Ronnie Jacob George, Sundaram Natarajan, Vandana Jain
DOI:10.4103/ijo.IJO_183_20  PMID:32971633
Purpose: To report the clinical outcomes of 0.5% timolol maleate eye drops for the treatment of conjunctival pyogenic granuloma (PG) and its effect on intraocular pressure (IOP). Methods: In this retrospective study, consecutive patients with conjunctival pyogenic granuloma between January 2019 and September 2019 were prescribed 0.5% timolol maleate eye drops twice a day and followed up for 8 weeks. IOPs were measured before treatment, while on treatment and 6 weeks after treatment. Results: A total of 12 patients with conjunctival PGs were treated with 0.5% timolol maleate eye drops. Patients ranged from 7 to 72 years with a mean age of 31.1 years. Eleven (11/12; 91.6%) patients had complete resolution of pyogenic granulomas after a mean duration of treatment of 4.4 weeks (range: 3–6 weeks). One patient had a persistent PG, which showed sub-optimal resolution at 6 weeks of treatment and was surgically excised. The mean IOP of the affected eye at presentation was 15.1 mm Hg (range: 10 to 20 mm Hg; SD: ±2.9 mm Hg). One week after initiating therapy, the mean IOP was 12.1 mm Hg (range: 8–16 mm Hg; SD: ±2.4 mm Hg). The mean reduction IOP compared to the baseline IOP was statistically significant (p = 0.02). No adverse events were noted in any of the patients. Conclusion: Topical timolol is effective in the treatment of conjunctival pyogenic granulomas with no major side effects. There is a significant reduction in IOP while on treatment which is reversible and returns to baseline following completion of therapy.
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Fluorescein dye as a novel cost-effective approach for staining raw specimens in ophthalmic pathology p. 2175
Dipankar Das, Panna Deka, Harsha Bhattacharjee, Saurabh Deshmukh, Pooja Gupta, Apurba Deka, Sabrin Sultana
DOI:10.4103/ijo.IJO_2153_19  PMID:32971634
Purpose: To study the usefulness of sodium fluorescein dye for staining raw specimens in ophthalmic pathology. Methods: Laboratory-based observational study. Eye specimens received in the ocular pathology department of a tertiary eye care center in northeast India were included in the study after obtaining the informed consent. The study period was from 2016 to 2019. Specimens received were a corneal button, lid, orbital tissues, enucleated eyeballs, eviscerated eye, explanted intraocular lens (IOLs), optic nerve and ocular parasites. Sections of the gross specimens were stained with sodium fluorescein (C20H12O5NA) dye. The average duration of tissue-stain contact time was 45 s. The sections were analyzed under the compound microscope. The intensity of illumination of the microscope was modulated to obtain high contrast digital photographs. Results: 26 corneal buttons with or without limbal tissue specimens were analyzed with fluorescein staining procedure; limbus with its pigmented cells were seen in the enucleated eyeballs. 33 enucleated eyes (retinoblastoma [RB] (n = 24), phthisical eyes (n = 4), choroidal melanomas (n = 2), and others (n = 3) were included in the study cohort. In these 33 enucleated eyes, vitreous were also examined for the presence of hyalocytes and other pathological cells. Retinal pigment epithelial cells were also seen (n = 11). RB seeds were seen with fluorescein stain and documented in 14 specimens. The RB seeds were mostly in vitreous (n = 9) and subretinal space (n = 5). Fat cells (n = 8) from orbital tissues and sebaceous cells (n = 5) from frozen section specimens were also observed and documented. Conclusion: This study highlights a novel method of rapid staining of gross ophthalmic pathology specimens.
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Identifying barriers to referrals in preschool-age ocular screening in Southern India p. 2179
Meenakshi Ravindran, Neelam Pawar, Ramakrishnan Renagappa, Thulsiraj Ravilla, Ruthika Khadse
DOI:10.4103/ijo.IJO_1603_19  PMID:32971635
Purpose: The aim of this study was to identify barriers to follow-up among children aged 0–5 years who failed ocular screening. Methods: A cross-sectional, descriptive study was conducted for screening children aged 0–5 years, covering three districts of South India from January 2012 to December 2012. Screening was performed under Lavelle Paediatric Eye Care Project, included under Integrated Child Development Services (ICDS) program. A survey was conducted within 60 days of the screening, with the parents of children who failed to follow up at base hospital. Family demographics, parental awareness of childhood eye diseases and eye care for children, and barriers to follow up eye care were assessed. Results: A total of 19,408 children were screened. Among them, 913 (4.7%) failed screening and were referred. 319 (35%) of those referred attended the base hospital, of which 133 (41.6%) had no abnormality on detailed examination. 111 (34.7%) had refractive errors, 10 (3%)) had strabismus, and three (1%) had amblyopia. 62 (19.4%) had other ocular conditions. Parents of 324/594 (65%) children who did not attend the base hospital were traced and completed the questionnaire. Low level of education, low income, types of occupation, and distance factors were the main barriers to follow-up of referral in preschool children. Factors such as cost of time taking off from work and monthly family income were statistically significant (P < 0.001). Conclusion: Education, financial status, and distance factors were the main barriers to follow up of referral in preschool children. Identification of these barriers to follow up and improving the referral services could help in detecting visual problem effectively.
