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   2005| October-December  | Volume 53 | Issue 4  
 
 
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OPHTHALMOLOGY PRACTICE
Botulinum toxin in ophthalmic plastic surgery
Milind N Naik, Charles NS Soparkar, R Murthy, SG Honavar
October-December 2005, 53(4):279-288
DOI:10.4103/0301-4738.18915  PMID:16333182
Botulinum toxin chemodenervation has evolved greatly over the past 30 years since its introduction in the 1970s for the management of strabismus. Among ophthalmic plastic surgeons, botulinum toxins are often used as the first line treatment for facial dystonias. These toxins are also efficacious for the temporary management of various other conditions including keratopathies (through so called chemo-tarsorraphy), upper eyelid retraction, orbicularis overaction-induced lower eyelid entropion, gustatory epiphora, Frey's syndrome, and dynamic facial rhytids such as lateral canthal wrinkles (crow's feet), glabellar creases and horizontal forehead lines. This article describes the pharmacology, reconstitution techniques and common current applications of botulinum toxins in ophthalmic plastic surgery.
  12,891 1,277 2
ORIGINAL ARTICLE
A comparison of the circadian rhythm of intraocular pressure in primary chronic angle closure glaucoma, primary open angle glaucoma and normal eyes
Ramanjit Sihota, R Saxena, M Gogoi, A Sood, V Gulati, RM Pandey
October-December 2005, 53(4):243-247
DOI:10.4103/0301-4738.18905  PMID:16333172
Purpose: To evaluate the circadian rhythm of intraocular pressure (IOP) in primary chronic angle closure glaucoma (PCACG), primary open angle glaucoma (POAG), and normal eyes. Methods: Cross-sectional study of newly diagnosed patients of POAG (60 eyes), PCACG following laser iridotomy (75 eyes), and age and sex matched normal controls (75 eyes). All subjects underwent applanation tonometry at 7 a.m., 10 a.m., 1 p.m., 4 p.m., 7 p.m., and 10 p.m. by a masked observer. Circadian rhythms were classified based upon the timing and presence of peak pressure. Results: Age and gender in all three groups were comparable. Diurnal IOP fluctuations were significantly higher in PCACG (7.69 + 3.03 mmHg) and POAG (8.31 + 2.58 mmHg) groups compared to normal controls (4.83 + 2.46 mmHg). PCACG eyes and controls had similarly timed circadian rhythms, with PCACG eyes having a consistently higher IOP. At 7 and 10 a.m., IOP peaked more often in POAG eyes compared to PCACG eyes. A plateau type of circadian rhythm was most common in normal eyes. The timing of peak IOP could be significantly correlated with the type of primary glaucoma examined. Conclusion: Afternoon peaks were more common in postiridotomy PCACG eyes, similar to the rhythm in normal eyes. Morning peaks were more frequent in POAG eyes. Diurnal fluctuation > 6 mmHg, associated with an IOP of 21 mmHg or more was never seen in a normal eye.
  12,437 673 23
Comparison of subtenon anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery
Tasneem Parkar, Parikshit Gogate, Madan Deshpande, Arif Adenwala, Amar Maske, K Verappa
October-December 2005, 53(4):255-259
DOI:10.4103/0301-4738.18907  PMID:16333174
Purpose: To compare the safety and efficacy of subtenon anaesthesia with peribulbar anaesthesia in manual small incision cataract surgery using a randomised control clinical trial. Method: One hundred and sixty-eight patients were randomised to subtenon and peribulbar groups with preset criteria after informed consent. All surgeries were performed by four surgeons. Pain during administration of anaesthesia, during surgery and 4 h after surgery was graded on a visual analogue pain scale and compared for both the techniques. Sub-conjuntival haemorrhage, chemosis, akinesia after administration of anaesthesia and positive pressure during surgery were also compared. Patients were followed up for 6 weeks postoperatively. Results: About 146/168 (86.9%) patients completed the six-week follow-up. Thirty-one out of 88 (35.2%) patients of peribulbar group and 62/80(77.5%) of subtenon group experienced no pain during administration of anaesthesia. There was no significant difference in pain during and 4 h after surgery. Subtenon group had slightly more sub-conjunctival haemorrhage. About 57 (64.8%) patients of the peribulbar group had absolute akinesia during surgery as compared to none (0%) in sub-tenon group. There was no difference in intraoperative and postoperative complications and final visual acuity. Conclusion: Sub-tenon anaesthesia is safe and as effective as peribulbar anaesthesia and is more comfortable to the patient at the time of administration.
