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EDITORIAL |
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Malignant tumors of the eyelid – To err is human, to learn divine  |
p. 2333 |
Santosh G Honavar DOI:10.4103/0301-4738.299219 PMID:33120608 |
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GUEST EDITORIALS |
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Is it essential to perform COVID-19 testing prior to ophthalmic procedures?  |
p. 2335 |
Ruchi Goel, Ritu Arora, Samreen Khanam, Sonal Saxena, Vikas Manchanda, Palak Pumma DOI:10.4103/ijo.IJO_3020_20 PMID:33120609 |
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Three-dimensional heads up display in anterior segment surgeries- Expanding frontiers in the COVID-19 era |
p. 2338 |
Manpreet Kaur, Jeewan S Titiyal DOI:10.4103/ijo.IJO_2978_20 PMID:33120610 |
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“Am I audible? Are my slides visible?” – Do we need to flatten the webinar curve? |
p. 2341 |
Akshay Gopinathan Nair DOI:10.4103/ijo.IJO_3038_20 PMID:33120611 |
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Intraocular devices associated adverse events reporting system in India |
p. 2343 |
Vivekanandan Kalaiselvan, Rohit Saxena DOI:10.4103/ijo.IJO_298_20 |
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TALES OF YORE |
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Dr. Wendell Hughes: Grafting Greatness |
p. 2346 |
Mrittika Sen, Santosh G Honavar DOI:10.4103/ijo.IJO_3129_20 PMID:33120613 |
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ONE MINUTE OPHTHALMOLOGY |
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Photopsia and visual loss in a patient with lung cancer |
p. 2348 |
Eric Shiuey, Sara E Lally, Carol L Shields DOI:10.4103/ijo.IJO_58_20 PMID:33120614 |
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REVIEW ARTICLES |
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Chronic cicatrizing conjunctivitis: A review of the differential diagnosis and an algorithmic approach to management  |
p. 2349 |
Jayesh Vazirani, Pragnya R Donthineni, Sahil Goel, Sayali S Sane, Sheetal Mahuvakar, Purvasha Narang, Swapna S Shanbhag, Sayan Basu DOI:10.4103/ijo.IJO_604_20 PMID:33120615
Cicatrizing conjunctivitis constitutes a group of chronic local and systemic disorders that cause conjunctival scarring. A systematic approach is required to sift through the clinical history, examination, and laboratory investigations of patients to arrive at the correct diagnosis of the underlying cause. Establishing the etiology is critical, as the therapeutic approach changes based on the cause of conjunctival inflammation. Effective management of patients with the condition requires knowledge of multiple modalities such as systemic immunosuppressive therapy, use of scleral contact lenses, and surgery for ocular surface and vision improvement. We review the clinical features of this condition and present diagnostic and treatment algorithms to help simplify the complexities in its management. This review attempts to place all the relevant information on chronic cicatrizing conjunctivitis together in one place for the benefit of cornea and ocular surface specialists, general ophthalmologists, and ophthalmology residents.
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Modern treatment of retinoblastoma: A 2020 review  |
p. 2356 |
David Ancona-Lezama, Lauren A Dalvin, Carol L Shields DOI:10.4103/ijo.IJO_721_20 PMID:33120616
Retinoblastoma management remains complex, requiring individualized treatment based on International Classification of Retinoblastoma (ICRB) staging, germline mutation status, family psychosocial factors and cultural beliefs, and available institutional resources. For this 2020 retinoblastoma review, PubMed was searched for articles dated as early as 1931, with an emphasis on articles from 1990 to the present day, using keywords of retinoblastoma, chemotherapy, intravenous chemotherapy, chemoreduction, intra-arterial chemotherapy, ophthalmic artery chemosurgery, intravitreal chemotherapy, intracameral chemotherapy, cryotherapy, transpupillary thermotherapy, laser, radiation, external beam radiotherapy, plaque radiotherapy, brachytherapy, and enucleation. We discuss current treatment modalities as used in the year 2020, including intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), intracameral chemotherapy (IcamC), consolidation therapies (cryotherapy and transpupillary thermotherapy [TTT]), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and enucleation. Additionally, we present a consensus treatment algorithm based on the agreement of three North American retinoblastoma treatment centers, and encourage further collaboration amongst the world's most expert retinoblastoma treatment centers in order to develop consensus management plans and continue advancement in the identification and treatment of this childhood cancer.
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COMMENTARIES |
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Commentary: Retinoblastoma management–Where are we and where do we go from here? |
p. 2365 |
P Mahesh Shanmugam DOI:10.4103/ijo.IJO_1954_20 PMID:33120617 |
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Commentary: Current standards in retinoblastoma care |
p. 2367 |
Pukhraj Rishi DOI:10.4103/ijo.IJO_3198_20 PMID:33120618 |
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ORIGINAL ARTICLE |
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Corneal transplantation and eye banking practices during COVID-19-related lockdown period in India from a network of tertiary eye care centers |
p. 2368 |
Arvind Roy, Sujata Das, Sunita Chaurasia, Merle Fernandes, Somasheila Murthy DOI:10.4103/ijo.IJO_2258_20 PMID:33120619
Purpose: The purpose of this study was to discuss the guidelines and modification of practices with respect to corneal transplantation and eye banking during the COVID-19 pandemic lockdown period and beyond, at a network of tertiary care centers in India. Methods: Descriptive study of the challenges faced in eye banking during the lockdown, and practices adopted to overcome the critical aspects in the clinical care of patients who presented with emergency corneal diseases requiring keratoplasty. Results: Complete lockdown orders from the Indian government, as a strategy to control the Coronavirus pandemic, resulted in drastic reduction of all types of elective corneal transplants and eye banking activities from March 24, 2020 to May 31, 2020. The sudden cessation of eye banking resulted in an acute demand and supply imbalance of fresh donor corneas for transplants during this time. Our network of eye banks addressed this issue by adopting glycerol preservation of donor corneas, which were subsequently utilized for tectonic penetrating keratoplasty. The donor cornea retrieval was resumed in a strategized manner 3 weeks prior to the date of exit of the lockdown, with modified guidelines on donor suitability, screening, retrieval, processing, and harvesting from various sources. A triage of keratoplasty priority was formulated to tide over the post lockdown shortage of corneas. We performed 31 therapeutic keratoplasties during the nationwide lockdown among our network of tertiary eye care centers. Conclusion: The study highlights the approach and strategies to manage and tide over an unprecedented crisis situation faced by corneal surgeons in general and, specifically, the eye banking community.
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COMMENTARY |
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Commentary: Eye banking during COVID-19 pandemic |
p. 2372 |
Naveen Radhakrishnan, N Venkatesh Prajna DOI:10.4103/ijo.IJO_3163_20 PMID:33120620 |
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ORIGINAL ARTICLES |
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Preoperative COVID-19 testing for elective vitreoretinal surgeries: Experience from a major tertiary care institute in South India  |
p. 2373 |
Naresh Babu Kannan, Sagnik Sen, Harshavardhan Reddy, Karthik Kumar, Renu P Rajan, Kim Ramasamy DOI:10.4103/ijo.IJO_2870_20 PMID:33120621
Purpose: To study the prevalence of asymptomatic SARS-CoV-2 virus infection (COVID-19) among patients undergoing elective vitreoretinal surgeries at a tertiary care eye hospital. Methods: This cross-sectional, observational study was performed between July 16, 2020 and August 31, 2020, in the retina clinic of a tertiary care eye hospital in south India. All patients undergoing elective retinal surgical procedures underwent RT-PCR testing for SARS-CoV-2 before being posted for surgery and after obtaining informed consent. Patients planned for surgery under general anesthesia underwent additional computed tomography of the chest. Testing strategies and outcomes were documented. Results: Out of a total of 413 patients who were given appointments for surgery during this period, nine patients (2.2%) were found to have positive RT-PCR for SARS-CoV-2, and their surgeries were postponed. The test positivity (prevalence) rate of asymptomatic COVID-19 infection among all elective vitreoretinal surgical patients in our hospital was 2.2%. None of the patients were symptomatic for COVID-19. Conclusion: Our results showed that among patients visiting high volume ophthalmic centers in the near future, approximately 1 in 45 patients may be asymptomatic, SARS-CoV-2 RT-PCR positive. Asymptomatic COVID-19 patients may lead to chances of transmission of the virus inside healthcare facilities among other visiting patients and healthcare workers.
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Impact of the COVID-19 lockdown on digital device-related ocular health  |
p. 2378 |
Fayiqa Ahamed Bahkir, Srinivasan Subramanian Grandee DOI:10.4103/ijo.IJO_2306_20 PMID:33120622
Purpose: Since the declaration of the lockdown due to COVID-19, the usage of digital devices has gone up across the globe, resulting in a challenge for the visual systems of all ages. The purpose of this study is to assess the impact of the lockdown on digital device usage, and consequently, the ocular surface health implications and circadian rhythm abnormalities related to digital eye strain. Methods: An open online survey was sent through various social media platforms and was open for a period of 2 weeks. Results: A total of 407 usable responses were obtained; the average age of respondents was 27.4 years. Typically, 93.6% of respondents reported an increase in their screen time since the lockdown was declared. The average increase in digital device usage was calculated at about 4.8 ± 2.8 h per day. The total usage per day was found to be 8.65 ± 3.74 hours. Sleep disturbances have been reported by 62.4% of people. Typically, 95.8% of respondents had experienced at least one symptom related to digital device usage, and 56.5% said that the frequency and intensity of these symptoms increased since the lockdown was declared. Conclusion: The study highlighted the drastic increase in use of digital devices after the initiation of the COVID-19 lockdown, and along with it, the slow deterioration of ocular health across all age groups. Awareness about prevention of digital eye strain should be stressed, and going forward, measures to bring these adverse effects to a minimum should be explored.