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COMMENTARY Top

Commentary: Identifying barriers to referrals in preschool-age ocular screening in Southern India p. 2185
Arvind K Morya, Sulabh Sahu, Sakshi Shiromani, Nishant Parashar
DOI:10.4103/ijo.IJO_436_20  PMID:32971636
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To assess the accuracy of Plusoptix S12-C photoscreener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India p. 2186
Kirandeep Kaur, Veena Kannusamy, Fredrick Mouttapa, Bharat Gurnani, Rengaraj Venkatesh, Anjali Khadia
DOI:10.4103/ijo.IJO_2046_19  PMID:32971637
Purpose: To assess the screening accuracy of a novel fourth generation, handheld Plusoptix S12 C photo screener in detecting amblyogenic risk factors in children aged 6 months to 6 years in remote areas of South India. Methods: In this cross sectional study, 381 children aged 6 months to 6 years were screened by a trained fieldworker in Anganwadis and schools using the Plusoptix photoscreener. This was followed by complete ophthalmic evaluation including retinoscopy, subjective refraction, and strabismus evaluation by an optometrist and an orthoptist. All children further underwent complete ocular examination by the senior pediatric ophthalmologist for validation of the results. Results: A total of 367 children were included in the study. The sensitivity and specificity of the photo screener were found to be 86.76% and 82.27%, respectively. Positive Predictive Value, Negative Predictive Value, and Receiver Operative Characteristics were 52.67%, 96.47%, and 83.11%, respectively. In subgroup younger than 3 years, sensitivity and specificity was 89.19% and 81.18%, respectively. Myopic astigmatism was the most common amblyogenic risk factor in our study group. Conclusion: In India, with a lack of adequate healthcare professionals and poor health-seeking behavior; photo screeners can play an important role. We recommend the use of photo screeners for screening children as young as 6 months, especially in remote low-resource settings. This will help in expanding reliable eye care services to previously underserved areas.
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Topical lambda-cyhalothrin in reducing eye oscillations in a canine model of infantile nystagmus syndrome p. 2190
Richard W Hertle, Louis F Dell'Osso, Jonathan B Jacobs, Dongsheng Yang, Jeffery Dumire, Michelle Evano-Chapman
DOI:10.4103/ijo.IJO_586_20  PMID:32971638
Purpose: To determine the ocular and systemic safety of using topical Lambda-Cyhalothrin (LCL) in a canine model of infantile nystagmus syndrome (INS). The rationale for this proposal is based on a case study of a patient whose INS improved after inadvertent ocular exposure to a pyrethroid pesticide containing LCL. Methods: After in-vitro safety testing and IUCAC approval, we studied increasing concentrations of topical LCL drops (0.002% to 0.07%) in canines with a purposely bred defect in the RPE65 gene resulting in both retinal degeneration and INS. We collected data on ocular and systemic effects and performed eye-movement recordings (EMR). Results: At the 0.07% concentration dose of LCL, there was minimal, reversible, conjunctival hyperemia. There was no other ocular or systemic toxicity. At the 0.06% dose, there was a visible decrease in the INS and EMR showed a 153%–240% increase in the nystagmus acuity function and a 30%–70% decrease in amplitude across gaze. There was also a 40%–60% decrease in intraocular pressure while on the drop in both eyes. Conclusion: This animal study suggests this new pharmacological agent has potential for topical treatment of both INS and diseases with raised intraocular pressure. Further, this new treatment approach confirms the importance of extraocular muscle proprioception in ocular motor diseases and their treatment.
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Ocular structural changes in patients with Duane retraction syndrome: Does a correlation exist? p. 2196
Ramesh Kekunnaya, Bhagya L Marella, Hari K Peguda, Virender Sachdeva
DOI:10.4103/ijo.IJO_123_20  PMID:32971639
Purpose: The purpose of this study was to investigate the structural changes (axial length, central macular thickness (CMT), subfoveal choroidal thickness, and keratometry) in subjects with unilateral Duane retraction syndrome (DRS) as compared with the normal fellow eye. Methods: In this prospective study, we included 34 subjects with unilateral DRS from January 2016 to December 2016 seen at our institute. Data was collected for axial length, keratometry using partial coherence interferometry, CMT, subfoveal choroidal thickness using the enhanced depth imaging-optical coherence tomography (EDI-OCT). All these measurements were compared between the affected and fellow eye. Results: During this period, we included 34 subjects with unilateral DRS (22 Type I, 1 Type II, and 11 Type III). The mean age (±SD) of subjects was 14 ± 8 years (range: 5–28 years). There were 15 males and 19 females. Eyes with DRS were significantly shorter (median axial length 22.4 mm, interquartile range (IQR): 21.56 - 23.17) as compared to fellow eye (median axial length 22.7 mm, IQR: 22.35-23.55), P = 0.04. Choroidal thickness, CMT, and average keratometry were similar in DRS and fellow eyes (P = 0.39, 0.06, and 0.11, respectively). A significant difference in axial length was found only between Type I and Type III DRS (P = 0.03). Conclusion: This study suggests that in subjects with DRS, the affected eye has shorter median axial length when compared with the fellow eye. Prevalence of refractive error in eye with DRS was higher compared to fellow eye. But, there was no difference in magnitude of refractive error found between eye with DRS and normal fellow eye.
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Use of 'U-shaped tool for follow up of corneal ulcer cases in the COVID-19 pandemic p. 2199
Rahul K Bafna, Abhijeet Beniwal, Nidhi Kalra, Suman Lata, Mohamed Ibrahime Asif, Namrata Sharma
DOI:10.4103/ijo.IJO_1560_20  PMID:32971640
To describe a smartphone-based telemedicine tool for monitoring of corneal ulcer size during the corona pandemic, a simple “U”-shaped tool was constructed using three Schirmer's strips that were provided to the patients with small to medium-sized corneal ulcers. The patient and the attendant were trained to use this simple U-shaped tool at home and send digital images to the treating ophthalmologist, to monitor the course of the ulcer. The tool was used in five eyes of five patients with active microbial keratitis. Patients were followed up regularly with the use of telemedicine facility every 48 h for an average duration of 7.6 days (range 6–9 days). In all the five eyes, assessment of the serial images with U-shaped tool showed decrease in size of corneal ulcer, which corroborated with subjective improvement in symptoms. Hence, the novel “'U'-shaped tool” may provide an effective measure in following-up of corneal ulcer patients in times of the COVID-19 pandemic, obviating frequent hospital visits and risk of contracting COVID.
