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   2007| July-August  | Volume 55 | Issue 4  
 
 
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CURRENT OPHTHALMOLOGY
Amniotic membrane transplantation: A review of current indications in the management of ophthalmic disorders
Virender S Sangwan, Sanghamitra Burman, Sushma Tejwani, Sankaranarayana Pillai Mahesh, Ramesh Murthy
July-August 2007, 55(4):251-260
DOI:10.4103/0301-4738.33036  PMID:17595472
Amniotic membrane transplantation is currently being used for a continuously widening spectrum of ophthalmic indications. It has gained widespread attention as an effective method of reconstruction of the ocular surface. Amniotic membrane has a unique combination of properties, including the facilitation of migration of epithelial cells, the reinforcement of basal cellular adhesion and the encouragement of epithelial differentiation. Its ability to modulate stromal scarring and its anti-inflammatory activity has led to its use in the treatment of ocular surface pathology as well as an adjunct to limbal stem cell grafts. Amniotic membrane transplantation has been used for reconstruction of the corneal surface in the setting of persistent epithelial defects, partial limbal stem cell deficiency, bullous keratopathy and corneoscleral ulcers. It has also been used in conjunction with limbal stem cell transplantation for total limbal stem cell deficiency. Amniotic membrane grafts have been effectively used as a conjunctival substitute for reconstruction of conjunctival defects following removal of pterygia, conjunctival lesions and symblephara. More recently, amniotic membrane has been used as a substrate for ex vivo cultivation of limbal, corneal and conjunctival epithelial cells. This article reviews the current literature on the applications of amniotic membrane transplantation and its outcome in various ophthalmic conditions.
  48,373 5,202 37
ORIGINAL ARTICLE
Computer vision syndrome: A study of the knowledge, attitudes and practices in Indian Ophthalmologists
Jatinder Bali, Neeraj Navin, Bali Renu Thakur
July-August 2007, 55(4):289-293
DOI:10.4103/0301-4738.33042  PMID:17595478
Purpose: To study the knowledge, attitude and practices (KAP) towards computer vision syndrome prevalent in Indian ophthalmologists and to assess whether 'computer use by practitioners' had any bearing on the knowledge and practices in computer vision syndrome (CVS). Materials and Methods: A random KAP survey was carried out on 300 Indian ophthalmologists using a 34-point spot-questionnaire in January 2005. Results: All the doctors who responded were aware of CVS. The chief presenting symptoms were eyestrain (97.8%), headache (82.1%), tiredness and burning sensation (79.1%), watering (66.4%) and redness (61.2%). Ophthalmologists using computers reported that focusing from distance to near and vice versa ( P =0.006, χ2 test), blurred vision at a distance ( P =0.016, χ2 test) and blepharospasm ( P =0.026, χ2 test) formed part of the syndrome. The main mode of treatment used was tear substitutes. Half of ophthalmologists (50.7%) were not prescribing any spectacles. They did not have any preference for any special type of glasses (68.7%) or spectral filters. Computer-users were more likely to prescribe sedatives/ anxiolytics ( P = 0.04, χ2 test), spectacles ( P = 0.02, χ2 test) and conscious frequent blinking ( P = 0.003, χ2 test) than the non-computer-users. Conclusions: All respondents were aware of CVS. Confusion regarding treatment guidelines was observed in both groups. Computer-using ophthalmologists were more informed of symptoms and diagnostic signs but were misinformed about treatment modalities.
  21,893 2,420 4
New classification system-based visual outcome in Eales' disease
Sandeep Saxena, Dipak Kumar
July-August 2007, 55(4):267-269
DOI:10.4103/0301-4738.33038  PMID:17595474
Purpose: A retrospective tertiary care center-based study was undertaken to evaluate the visual outcome in Eales' disease, based on a new classification system, for the first time. Materials and Methods: One hundred and fifty-nine consecutive cases of Eales' disease were included. All the eyes were staged according to the new classification: Stage 1: periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages; Stage 2a: capillary non-perfusion, 2b: neovascularization elsewhere/of the disc; Stage 3a: fibrovascular proliferation, 3b: vitreous hemorrhage; Stage 4a: traction/combined rhegmatogenous retinal detachment and 4b: rubeosis iridis, neovascular glaucoma, complicated cataract and optic atrophy. Visual acuity was graded as: Grade I 20/20 or better; Grade II 20/30 to 20/40; Grade III 20/60 to 20/120 and Grade IV 20/200 or worse. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. Results: Vitreous hemorrhage was the commonest presenting feature (49.32%). Cases with Stages 1 to 3 and 4a and 4b achieved final visual acuity ranging from 20/15 to 20/40; 20/80 to 20/400 and 20/200 to 20/400, respectively. Statistically significant improvement in visual acuities was observed in all the stages of the disease except Stages 1a and 4b. Conclusion: Significant improvement in visual acuities was observed in the majority of stages of Eales' disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales' disease.