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COMMENTARY |
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Commentary: Impact of the COVID-19 pandemic on digital eye strain in children  |
p. 2383 |
Chaitra Jayadev, Puja Sarbajna, Anand Vinekar DOI:10.4103/ijo.IJO_3028_20 PMID:33120623 |
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ORIGINAL ARTICLES |
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Knowledge, attitude and practise toward COVID-19 among patients presenting to five tertiary eye care hospitals in South India - A multicentre questionnaire-based survey  |
p. 2385 |
Josephine S Christy, Kirandeep Kaur, Bharat Gurnani, Olivia M Hess, Kalpana Narendran, Anitha Venugopal, J Anuja, Divya Manohar, Ramalakshmi Raman, Rengaraj Venkatesh DOI:10.4103/ijo.IJO_2522_20 PMID:33120624
Purpose: The aim of this study was to assess the knowledge, attitude, and practice (KAP) pattern towards COVID-19, among patients presenting to eye care hospitals during the last phase of lockdown period. Methods: A multicenter cross-sectional survey was conducted from May 15 to June 15, 2020 in five tertiary eye care hospitals in South India to assess the KAP towards COVID-19. Each of the hospitals belonged to one of the three different zones assigned in India based on number of infections. Red zones represent hotspots and orange/green zones represent regions with medium and lower caseloads, respectively. A validated questionnaire was administered through telephone and responses were recorded on a Google form. Results: Out of the total (n = 6119) participants, 3081 were from hospitals in green zone, 2110 from the orange zone, and 928 from red zone. Majority of participants were above 50 years of age (42%) and 15.54% were illiterate. The mean (percentage) scores of knowledge, attitude, and practice were 21.26 (82%), 9.37 (92%), and 10.32 (86%), respectively. KAP among patients more than 50 years of age and in illiterate individuals was significantly less (P < 0.01) when compared with all other groups. Participants from red zone had a significantly better attitude (P < 0.01) compared to other centers. Conclusion: Although the overall KAP regarding COVID-19 disease was robust (above 80% in all categories) in our participants, the high risk elderly population (>50 years) and illiterate individuals had a significantly lower KAP. These are populations in which education should be emphasized and appropriately delivered as a way to reduce COVID-19 risk.
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Impact of COVID-19 pandemic, national lockdown, and unlocking on an apex tertiary care ophthalmic institute  |
p. 2391 |
Rinky Agarwal, Namrata Sharma, Anuja Patil, Himani Thakur, Rohit Saxena, Atul Kumar DOI:10.4103/ijo.IJO_2366_20 PMID:33120625
Purpose: To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India. Methods: Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions. Results: During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period. Conclusion: COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.
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Impact of COVID-19-related lockdown-I on a network of rural eye centres in Southern India |
p. 2396 |
Varsha M Rathi, Anthony Vipin Das, Rohit C Khanna DOI:10.4103/ijo.IJO_2303_20 PMID:33120626
Purpose: With the outbreak of coronavirus disease 2019 (COVID-19), India went for lockdown-I on March 23, 2020. In this article, we report on the demographic profile and ocular disorders from our 20 rural eye centres during lockdown-I and its comparison with the pre-lockdown period. Methods: A retrospective analysis was conducted for all patients who visited or had teleconsultations at the 20 rural centres in our network between March 23 and April 19, 2020. Demographic and clinical details were collected from electronic medical records (EMR). Subspecialty was decided based on the diagnosis. Patients who needed advanced care were referred to the higher tertiary centres. We report the profile of patients seen and managed at the rural centres and the reasons for referrals. We also compare the data with the pre-lockdown period. Results: During the lockdown-I period, a total of 263 patients were treated including 48 teleconsultations (18.25%). The mean age was 48.16 years (SD: 19.53 years). There were 118 females (44.87%). As compared to pre-lockdown, during the lockdown, the patient visits were highest in the cornea and anterior segment specialty with 114 patients (43.35%), including conjunctivitis (n = 25; 22.32%). Of the 263 patients, 24 patients (9.12%) were referred to tertiary centres. This includes 6/27 (22.22%) patients of microbial keratitis. As compared to this, during pre-lockdown, 28,545 patients were seen. The mean age was 49.03 years (SD: 19.24 years). There were 14,927 (52.29%) females. The referral was 1525 (5.34%), including 34/249 (13.65%) of those with keratitis. Conclusion: Lockdown-I had significantly impacted patient care in rural areas. As compared to the pre-lockdown period, during the lockdown, there was an issue with access to services by females. Despite a higher number of specialty patients (including emergencies) visiting during the lockdown, 91% of the patients who visited rural centres could be managed locally, avoiding long-distance travel.
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Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country – An online survey  |
p. 2399 |
Devanshi Desai, Saswati Sen, Sanjiv Desai, Ranjana Desai, Snehalata Dash DOI:10.4103/ijo.IJO_2049_20 PMID:33120627
Purpose: The aim of this study was to assess awareness about online classes and to assess if they can aid learning in the field of medicine amid lockdown. Methods: Online survey comprising a questionnaire related to the aspects of online teaching was undertaken. There were 16 questions, and responses were collected from undergraduates, postgraduates, and the teaching faculties. Results: Online classes were viewed favorably by the vast majority of respondents. Out of 412 respondents 79.9% actively attended the classes. While 42% felt the timings were inappropriate as they clashed with duty hours, a set of 35% had difficulty understanding the content and most of them were undergraduates. Poor internet connection was a main hindrance identified. In total, 69.2% respondents were happy with the feasibility of the classes and believed these classes had the advantage of being economical as they offered exposure to national and international faculty from the comfort of their homes. Conclusion: Conducting online classes on a national scale is a herculean task for a developing country because of poor internet connectivity and deficient access to high-speed broadband services. Nevertheless, their popularity among students during the current crisis shows that it is a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching.
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Surface quality and endothelial cell viability after femtosecond laser-assisted donor lenticule preparation for endothelial keratoplasty - An in-vitro study |
p. 2404 |
Jeewan S Titiyal, MJ Aravind, Manpreet Kaur, Tapas C Nag, Namrata Sharma, Tushar Agarwal, Rajesh Sinha DOI:10.4103/ijo.IJO_99_20 PMID:33120628
Purpose: To compare surface quality and endothelial cell viability of descemet stripping automated endothelial keratoplasty (DSAEK) donor lenticules prepared with femtosecond laser (FSL) or microkeratome (MK). Methods: Experimental ex-vivo evaluation of 15 DSAEK donor lenticules prepared from optical quality donor corneas using 200 KHz FSL (9 eyes) or MK (6 eyes). Surface quality and smoothness of the cut were assessed using atomic force microscopy and endothelial cell viability was assessed using transmission electron microscopy. Results: Mean lenticule thickness was 121.89 ± 17.13 μm in FSL group and 112.67 ± 5.89 μm in MK group (P = 0.33). Average roughness of stromal surface (RMSavg) [FSL- 30.51 ± 4.55 nm, MK-22.37 ± 1.83 nm; P = 0.02] and root mean square roughness (RMSrough) [FSL-31.39 ± 5.75 nm, MK-23.08 ± 0.40 nm; P = 0.012] was significantly more in FSL group. Increased granular and linear irregularities were observed in the FSL group. Endothelial cell disruption was more in FSL group (FSL- 29.49 ± 6.91% MK-13.28 ± 3.62%; P < 0.001) with decreased mean nucleus length (FSL-5.56 ± 0.17 μm, MK-7.52 ± 0.65 μm; P < 0.001). Conclusion: Automated MKs are still the standard of care for donor lenticule preparation and MK-assisted donor lenticules have smoother surface with less endothelial cell disruption than FSL. Further research is mandatory before FSL platforms can be considered a viable alternative to the MK.
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Two-year clinical outcome after Descemet membrane endothelial keratoplasty using a standardized protocol |
p. 2408 |
KS Siddharthan, Varna Shet, Anushri Agrawal, Jagdeesh Kumar Reddy DOI:10.4103/ijo.IJO_2364_19 PMID:33120629
Purpose: The purpose of this study is to evaluate 2-year clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in a variety of endothelial dysfunctions using a standardized protocol. Methods: From a group of 230 eyes which underwent DMEK for Fuchs' endothelial corneal dystrophy (FECD), aphakic and pseudophakic bullous keratopathy, failed full thickness corneal transplants, ICE syndrome, failed DSEK, and TASS the clinical outcomes [best spectacle-corrected visual acuity (BSCVA), central endothelial cell density (ECD)] were evaluated before, and at 6, 12, and 24 months and the success rate, failure rate and postoperative complications were also analyzed. Results: Out of 230 eyes, 144 eyes (70%) had BSCVA 6/9 or better 2 years postoperatively. Mean donor ECD was 2692.23 (range, 2300–3436) cells/mm2 preoperatively, which was reduced to 1433.64 (range, 619.0–2272.0) cells/mm2 2 years after DMEK surgery, indicating a mean reduction of 1258 cells/mm2 (46%) in ECD. Conclusion: DMEK is a highly successful surgical procedure when following a standard protocol for treating diseases of the corneal endothelium providing a near perfect anatomic restoration and a high degree of visual rehabilitation.
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Evaluation of corneal topography and tomography in fellow eyes of unilateral keratoconus patients for early detection of subclinical keratoconus |
p. 2415 |
Mithun Thulasidas, Prateek Teotia DOI:10.4103/ijo.IJO_2129_19 PMID:33120630
Purpose: To analyse topographic and tomographic changes in fellow eyes of unilateral keratoconus patients by comparing them with normal eyes. Methods: This five-year retrospective observational comparative case study included 15 advanced keratoconus eyes of unilateral keratoconus (KCN group), 15 normal fellow eyes of unilateral keratoconus (Fellow eye group) and 34 eyes of normal refractive surgery candidates (Normal group). Topographic and tomographic data, data from enhanced elevation maps, and keratoconus indices were measured in all study eyes using Pentacam. Receiver operating characteristic (ROC) curves were used to evaluate the area under the curve (AUC), sensitivity and specificity of each parameter and identify cut-off points in discriminating between the fellow and normal eyes. Results: Corneal thickness at the apex (CTA, P = 0.001) and at the thinnest point (CTT, P < 0.001), corneal volume (CV, P = 0.007), Belin/Ambrosio Enhanced Ectasia Display (BAD) - thinnest point (Dt, P = 0.002) and thinnest point displacement (Da, P = 0.002) were significantly lower in the fellow group compared to eyes of normal subjects. On ROC curve analysis, the most efficient distinguishing indices between the fellow group and normal controls were BAD - overall D value (AUC = 0.859), Dt (AUC =0.827), Da (AUC = 0.789) followed by pachymetric progression index maximum (AUC = 0.741). Conclusion: BAD-D value and pachymetric progression index could be useful in detecting the earliest form of subclinical keratoconus. However, every single parameter alone is not enough to detect early changes; a combination of different data is required to distinguish subclinical keratoconus.
