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   2007| September-October  | Volume 55 | Issue 5  
 
 
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ORIGINAL ARTICLE
Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: Ten year data from a tertiary care center in a developing country
Anand Vinekar, Mangat R Dogra, Tiakumzuk Sangtam, Anil Narang, Amod Gupta
September-October 2007, 55(5):331-336
DOI:10.4103/0301-4738.33817  PMID:17699940
Background: Retinopathy of prematurity (ROP) is an important cause of childhood blindness in developing countries. Aim: To report the spectrum of ROP and associated risk factors in babies weighing > 1250 g at birth in a developing country. Setting and Design: Institutional, retrospective, non-randomized, observational clinical case series. Materials and Methods : Retrospective analysis (10 years) of 275 eyes (138 babies) with ROP. Statistical Analysis: Qualitative data with the Chi-square test. Quantitative data using the unpaired t test or the ANOVA and further tested using multivariate logistic regression. Results: The mean birth weight was 1533.9 g (range 1251 to 2750 g) and the mean period of gestation was 30.9 weeks (range 26 to 35). One hundred and twenty-four of 275 eyes (45.1%) had threshold or worse ROP. Risk factors for threshold or worse disease were, 'outborn babies' ( P < 0.001), respiratory distress syndrome ( P = 0.007) and exchange transfusion ( P = 0.003). The sensitivity of the American and British screening guidelines to pick up threshold or worse ROP in our study group was 82.4% and 77.4% respectively. Conclusions : Severe ROP is often encountered in babies weighing greater than 1250 g at birth in developing countries. Western screening guidelines may require modifications before application in developing countries.
  8,877 1,271 48
BRIEF REPORTS
Pterygium-induced corneal refractive changes
Sejal Maheshwari
September-October 2007, 55(5):383-386
DOI:10.4103/0301-4738.33829  PMID:17699952
To study the effect of pterygium on corneal topography, a retrospective analysis of 151 eyes with primary pterygia was done. All cases underwent videokeratography preoperatively and one month postoperatively. Statistical analysis of average corneal power (ACP), corneal astigmatism, surface regularity index (SRI) and surface asymmetry index (SAI) was done before and one month after surgery. Topographic indices were compared statistically for various grades of pterygia. Increase in the grade of pterygia had a significant effect on topographic indices. Corneal astigmatism reduced from 4.403.64 diopter (D) to 1.551.63D ( P value <0.001) following surgery. The regularity of corneal surface improved and asymmetry of the cornea reduced one month after surgery. Pterygium leads to significant changes in corneal refractive status, which increase with the increase in the grade of pterygia and improve following pterygium excision.
  8,582 1,113 14
ORIGINAL ARTICLE
Comparative evaluation of megadose methylprednisolone with dexamethasone for treatment of primary typical optic neuritis
Vimala Menon, Abhas Mehrotra, Rohit Saxena, Nargis F Jaffery
September-October 2007, 55(5):355-359
DOI:10.4103/0301-4738.33821  PMID:17699944
Aim: To compare the efficacy of intravenous methylprednisolone and intravenous dexamethasone on visual recovery and evaluate their side-effects for the treatment of optic neuritis. Materials and Methods: Prospective, randomized case-controlled study including 21 patients of acute optic neuritis presenting within eight days of onset and with visual acuity less then 20/60 in the affected eye who were randomly divided into two groups. Group I received intravenous dexamethasone 200 mg once daily for three days and Group II received intravenous methylprednisolone 250 mg/six-hourly for three days followed by oral prednisolone for 11 days. Parameters tested were pupillary reactions, visual acuity, fundus findings, color vision, contrast sensitivity, Goldmann visual fields and biochemical investigations for all patients at presentation and follow-up. Results: Both groups were age and sex-matched. LOGMAR visual acuity at presentation was 1.10 0.52 in Group I and 1.52 0.43 in Group II. On day 90 of steroid therapy, visual acuity improved to 0.28 0.33 in Group I and 0.36 0.41 in Group II ( P =0.59). At three months there was no statistically significant difference in the color vision, contrast sensitivity, stereoacuity, Goldman fields and the amplitude and latency of visually evoked response between the two groups. The concentration of vitamin C, glucose, sodium, potassium, urea and creatinine were within the reported normal limits. Conclusion: Intravenous dexamethasone is an effective treatment for optic neuritis. However, larger studies are required to establish it as a safe, inexpensive and effective modality for the treatment of optic neuritis.