  6,854 905 5
BRIEF REPORTS
Clinical spectrum of spontaneous carotid-cavernous fistula
Jayanta Kr Das, Jnanankar Medhi, Pankaj Bhattacharya, Nilutpol Borah, Kasturi Bhattacharjee, Ganesh C Kuri, Hemlata Deka, Biraj J Goswami
July-August 2007, 55(4):310-312
DOI:10.4103/0301-4738.33051  PMID:17595487
A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF is divided into two categories, direct and indirect. Direct fistulas usually account for 70 to 90% of all CCF. Spontaneous, low-flow fistulas are usually associated with atherosclerosis, hypertension and collagen vascular disease or may develop in females during peripartum period. The elderly age group, especially women are at increased risk. We report three cases of spontaneous CCF presenting with ocular manifestations and hypertension, without any collagen vascular disease. One case was a direct variety and the other two were of indirect variety.
  6,541 732 9
ORIGINAL ARTICLE
Application of semi-nested polymerase chain reaction targeting internal transcribed spacer region for rapid detection of panfungal genome directly from ocular specimens
R Bagyalakshmi, KL Therese, HN Madhavan
July-August 2007, 55(4):261-266
DOI:10.4103/0301-4738.33037  PMID:17595473
Background: The incidence of fungal endophthalmitis has dramatically increased in recent years and rapid detection of fungi using nucleic acid-based amplification techniques is helpful in management. Aim: To evaluate semi-nested polymerase chain reaction (PCR) targeting internal transcribed spacer (ITS) region for detection of panfungal genome in ocular specimens. Statistical analysis used: Z test for two proportion. Materials and Methods: Standardization of PCR targeting ITS primers was carried out by determining analytical sensitivity and specificity. The sensitivity and specificity of PCR was determined by serial tenfold dilutions of C. albicans (ATCC 24433) DNA and DNA extracts of laboratory isolates of Aspergillus fumigatus , Fusarium lichenicola (4), other fungal and closely related bacterial strains and also human DNA. Semi-nested PCR was applied onto a total of 168 ocular specimens with clinically suspected fungal etiology during 2003-2005. Results and Conclusions: PCR was specific and sensitive to detect 1fg of fungal DNA with ITS primers. PCR detected fungal genome in 90 (53.57%) in comparison with the conventional technique, positive in 34 (20.23%) by smear examination and in 42 (25%) by culture. The increase in clinical sensitivity by 28.57% using PCR was found to be statistically significant { P < 0.001 using Z test for two proportion}. The accuracy of the test was found to be 70.85%. PCR proved to be a rapid diagnostic technique for detection of panfungal genome directly from clinical specimens
  6,236 733 11
Comparative evaluation of optical coherence tomography in glaucomatous, ocular hypertensive and normal eyes
Sujata Subbiah, S Sankarnarayanan, Philip A Thomas, CA Nelson Jesudasan
July-August 2007, 55(4):283-287
DOI:10.4103/0301-4738.33041  PMID:17595477
Background: To correlate the findings of optical coherence tomography (OCT) evaluation of retinal nerve fiber layer (RNFL) thickness with visual field changes in glaucomatous, ocular hypertensive and normal eyes. Materials and Methods: Thirty consecutive normal, 30 consecutive ocular hypertensive and 30 consecutive glaucomatous eyes underwent a complete ophthalmic examination, including applanation tonometry, disc evaluation, (30-2) Humphrey field analyzer white on white (W/W) perimetry and short- wavelength automated perimetry. Thickness of the RNFL around the optic disc was determined with 3.4 mm diameter-wide OCT scans. Average and segmental RNFL thickness values were compared among all groups. A correlation was sought between global indices of perimetry and RNFL thickness. Results: Of the 90 eyes enrolled (mean age of patients 52.3210.11 years), the mean RNFL thickness was significantly less in ocular hypertensive (82.8717.21 mm; P =0.008 and glaucomatous eyes (52.9531.10 mm; P <0.001), than in normals (94.2612.36 mm). The RNFL was significantly thinner inferiorly in glaucomatous eyes (64.4143.68 mm; P < 