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Sinskey hook and viscoelastic assisted posterior capsular plaque extraction p. 2202
Rinky Agarwal, Chirakshi Dhull, Navneet Siddhu, Vatika Jain, Namrata Sharma
DOI:10.4103/ijo.IJO_2013_19  PMID:32971641
Posterior capsule plaques (PCPs) are a rare cause of suboptimal vision after eventless cataract surgery. While these can be managed with posterior capsulotomy, violation of the posterior capsular integrity and associated vitreous disturbances may lead to sight-threatening complications. Viscoseparation and peeling of PCPs with the aid of retinal end-grasping forceps and irrigation and aspiration have also been described in adults for getting rid of PCPs with minimal disturbance of PC and vitreous. While Sinskey hook (SH) has been used to peel PCPs in children, the combined use of SH with viscoseparation for removal of PCP, particularly for adults, remains vaguely described in the literature. Presently, we describe a method of SH and viscoelastic assisted PCP extraction (SVAPE) in adult eyes with centrally located PCPs.
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A novel device for safe exteriorization of haptic in scleral fixation intraocular lens surgery p. 2205
Prabu Baskaran, Rengaraj Venkatesh, Seema Ramakrishnan, Ravilla Duraisami Sriram, Gautham Iyer, RK Ramnath
DOI:10.4103/ijo.IJO_2330_19  PMID:32971642
The aim of this study was to describe a novel device that has been designed to facilitate anterior segment and novice surgeons to perform extraocular needle-guided haptic insertion technique (X-NIT) for scleral fixation intraocular lens surgery (SFIOL). We performed SFIOL surgery using X-NIT device in 21 eyes of 21 patients. The mean preoperative best-corrected visual acuity (BCVA) was 0.5 ± 0.2 logarithm of minimum angle of resolution (log MAR), which improved by one or more lines postoperatively in all eyes. There were no intraoperative complications. Postoperatively, we noted minimal corneal edema in one patient and dispersed vitreous hemorrhage in one patient. The sharpness and angulation of the needle and the haptic holding ability of silicone stopper were found to be satisfactory. The X-NIT device may potentially improve the safety of SFIOL procedures by minimizing intraocular maneuvers.
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Commentary: Glued intraocular lens: A technique too many p. 2208
Mahipal S Sachdev
DOI:10.4103/ijo.IJO_1091_20  PMID:32971643
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'Stop-and-Slide' technique for trocar insertion during lens-sparing vitrectomy for retinopathy of prematurity p. 2209
Mangat Ram Dogra, Simar Rajan Singh, Deeksha Katoch, Mohit Dogra, Bruttendu Moharana, Sahil Jain
DOI:10.4103/ijo.IJO_2273_19  PMID:32971644
The modern-day trocar cannula systems meant for adult eyes pose a challenge in infant's eyes with stage 4 retinopathy of prematurity (ROP) undergoing lens-sparing vitrectomy. This is primarily owing to the length of the trocar, globular lens, smaller axial length, and anteriorly displaced retina. We describe an inexpensive modification of the technique of trocar insertion in such cases wherein the trocar is inserted partially till the cannula impinges the sclera and thereon, the cannula slides over the trocar into the vitreous cavity. This obviates the need for complete insertion of the trocar into the vitreous cavity and hence limits the chances of inadvertent injury to the crystalline lens or the anteriorly lifted retina. We have experience in using this technique in 52 eyes of 44 infants over the past 2 years with no episode of iatrogenic lens touch or retinal break during trocar insertion.
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Commentary: Entry sites and access in retinopathy of prematurity surgery: How important are they? p. 2211
Pramod S Bhende
DOI:10.4103/ijo.IJO_766_20  PMID:32971645
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Smartphone-based intraocular lens microscope p. 2213
Prithvi Chandrakanth, KS Chandrakanth
DOI:10.4103/ijo.IJO_2032_19  PMID:32971646
Microscopes play an important role in the diagnosis of microorganisms and pathological lesions in ophthalmology guiding us to the appropriate management. The current trend of collecting samples and examination is mostly laboratory-based which consume time, labor, and are costly. Smartphones are being used in different fields of ophthalmology with great ubiquity. The good quality photographs obtained by smartphones along with the ease of mobility has made it possible to warrant its use in the microscopic world. This article describes a simple novel technique of preparing an intraocular lens system which can be used in conjunction with a smartphone to detect microorganisms and pathological lesions.