  6,794 886 9
COMMUNITY EYE CARE
Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India
Vilas Kovai, Sannapaneni Krishnaiah, Bindiganavale Ramaswamy Shamanna, Ravi Thomas, Gullapalli N Rao
September-October 2007, 55(5):365-371
DOI:10.4103/0301-4738.33823  PMID:17699946
Purpose: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. Materials and Methods: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. Results: Of the eligible subjects, 1234 (22.1%, N=5573)) presented with distant visual acuity <20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234) subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90) and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03). Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 42% of the respondents, economic in 37% and social in 21%. Conclusion: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.
  6,782 700 15
ORIGINAL ARTICLE
Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis
Rajeev Jain, Grewal Dilraj, Satinder Pal Singh Grewal
September-October 2007, 55(5):341-347
DOI:10.4103/0301-4738.33819  PMID:17699942
Aim: To investigate the coefficient of repeatability (CR) for corneal parameters evaluated with Pentacam after laser in situ keratomileusis (LASIK) in myopic eyes. Design and Setting: Prospective, non-interventional, non-comparative study in an institutional setup. Materials and Methods: Forty eyes of 40 consecutive subjects who had undergone LASIK for myopia were assessed with the Scheimpflug system (Pentacam 70700: Oculus, Wetzlar Germany). The mean of five consecutive measurements of all the corneal parameters was recorded and CR was calculated as standard deviation of the difference from the mean of these repeat measurements divided by the mean response. The statistical significance of the CR was calculated for these parameters at 5% significance level. Results: The best CR was observed for the periphery of the anterior corneal curvature (0.18%) and the least for the horizontal meridian of the posterior corneal curvature (1.29%). Despite being significantly different ( P <0.001), both the measurements were highly repeatable in post-LASIK eyes. The central, apical and minimal corneal thickness had a CR of 1%, 0.78% and 0.77% respectively. These were equally repeatable ( P >0.323). The CR of the mean radius of curvature of the anterior cornea (0.29%) was significantly better ( P <0.001) than the posterior corneal curvature (0.57%). Conclusion: The CR for the post-LASIK cornea with Pentacam was the best for the anterior corneal curvature. Significantly, Pentacam has a high degree of repeatability for the posterior corneal curvature, which has a potential for early detection of keratectasia in these eyes. Post-LASIK pachymetry with Pentacam also showed excellent repeatability.
  6,811 536 23
GUEST EDITORIAL
Retinopathy of prematurity screening in the Indian population: It's time to set our own guidelines!
Vasumathy Vedantham
September-October 2007, 55(5):329-330
DOI:10.4103/0301-4738.33816  PMID:17699939
  6,517 799 8
LETTER TO EDITOR
Ophthalmic artery occlusion: A cause of unilateral visual loss following spine surgery
Mihir T Kothari, Aniruddha Maiti
September-October 2007, 55(5):401-402
DOI:10.4103/0301-4738.33841  PMID:17699964
  5,244 230 3
Intraoperative floppy iris syndrome associated with terazosin
Rengaraj Venkatesh, Kannusamy Veena, Santhosh Gupta, Ravilla D Ravindran
September-October 2007, 55(5):395-396
DOI:10.4103/0301-4738.33835  PMID:17699957
  5,139 299 10
ORIGINAL ARTICLE
Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment
Fatih Horozoglu, Ates Yanyali, Erkan Celik, Banu Aytug, Ahmet F Nohutcu
September-October 2007, 55(5):337-340
DOI:10.4103/0301-4738.33818  PMID:17699941
Aims: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). Design: Prospective, interventional case series. Materials and Methods: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. Results: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). Conclusions: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.