0.001) than in normals (120.1514.32 mm) and ocular hypertensives (107.8725.79 mm; P < 0.001). Ocular hypertensives had thinner RNFL in the nasal, inferior and temporal quadrants ( P < 0.001) when compared to normals. Global indices in ocular hypertensives on SWAP showed Mean Deviation (MD) of 5.324.49, Pattern Standard Deviation (PSD) 3.831.59 and Corrected Pattern Standard Deviation (CPSD) 2.841.85. The RNFL thickness could not be significantly correlated with global indices of visual fields in ocular hypertensives. Conclusion: Optical coherence tomography is capable of detecting changes at the level of RNFL in ocular hypertensive eyes with normal appearance of discs and W/W perimetry fields.
  5,628 801 9
LETTER TO EDITOR
Intravitreal bevacizumab in aggressive posterior retinopathy of prematurity
Rajvardhan Azad, Parijat Chandra
July-August 2007, 55(4):319-319
DOI:10.4103/0301-4738.33057  PMID:17595491
  5,330 697 12
BRIEF REPORTS
Triple A syndrome with ophthalmic manifestations in two siblings
Kalpana Babu, Krishna R Murthy, Narendra Babu, S Ramesh
July-August 2007, 55(4):304-306
DOI:10.4103/0301-4738.33048  PMID:17595484
Triple A syndrome (Allgrove syndrome) is a rare, autosomal recessive disorder characterized by adrenocorticotropic hormone resistant adrenal insufficiency, alacrima, achalasia of the esophageal cardia, progressive neurological degeneration and occasionally autonomic instability. We report the ophthalmic manifestations in 2 siblings from a consanguineous family with this syndrome. A routine ophthalmic examination showed absence of palpebral portion of lacrimal gland, dry eyes and sluggish pupillary reflexes in both eyes of these patients. Both of these patients had achalasia cardia while the boy additionally had increased serum cortisol levels. Topical ocular lubricants were prescribed for both of them and Heller's cardiomyotomy with fundus plication was done for achalasia. These cases would create an awareness of this rare condition in ophthalmology in addition to suggesting its management.
  5,161 447 5
ORIGINAL ARTICLE
Topical diclofenac versus dexamethasone after strabismus surgery: A double-blind randomized clinical trial of anti-inflammatory effect and ocular hypertensive response
Hayat A Khan, Abadan K Amitava
July-August 2007, 55(4):271-275
DOI:10.4103/0301-4738.33039  PMID:17595475
Background: Compared to steroids non-steroidal anti-inflammatory drugs offer comparable anti-inflammatory action without ocular side-effects. Aim: To compare the anti-inflammatory effect and effect on IOP (Goldmann) of topical diclofenac 0.1% with dexamethasone 0.1% after strabismus surgery. Design: Prospective, randomized, double-blind, single-center, clinical trial. Materials and Methods: Forty-three cases of constant horizontal strabismus, qualifying for standard uniocular recession-resection surgery on two horizontal rectus muscles were randomized to either the dexamethasone or diclofenac group. They were excluded if they had previous ocular surgery, recently used anti-inflammatory drugs and had a neurological, systemic or an ocular inflammatory condition. In addition all received ciprofloxacin 0.3% four times daily. Assessment was done on the first postoperative day and at two and four weeks. The inflammatory characteristics graded from nil (0) to severe (3) were: discomfort, chemosis, injection, discharge and drop-intolerance. Their sum provided the total inflammatory score (TIS). Results: Dexamethasone group (n=21) was comparable in age, gender, preoperative IOP, strabismus, anesthesia administered and baseline IOP, to diclofenac (n=22). There were no significant differences in the inflammatory characteristics and TIS. The dexamethasone group had IOP significantly higher at two weeks (95% CI 0.17 to 3.25) and four weeks (95% CI 1.09 to 4.24) compared to diclofenac group and the net change of IOP at four weeks (95% CI 0.60 to 3.14). Compared to the baseline IOP. Conclusion: Topical diclofenac is comparable to dexamethasone in providing anti-inflammatory and analgesic effect with the advantage of significantly lesser IOP rise and should be preferred after strabismus surgery.