  10,486 759 16
Synthetic hydroxyapatite-based integrated orbital implants: A human pilot trial
Biswanath Kundu, Mithlesh K Sinha, Santanu Mitra, Debabrata Basu
October-December 2005, 53(4):235-241
DOI:10.4103/0301-4738.18904  PMID:16333171
Purpose: Orbital implants are used as fillers following enucleation or evisceration surgeries to replace the lost volume for better cosmesis and motility of the artificial eye. Over the last decade porous hydroxyapatite (HAp) implants derived from the naturally occurring corals, are increasingly used. Recently synthetic HAp-based implants have been introduced. After fibrovasculrisation they have the added advantage of being directly integrated with the artificial shell, thereby increasing the motility to a great extent. The current study, evaluated the efficacy of two different models of synthetic HAp with 75% porosity and pore sizes ranging from 100 to 300 mm. Methods: Synthetic HAp powders were prepared with a novel wet chemical route. Two models of porous orbital implants with the characteristic designs for both evisceration and enucleation surgery were developed, characterised and implanted to consecutive 25 human subjects, 17 following evisceration, and 8 following enucleation. The postoperative performances of these implants were evaluated in respect to the degree of volume replacement (implant + prosthesis), presence/absence of lagophthalmos and lower eye-lid laxity, status of socket and fornices. Magnetic resonance imaging assessed the stability of the implants within the socket and progressive fibro-vascularisation within the porous scaffold as a function of time. Finally, motility of the implants as well as the prostheses (horizontal movements by Lister Perimeter) and subjective cosmetic results (qualitative) were also evaluated. Results: During the 2.5 years of follow-up study, no significant postoperative complications were noticed. One case, showed an anterior implant exposure of 3-4 mm, and was managed with donor scleral patch graft and one case of conjunctival thinning was corrected by re-suturing the conjunctival dehiscence. Fourteen of the 25 patients had a very good movement of the prostheses (> 20 horizontal movement) and the other 11 patients had a fair motility (10 - 20). The degree of volume replacement (with prosthesis) was found to be very good in 21 patients and fair in other 4 patients. All patients reported cosmetic satisfaction. Conclusion: Synthetic HAp-based integrated orbital implants with this modified design were found clinically safe and cosmetically acceptable.
  9,128 480 9
Profile of amblyopia in a hospital referral practice
Vimla Menon, Zia Chaudhuri, Rohit Saxena, Kulwant Gill, MM Sachdev
October-December 2005, 53(4):227-234
DOI:10.4103/0301-4738.18903  PMID:16333170
Objective: Evaluation of the clinical profile and distribution of different sub-types of amblyopia in a referral eye hospital in India. Methods: This was a prospective hospital-based observational study, evaluating the clinical profile of patients with amblyopia presenting to a referral strabismology practice. The examination included assessment of the visual acuity, the refractive status, the fixation pattern, the grade of binocularity, and evaluation of the associated strabismus, if any before treatment was started. Results: The average age of the patients at presentation was 7.976.18 years with 81 out of 683 patients (11.8%) presenting above the age of 20 years. The best-corrected visual acuity (BCVA) was less than 6/60 in the amblyopic eye in 121 out of 733 eyes (16.5%). Strabismic amblyopia was the most common sub-type of amblyopia seen (274/733 eyes, 37.38%). Though patients with anisometropic amblyopia presented at a later age (average of 10.036.92 years), they had better visual acuity, binocular functions, and centricity of fixation at all ages, relative to other sub-types of amblyopia. The BCVA did not show any co-relation with the age of presentation [co-relation co-efficient (CF) of 0.074], refractive status of the amblyopic eye (CF of 0.078), the type of amblyopia (CF of 0.196), or the type of strabismus present (CF of 0.079). However, a very significant co-relation was seen between the BCVA and the fixation pattern of the amblyopic eye (CF of 0.817). Conclusions: Lack of knowledge and awareness about amblyopia and its appropriate timely management has been the main cause for the late presentations and significant visual impairment associated with the condition.
  8,954 644 5
BOOK REVIEW
Pediatric cataract surgery: techniques, complications and management
Ashok Garg
October-December 2005, 53(4):296-296
  7,004 661 -
BRIEF REPORTS
Isolated foveal hypoplasia detected by optical coherence tomography
Vasumathy Vedantham
October-December 2005, 53(4):276-277
DOI:10.4103/0301-4738.18914  PMID:16333181
  6,707 352 6
ORIGINAL ARTICLE
Fulminate retinopathy of prematurity - Clinical characteristics and laser outcome
Parag K Shah, V Narendran, VR Saravanan, A Raghuram, Abhijit Chattopadhyay, Maithreyi Kashyap, Rodney J Morris, N Vijay, V Raghuraman, Virna Shah
October-December 2005, 53(4):261-265
DOI:10.4103/0301-4738.18908  PMID:16333175
Purpose: To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP. Methods: Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiro's classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP. Results: Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease. Conclusion: Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.