  4,743 449 22
Immunohistochemical localization of human papilloma virus in conjunctival neoplasias: A retrospective study
Seema Sen, Anjana Sharma, Anita Panda
September-October 2007, 55(5):361-363
DOI:10.4103/0301-4738.33822  PMID:17699945
Background: The extent of association of human papilloma virus (HPV) in human conjunctival neoplasias has been debated in studies originating from different parts of the world, but no substantial evidence has been generated on Indian subjects. This prompted us to carry out a retrospective study on conjunctival neoplasias diagnosed over the past 12 years. Materials and Methods: Histopathological and immunohistochemical analysis of 65 specimens of ocular neoplasias and 30 normal controls diagnosed between 1991 and 2002 at a tertiary eye care hospital, was undertaken. Formalin-fixed, paraffin-embedded tissues were reviewed for confirming histopathological diagnosis, presence of koilocytosis and changes related to actinic keratosis. Immunohistochemical analysis was done using HPV-specific monoclonal antibodies. Clinicopathological correlation and the association of HPV antigen with the histopathological features were performed. Results: Out of the 65 cases analyzed, 35 were papillomas and 30 were ocular surface squamous neoplasias (OSSN). The mean age was 48 years with a male preponderance. Histologically, koilocytosis was observed in 17.1% of papillomas and 36.6% of OSSN. Actinic keratosis was present in 33% of OSSN. Immunohistochemically 17.1% conjunctival papillomas stained positive for HPV antigen, all cases of OSSN were negative for HPV. There was no correlation between koilocytosis or actinic keratosis and the detection of HPV antigen. Conclusions: The association between HPV and conjunctival neoplasias is variable in different geographical areas and also depends on the methods of detection used. This study warrants the need for applying more advanced techniques at a molecular level to determine the possible etiology of HPV in conjunctival neoplasias among Asian-Indians.
  4,728 431 14
Role of concanavalin A lectin in recognition of pterygium remnant after surgical excision: Preliminary results of a prospective study
Juan A Diaz-Gonzalez, Miguel A Mayoral-Chavez, Paulina Leyva Bohorquez, del Pilar Gabriel de la Torre, Pedro Hernandez-Cruz, Ruth Martinez-Cruz, Eduardo Perez-Campos
September-October 2007, 55(5):349-353
DOI:10.4103/0301-4738.33820  PMID:17699943
Background: Pterygium is one of the most common conjunctival diseases among ophthalmic pathologies. The frequency of recurrences is high, either after surgical treatment or after treatment combined with mitomycin C or beta-radiation therapy. Aims: The purpose of this study was to determine whether concanavalin A (ConA) lectin bound to the pterygial surface can be used to detect recurrence or remnants of pterygium after surgical excision. Materials and Methods: This was a prospective study on 20 patients with pterygium, divided in five stages, pre-surgery, early post-surgery (24h), late post-surgery (seven days), very late post-surgery (four weeks) and two months after the procedure. A drop of fluorescein-marked Con A (35 g/mL) was instilled in the lower conjunctival eyelid sac and the eye was exposed to the light of a Wood's lamp for an average of five seconds. Results: Out of the 20 patients, eight patients were found to have fluorescent stretch marks over the scar corresponding to residual pterygial tissue at four weeks; two months after the procedure of re-surgery we observed no fluorescent remnants. All residual pterygia were confirmed through histochemistry studies. Conclusion: It was possible to detect remnants of pterygium in postoperative patients and recurrences in early pre-clinical stages through the visualization of fluorescent ConA bound to the pterygial surface.
  4,713 358 2
BRIEF REPORTS
Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: A case report
Deepender Chauhan, Ritu Arora, Sima Das, Daraius Shroff, Ritesh Narula
September-October 2007, 55(5):373-374
DOI:10.4103/0301-4738.33824  PMID:17699947
Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.