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Cytomegalovirus epithelitis in an immunocompromised patient of T-cell acute lymphoblastic leukemia p. 2216
Prachi Agashe, Shraddha Seth, Ashish Doshi
DOI:10.4103/ijo.IJO_1748_19  PMID:32971647
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Natural course of congenital corneoscleral cyst: 10-year follow-up p. 2217
Tanvi Soni, Sujata Das
DOI:10.4103/ijo.IJO_206_20  PMID:32971648
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An unusual case of acute hydrops in a case of regressed retinoblastoma p. 2218
Ritika Mukhija, Neiwete Lomi, Akash D Saha, Radhika Tandon
DOI:10.4103/ijo.IJO_2408_19  PMID:32971649
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Combining keratoplasty with corneal tattooing p. 2220
Prateek Gujar, Monica Budhwani
DOI:10.4103/ijo.IJO_1234_19  PMID:32971650
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What lies beneath: Posterior capsular imaging in posterior polar cataracts p. 2221
Mahipal S Sachdev, Raghav Malik, Hemlata Gupta, Ritesh Narula, Gitansha Shreyas Sachdev
DOI:10.4103/ijo.IJO_283_20  PMID:32971651
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Spontaneous multiple iris sphincter tears during cataract surgery in high myopic children with midfacial hypoplasia p. 2223
Amit Mohan, Pradhnya Sen, Chintan Shah, Elesh Jain, Alok Sen
DOI:10.4103/ijo.IJO_1901_19  PMID:32971652
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A pigmented disc in glaucoma! p. 2225
Tarannum Mansoori, Satish Gooty Agraharam
DOI:10.4103/ijo.IJO_192_20  PMID:32971653
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Kill with cold p. 2227
Maithili Mishra, Rajesh Ramanjulu, Mahesh Shanmugam, Divyansh Mishra
DOI:10.4103/ijo.IJO_79_20  PMID:32971654
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A rare association of optic disc pit maculopathy and ectopia lentis p. 2229
Harpreet Kaur Narde, Divya Agarwal, Deeksha Rani, Ragini Sonkar, Atul Kumar
DOI:10.4103/ijo.IJO_1707_19  PMID:32971655
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Retinitis pigmentosa with bilateral irido-fundal coloboma p. 2230
Devi Bharathi Daggula, Hima Bindu Adusumilli, Krishna Chaitanya Penmetsa, Venkata Bindu Nekkanti, Avinash Mahindrakar
DOI:10.4103/ijo.IJO_204_20  PMID:32971656
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Multimodal imaging in circumpapillary congenital hypertrophy of retinal pigment epithelium p. 2232
Mahesh Shanmugam, Devashish Dubey, Rajesh Ramanjulu, Divyansh Mishra
DOI:10.4103/ijo.IJO_196_20  PMID:32971657
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Atypical traumatic retinal tear p. 2233
Himabindu Adusumilli, Krishna P Chaitanya, D Devi Bharathi, Prameela Kada
DOI:10.4103/ijo.IJO_36_20  PMID:32971658
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Simultaneous multiple pachychoroid spectrum entities coexisting in the same eye p. 2234
George J Manayath, Shishir Verghese, Ratnesh Ranjan, Venkatapathy Narendran
DOI:10.4103/ijo.IJO_931_20  PMID:32971659
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Coexistence of retinal angiomatous proliferation and pachychoroid phenotype p. 2236
Kumar Saurabh, Rupak Roy, Ekta Batavia
DOI:10.4103/ijo.IJO_96_20  PMID:32971660
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Orange ring sign: A novel finding on multicolor imaging in eyes with idiopathic choroidal neovascular membrane p. 2238
Rupak Roy, Kumar Saurabh, Sugandha Goel
DOI:10.4103/ijo.IJO_2108_19  PMID:32971661
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Adaptive optics imaging in a case of welder's maculopathy p. 2240
Shorya Vardhan Azad, Tejaswini Vukkadala, Vinod Kumar, Archana Kumari
DOI:10.4103/ijo.IJO_2289_19  PMID:32971662
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Acquired tractional retinoschisis with giant outer – layer break underneath macula p. 2241
Kshitiz Kumar, Santosh Balasubramaniam, Coimbatore Sekar Geetha, Amar Agarwal
DOI:10.4103/ijo.IJO_461_20  PMID:32971663
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A rare case of bilateral congenital upper eyelid eversion managed conservatively p. 2243
Nilesh Jain, Julie Jain
DOI:10.4103/ijo.IJO_35_20  PMID:32971664
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Squamous cell carcinoma of the lacrimal punctum: A rare presentation p. 2245
Akshay Gopinathan Nair, Indumati Gopinathan, Vandana Jain
DOI:10.4103/ijo.IJO_2308_19  PMID:32971665
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Gossypibioma: An unusual complication of an endoscopic dacryocystorhinostomy p. 2247
Nandini Bothra, Kavya Madhuri Bejjanki, Mohammad Javed Ali
DOI:10.4103/ijo.IJO_2225_19  PMID:32971666
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OPHTHALMIC IMAGE Top

Smartphone anterior segment photography with slit-lamp assisted illumination p. 2249
PR Aswin
DOI:10.4103/ijo.IJO_444_20  PMID:32971667
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COMMENTARY Top

Commentary: Call for innovative indigenous ideas in smartphone ophthalmic imaging p. 2250
Amar Pujari, Namrata Sharma, Rahul K Bafna, Deeksha Rani
DOI:10.4103/ijo.IJO_920_20  PMID:32971668
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OPHTHALMIC IMAGES Top

High-contrast scleroconjunctival microvasculature via deep learning denoising p. 2251
Shin Kadomoto, Akihito Uji, Yuki Muraoka, Akitaka Tsujikawa
DOI:10.4103/ijo.IJO_1079_20  PMID:32971669
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Corneal epithelial cells division assessed by scanning electron microscopy p. 2252