  4,780 709 3
BRIEF REPORTS
Orbital cavernous hemangioma of childhood
Rajat Maheshwari, Alka Thool
July-August 2007, 55(4):313-315
DOI:10.4103/0301-4738.33052  PMID:17595488
Ocular and orbital tumors, both benign and malignant, occur relatively frequently in infants and children. Benign masses are much more common than malignant in the orbital region. However, childhood tumors show great variability and it is difficult to differentiate benign from malignant lesions. Cavernous hemangioma is the most common benign neoplasm of the orbit in adults. We report a case of orbital cavernous hemangioma in a four-year-old girl presenting as unilateral painless proptosis.
  4,538 493 2
Retinitis pigmentosa and congenital toxoplasmosis: A rare coexistence
Manpreet S Chhabra, Gunjan Prakash, Nagender Vashisht, SP Garg
July-August 2007, 55(4):303-304
DOI:10.4103/0301-4738.33047  PMID:17595483
We describe a previously unreported co-existence of retinitis pigmentosa and congenital toxoplasmosis. An eight year old male presented to our center with complaints of decreased night vision. Fundus evaluations in both the eyes demonstrated features typical of retinitis pigmentosa. There were well-defined punched out healed chorio-retinal scars suggestive of congenital toxoplasmosis. On the basis of history, clinical findings and reduction of a and b wave amplitudes on scotopic and photopic electroretinograph, a diagnosis of retinitis pigmentosa with congenital toxoplasmosis was made. Retinitis pigmentosa may co-exist with congenital toxoplasmosis that may affect the patient's overall ocular morbidity and visual acuity.
  4,061 348 -
LETTER TO EDITOR
Optical coherence tomographic features of unilateral macular coloboma
Nazimul Hussain, LS Mohan Ram
July-August 2007, 55(4):321-322
DOI:10.4103/0301-4738.33061  PMID:17595493
  3,941 356 1
Intravitreal bevacizumab (Avastin) for post-laser photocoagulation anterior segment ischemia in aggressive posterior retinopathy of prematurity
Tiakumzuk Sangtam, Anand Vinekar, Bakthavatsalu Maheshwar, Mangat R Dogra, Kah-Guan Au Eong
July-August 2007, 55(4):317-317
DOI:10.4103/0301-4738.33053  PMID:17595489
  3,655 577 3
BRIEF REPORTS
Stratus optical coherence tomogram III: A novel, reliable and accurate way to measure corneal thickness
Indira M Madgula, Satish Kotta
July-August 2007, 55(4):301-303
DOI:10.4103/0301-4738.33046  PMID:17595482
The commercially available optical coherence tomogram (Stratus OCT III) designed for posterior segment imaging can be used for central corneal thickness (CCT) measurement. The aim of the study was to determine the accuracy and reliability of CCT measurements using Stratus OCT III versus ultrasound pachymetry. CCT using Stratus OCT III (CCT oct) was taken and averaged. The focusing system had to be defocused near the maximum to relay the image of the OCT beam onto the cornea. CCT was then determined using the ultrasound pachymeter (CCT usg). Thirty white volunteers (12 male, 18 female) participated in this study. The mean CCToct was 522.3334.44 microns. The mean CCTusg was 547.3733.08 microns. The mean differences between CCTusg and CCToct was 25.0411.67. CCT usg was found to be highly correlated with CCToct ( P <0.001) The relation can be represented by the equation. CCToct = 0.98 (CCTusg) - 13.9 The Stratus OCT III gave reliable readings of CCT and is a novel, reliable and accurate way to measure CCT.