  4,649 262 6
Bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery
Mohsen Bahmani Kashkouli, Shabnam Salimi, Hossein Aghaee, Masood Naseripour
September-October 2007, 55(5):374-375
DOI:10.4103/0301-4738.33825  PMID:17699948
A bilateral simultaneous cataract surgery (BSCS) was performed on a 67-year-old man. The surgeon had not changed the surgical settings in between the two procedures for the two eyes. The patient developed fulminant bilateral endophthalmitis a day following the BSCS. Intravitreal culture grew Pseudomonas aeruginosa . The source of infection was not found. Immediate bilateral vitrectomy and intravitreal, subconjunctival, topical and systemic antibiotic did not save the eyes. Patient ended up with bilateral visual loss.
  4,320 395 25
LETTER TO EDITOR
Spontaneous subcutaneous orbital emphysema following forceful nose blowing: Treatment options
N Shah
September-October 2007, 55(5):395-395
DOI:10.4103/0301-4738.33834  PMID:17699958
  4,471 235 8
BRIEF REPORTS
Ocular features of hantavirus infection
Salil Mehta, Prakash Jiandani
September-October 2007, 55(5):378-380
DOI:10.4103/0301-4738.33827  PMID:17699950
Hantavirus infections are an emerging infectious disease that is beginning to be recognized both worldwide and in India as a cause of hemorrhagic fever that may present as a pulmonary syndrome or as a renal syndrome. Reports of ocular involvement are rare and include transient myopia, low intraocular pressure, conjunctival hemorrhages and changes of intraocular dimensions. Eleven patients (10 males, one female, mean age 37.6 years) were admitted to the intensive care unit for pyrexia of unknown origin or hemorrhagic fever following exposure to flood waters. Five male patients (mean age 31.6 years) were identified as suffering from hantavirus infection. In one patient, dot and blot intraretinal hemorrhages were seen in the macula of one eye and streak hemorrhages of the disc in the other. In the remaining four, no fundus abnormalities were seen. Ophthalmologists should be aware of these features.
  4,069 351 10
Drug-induced acute myopia following chlorthalidone treatment
G Mahesh, A Giridhar, SJ Saikumar, Sachin Fegde
September-October 2007, 55(5):386-388
DOI:10.4103/0301-4738.33830  PMID:17699953
We report a case of sudden loss of vision due to the development of acute myopia after the intake of chlorthalidone used for treating systemic hypertension. Clinically this was associated with ciliary spasm, shallow peripheral choroidal effusion and retinal striae at the macula with increase in macular thickness seen on optical coherence tomography. All these findings were reversed completely once the drug was discontinued. Development of acute myopia should be kept in mind as an adverse effect of a commonly used antihypertensive drug, namely chlorthalidone.
  3,993 344 4
Combined aniridic intraocular lens implantation and vitreoretinal surgery
Hitendra Mehta, Hijab Mehta, Chaitra Jayadev, S Natarajan
September-October 2007, 55(5):391-393
DOI:10.4103/0301-4738.33833  PMID:17699956
A 45-year-old man presented with post-traumatic aniridia. We describe the combined surgery done to treat both aniridia and epiretinal membrane simultaneously. A combined aniridic intraocular lens and vitreoretinal surgery was done. The case report highlights the advantage of combined surgery in terms of cost factor and surgical time.
  3,824 253 2
In vivo confocal microscopy in different types of posterior polymorphous dystrophy
Kalpana Babu, KR Murthy
September-October 2007, 55(5):376-378
DOI:10.4103/0301-4738.33826  PMID:17699949
Posterior polymorphous dystrophy is a rare corneal dystrophy, usually detected by chance. This case series describes the morphologic features in the three different types of posterior polymorphous dystrophy using confocal microscopy.
  3,468 287 12
LETTER TO EDITOR
Marin-Amat syndrome: A rare facial synkinesis
Jitendra Jethani
September-October 2007, 55(5):402-403
DOI:10.4103/0301-4738.33842  PMID:17699965
  3,403 273 1
BRIEF REPORTS
Bilateral inverse globe retraction (Duane's) syndrome
Arif O Khan
September-October 2007, 55(5):388-389
DOI:10.4103/0301-4738.33831  PMID:17699954
A case of true inverse Duane's retraction syndrome, bilateral inverse globe retraction syndrome apparently due to abnormal innervation, is the subject of this clinical report.