  5,902 491 11
BRIEF REPORTS
Goldenhar's sequence with associated juvenile glaucoma in Turner's syndrome
Vasudev Anand Rao, Subashini Kaliaperumal, Thanikachalam Subramanyan, Kotapalli Ramachandra Rao, Rajesh Bhargavan
October-December 2005, 53(4):267-268
DOI:10.4103/0301-4738.18909  PMID:16333176
  5,871 280 4
Conjunctival oculosporidiosis with scleral thinning and staphyloma formation
Sheeja Susan John, Shobhana G Mohandas
October-December 2005, 53(4):272-274
DOI:10.4103/0301-4738.18912  PMID:16333179
  5,746 296 2
ORIGINAL ARTICLE
Corneal hydration intra-operatively during phacoemulsification
Abhay R Vasavada, Sheena A Dholakia
October-December 2005, 53(4):249-253
DOI:10.4103/0301-4738.18906  PMID:16333173
Purpose: To evaluate incidence and risk factors for corneal hydration intra-operatively during phacoemulsification (CHIP). Methods and Materials: This was a randomised, clinical trial, where 240 eyes of 240 patients with senile cataracts undergoing phacoemulsification were prospectively randomised to receive one of three possible types of incision architecture - single, two or three planes. Viscoelastic injection through paracentesis, before instruments were withdrawn from the main incision, was randomly done. Incision length was grouped into 1.5, 2 and 2.5 mm. CHIP was graded as nil, mild, moderate or severe: nil - no visible CHIP, mild-CHIP involving pillars of the incision, moderate - CHIP involving pillars and lateral extension, severe - extension of CHIP in front into the clear cornea. Moderate and severe categories were combined as 'significant' CHIP. Statistical analysis was done by logistic regression. Results: The incidence of significant CHIP was 17.9 % (43 eyes out of 240). Five out of 80 eyes (6.25%) single plane, 8 out of 80 (10%) two plane and 30 out of 80 (37.5%) three- plane incisions developed significant CHIP (p = 0.005). Fifteen out of 120 (12.5%) with and 28 out of 120 (23.3%) without injection of viscoelastic developed significant CHIP (p = 0.044). Eighteen out of 43 (42.8%) and 25 out of 43(58.1%) with incision lengths 2 and 2.5 mm developed significant CHIP respectively (p<0.001). Conclusions: The incidence of significant CHIP was 17.9 %. Three-plane incisions, not injecting viscoelastic prior to retraction of instruments and incision length 2 mm or more are risk factors for significant CHIP.
  5,309 321 6
EDITORIAL
ABC of authorship: Aims, banes and credits
Barun K Nayak, Sunil Moreker, Deepti Pawar
October-December 2005, 53(4):223-224
DOI:10.4103/0301-4738.18902  PMID:16333169
  4,965 249 4
COMMUNITY OPHTHALMOLOGY
Correlation of confocal laser scanning tomography with planimetric photographic measurements of the optic disc in a normal South Indian population: The Vellore eye study
Ravi Thomas, Ronnie George, Jayapraksh Muliyil, Jost B Jonas
October-December 2005, 53(4):289-294
DOI:10.4103/0301-4738.18916  PMID:16333183
Purpose: To compare the confocal laser tomographic scanning evaluation with photographic measurements of the optic nerve head in a South Indian population. Methods: The prospective comparative clinical non-interventional epidemiologic study included 62 subjects (62 eyes) forming a population-based sample, selected randomly. Mean age was 47.2 8.9 years, mean refractive error measured was -0.17 1.10 diopter (range, - 4.50 to + 2.50 diopter). Confocal laser scanning tomographic images on Heidelberg Retina Tomograph (HRT) and colour optic disc photographs were morphometrically analysed and compared. Main outcome measures were morphologic optic disc parameters. Results: The optic disc area measurements were significantly smaller (p < 0.001) in the HRT technique than in the photographic method. In contrast, the HRT as compared to the photographic measurements showed significantly (p < 0.001) larger values for the relative width and relative area of the neuroretinal rim. The differences in measurements between both methods were maximum in the nasal part (p < 0.001) of the optic disc and minimum in the temporal disc region. Conclusion: In normal eyes of South Indians, neuroretinal rim measurements by the HRT and expressed as percentage of disc size measurements are significantly larger than rim measurements on disc photographs.
  4,755 223 5
BRIEF REPORTS
Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal haemangioma in Sturge-Weber syndrome
Ramesh Murthy, Santosh G Honavar, Milind Naik, Sollappan Gopi, Vijay Anand P Reddy
October-December 2005, 53(4):274-275
DOI:10.4103/0301-4738.18913  PMID:16333180
  4,382 300 5
Demonstration of varicella zoster virus in a case of presumed seasonal hyperacute panuveitis
Pratima Kathil, Jyotirmay Biswas, Lingam Gopal
October-December 2005, 53(4):270-272
DOI:10.4103/0301-4738.18911  PMID:16333178
  4,399 222 4
Optical coherence tomography in Amikacin-induced macular infarction
Pradeep Venkatesh, Parul Sony, Hem Kumar Tewari, Sat Pal Garg
October-December 2005, 53(4):269-270
DOI:10.4103/0301-4738.18910  PMID:16333177
  3,929 261 2
LETTER TO EDITOR
Are the Indian retinopathy of prematurity criteria appropriate for Indian babies?
Nikunj J Shah
October-December 2005, 53(4):295-295
DOI:10.4103/0301-4738.18917  PMID:16333184
  3,558 229 2
BOOK REVIEW
Dr. Agarwal's step by step phaco
Ashok Garg
October-December 2005, 53(4):296-296
  0 0 -
Management of ocular trauma
Ashok Garg
October-December 2005, 53(4):296-296
  0 0 -