  3,811 326 4
Accessory optical device for the Heidelberg retina angiograph ( HRA classic ) to perform angiography of the vitreous cavity and the anterior eye segment
Stefan Mennel, Rudolf Schwendinger, Norbert Hausmann, Silvia Peter
July-August 2007, 55(4):295-297
DOI:10.4103/0301-4738.33043  PMID:17595479
The Heidelberg retina angiograph ( HRA) classic enables fluorescein angiography (FA) and indocyanine green angiography (ICG-A) of the retina and choroid. The goal of this study was to design an accessory device to adapt the HRA classic for application on structures anterior to the retina. The optical device consisted of a cylindrical two-piece plastic frame holding a magnifying lens commonly used with the indirect ophthalmoscope. A 60-diopters lens was inserted in this frame to enable the angiography of the anterior segment. A less strong lens of 30 diopters was used for the visualization of pathologic findings in the vitreous cavity. We designed an easy-to-use and low-cost device to adapt the HRA classic for angiography of the fundus, vitreous cavity and anterior segment in the same session and without delay. FA and ICG-A images of two patients with rubeosis iridis and of one patient with choroidal melanoma are described.
  3,774 269 2
Oculosporidiosis in a tertiary care hospital of western Orissa, India: A case series
Ravindra K Chowdhury, Sharmistha Behera, Debendranath Bhuyan, Gunasagar Das
July-August 2007, 55(4):299-301
DOI:10.4103/0301-4738.33045  PMID:17595481
The authors present a case series of 54 subjects of Rhinosporidium . They were reported in two years at a tertiary care hospital of Western Orissa. The clinically diagnosed cases by ophthalmologists were confirmed by histopathological samples following surgery. In our series, we noted Rhinosporidium seeberi organisms as the main causative agent. Males were affected three times more than females. Children less than 10 years of age comprised more than 50% of our series. In 91% of cases, the conjunctiva was the site of this infection. Total excision of fungal mass was carried out in all cases and two cases had recurrence between 9 and 12 months following intervention. Although this is an endemic area for such infestation, unilateral manifestation observed in all cases is interesting to note. Low recurrence rate in limited follow-up period could be due to early detection and standard management.
  3,643 335 11
The role of Botulinum toxin in correcting frontalis-induced eyelid pseudo-retraction post ptosis surgery
Debraj Shome, Vandana Jain, Sundaram Natarajan
July-August 2007, 55(4):307-308
DOI:10.4103/0301-4738.33049  PMID:17595485
We report a case of a 52-year-old female patient who developed overcorrection, due to brow overuse, post surgery for bilateral aponeurotic ptosis. The patient had undergone levator palpebrae superioris plication bilaterally. Due to brow overuse habituated by long standing ptosis, the patient presented with superior scleral show, post ptosis surgery. The lid contour was normal in both eyes and when brow overaction was blocked mechanically, the palpebral fissure heights were normal, comparable, with no scleral show bilaterally. Despite repeated instructions, when the patient continued brow overuse subconsciously, an injection of botulinum toxin was given just above both brows. This led to elimination of brow overuse within a month, with elimination of superior scleral show. The patient maintained lid and brow symmetry with no overaction, eight months post injection.
  3,594 328 1
ORIGINAL ARTICLE
A pilot trial for comparison of photodynamic therapy and transpupillary thermotherapy for the management of classic subfoveal choroidal neovascularization secondary to age-related macular degeneration
Hem K Tewari, Gaurav Prakash, Raj V Azad, Dinesh Talwar, Sanjay Kai
July-August 2007, 55(4):277-281
DOI:10.4103/0301-4738.33040  PMID:17595476
Aim: The aim of the study was to compare the visual outcomes of photodynamic therapy (PDT) with verteporfin and transpupillary thermotherapy (TTT) for classic subfoveal choroidal neovascularization (CNVM) secondary to age-related macular degeneration (ARMD). Settings and Design: Patients with subfoveal classic CNVM caused by ARMD attending vitreo-retinal services at a tertiary care setup were included in this nonrandomized, open label, prospective, clinical, comparative pilot trial. Materials and Methods: Standardized refraction, visual acuity testing, evaluation of fundus and serial color photography and fundus fluorescein angiography were carried out to evaluate the effects of treatment in 32 eyes each undergoing either PDT or TTT. Follow-up was carried out at four weeks, 12 weeks and six months. Retreatment if indicated was carried out three months post treatment. Results: Stabilization or improvement occurred in 69% of patients undergoing PDT and 50% patients undergoing TTT at six months of follow-up. Among patients with a pretreatment visual acuity greater than or equal to 20/63, only one out of six patients who underwent PDT had a drop of visual acuity > 2 lines as compared to four patients (100%) who underwent TTT. ( P =0.0476, two-tailed Fisher's exact test). Conclusion: For short-term preservation of vision in patients of classic CNVM due to ARMD, PDT seems to be better than TTT if the pre-laser best corrected visual acuity is > 20/63 but both are equally effective if pre-laser best corrected visual acuity is < 20/63.