Carlos Rocha-de-Lossada, Josep Torras-Sanvicens, Jorge Peraza-Nieves
DOI:10.4103/ijo.IJO_1214_20  PMID:32971670
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Descemet's membrane rupture secondary to forceps-induced birth injury p. 2253
Prafulla Sarma, Mayuri Borgohain, Shahinur Tayab, Chengchira A Sangma
DOI:10.4103/ijo.IJO_149_20  PMID:32971671
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Pinwheel cataract p. 2254
Surbhi Khurana, Parul C Gupta, Jagat Ram
DOI:10.4103/ijo.IJO_857_20  PMID:32971672
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Bilateral ectopia lentis in opposite quadrants in a child with Marfan syndrome p. 2255
Gitanjli Sood, Hemlata Udenia, Ramanuj Samanta, Ajai Agrawal, Harshad Ghawghawe
DOI:10.4103/ijo.IJO_301_20  PMID:32971673
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Beware of the ominous folds p. 2256
Pasyanthi Balijepalli, Arjun Srirampur
DOI:10.4103/ijo.IJO_238_20  PMID:32971674
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Delayed capsular bag distension syndrome p. 2257
Usha Kommineni, Pratik Gogri, Abhinav Biala
DOI:10.4103/ijo.IJO_863_20  PMID:32971675
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Fish-net posterior capsular opacification: A newer variant p. 2258
Isha Agarwalla, Harsha Bhattacherjee, Palak Chiraniya, Mohit Garg
DOI:10.4103/ijo.IJO_643_20  PMID:32971676
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Corneal melt causing direct visualization of choroidal detachment p. 2259
Rahul Kumar Bafna, Namrata Sharma, Karthikeyan Mahalingam, Kalathil Reshmi Shaji
DOI:10.4103/ijo.IJO_1024_20  PMID:32971677
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Macular vortex vein in high myopia p. 2260
Ramesh Venkatesh, Arpitha Pereira, Sherina Thomas, Sajjan Sangai, Akhila Sridharan, Naresh Kumar Yadav
DOI:10.4103/ijo.IJO_392_20  PMID:32971678
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The chorioretinal “blast” p. 2261
M Akhila, Brijesh Takkar
DOI:10.4103/ijo.IJO_186_20  PMID:32971679
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Focal choroidal excavation with macular hole in a case of advanced retinitis pigmentosa p. 2262
Raj Shri Hirawat, CK Nagesha, Chanchal Poddar
DOI:10.4103/ijo.IJO_141_20  PMID:32971680
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Swiss cheese retina p. 2263
Manavi D Sindal, M Arthi
DOI:10.4103/ijo.IJO_88_20  PMID:32971681
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Extensive myelinated nerve fibers in eye with colobomatous optic disk p. 2264
Raj S Hirawat, CK Nagesha, Megha M Divakar
DOI:10.4103/ijo.IJO_2234_19  PMID:32971682
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Bilateral macular Roth spots as a rare manifestation of hemoglobin E trait p. 2265
Krati Gupta, Dipankar Das, Saurabh Deshmukh
DOI:10.4103/ijo.IJO_2176_19  PMID:32971683
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Multimodal imaging in familial dominant drusen p. 2266
Nitin Kumar, Monika Balyan, Reema Bansal
DOI:10.4103/ijo.IJO_233_20  PMID:32971684
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Photoreceptor damage following long-standing premacular hemorrhage in Terson syndrome p. 2267
Amogh Kittur, Juhi Daga, Abhidnya Surve, Vinod Kumar
DOI:10.4103/ijo.IJO_405_20  PMID:32971685
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Intraocular incarceration of eyelash p. 2268
Karthik Kumar, Ram S Ravindran, Naresh B Kannan
DOI:10.4103/ijo.IJO_647_20  PMID:32971686
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Tick infestation of upper eyelid p. 2269
Mohmad Uzair, Deepak Varma
DOI:10.4103/ijo.IJO_135_20  PMID:32971687
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CASE REPORTS Top

The painless eye: Neurotrophic keratitis in a child suffering from hereditary sensory autonomic neuropathy type IV p. 2270
Aditya Sethi, Srikanth Ramasubramanian, Meenakshi Swaminathan
DOI:10.4103/ijo.IJO_2101_19  PMID:32971688
Hereditary sensory autonomic neuropathy (HSAN) is a group of inherited disorders (total 5 types) that are associated with sensory dysfunction and varying degrees of autonomic dysfunction. HSAN type IV (HSAN-IV) or congenital insensitivity to pain and anhidrosis (CIPA) is a rare genetic disorder inherited in an autosomal recessive manner. We report a case of this very rare genetic disease in a 3-year-old girl child, born to a family in north India with ocular features of neurotrophic keratitis. The diagnosis was made clinically based on the hallmark features of insensitivity to pain and temperature, anhidrosis, self-mutilating behavior with multiple recurrent oral ulcers, nasal bleeds, multiple trophic ulcers over joints, and decreased intellect.
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First report of Mortierella wolfii causing fungal keratitis from a tertiary eye hospital in India p. 2272
Kulandai Lily Therese, Meena Lakshmipathy, Dhanurekha Lakshmipathy
DOI:10.4103/ijo.IJO_2136_19  PMID:32971689
A young 33 year old male presented with non-resolving corneal infiltrate for 2 month duration in the right eye. KOH/ Calcoflour wet mount revealed sparsely septate fungal hyphae. Post therapeutic penetrating keratoplasty 3 doses of intracameral voriconazole(100μg/0.1ml) was administered suspecting recurrence. Fungal culture revealed non sporulating mould on SDA. PCR based DNA sequencing targeting the ITS region identified the fungal isolate as Mortierella wolfii (M. wolfii) belonging to zygomycetes. To the best of our knowledge, this is the first report of human fungal keratitis caused by M. wolfii.