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A clinical study to assess feasibility, acceptance, and outcome of multifocal intraocular lens in patients with bilateral immature cataract at a tertiary eye care institute |
p. 2421 |
Rahul Deshpande, Varsha Mangiraj, Madan Deshpande, Kuldeep Dole, Khurshed Bharucha, Nirali Sanghavi DOI:10.4103/ijo.IJO_1951_19 PMID:33120631
Purpose: To assess feasibility, acceptability, and outcome of multifocal intraocular lenses (IOL) in patients with bilateral immature cataract. Methods: 1691 patients with bilateral immature cataract were included in the study. The feasibility of these IOLs was calculated by studying ocular parameters using Visionix VX120 and subjective characteristics. A prospective study was then conducted in 148 eyes of 74 patients in which multifocal IOLs were implanted. Their visual outcome was assessed using LogMAR for distance and Snellen's chart for near vision, contrast sensitivity by Pelli-Robson chart, and satisfaction using visual function-7 questionnaire. Results: Considering ocular and subjective characteristics, it was feasible to implant the lens in 920 patients (54.40%) and the acceptability rate was 8.04%, most common reason for decreased acceptability was cost (85%) of IOL. The median distance uncorrected visual acuity (UCVA) at day 7 and at 30 days was LogMAR 0.2 (0.1–0.3) and 0.15 (0.1–0.2), respectively, which was statistically significant compared to preoperative distance UCVA (P < 0.001). The median near UCVA at day 7 and 30 days was N6 for both and statistically significant (P < 0.001) compared to preoperative near UCVA. 77.02% patients had distance UCVA of LogMAR (0.0–0.2) and 91.8% had near UCVA of N6–N8 at 30 days. The contrast sensitivity was decreased in all patients. Conclusion: Appropriately selected patients can achieve spectacle independence and good visual satisfaction which begins with proper patient education, lifestyle and personality dynamics, and individualized weighing of benefits and side effects of multifocal IOLs.
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Relationship between nocturnal intraocular pressure-related peak recorded by contact lens sensor and disease progression in treated glaucomatous eyes |
p. 2427 |
Suneeta Dubey, Deepti Mittal, Saptarshi Mukherjee, Madhu Bhoot, Yadunandan P Gupta DOI:10.4103/ijo.IJO_2365_19 PMID:33120632
Purpose: The aim of this study is to study the association between Nocturnal Intraocular Pressure (IOP) related Peak recorded by a Contact Lens Sensor (CLS) and glaucoma progression in treated glaucomatous eyes. Methods: Institutional study in which forty glaucoma patients were recruited from glaucoma clinic. A total of 19 patients were labeled as progressors on current anti-glaucoma treatment despite controlled day time IOP whereas twenty one patients were clinically stable showing no progression. Worse eye of each patient was selected for placement of CLS. The timing of the highest signal (IOP related peak) was noted in 24 hour CLS graph and if it fell within the time frame of 11 pm to 5 am, it was labeled as 'nocturnal IOP related peak'. Results: Progressors were found to be significantly more prone to night spike than Non Progressors (χ2 = 6.812; n = 40; P = 0.009), thus, showing a definite association between the two. Association between Nocturnal IOP related peak and various other variables like age, gender, mean daytime IOP and systemic illness was studied. A positive correlation was established between female gender and Nocturnal IOP related spike with a significantly higher proportion of females showing night spike than their male counterparts (χ2 = 5.763; n = 40; P = 0.016). Other parameters did not show any significant relationship with Nocturnal IOP related spike. Conclusion: Dynamic 24 hour recording by CLS is beneficial in detecting nocturnal IOP-related peak, and thus, can potentially improve the clinical care of glaucoma patients, especially those showing progression.
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COMMENTARY |
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Commentary: Contact lens sensormeasured circadian intraocular pressure and glaucoma progression |
p. 2433 |
R Krishnadas DOI:10.4103/ijo.IJO_1893_20 PMID:33120633 |
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ORIGINAL ARTICLES |
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Assessment of psychosocial impact of primary glaucoma and its effect on quality of life of patients in Western India |
p. 2435 |
V K S Kalyani, Ashutosh Dayal, Vidya Chelerkar, Madan Deshpande, Anwesha Chakma DOI:10.4103/ijo.IJO_2117_19 PMID:33120634
Purpose: To assess the impact of primary glaucoma of varying severity and duration on psychosocial functioning and quality of life of patients. Methods: A cross-sectional observational study was carried on 200 patients attending the glaucoma clinic of a tertiary care hospital in western India. After obtaining approval from the institutional ethics committee, written informed consent was taken. All patients underwent a thorough ophthalmic examination. Those with primary glaucoma were classified as per Hodapp–Parrish–Anderson criteria and asked to respond to the National Eye Institute Visual Function Questionnaire (NEIVFQ)-25 questionnaire. Responses were analyzed statistically. Results: Overall mean NEIVFQ 25 composite score was 74.4 ± 18.6. Mean scores were 87.0 (SD 7.2) for mild, 75.9 (SD 8.1) for moderate, and 47.0 (SD 13.7) for severe glaucoma groups. Lower scores were associated with males. Driving (62.2, SD 34.6) and ocular pain (63.5, SD 18.7) were maximally affected while color vision (90.1, SD 18.7) and social health (86.7, SD 20.1) were least affected. The duration of treatment had no effect on mean composite scores with impaired scores seen even in newly diagnosed cases. Age of the patient negatively correlated with NEIVFQ 25 composite score. Conclusion: With disease progression, the psychosocial functioning of the patients is negatively affected. This effect is irrespective of treatment duration and newly diagnosed cases can have impaired Quality of life scores. Quantification of psychosocial status along with education and counseling for all patients may play a definitive role in customizing treatment and providing patients with a better quality of Life.
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Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study |
p. 2439 |
Anthony Fam, Paul T Finger, Ankit S Tomar, Gaurav Garg, Kimberly J Chin DOI:10.4103/ijo.IJO_2001_20 PMID:33120635
Purpose: Current ocular antiseptic practice for intravitreal injection (IVI) employs 5% povidone–iodine (Betadine®) drops which frequently cause ocular discomfort and prolonged irritation. In an effort to improve comfort while maintaining efficacy, we studied a hypochlorous acid (HOCL 0.01%) spray washout prior to injection. Methods: Patients had received a minimum of 3 IVIs prepared with Betadine®antisepsis prior to entry in this study. Their subsequent IVIs were prepared with Betadine®followed by HOCL 0.01% washout. Facets of comfort were measured by a Likert-scaled questionnaire to compare their experiences after IVI. Results: Thirty-seven participants were enrolled. Addition of HOCL 0.01% spray after Betadine®reduced the duration of discomfort (P = 0.001) and need for artificial tears postinjection (P = 0.003). It improved their reported quality of life (P = 0.04) and sleep (P = 0.01). There were neither HOCL-related side effects nor endophthalmitis during this study. Conclusion: Topical HOCL 0.01% spray after topical Betadine®antisepsis significantly improved patient comfort following IVIs.
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Acute endophthalmitis after penetrating and endothelial keratoplasty at a tertiary eye care center over a 13-year period |
p. 2445 |
Shilpa Das, Muralidhar Ramappa, Ashik Mohamed, Sunita Chaurasia, Savitri Sharma, Taraprasad Das DOI:10.4103/ijo.IJO_71_20 PMID:33120636
Purpose: To evaluate the clinico-microbiological profile, donor cornea risk factors, and outcomes of postkeratoplasty endophthalmitis at a tertiary care center. Methods: Retrospective analysis of charts of 28 consecutive patients (28 eyes) of acute endophthalmitis following either an endothelial keratoplasty (EK) or an optical penetrating keratoplasty (PK) surgery, performed between 2006 and 2018 (13-year period). Positive microbiology, identification and classification of predisposing factors, surveillance of utilized paired donors, treatment outcomes, and differences in the rate and severity of the event between optical penetrating and endothelial keratoplasty. Results: The estimated incidence of endophthalmitis was 0.23% in the entire cohort; it was 0.34% and 0.15%, after EK and PK, respectively (P = 0.049). The median time of endophthalmitis was 4.5 days postsurgery. Donor-related endophthalmitis was recognized in 7/28 (25%) eyes. Culture positivity was 68% (n = 19 of 28). Bacteria was isolated in 84% (n = 16 of 19) instances; Gram-negative bacilli were more common (87.5%; 14 of 16), and Pseudomonas species (50%; 7 of 14) was the most common Gram-negative bacterium. Majority (>75%) of the Gram-negative bacteria were resistant to all fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, and meropenam; 1/3rd were resistant to imipenem; and 90% were sensitive to colistin. Treatment included intraocular antibiotic injections (96.4%), vitrectomy (42.9%), and therapeutic keratoplasty (50%). In 85.7% (24 of 28), globe was salvaged. The final vision was 20/200 or better in 39.1% (9 of 23) eyes. Conclusion: EK carried a higher risk of endophthalmitis than PK in this cohort. Bacterial infection was more common in this series, with Gram negative bacilli being the commonest organisms. Multidrug resistance was common (~75%) in Gram negative isolates.