  3,454 374 -
BRIEF REPORTS
Severe hemorrhagic retinopathy as initial manifestation of acute retinal necrosis caused by herpes simplex virus
Subhadra Jalali, Rohini S Kolari, Avinash Pathengay, Sreedharan Athmanathan
July-August 2007, 55(4):308-310
DOI:10.4103/0301-4738.33050  PMID:17595486
A case of bilateral acute retinal necrosis due to herpes simplex virus 1, in a child is reported. The case presented as an extensive hemorrhagic retinopathy that was misdiagnosed as non-infective initially. Diagnostic aqueous tap of the blind eye for viral DNA by polymerase chain reaction helped to confirm viral etiology when the other eye was affected. Appropriate antiviral therapy followed by prompt surgeries for subsequent retinal detachment helped to salvage useful vision in the second eye.
  3,308 308 2
Vitrectomy for circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy
Dhananjay Shukla, Kim Ramasamy
July-August 2007, 55(4):298-299
DOI:10.4103/0301-4738.33044  PMID:17595480
We report successful surgical management of a circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy (TTT). A 33-year-old man with symptomatic serous macular detachment in the left eye (Snellen acuity: 20/200) secondary to a paramacular choroidal hemangioma was treated with TTT. The nonresponsive detachment was subsequently managed by vitrectomy, endophotocoagulation and silicon-oil tamponade. It resulted in complete resolution of the tumor and the detachment. Silicon oil was removed at four months. Visual acuity improved to 20/80 by the last follow-up visit at 10 months without any recurrence.
  2,978 317 3
EDITORIAL
Disclosure of conflict of interest in biomedical publication
Barun Kumar Nayak
July-August 2007, 55(4):249-250
DOI:10.4103/0301-4738.33035  PMID:17595471
  2,873 312 2
LETTER TO EDITOR
Is ambulatory retina surgery the order of the day?
Nikunj J Shah, Urmi N Shah
July-August 2007, 55(4):322-323
DOI:10.4103/0301-4738.33062  PMID:17595494
  2,512 180 -
Clinical characteristics of spontaneous late onset comitant acute nonaccommodative esotropia in children
Ritu Gadia, Pradeep Sharma
July-August 2007, 55(4):318-319
DOI:10.4103/0301-4738.33055  PMID:17595490
  2,429 253 1
Recurrence of herpes simplex keratitis after azithromycin
Vijaya H Pai
July-August 2007, 55(4):320-321
DOI:10.4103/0301-4738.33059  PMID:17595492
  2,192 243 -
Authors' reply
Parag K Shah, V Narendran, Khaled A Tawansy, A Raghuram, Kalpana Narendran
July-August 2007, 55(4):317-318
DOI:10.4103/0301-4738.33054  
  2,077 180 -
Authors' reply
Parag K Shah, V Narendran, Khaled A Tawansy, A Raghuram, Kalpana Narendran
July-August 2007, 55(4):320-320
DOI:10.4103/0301-4738.33058  
  1,860 170 -
Authors' reply
Sunil Kumar
July-August 2007, 55(4):321-321
DOI:10.4103/0301-4738.33060  
  1,663 163 -
Authors' reply
Mihir Kothari
July-August 2007, 55(4):319-319
DOI:10.4103/0301-4738.33056  
  1,580 123 -