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Atypical variant of Fuchs' endothelial dystrophy mimicking iridocorneal endothelial syndrome: A case report p. 2274
Mona Bhargava, Jyotirmay Biswas, Shweta Patil
DOI:10.4103/ijo.IJO_1434_19  PMID:32971690
To report an unusual presentation of Fuch's endothelial dystrophy (FED) and its management. A 53-year-old male patient presented with unilateral progressive painless diminution of vision. Best-corrected visual acuity of the right and left eyes were 20/20 and 20/400, respectively. Slit lamp examination of the right eye was unremarkable, on left eye examination there was corneal edema, shallow anterior chamber, areas of 360 degrees iridocorneal touch with few synechiae on gonioscopy and age-related nuclear sclerosis. Pachymetry and specular microscopy imaging were performed before and after the surgical procedure. Ultrasound biomicroscopy (UBM) was performed preoperatively to rule out the presence of any angle anomalies. Combined procedure of Phacoemulsification with intraocular lens implantation and Descemet's membrane endothelial keratoplasty (DMEK) with peripheral iridectomy were performed. At 6-weeks follow-up, best-corrected visual acuity improved from 20/400 to 20/20. Slit lamp examination of the left eye showed clear DMEK graft with patent inferior peripheral iridectomy. Specular microscopy showed a cell count of 1761 cells/mm2. In a patient presenting with unilateral corneal edema, shallow anterior chamber depth, and iridocorneal adhesions, one needs to rule out the diagnosis of atypical variant of FED.
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Bilateral non-resolving punctate keratitis in a keratoplasty patient p. 2277
Nikhil S Gokhale, Jyoti Prakash Panda
DOI:10.4103/ijo.IJO_312_20  PMID:32971691
This study aimed to report a case of non-resolving bilateral coarse punctate keratitis in a patient with prior bilateral penetrating keratoplasty. In view of non-response to antivirals, corneal epithelial scraping was carried out, which revealed the presence of microsporidial cysts. The infection resolved after a period of 12 days following the diagnosis, during which steroids were discontinued. Microsporidial keratitis needs to be considered in non-resolving coarse punctate keratitis and microbiologic evaluation is essential to establish the diagnosis.
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Rotating wire brush ocular trauma in a fighter pilot p. 2279
Karmiris I Efthymios, Manousakis E Evangelos, Ntravalias G Thomas, Kasmas M Konstantinos, Giannakis P Ioannis
DOI:10.4103/ijo.IJO_107_20  PMID:32971692
Penetrating ocular injuries from rotating wire brush is a previously underreported still preventable risk of ocular trauma which poses serious threats for vision. We describe a case of an injury caused by rotational wire brush to a pilot of a high-performance fighter plane, with an excellent visual outcome, and a fully restored vision and functionality status. Despite the unpropitious expected visual outcome due to the severity of the trauma, proper management can restore the vision. This is the first case, reporting this type of injury, with a fully restored vision to maintain flying status in a high performance and demanding military environment.
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Endocapsular hematoma as an uncommon early postoperative complication of phacoemulsification with intraocular lens implantation surgery p. 2282
Mahmoud Nejabat, Mohammad Reza Khalili, Nasrin Masihpour, Mansoureh Mohammadpour, Shahla Hosseini, Mohammad Shirvani
DOI:10.4103/ijo.IJO_1873_19  PMID:32971693
Herein we describe a 55-year-old woman presented with a chief complaint of visual loss in the right eye of 3 days duration. The patient underwent uncomplicated phacoemulsification cataract surgery on the right eye 1 week ago. Slit lamp examination revealed accumulation of blood in the capsular bag behind the intraocular lens with blood level. The patient was diagnosed as endocapsular hematoma. Neodymium-doped: yttrium-aluminum-garnet laser posterior capsulotomy was performed. The patient's vision improved completely.
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Endogenous endophthalmitis secondary to Burkholderia cepacia: A rare presentation p. 2283
Raji Kurumkattil, Hemant S Trehan, Kundan Tandel, Vijay K Sharma, Sanjay K Dhar, Tanmay Mahapatra
DOI:10.4103/ijo.IJO_1648_19  PMID:32971694
Burkholderia cepacia (previously known as Pseudomonas cepacia) is low virulent, gram negative bacilli, known to cause infections in immunocompromised hosts. There are reports about this organism causing keratitis, acute or delayed postoperative, or post traumatic endophthalmitis. Persistence of infection and poor visual outcome are well known complications of infection caused by this organism. Endogenous endophthalmitis due to Burkholderia cepacia is rare. There is no such case report available of endogenous endophthalmitis caused by these bacteria in the literature, where it is presented as retinal abscess and retinal vasculitis. Our aim is to report such a rare case from our hospital, which was treated with systemic and intravitreal antibiotics, with control of infection.
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Persistent asymptomatic vitreous cyst with ten years follow-up: A case report p. 2286
Dhivya Ashok Kumar, Prashanthi Balaraman, Amar Agarwal
DOI:10.4103/ijo.IJO_2280_19  PMID:32971695
Asymptomatic free floating vitreous cyst with macular coloboma constantly been stable for 10 years is a rarely reported case. Here, we report a case of 30-year-old male who presented to us with best corrected visual acuity of 6/12 and 6/18 in right and left eye, respectively. On slit-lamp examination anterior segment was normal. His fundus examination showed a solitary free floating cyst in the vitreous in right eye and bilateral macular coloboma. Blood tests for toxoplasmosis and cysticercosis were negative. The patient had no symptoms, so we decided to follow the patient without any treatment.