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Endophthalmitis Prophylaxis Study, Report 2: Intracameral antibiotic prophylaxis with or without postoperative topical antibiotic in cataract surgery |
p. 2451 |
Varsha M Rathi, Savitri Sharma, Taraprasad Das, Rohit C Khanna DOI:10.4103/ijo.IJO_1738_19 PMID:33120637
Purpose: Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India. Methods: A prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant. Results: In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376). Conclusion: Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India
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COMMENTARIES |
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Commentary: Dropless cataract surgery with intracameral antibiotic: An informed approach |
p. 2455 |
Kumar Saurabh, Rupak Roy DOI:10.4103/ijo.IJO_1710_20 PMID:33120638 |
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Commentary: Intracameral antibiotic reduces the risk of post-cataract surgery endophthalmitis but does not eliminate it |
p. 2456 |
Divya Agarwal, Atul Kumar DOI:10.4103/ijo.IJO_1863_20 PMID:33120639 |
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Do all children need a cycloplegic refraction? A comparison of Mohindra's versus cycloplegic refraction  |
p. 2458 |
Farnaz Kauser, Yogesh Gupta, Abadan K Amitava, Juhi Saxena, S Aisha Raza, Anam Masood, Md Shahid Alam DOI:10.4103/ijo.IJO_229_20 PMID:33120640
Purpose: In 1–12 years old children, we assessed correlation, regression, and agreement between spherical equivalents (SE) obtained on Mohindra's near retinoscopy (MNR) and the post cycloplegic refraction (PCRef), performed 72 h after a cycloplegic refraction (CRef) using cyclopentolate 1% drops. Methods: In this prospective comparative study, Mohindra's near retinoscopy (MNR) was performed on 202 eyes of 101 children, from 50 cm with a streak retinoscope, in a dimly lit room, subtracting 1.25 from the trial lens used for neutralization, to obtain the final refraction. Subsequently we undertook CRef, half-hour after instilling 1% cyclopentolate, with a PCRef 72 h later. All refractive data were converted to SE for evaluation. We compared the SEs using correlation, linear regression, and agreement (Bland–Altman graphic analysis) and paired t-test. Significance was set at P ≤ 0.05. Results: The mean SE on MNR was 1.71 ± 2.49 D compared to 1.43 ± 2.42 D on PCRef. A significant correlation with r = 0.97 (r2= 0.94, P < 0.001) existed. Agreement analysis suggested that MNR overestimates hypermetropia and underestimates myopia each by 0.3 D than the standard procedure of CRef-PCRef. The regression analysis suggested that SE on PCRef is 95% of that on MNR, less 0.20. Conclusion: Our study suggests that MNR offers single point refraction very similar to CRef-PCRef, and may be considered as a viable option more often.
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Looking beyond occlusion: A novel perspective for amblyopia treatment |
p. 2462 |
KS Santhan Gopal, Chaitra Jayadev, Sherina Thomas, Sugandhi Gopal DOI:10.4103/ijo.IJO_741_20 PMID:33120641
Purpose: The aim of this study was to evaluate the efficacy of Orthoptek (Magnocellular Stimulator OMS; Carditek Pvt. Ltd., Bangalore) as a treatment modality for amblyopia and strabismus. Methods: Thirty-five patients with amblyopia of any type, reduced vision in one or both eyes with no binocular vision and or poor stereopsis were included in the study. All patients underwent a minimum of 10 sessions of therapy with each session lasting for a cumulative period of 60 min. At the end of the 10th session, patients were evaluated for improvement in visual acuity, stereopsis, Binocular single vision and amount of strabismus, if any. Results: The mean logMAR corrected distance visual acuity improved from 0.31 ± 0.34 and 0.32 ± 0.44 to 0.08 ± 0.12 and 0.07 ± 0.12 posttreatment in the right eye and left eye, respectively. Following therapy, 34 (97%) patients showed improvement in stereopsis, orthophoria was noticed in 28 (80%), and binocular single vision was noted in 33 (94%). All patients were followed up for 1 year with maintenance therapy and none showed any regression. Conclusion: We believe that top–down impulses and the role of the attention area in the parietal cortex have not been studied well enough in the treatment of amblyopia. Our device addresses these issues and corrects the visual deficits in amblyopia. However, the study needs validation of this pilot study from independent centers. The same will be done at some stage
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Malignant tumors of the eyelid in India: A multicenter, multizone study on clinicopathologic features and outcomes |
p. 2466 |
Roshmi Gupta, Anirban Bhaduri, Savari Desai, Sima Das, Vikas Menon DOI:10.4103/ijo.IJO_2306_19 PMID:33120642
Purpose: To analyze data on eyelid malignancy in India, clinical and pathologic features, and outcomes. Methods: A multicentre study, from oculoplastic practices in four geographic zones in India. The centers perform similar documentation and protocol-based management for eyelid tumors. Clinical features, pathology, American Joint Committee on Cancer (AJCC) class, management, and the outcomes were analyzed. Results: The study included 129 patients, with slight female preponderance and mean age 62.7 years. The median delay to the consultation was 9 months. Rural patients traveled a mean distance of 115.2 km; there was no difference between the city and outstation patients in the delay to consultation or follow up. Pathology included 55/129 (42.6%) sebaceous gland carcinoma (SGC), 47/129 (36.4%) basal cell carcinoma (BCC), squamous cell carcinoma (SCC) in 15 (11.6%), and 12 (9.3%) other tumors. Commonest AJCC class was T2b/T3a in 80/111 (72%), invasion of the orbit was present in 16 (12.4%). Surgery with margin clearance was performed in 103. With a mean follow-up of 21.44 months, local recurrence and/or metastasis were seen in 12%. The diagnosis of SGC was strongly associated with adverse outcomes (odds ratio: 7.36). On multiple logistic regression analysis, diagnosis of SGC (P = 0.011) was significant in having adverse outcomes. Conclusion: The multicenter Indian data shows the highest prevalence of SGC, with the commonest AJCC class T2b. Most tumors were locally resectable at presentation. The histopathologic diagnosis of SGC is the factor strongly associated with adverse outcomes.
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SURGICAL TECHNIQUE |
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Four in one: Four recepients with a single donor tissue - A novel concept for eye transplantation surgery post-COVID-19 |
p. 2471 |
KS Siddharthan, Anushri Agrawal, Jagdeesh Kumar Reddy DOI:10.4103/ijo.IJO_1602_20 PMID:33120643
A donor corneo-scleral button was dissected into four parts using a simple manual technique. The anterior corneal lamellae was stripped from the Descemet's Membrane (DM) and Deep Anterior Lamellar Keratoplasty (DALK) was performed in a patient with advanced keratoconus after removing the recipient's stroma using the big bubble technique. Descemet's Membrane Endothelial Keratoplasty (DMEK) was done with the stripped donor DM in a patient with Fuch's endothelial dystroph (FECD). The cadaveric limbal stem cells from the tissue were used for simple limbal epithelial transplantation (SLET) in a Steven- Johnson Syndrome (SJS) with localized limbal stem deficiency and symblepharon. The sclera was used to revise a leaking hypotonus bleb in an advanced single-eyed glaucoma patient. No intraoperative or postoperative complications were observed. At 1 year, all the 4 cases retained healthy transplanted tissues with good visual outcomes. Shortage of donor eyes is a global problem and with the present COVID-19 scenario the situation is bound to worsen. The advent of customized component corneal transplantation using simple cost-effective techniques will be the future trend in the years to come.
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COMMENTARY |
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Commentary: Four in one: Four recipients with a single donor tissue – A novel concept for eye transplantation surgery post-COVID-19 |
p. 2474 |
Uma Kulkarni DOI:10.4103/ijo.IJO_2967_20 PMID:33120644 |
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SURGICAL TECHNIQUES |
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Cortical aspiration - The “POPS” technique |
p. 2476 |
Viraj A Vasavada, Abhay R Vasavada, Vijayevarshcini Dhanasekaran, Vaishali Vasavada, Aditya Sudhalkar, Shail Vasavada, Samaresh Srivastava, Alper Bilgic DOI:10.4103/ijo.IJO_2384_19 PMID:33120645
In the present study, we describe a step-by-step technique for cortex aspiration during cataract surgery- POPS (positioning, occlusion, posterior displacement, and swiping). Firstly, the aspiration probe is positioned under the bulk of cortical fibers beyond the capsulorhexis margin. Subsequently, the aspiration port is occluded with minimal vacuum, and the occluded port is displaced posteriorly to detach the cortical fibers off the anterior capsule. Now, tangential, arc-like swiping movements are performed while gradually increasing vacuum at the same time. The fibers are brought to the center and finally aspirated. This allows complete removal of the equatorial fibers and lens epithelial cells (LEC) with the least stress to the capsulozonular complex. Unlike the conventional technique, which involves the radial pull of cortical fibers, in this technique, there is swiping and posterior displacement of the cortical fibers before pulling towards the center and aspirating. We believe this technique will ensure safer, more effective cortical and LEC removal, reducing zonular stress.
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Autologous blood-assisted scleral fixation of intraocular lens |
p. 2479 |
Avadhesh Oli, Divya Balakrishnan DOI:10.4103/ijo.IJO_129_20 PMID:33120646
In this technique, the lamellar scleral tunnel is fashioned to cover IOL haptics and autologous blood is used to close the conjunctiva, which alleviates the need for fibrin glue. The cornea is marked at four and 10'O clock meridian, and 2 mm incision is made on the conjunctiva. A lamellar scleral tunnel is fashioned 2 mm superior on one side and 2 mm inferior on the other side of this mark. The IOL is inserted into the anterior chamber and the haptics are exteriorized using bent 26-gauge hypodermic needle, flanged, and buried in the tunnel. A visible conjunctival blood vessel is punctured, allowing the blood to pool underneath the conjunctiva. The conjunctiva is approximated with the help of blood coagulum and allowed to remain dry for 3 min. Lamellar scleral tunnels give adequate cover to haptics, and autologous blood can be used to glue the conjunctival flaps instead of fibrin glue.