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From an asymptomatic lesion to a vision-threatening condition: Congenital hypertrophy of the retinal pigment epithelium complicated by choroidal neovascular membrane p. 2288
Raziye Dönmez Gün, Güzide Akcay, Hatice Selen Kanar, Şaban Şimşek
DOI:10.4103/ijo.IJO_2185_19  PMID:32971696
We reported a case of congenital hypertrophy of the retinal pigment epithelium (CHRPE) complicated by choroidal neovascular membrane (CNVM). A 41-year-old woman presented to our clinic with visual loss in the left eye. She was diagnosed as CHRPE complicated by a CNVM. The patient was treated with 2 consecutive monthly intravitreal aflibercept (IVA) injections. The best-corrected visual acuity (BCVA) improved and stabilized at 6/6. Subretinal fluid depending on CNVM resolved completely. CHRPE complicated by CNVM in the macular area is a rare condition and these cases can be treated with IVA therapy.
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Retinal vein occlusion in COVID-19: A novel entity Highly accessed article p. 2291
Jay Umed Sheth, Raja Narayanan, Jay Goyal, Vinod Goyal
DOI:10.4103/ijo.IJO_2380_20  PMID:32971697
Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the “cytokine-storm” as the pathogenesis for systemic manifestations of COVID-19.
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Surgical management of a large retinal cyst in X-linked retinoschisis with internal drainage: Report of an unusual case p. 2294
Parveen Sen, Samarth Mishra
DOI:10.4103/ijo.IJO_2336_19  PMID:32971698
Although X-linked retinoschisis is a common retinal degeneration condition, the presence of a large retinal cyst obscuring the visual axis in an infant is a rare presentation. Herein, we describe such a case of a child who presented to us with the diagnosis of retinal detachment in both the eyes. However, following multimodal imaging and electrophysiology, the child was found to have bilateral juvenile retinoschisis with a large retinoschisis cyst involving the visual axis seen intraoperatively in the left eye. A limbal approach followed by lensectomy was used to excise the inner retinal layer of the cyst. The intracystic fluid was then drained and the stretched retinal vessels were endocauterized and severed without causing any iatrogenic outer retinal breaks and retinal detachment. The correct diagnosis and meticulous preoperative planning of the surgical procedure helped us manage this challenging case with a favorable anatomical and functional outcome.
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“Macular sink hole” with intrachoroidal cavitation in a case of pathological myopia p. 2296
Ashish Markan, Sabia Handa, Mohit Dogra, Ramandeep Singh
DOI:10.4103/ijo.IJO_118_20  PMID:32971699
Intrachoroidal cavitation (ICC) is a morphological feature outlined by optical coherence tomography and is characterized by presence of a hyporeflective space beneath the unaltered retinal pigment epithelium. It can be peripapillary or macular in location. Macular ICCs are reported in both myopic and non-myopic eyes. We report a case of full thickness macular hole with retinal incarceration into the macular ICC in a patient with pathological myopia. The term “Peripapillary sink hole” has been described in the literature. We propose the use of term “Macular sink hole” for our case owing to similar findings in the macula.
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Periocular steroids for macular edema associated with retinal arteriovenous malformation: A case report p. 2298
Roshni Mohan, Romana Fazal
DOI:10.4103/ijo.IJO_293_20  PMID:32971700
Retinal racemose hemangiomas (RRH) are vascular malformations comprising of direct arteriovenous communications in the retina. Exudation and neurosensory detachment are some of the complications which may cause decreased visual acuity. Herein, we describe a case of a 38-year-old male presenting with unilateral Group II RRH complicated with macular edema. Initial treatment with intravitreal bevacizumab yielded a poor therapeutic response. Subsequently, he was treated with a posterior sub-tenon injection of triamcinolone acetonide following which there was a prompt decrease in edema with simultaneous improvement in vision. The visual acuity was maintained and no recurrence was seen even after 6 months of successful treatment.
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COMMENTARY Top

Commentary: Retinal arteriovenous malformations and retinal exudation and/or macular edema p. 2301
Koushik Tripathy
DOI:10.4103/ijo.IJO_1036_20  PMID:32971701
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CASE REPORTS Top

Multimodal imaging of an idiopathic florid vascularised epiretinal membrane: Course, treatment, and outcome p. 2302
B Poornachandra, Edwin James, Aditya Aseem, Chaitra Jayadev, Srinivasan Sanjay, KT Ashwini, Santosh G K Gadde, Naresh K Yadav
DOI:10.4103/ijo.IJO_2363_19  PMID:32971702
Idiopathic vascular epiretinal membrane is an extremely rare entity and the pathogenesis and clinical course is not clearly understood. A 53-year-old hypertensive female patient presented with complaints of altered vision in the right eye. On examination, her vision was 20/30 and fundoscopy showed a vascularized epiretinal membrane (ERM), which was confirmed on spectral-domain optical coherence tomography. No primary cause was found after investigations. The symptoms and ERM showed slow progression over the next three years with a visual acuity of 20/60. She underwent surgery for removal of the ERM, which was subjected to histopathological evaluation. This is a unique case of a florid proliferative vascularisation of an ERM in the absence of any identifiable cause, which had a good visual outcome following surgery.
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Multicentric recurrent uveal melanoma p. 2305
Vikas Menon, Mithun Thulasidas, Ritesh Narula, Kautubh Mulay, Santosh G Honavar
DOI:10.4103/ijo.IJO_511_20  PMID:32971703
Uveal melanoma is a rare malignancy originating from melanocytes within the uveal tract of the eye. True multifocal uveal melanomas (>2melanomas in 1 eye) occurring in the same eye are very rare. We report a clinically and histologically well-documented case of a patient who presented with 3 uveal melanoma lesions in the same eye over a span of 2.5 years. The eye had to be enucleated finally and diagnosis confirmed histologically. This case report highlights the need for a close follow-up, even after successful treatment of the presenting lesion in uveal melanomas.