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COMMENTARY |
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Commentary: Sutureless fixation of scleral fixated intraocular lens: Relevance and applicability |
p. 2481 |
Deepak Soni, Samendra Karkhur, Sunita Sabarwal, Bhavana Sharma DOI:10.4103/ijo.IJO_3180_20 PMID:33120647 |
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CONSENSUS CRITERIA |
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Guidelines for the management of ocular trauma during the COVID-19 pandemic |
p. 2483 |
Sundaram Natarajan, Akshay Gopinathan Nair, Raghuraj Hegde, Gangadhara Sundar, Maneesh M Bapaye, Gobinda Mukherjee, Purendra Bhasin, Mahipal S Sachdev, Namrata Sharma, Rajesh Sinha, AIOS Writing Group DOI:10.4103/ijo.IJO_1892_20 PMID:33120648
As the COVID-19 pandemic rages on, India is recording a very high number of new cases daily; even as the country prepares to gradually “unlock”, after months of lockdown. While elective eye surgeries such as uncomplicated cataract surgeries, blepharoplasty and eyelid procedures and refractive surgeries can be planned at a later date; emergency cases pertaining to ocular trauma cannot be deferred. This manuscript gives a brief overview of the general guidelines for the management of ocular trauma during the COVID-19 pandemic.
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INNOVATION IN OPHTHALMOLOGY |
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Safe Slit-lamp Shield: Maintaining a balance between ergonomics and safety |
p. 2486 |
Anjali Khadia, Sivagami Nachiappan, Iva R Kalita, Harsh Vardhan Singh, Rajesh Vedachalam, Rengaraj Venkatesh DOI:10.4103/ijo.IJO_2325_20 PMID:33120649
Since the emergence of COVID pandemic, health workers have been facing major challenges every day. Ophthalmology practice has encountered countless modifications in the practice pattern not to jeopardize patient care and at the same time maintain all safety measures to reduce transmission. One such modification we made was the Safe Slit-Lamp Shield (SSS) which has been found to be extremely protective in differentiation to other available shield. Although SSS has a larger surface area when compared to already available shields, it won't compromise the comfort of the clinician at the same time gives satisfactory protection.
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PHOTO ESSAY |
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Confocal imaging in a fungal invasion of contact lenses |
p. 2490 |
Garvit Bhutani, Pravin K Vaddavalli DOI:10.4103/ijo.IJO_2181_19 PMID:33120650
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Corneal epithelial hyperplasia masquerading as ocular surface squamous neoplasia |
p. 2491 |
Swati Singh, Ruchi Mittal, Purvasha Narang, Vikas Mittal DOI:10.4103/ijo.IJO_264_20 PMID:33120651
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Globe rupture following eye rubbing in a case of Terrien's marginal degeneration in a young male |
p. 2493 |
Surbhi Khurana, Parul Chawla Gupta, Aman Kumar, Jagat Ram DOI:10.4103/ijo.IJO_1858_19 PMID:33120652
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Idiopathic spontaneous filtering bleb: Is there an autoimmune etiology? |
p. 2494 |
Siva Prasanna Thilagar, Prasanna Venkataraman, Premanand Chandran DOI:10.4103/ijo.IJO_406_20 PMID:33120653
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Ruptured unilateral anterior lenticonus with congenital hypertrophy of retinal pigment epithelium: A rare association |
p. 2496 |
Kirandeep Kaur, Bharat Gurnani, K Jezeela, K Veena DOI:10.4103/ijo.IJO_898_20 PMID:33120654
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Prepapillary vascular loop – A rare cause of vitreous hemorrhage |
p. 2497 |
Somya Ish, Deepa Sharma, Ashok Pathak, Rahul Verma, Himanshu Garkoti, Sudha Kumari DOI:10.4103/ijo.IJO_382_20 PMID:33120655
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Secondary choroidal neovascular membrane in a case of torpedo maculopathy |
p. 2499 |
Manoj Soman, Asmita Indurkar, Ashwin Mohan, Unnikrishnan Nair DOI:10.4103/ijo.IJO_468_20 PMID:33120656
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Unilateral cone dysfunction with asymmetric maculopathy - Clinical features, multimodal imaging and genetic analysis of a novel phenotype |
p. 2501 |
B Poornachandra, Bharathi Bhavaharan, Sherina Thomas, Padmamalini Mahendradas, Arkasubhra Ghosh, Chaitra Jayadev, Anuprita Ghosh, Santosh G Krishna DOI:10.4103/ijo.IJO_795_20 PMID:33120657
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Retinal astrocytic hamartoma and systemic spectrum of disease in successive generations with tuberous sclerosis complex |
p. 2504 |
Gitanjli Sood, Ramanuj Samanta, Sneha Pandurangan, Pankaj Sharma, Anupam Singh, Ajai Agrawal DOI:10.4103/ijo.IJO_891_20 PMID:33120658
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Bilateral isolated choroidal melanocytosis with hypopigmented posterior pole |
p. 2507 |
Jae Kyoung Lee, Yu Cheol Kim DOI:10.4103/ijo.IJO_1731_20 PMID:33120659
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Recurrent posterior scleritis with secondary choroidal osteoma in a child |
p. 2509 |
Nivedita Nair, Sharanya Abraham, Sudha K Ganesh DOI:10.4103/ijo.IJO_521_20 PMID:33120660
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Bilateral macular infarction in a patient with metastatic breast carcinoma |
p. 2511 |
Devesh Kumawat, Siddharth Patel, Sandhya Yadav, Ramanuj Samanta, Sanjeev Kumar Mittal DOI:10.4103/ijo.IJO_1734_20 PMID:33120661
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Concurrent ophthalmic artery occlusion and optic nerve infarction after cosmetic facial filler |
p. 2512 |
Hyun-Hae Cho, Dae Joong Ma, Min Seong Kim, In Hwan Cho DOI:10.4103/ijo.IJO_294_20 PMID:33120662
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A flower in the brain: Planum sphenoidale meningioma |
p. 2514 |
Soveeta Rath, Dandu R Varma, Shailja Tibrewal, Suma Ganesh, Neha Gupta DOI:10.4103/ijo.IJO_618_20 PMID:33120663
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Beware of artifacts in orbital magnetic resonance imaging |
p. 2516 |
Dandu R Varma, Sandeep Ponnaganti, Rithika V Dandu DOI:10.4103/ijo.IJO_640_20 PMID:33120664
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Linear scleroderma en coup de sabre in an adult female: Ocular, adnexal and tomographic features |
p. 2518 |
Sushmita G Shah, Nirav D Raichura, Komal Parikh, Deepa Sonawane, Gaurav Y Shah DOI:10.4103/ijo.IJO_525_20 PMID:33120665
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A case of cutaneous fistula at the incision site following external dacryocystorhinostomy in a patient with rheumatoid arthritis and reconstruction via bilobed flap technique |
p. 2520 |
Mehmet Serhat Mangan, Seyma Gulcenur Ozturan, Serap Yurttaser Ocak, Ceyhun Arici, Yavuz Uyar DOI:10.4103/ijo.IJO_463_20 PMID:33120666
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OPHTHALMIC IMAGES |
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Eccrine poroma of the eyelid |
p. 2522 |
Manjula Sharma, Manpreet Singh, Kirti Gupta, Manpreet Kaur, Pankaj Gupta DOI:10.4103/ijo.IJO_666_20 PMID:33120667 |
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Conjunctival dirofilariasis presenting as a painless, cystic nodule: An unusual manifestation |
p. 2523 |
Shivani Bidaye Sule, Akshay Gopinathan Nair, Satish Sule, Abhay Pande DOI:10.4103/ijo.IJO_712_20 PMID:33120668 |
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In-vivo and ex-vivo analysis of an unusual case of huge bullous keratopathy |
p. 2524 |
Giuseppe Giannaccare, Andrea Lucisano, Vincenzo Scorcia DOI:10.4103/ijo.IJO_1085_20 PMID:33120669 |
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Radial ciliary vessel in the angle of anterior chamber |
p. 2525 |
Premanand Chandran, Ekta Arora, Abhipsa Sahu DOI:10.4103/ijo.IJO_684_20 PMID:33120670 |
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Iris implantation cyst: A benign visual prognosticator |
p. 2526 |
Subodh Lakra, Dewang Angmo DOI:10.4103/ijo.IJO_241_20 PMID:33120671 |
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Starry sky cataract in a teenage girl |
p. 2527 |
Surbhi Khurana, Parul Chawla Gupta, Jagat Ram DOI:10.4103/ijo.IJO_905_20 PMID:33120672 |
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Retained anterior capsule: A masquerader of Descemet's membrane detachment |
p. 2528 |
Prathama Sarkar, Harish C Gandhi, Mohit K Gupta, Parag M Tembhurde DOI:10.4103/ijo.IJO_784_20 PMID:33120673 |
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Rare traumatic anterior dislocation of capsular tension ring-intraocular lens complex in-toto |
p. 2529 |
Bharat Gurnani, Kirandeep Kaur DOI:10.4103/ijo.IJO_807_20 PMID:33120674 |
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Optic disc pseudoduplication accompanied with macular hole |
p. 2530 |
Farhad Fazel, Yasaman Zarrin, Mohammadreza Fazel DOI:10.4103/ijo.IJO_927_20 PMID:33120675 |
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Multiplexed optical coherence tomography imaging of optic disc drusen |
p. 2531 |
Isabelle Karlesand, Anne-Sofie Wessel Lindberg, Lasse Malmqvist, Lea Lybek Rueløkke, Steffen Hamann DOI:10.4103/ijo.IJO_607_20 PMID:33120676 |
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Polypoidal choroidal vasculopathy invading the optic disc |
p. 2532 |
Alessandro Marchese, Francesco Bandello, Giuseppe Querques DOI:10.4103/ijo.IJO_937_19 PMID:33120677 |
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Posterior subtenon injection of triamcinolone acetate in subhyaloid space: A rare complication |
p. 2533 |
CK Minija, Nidhi Dubey, Mahesh P Shanmugam, Devashish Dubey DOI:10.4103/ijo.IJO_1313_20 PMID:33120678 |
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Cherubism with orbital involvement |
p. 2534 |
Javier Lacorzana, Carlos Galvez Prieto-Moreno DOI:10.4103/ijo.IJO_870_20 PMID:33120679 |
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Unilateral orbital emphysema in a COVID-19 patient |
p. 2535 |
Deepsekhar Das, Zakia Anwer, Neha Kumari, Stuti Gupta DOI:10.4103/ijo.IJO_2385_20 PMID:33120680 |
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Enophthalmos in silent brain syndrome |
p. 2536 |
Leonardo Lando, Marina O S Paiva, Luciano S Pereira DOI:10.4103/ijo.IJO_897_20 PMID:33120681 |
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Optic chiasm: Visualizing the visual pathway |
p. 2537 |
Apinderpreet Singh, Rajesh Chhabra, Aditi Mehta, Ramandeep Singh Virk DOI:10.4103/ijo.IJO_1163_20 PMID:33120682 |
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CASE REPORTS |
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Limbal, low-grade myofibroblastic sarcoma: Case report and literature review |
p. 2538 |
Kaustubh Mulay, Mrittika Sen, Santosh G Honavar DOI:10.4103/ijo.IJO_2410_20 PMID:33120683
Low-grade myofibroblastic sarcoma is a relatively recently-described neoplasm of the myofibroblasts having a predilection for the head and neck region. Ophthalmic involvement is extremely rare. Limbal involvement has not yet been documented in the literature. We describe one such case involving the limbus of a 48-year-old Asian male.
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Management of ocular surface squamous neoplasia extending up to a filtering trabeculectomy bleb |
p. 2540 |
Sonal P Yadav, Swapnil S Patil, Rahul D Deshpande DOI:10.4103/ijo.IJO_814_20 PMID:33120684
A 73-year-old-gentleman was referred for ocular surface squamous neoplasia (OSSN) in his right eye (RE). He had history of combined cataract with trabeculectomy in RE and was maintaining his intraocular pressure (IOP). He showed a corneoscleral lesion measuring 11 × 8 mm in nasal quadrant wherein, the superior edge of the lesion was extending up to the filtering bleb. After ruling out intraocular invasion or regional spread, he underwent complete tumor excision with “no touch” technique along with cryotherapy and surface reconstruction and a perilesional injection of Interferon α2B. At 6-month visit, he shows no locoregional recurrence and has controlled IOP.
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Persistent loss of marginal corneal arcades after chemical injury |
p. 2543 |
Carlos Rocha de Lossada, Luca Pagano, Kunal A Gadhvi, Davide Borroni, Gustavo Figueiredo, Stephen Kaye, Vito Romano DOI:10.4103/ijo.IJO_2056_20 PMID:33120685
Changes in the limbal microvasculature following a chemical eye injury are essential for prognosis and management. At the slit lamp, it can be difficult to assess, here using fluorescein and indocyanine green angiography we show that anterior segment angiography may be informative to assess objectively the limbal microvascular changes over the follow-up period.
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Case report of a PRDM5 linked brittle cornea syndrome type 2 in association with a novel SLC6A5 mutation |
p. 2545 |
Agnes Selina, Deepa John, Lakshmi Loganathan, Vrisha Madhuri DOI:10.4103/ijo.IJO_325_20 PMID:33120686
A 3-year-old girl presenting with blue sclera, hyperlaxity and developmental dysplasia of hip was found to have bilateral corneal thinning with astigmatism and keratoconus. By clinical exome sequencing, a frameshift mutation c.713_716 del TTTG p.(Val238Alafs*35) in PRDM5 gene causing brittle cornea syndrome 2 and a novel frameshift mutation c.401dup p.(Ser135Glufs*53) in SLC6A5 gene causing Hyperekplexia 3 were identified. No features of hyperekplexia were identified in proband. The novel homozygous mutation of SLC6A5 gene in the proband was presently asymptomatic but they were apprised of the possibility of developing neurological symptoms in the later years.
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Invasion of the therapeutic contact lens by a rare fungal species presenting as the acute red eye: A case report |
p. 2548 |
CS Lalitha, Bhagabat Nayak, Vinaykumar Hallur, Anjali Kharolia DOI:10.4103/ijo.IJO_1634_20 PMID:33120687
Therapeutic contact lens used in the treatment of non-infective corneal pathologies are prone to infection by microorganisms like bacteria, protozoa and fungi. Bacteria cause the majority of contact lens-related infections. Although rare, fungal invasion of soft contact lenses is a potentially severe complication which may cause keratitis and more fulminating infections. Contact lens invasion can present as acute red eye warranting its replacement to prevent the development of keratitis. Different genera and species of fungi are documented to cause contact lens invasion. We report a rare case of fungal invasion of the contact lens by Aspergillus nidulans.
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Burkholderia cenocepacia keratitis |
p. 2550 |
Geeta Behera, Radha Sugumar, Sujata Sistla, Mary Stephen, Subashini Kaliaperumal, K Ramesh Babu DOI:10.4103/ijo.IJO_1905_20 PMID:33120688
Case report: A 33-year-old lady with history of failed keratoplasty for decompensated cornea due to childhood trauma and secondary glaucoma, post glaucoma drainage implant, with pseudophakia in the right eye, developed bacterial keratitis following foreign body trauma to corneal graft. Corneal cultures yielded Burkholderia cenocepacia identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF- MS, bioMerieux, France). She healed with topical antibiotics (moxifloxacin 0.5%) in 1 month. Ours is the first report of ocular Burkholderia cenocepacia infection, possibly an under reported, aerobic, organism.
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Microsporidial stromal keratitis in an immunocompromised patient: Successful management with medical therapy |
p. 2552 |
Amanjot Kaur, Srikant K Sahu, Sanchita Mitra, Sujata Das DOI:10.4103/ijo.IJO_2348_20 PMID:33120689
Microsporidial stromal keratitis is refractory to topical drugs and is classically described in immunocompetent hosts. A 55-year-old patient with renal transplant and oral immunosuppressants, presented with a 15-day history of redness, pain, and diminution of vision in the right eye. Slit-lamp examination revealed epithelial defect and mid-stromal infiltrate. On corneal scraping, microsporidial spores were observed. The patient was started on topical 0.02% polyhexamethylene biguanide (PHMB) and the infiltrate resolved after 6 weeks of initiation of topical therapy.
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Necrotizing scleritis following uncomplicated strabismus surgery |
p. 2555 |
Amar Pujari, Manthan Hasmukhbhai Chaniyara, Pradeep Sharma, Namrata Sharma DOI:10.4103/ijo.IJO_1839_19 PMID:33120690
A 5-year-old child having infantile esotropia with bilateral inferior oblique over action underwent uncomplicated strabismus surgery. On the first postoperative day, the child was orthophoric but on day 10, the child was brought with the complaints of severe pain and redness along the original insertion of left medial rectus muscle. Immediate medical management was initiated after appropriate microbiological sampling. Subsequently, on day 13, patient developed sudden discomfort after a bout of violent cough followed by severe pain and discomfort. Slit-lamp examination confirmed the scleral wound dehiscence with vitreous prolapse for which early scleral patch graft within 6 h was performed to achieve optimal visual and cosmetic outcomes.
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Combination microinvasive glaucoma surgery: 23-gauge cystotome goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube surgery in refractory and severe glaucoma: A case series |
p. 2557 |
Daniel Laroche, Gideon Nkrumah, Chester Ng DOI:10.4103/ijo.IJO_892_20 PMID:33120691
The purpose of this study is to present the efficacy of combined goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube insertion surgery in five patients with refractory and severe glaucoma. This Single-center, case series of five (5) Black and Afro-Latino patients with refractory and severe glaucoma who underwent combination microinvasive glaucoma surgery; 23-gauge goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube insertion. Patients who underwent the above procedure with 6 months follow-up were included. Investigated parameters were intraocular pressure (IOP), number of medications, visual field findings, and visual acuity. Five patients with moderate to severe refractory glaucoma who had undergone 23-gauge cystotome goniotomy and ciliary sulcus suprachoroidal microtube had a reduction of IOP by 32% (mean pre-op and post-op 16.6 mmHg and 11 mmHg, respectively) and a reduction of ocular medications by 61.5% (mean pre-op and post-op of 5.2 and 2.4, respectively). All patients had either stabilization or improvement of their visual fields. Four of the five patients also showed an improvement in visual acuity. This novel approach of combined 23-gauge goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube insertion surgery is safe and is an affordably effective means of managing patients with moderate to advanced refractory glaucoma, leading to a reduction in IOP and the number of medications with no serious adverse effects.
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Femtosecond laser-assisted refractive capsulorhexis – Precise capsulotomy with accurate toric intraocular lens alignment |
p. 2562 |
Manpreet Kaur, Jeewan Singh Titiyal, Farin Shaikh, Deeksha Rani DOI:10.4103/ijo.IJO_1677_20 PMID:33120692
Femtosecond laser-assisted cataract surgery with refractive capsulorhexis and toric intraocular lens (IOL) implantation was performed in 14 eyes with senile cataract and a preexisting regular corneal astigmatism of 1.5 D or more. Intraoperatively, the accuracy of the capsular rim marks was confirmed using the digital overlay of CALLISTO Eye and Z Align (Carl Zeiss Meditec, Germany). Postoperatively, the mean deviation from target axis of implantation was 2.07° ± 1.49°. Refractive capsulorhexis combines the advantages of a femtosecond laser capsulotomy with a one-step visual guide for intraoperative toric IOL alignment as well as postoperative assessment of rotational stability.
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Toric Artisan after transepithelial topography-guided photorefractive keratectomy for higher-order aberrations following intrastromal corneal ring segments in keratoconus – Trioptics |
p. 2564 |
Gabriel de Almeida Ferreira, Vinícius Coral Ghanem, Renata Leite de Pinho Tavares, Ramon Coral Ghanem DOI:10.4103/ijo.IJO_73_20 PMID:33120693
We report a case of a 40-year-old female with keratoconus and high myopia who had previous ICRS implantation in both eyes (OU) and was intolerant to contact lenses. Manifest refraction was -8.50 -1.50 × 95 (20/25--) in right eye (OD) and -9.50 -2.50 × 60 (20/70--) in left eye (OS). A topography-guided transepithelial-photorefractive keratectomy (ttPRK) was performed to correct high-order aberrations on OS, resulting in corneal surface and coma improvement, and CDVA achieved 20/30. Correction of residual ametropia was performed with an iris-fixated toric phakic lens in OU. CDVA improved to 20/20- (Plano) in OD and 20/20- (Plano -1.00 90°) in OS. In conclusion, it is possible to rehabilitate a patient with keratoconus and high ametropia after intrastromal corneal ring segments (ICRS) implantation associating ttPRK and phakic lens (”Trioptics”).