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LETTERS TO THE EDITOR Top

Viral shedding in tears of COVID-19 cases presenting as conjunctivitis p. 2308
Ruchi Goel, Ritu Arora, Mohit Chhabra, Sumit Kumar
DOI:10.4103/ijo.IJO_2567_20  PMID:32971704
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Pain, the driving force behind eye casualty attendance during the COVID-19 lockdown p. 2309
Ricardo De Sousa Peixoto, Bansri K Lakhani, Yuanchao Xue, Harminder S Dua, Dalia G Said, Anthony J King
DOI:10.4103/ijo.IJO_2457_20  PMID:32971705
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“Ray of light during tough times”—Role of gamma irradiated corneal tissue in emergency keratoplasty p. 2310
Josephine S Christy, Esen K Akpek, Priya M Mathews, Srinivasan Kavitha
DOI:10.4103/ijo.IJO_1781_20  PMID:32971706
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Comments on: Preferred practice guidelines for glaucoma management during COVID-19 pandemic p. 2311
Rajul S Parikh, Ronnie George, B Shantha, Shefali R Parikh, L Vijaya
DOI:10.4103/ijo.IJO_2255_20  PMID:32971707
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Response to comments on: Preferred practice guidelines for glaucoma management during COVID-19 pandemic p. 2312
Sushma Tejwani, Dewang Angmo, Barun K Nayak, Namrata Sharma, Mahipal S Sachdev, Tanuj Dada, Rajesh Sinha
DOI:10.4103/ijo.IJO_2339_20  PMID:32971708
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Anti-vascular endothelial growth factor treatment regimens preference by choroidal neovascularization patients under COVID-19 Highly accessed article p. 2314
Sunny Chi Lik Au
DOI:10.4103/ijo.IJO_1799_20  PMID:32971709
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Perspective of ophthalmologists providing direct care to COVID-19 positive patients at JIPMER, Puducherry p. 2315
Amit Kumar Deb, Tanmay N Gokhale, Malavika Mani, Sandip Sarkar
DOI:10.4103/ijo.IJO_2157_20  PMID:32971710
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Academic quality of incoming ophthalmology residents in India: Concerns for the future p. 2316
Ahmad Ozair, Kaushal K Singh, Siddharth Agrawal
DOI:10.4103/ijo.IJO_1154_20  PMID:32971711
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Project ECHO (extension for community health care outcomes), An online tool for residents' education: A pilot study p. 2318
Aravind Roy, Bidula Das, Prashant Garg
DOI:10.4103/ijo.IJO_588_20  PMID:32971712
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Senior residency: An opportunity missed? p. 2319
Rajat M Srivastava, Siddharth Agrawal
DOI:10.4103/ijo.IJO_1623_20  PMID:32971713
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Recognising teaching talent p. 2320
Siddharth Agrawal, Rajat M Srivastava, Vinita Singh
DOI:10.4103/ijo.IJO_1635_20  PMID:32971714
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Amended criteria for promotion of medical teachers: A step towards sound research and publication p. 2321
Himel Mondal, Shaikat Mondal
DOI:10.4103/ijo.IJO_729_20  PMID:32971715
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Are we treating the effect and neglecting the cause of keratoconus? p. 2322
Lakshey Dudeja, Ishani Dudeja
DOI:10.4103/ijo.IJO_222_20  PMID:32971716
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Clinico-etiological profile of microbial keratitis: A pilot study from the foothills of Himalayas p. 2323
Ranjana Rohilla, Suneeta Meena, Neeti Gupta, Aroop Mohanty, Neelam Kaistha, Pratima Gupta, Amit Mangla, U Sasi Rekha, Balram Ji Omar
DOI:10.4103/ijo.IJO_2125_19  PMID:32971717
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Eureka moments in pediatric cataract screening p. 2325
Sudarshan Khokhar, Yogita Gupta, Chirakshi Dhull
DOI:10.4103/ijo.IJO_1125_20  PMID:32971718
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Indovations in vitreoretinal surgery p. 2326
Ajay I Dudani, Anupam Dudani, Krish Dudani, Anadya Dudani
DOI:10.4103/ijo.IJO_983_20  PMID:32971719
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Controversial treatment using coloured overlays in visual processing disorders p. 2327
Jayaprakash Patil
DOI:10.4103/ijo.IJO_623_20  PMID:32971720
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Comments on: Comparison of higher order aberrations in amblyopic and non-amblyopic eyes in pediatric patients with anisometropic amblyopia p. 2328
Meghna Solanki, Shairin Jahan, Mihir Kothari, Mohammad Oliullah Abdal, Mansi Mehta, Gunjan Ingle
DOI:10.4103/ijo.IJO_353_20  PMID:32971721
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Response to comments on: Comparison of higher order aberrations in amblyopic and non-amblyopic eyes in pediatric patients with anisometropic amblyopia p. 2329
Abhishek Hoshing, Monica Samant, Seema Bhosale, Anaya Naik
DOI:10.4103/ijo.IJO_924_20  PMID:32971722
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ERRATUM Top

Erratum: Analysis of differentially expressed genes in bacterial and fungal keratitis p. 2331

DOI:10.4103/0301-4738.295752  PMID:32971723
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Erratum: Ophthalmic biosimilars: Lessons from India p. 2331
,
DOI:10.4103/0301-4738.295753  PMID:32971724
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Erratum: Meningoencephalitis due to endogenous endophthalmitis by Klebsiella pneumoniaein a diabetic patient p. 2331
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DOI:10.4103/0301-4738.295754  PMID:32971725
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Erratum: The history of Uveitis Society of India p. 2331
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DOI:10.4103/0301-4738.295755  PMID:32971726
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