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A case report of children of the same family presenting with congenital cataract- as part of a rare genetic disorder–Sengers Syndrome |
p. 2567 |
Rajesh V Prabu, Parul Priyambada, H Ranjini, Rajlaxmi B Wasnik DOI:10.4103/ijo.IJO_760_20 PMID:33120694
Sengers syndrome is a rare autosomal recessive mitochondrial disorder characterized by congenital cataract, hypertrophic cardiomyopathy, and mitochondrial myopathy. We report two siblings with known mutation for Sengers Syndrome (AGK gene mutation) who presented to us with cataract and hypertrophic cardiomyopathy. They have a deceased elder sibling who was operated for cataract earlier.
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Role of secukinumab in ankylosing spondylitis with tubercular uveitis |
p. 2569 |
Padmamalini Mahendradas, Vikramraj K Jain, Sherina Thomas, Ankush Kawali, Srinivasan Sanjay, Bhujang K Shetty DOI:10.4103/ijo.IJO_1081_20 PMID:33120695
We present the case of a 32-year-old Indian male one-eyed individual with a history of unilateral panuveitis with HLA B 27 positive spondyloarthropathy on systemic immunosuppressant (Adalimumab). He developed recurrent inflammation in the same eye in a span of 2 years, later complicated with retinal vasculitis. On evaluation, he was diagnosed with tubercular uveitis and started on antitubercular treatment along with systemic steroids. Inview of Increased IOP due to steroid response, Inj. Secukinumab ( IL 17 A inhibitor) was started and significant improvement was noted.
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Central retinal vein occlusion with COVID-19 infection as the presumptive etiology  |
p. 2572 |
Jaydeep A Walinjkar, Sneha C Makhija, Hitesh R Sharma, Sunil R Morekar, Sundaram Natarajan DOI:10.4103/ijo.IJO_2575_20 PMID:33120696
Thromboembolic phenomenon related to Coronavirus disease 2019 (COVID-19) has been well documented in literature; however, reported ocular manifestations of COVID-19 are limited to vision sparing ocular conditions like conjunctivitis. We report a case of a 17-year-old female who presented to us with central retinal vein occlusion with proven recent past COVID-19 infection as presumed etiology which was not known to her at the time of presentation.
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Retinal vasospastic phenomenon in a known case of systemic lupus erythematosus |
p. 2575 |
Sumita Phatak, Jilna Jaison, Manoj Soman, Ashwin Mohan, R Unnikrishnan Nair DOI:10.4103/ijo.IJO_161_20 PMID:33120697
Retinal vasospasm was visualized in a young female; a known case of systemic lupus erythematosus (SLE) retinopathy with unaffected vision. The fundus fluorescein angiogram showed a cyclical filling and emptying of the retinal vessels which was suggestive of vasospasm and a retinal Raynaud's-like phenomenon with no obvious perfusion deficit. There was retinal thinning involving the superficial layers that was seen on optical coherence tomography (OCT), capillary fill voids on OCT angiography, and retinal surface undulations seen on multicolor imaging. All imaging was performed on Spectralis (Heidelberg, Germany).
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Management of a unique case of post-traumatic posterior giant retinal tear and macular hole-associated rhegmatogenous retinal detachment |
p. 2577 |
Ramanuj Samanta, Gitanjli Sood, Shalaka R Waghamare, Raghavendra R Mareguddi, Sanjeev K Mittal, Ajai Agrawal DOI:10.4103/ijo.IJO_955_20 PMID:33120698
Blunt trauma to the eye can present with protean manifestations involving the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Herein, we present a case of a 21-year-old male, who presented with sudden diminution of vision in the right eye following blunt-trauma with a cricket ball. Examination revealed a posterior-GRT, full-thickness macular hole, rhegmatogenous retinal detachment, and vitreous hemorrhage in the right eye. He was managed with vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. The probable etiopathogenesis of posterior-GRT and various surgical challenges encountered in this case were also described illustratively in this report.
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Metastatic subretinal abscess in a patient with perinephric abscess |
p. 2580 |
Monika Kapoor, Preeti Singh, TK Nayana, Siddharth Madan, Sarita Beri DOI:10.4103/ijo.IJO_1369_20 PMID:33120699
An 80-year-old lady with uncontrolled type 2 diabetes developed fever and abdominal pain followed by a sudden diminution of vision in her left eye. Right infra-renal abscess accounted for abdominal pain. A metastatic left subretinal abscess was diagnosed subsequently. Medical management for her systemic condition initiated. Vitreous biopsy was performed along-with intravitreal antibiotic administration. Because of no clinical recovery, patient underwent pars plana vitrectomy. Prompt systemic stabilization and a timely surgical intervention in the left eye resulted in a satisfactory visual gain. Metastatic subretinal abscess following a perinephric abscess is rare phenomenon and only a few cases are reported to date.
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Extraocular spread following evisceration for rapidly progressive intraocular tuberculosis |
p. 2583 |
Hrishikesh Kaza, Soumyava Basu, Mudit Tyagi, Saumya Jakati, Tarjani Dave, Somasheila I Murthy DOI:10.4103/ijo.IJO_1392_20 PMID:33120700
We describe a case of right eye tubercular (TB) panuveitis with corneal involvement where repeated intraocular sampling was unsuccessful. Finally, evisceration and histopathology of ocular tissue confirmed the diagnosis of ocular tuberculosis. A chest X-ray showed signs of pulmonary TB. The patient was lost to follow-up but reported 2 months later with the right eyelid margin nodules with surface ulceration. Both eyelid and pulmonary lesions were resolved with anti-TB therapy.
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Bilateral retinal detachment in Goldenhar syndrome |
p. 2585 |
Phuntsho Dorji, Muralidhar Ramappa, Brijesh Takkar DOI:10.4103/ijo.IJO_401_20 PMID:33120701
The ocular features of Goldenhar syndrome (GS) are typically external, like surface dermoids and lid coloboma. Retinal detachment (RD) is rare and has not been reported in absence of other concomitant predisposing congenital ocular disorders. We present a unique case of bilateral rhegmatogenous retinal detachment (RRD) with GS. To the best of our knowledge, this association of GS with RRD is novel and has not been reported earlier in ophthalmic and systemic literature on RRD.
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Idiopathic thrombocytopenic purpura and its fundus features in a patient with diabetes mellitus |
p. 2587 |
R Rajesh, Mahesh P Shanmugam, Pradeep Sagar DOI:10.4103/ijo.IJO_933_20 PMID:33120702
In this case report, we present a patient with thrombocytopenia secondary to idiopathic thrombocytopenic purpura (ITP), whose fundus appearance had features of diabetic retinopathy with macular edema. The macular edema did not respond to multiple intravitreal Anti-Vascular endothelial growth factor (Anti-VEGF), contrary to diabetic cystoid macular edema (CME). He was systemically investigated and was found to have ITP, and its management resulted in complete regression of the hemorrhages and CME.
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Amycolatopsis sulphurea as the first reported agent of endophthalmitis in a patient after penetrating eye trauma with intraocular foreign body: A case report |
p. 2589 |
Berna Yuce, Sila Dogan, Gamze Ture, Nisel Ozkalay DOI:10.4103/ijo.IJO_399_20 PMID:33120703
We report an Amycolatopsis sulphurea endophthalmitis after the surgical repair of penetrating eye trauma with a metallic intraocular foreign body. A 27-year-old male referred with occupational injury by a nail from his left eye. Endophthalmitis occurred 12 h after the removal of foreign body and repair of the globe. The culture of vitreus samples revealed gram-positive bacillus proliferation, confirming A. sulphurea. Endophthalmitis was eradicated successfully with intravitreal, topical, and systemic antibiotics. To the best of our knowledge, this is the first case, reporting A. sulphurea endophthalmitis.
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Endophthalmitis due to Delftia acidovorans: An unusual ocular pathogen |
p. 2591 |
Amit K Deb, Pratima Chavhan, Sushmita S Chowdhury, Sujatha Sistla, Radha Sugumaran, Gayathri Panicker DOI:10.4103/ijo.IJO_373_20 PMID:33120704
Endophthalmitis is a dreaded postoperative complication of cataract surgery. Delftia acidovorans is usually nonpathogenic and an unusual ocular pathogen. Isolated reports of delftia-associated sepsis, otitis media, endocarditis, keratitis, etc. exist in literature. We report a rare and unique case of delftia-related endophthalmitis in a 67-year-old male diagnosed 2 weeks after uneventful cataract surgery. He was treated successfully with core vitrectomy and intravitreal antibiotics. Microbiological evaluation of vitreous sample identified the causative organism as Delftia acidovorans. Post-vitrectomy fundus evaluation at 1 week revealed the presence of retinal vascular sheathing and sclerosis along with few retinal hemorrhages. Final visual recovery was poor due to the presence of macular edema, epiretinal membrane, and temporal disc pallor.
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Endogenous endophthalmitis due to Staphylococcus aureus in a lactating woman |
p. 2595 |
Simar R Singh, Anusuya Bhattacharyya, Mangat R Dogra, Ramandeep Singh, Mohit Dogra DOI:10.4103/ijo.IJO_740_20 PMID:33120705
Endogenous endophthalmitis (EE) is a rare but fulminant intraocular infection that needs prompt recognition and management. Bacteria are the commonest causative organisms and they may colonize the eye secondary to hematogenous spread from a focus anywhere in the body. EE in the peripartum period is an infrequent occurrence with no cases reported to occur secondary to a peurperal mastitis. We report a case of EE due to Staphylococcus aureous in a lactating female and describe its clinical presentation and management.
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COMMENTARY |
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Commentary: Peripartum endogenous bacterial endophthalmitis: A conundrum |
p. 2597 |
Jyotirmay Biswas, Nivedita Nair DOI:10.4103/ijo.IJO_1843_20 PMID:33120706 |
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CASE REPORTS |
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Pseudophakic macular edema involving epiretinal proliferation associated with macular hole |
p. 2599 |
Figen Batioglu, Özge Yanık, Sibel Demirel, Emin Özmert DOI:10.4103/ijo.IJO_602_20 PMID:33120707
This case report describes an unusual course of an impending macular hole (MH) throughout a 72-month follow-up period. A 53-year-old female presented with impending MH associated with epiretinal proliferation (EP) which showed unusual progress including full thickness MH, spontaneous closure, reopening as lamellar MH, and full anatomical closure with EP tissue. After cataract surgery, cystoid spaces occurred involving both EP tissue and neuroretina. Due to full recovery following a single dose of aflibercept, the source of the cystoid spaces was thought to be associated with postoperative inflammation leading to pseudophakic macular edema involving not only but also EP tissue.
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Macular tractional retinal detachment: A rare complication of blunt trauma |
p. 2602 |
Santosh Gopi Krishna Gadde, Ram Snehith, Chaitra Jayadev, B Poornachandra, Naveen K Naik, Naresh Kumar Yadav DOI:10.4103/ijo.IJO_1424_20 PMID:33120708
Traumatic rhegmatogenous retinal detachment after blunt ocular trauma is a known entity. A tractional macular detachment occurring posttrauma without a retinal break is a unique presentation. A 25-year-old gentleman after blunt ocular trauma with a ball presented a week later with a vision of 20/800, large subretinal bleed and resolving vitreous hemorrhage in the right eye. Three weeks later, an extensive glial proliferation at the posterior pole and macular tractional retinal detachment was noted with the worsening of visual acuity. A vitrectomy, membrane peeling, and silicone oil tamponade with a subsequent silicone oil removal at 6 months stabilized the macula, and vision improved to 20/120. A tractional macular detachment post blunt trauma is rare albeit an interesting occurrence, which can be effectively managed with vitrectomy and allied procedures.
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Double trouble with the disc - Hickam's dictum versus Occam's razor! |
p. 2605 |
Sujatha V Kadambi, Vijaya Lingam, Smita Praveen, Durga Priyadarshini, Ronnie George DOI:10.4103/ijo.IJO_825_20 PMID:33120709
Differentiating glaucomatous and non-glaucomatous optic neuropathy can be challenging even to an experienced clinician and it is even more complex to identify early ophthalmic manifestation of neurological lesions when the optic nerve is already jeopardized by advanced glaucoma. This is a case of a patient with juvenile open-angle glaucoma with advanced glaucomatous cupping who developed an intracranial tuberculoma and subsequent obstructive hydrocephalus. Subtle edema identified in an almost totally damaged nerve, coupled with a history of headache and tinnitus, was the clinching factor prompting early treatment in the form of ventriculoperitoneal shunting and antituberculous therapy. Detailed history, systematic clinical exam, and appropriate imaging are imperative in reducing morbidity and sometimes mortality associated with these neurological conditions.
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Paediatric Horner Syndrome: How much further to investigate? |
p. 2607 |
Manjushree Bhate, Maree Flaherty, Neil Rowe, Robert Howman-Giles DOI:10.4103/ijo.IJO_1603_20 PMID:33120710
We report an infant with an early-onset Horner syndrome and normal urinary catecholamine levels. Further investigations with Nuclear medicine imaging with123I-MIBG (meta-iodo benzyl-guanidine) confirmed a right thoracic inlet mass consistent with a neuroblastoma, a tumor of neural crest origin. The authors emphasize the need for investigating idiopathic acquired pediatric Horner syndrome and the value of an MIBG scan as a diagnostic test for suspected neuroblastoma.
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Acute comitant esotropia in a very young child due to combined mechanism: A case report |
p. 2610 |
Allapitchai Fathima, Meenakshi Ravindran, Neelam Pawar, Padmavathy Maharajan, Ramakrishnan Renagappa DOI:10.4103/ijo.IJO_344_20 PMID:33120711
We report a case of esotropia with high hyperopia in a 3-year-old female child. She was initially treated with hyperopic correction and noted to have residual esotropia, which was diagnosed as partial accommodative esotropia. Later when she presented with headache, she was diagnosed to have an intracranial tumour. To our surprise, after neurosurgical excision of tumour, her non-accommodative component of the esotropia resolved over 1 year implying that the intracranial lesion was an additional causative factor for this acute onset Accommodative esotropia. The child attained Orthophoria with the same hyperopic correction.
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Retroequatorial myopexy in the management of adult-onset cyclic esotropia |
p. 2613 |
Gunjan Saluja, Pradeep Sharma DOI:10.4103/ijo.IJO_1229_20 PMID:33120712
A 65-year-old otherwise healthy female, with bilateral normal visual acuity, presented with a unique pattern of strabismus. She complained of esotropia and diplopia occurring after every 24 h. There was no history of previous injury or ocular surgery. Other differentials were ruled out and the patient was diagnosed as adult-onset cyclic esotropia. The patient underwent right eye medial rectus retroequatorial myopexy, which tackled both diplopia and strabismus, without causing exotropia on nonsquint days.
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Combined medical and surgical management for cicatricial ectropion in lamellar ichthyosis: A report of three cases |
p. 2615 |
Nirmala Subramanian, Pratheeba Devi Nivean, Md Shahid Alam DOI:10.4103/ijo.IJO_855_20 PMID:33120713
Ichthyosis is a rare inherited skin disorder characterized by abnormal keratinization of the epidermis. Cicatricial ectropion is the most common ophthalmic feature of congenital ichthyosis. Progressive subepithelial cicatrization and abnormal cornification of eyelid skin cause progressive ectropion in both eyelids, leading to lagophthalmos and corneal exposure. Surgical correction of cicatricial ectropion in these cases is challenging with unsatisfactory results. Proper processing of the donor and recipient site with lubricants and topical retinoids before surgery makes grafting easier and its survival better. We present three cases of lamellar ichthyosis with cicatricial ectropion managed with combined preoperative topical therapy followed by surgery. All patients had extremely good surgical outcomes, with none of them requiring repeat surgery.
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Successful salvage intravenous chemotherapy after tandem selective ophthalmic artery infusion chemotherapy in bilateral retinoblastoma |
p. 2618 |
Hyun J Kim, Maura Di Nicola, James J Augsburger, Basil K Williams DOI:10.4103/ijo.IJO_576_20 PMID:33120714
We report the case of a 9-month-old girl with bilateral retinoblastoma who had incomplete tumor resolution after selective ophthalmic artery infusion chemotherapy (SOAIC). Systemic chemotherapy, rarely used as salvage therapy after SOAIC, with systemic carboplatin, etoposide, and vincristine achieved complete and sustained regression in both eyes.
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Malignant melanoma of the rectum presenting as orbital metastasis |
p. 2620 |
Natasha Narayanan, Utkarsha Padwal, Indumati Gopinathan, Rima S Pathak, Akshay Gopinathan Nair DOI:10.4103/ijo.IJO_847_20 PMID:33120715
An orbital mass being the presenting sign of disseminated systemic metastasis is a rare clinical picture. Here, the authors describe the case of a 52-year old Asian-Indian female who presented with unilateral proptosis and motility restriction. Imaging showed an irregular orbital mass infiltrating the right lateral rectus and with a significant intraconal component. Incisional biopsy helped to diagnose a malignant melanoma and exhaustive systemic imaging showed that the primary was found to be arising from the rectum. This represents the first reported case of malignant melanoma of the rectum metastasizing to the orbit and presenting with proptosis and reduced vision.
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LETTERS TO THE EDITOR |
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Commentary: Retinal hemodynamics, retrobulbar circulation and the use of color doppler imaging |
p. 2623 |
Mayank Bansal, Krithika Rangarajan DOI:10.4103/ijo.IJO_1378_20 PMID:33120716 |
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A quick glance at publications on COVID-19 and ophthalmology |
p. 2624 |
Sabera Banu, Swati Singh DOI:10.4103/ijo.IJO_2670_20 PMID:33120717 |
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“Eyecare on call” – Extending the frontiers of care through home-based eye care – Concept and the protocol |
p. 2625 |
Srinivas Marmamula, Niranjan K Yanamala, Rohit C Khanna DOI:10.4103/ijo.IJO_2352_20 PMID:33120718 |
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Tech-imprisonment in post.millennials: A boon or bane in the COVID-19 era? |
p. 2628 |
Karobi Lahiri Coutinho, Sailie Shirodkar, Anisha Rathod DOI:10.4103/ijo.IJO_2383_20 PMID:33120719 |
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Post-graduate exams amidst COVID-19 pandemic: Our experience |
p. 2630 |
VS Gupta, Monika Kapur, Mayuresh Naik, Ashraf Mohammad DOI:10.4103/ijo.IJO_2672_20 PMID:33120720 |
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Ocular complications of spitting cobra venom |
p. 2632 |
Maarten B Jalink DOI:10.4103/ijo.IJO_1164_20 PMID:33120721 |
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A surprising intravitreal injection attempt: Ozurdex™ implantation for Behçet's disease |
p. 2634 |
Onur Furundaoturan, Mine E Barış, Suzan Güven Yılmaz DOI:10.4103/ijo.IJO_2241_20 PMID:33120722 |
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A rare association of aniridia with conjunctival xerosis in two Indian siblings with PAX6 mutation |
p. 2635 |
Nair Vidya Gopinathan, Sankaranarayanan Rajkumar, Abhay Raghukant Vasavada DOI:10.4103/ijo.IJO_2185_20 PMID:33120723 |
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Systemic side effects of topical prostaglandin analogues: Rare but real |
p. 2637 |
Lipi Chakrabarty DOI:10.4103/ijo.IJO_2039_20 PMID:33120724 |
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