  3,159 395 2
GUEST EDITORIAL
Research by small private establishments
VR Joshi
September-October 2007, 55(5):327-327
DOI:10.4103/0301-4738.33815  PMID:17699938
  3,170 352 -
LETTER TO EDITOR
Congenital or acquired Horner's?
Ketki Toprani, Shashikant Shetty, P Vijayalakshmi
September-October 2007, 55(5):399-400
DOI:10.4103/0301-4738.33840  PMID:17699962
  2,950 271 3
BRIEF REPORTS
Ophthalmoscopy in the early diagnosis of opportunistic tuberculosis following renal transplant
Salil Mehta, Lohitaksha Suratkal
September-October 2007, 55(5):389-391
DOI:10.4103/0301-4738.33832  PMID:17699955
Chronic renal failure is a common sequel of renal inflammatory disease or diabetes mellitus. As a result of the immunosuppression that is induced by uremia, hemodialysis or posttransplant immunosuppressive medication, these patients are at a higher risk of opportunistic infections. Various viral, bacterial and mycobacterial infections have been reported. Tuberculosis is a common systemic opportunistic infection but reports of ocular involvement with pulmonary or disseminated tuberculosis are rare. We report the systemic and ocular findings in two postrenal-transplant patients with pulmonary or disseminated tuberculosis in whom detection of choroidal tubercles led to confirmation of the diagnosis in both patients and was the only specific premortem finding in one. Fundoscopy in this group of patients may help in the diagnosis of opportunistic tuberculosis, its earlier treatment and the consequent reduction of morbidity and mortality.
  2,803 261 3
LETTER TO EDITOR
Ocular defects in children with cerebral palsy
Jitendra Jethani
September-October 2007, 55(5):397-397
DOI:10.4103/0301-4738.33837  PMID:17699961
  2,640 365 1
BRIEF REPORTS
Clinicopathologic correlations in eyes enucleated after uveal melanoma resection with positive surgical margins
Yousuf Khalifa, Thomas M Aaberg Jr, Thomas M Aaberg Sr, Hans E Grossniklaus
September-October 2007, 55(5):380-383
DOI:10.4103/0301-4738.33828  PMID:17699951
We identified three eyes that had undergone enucleation after transscleral resection of uveal melanoma. Two enucleated eyes with microscopically positive margins of resection exhibited no evidence of residual melanoma and these patients were alive without metastasis with at least four years' follow-up. One eye with a transected melanoma contained residual melanoma and that patient died with metastatic melanoma to the liver three years after enucleation. There appear to be at least two general types of positive surgical margins of resection of uveal melanoma: microscopically positive margins and macroscopically positive (transected) margins of resection.
  2,682 204 -
LETTER TO EDITOR
Intraoperative cracking of the AMO Phacoflex-II Silicone (SI-40NB) intraocular lens while implanting with the Unfolder TM silver series system using hydroxypropylmethylcellulose
Rohit Saxena, Ankur Sinha, Sudarshan Khokhar, Munish Dhawan, Kiran Turuka
September-October 2007, 55(5):396-397
DOI:10.4103/0301-4738.33836  PMID:17699959
  2,506 169 -
Bilateral acute keratouveitis in leptospirosis: A new entity
Arvind Gupta, Datta Pandian Gulnar, Renuka Srinivasan, Subashini Kaliaperumal
September-October 2007, 55(5):399-399
DOI:10.4103/0301-4738.33839  PMID:17699963
  2,272 265 -
Evaluation of impression smears in the diagnosis of fungal keratitis
Samrat Chatterjee
September-October 2007, 55(5):403-404
DOI:10.4103/0301-4738.33843  PMID:17699966
  2,278 240 -
Unilateral hemorrhagic keratouveitis as the initial presentation of Takayasu's arteritis
Subashini Kaliaperumal, Arvind Gupta, Sabyasachi Sengupta, Renuka Srinivasan
September-October 2007, 55(5):397-398
DOI:10.4103/0301-4738.33838  PMID:17699960
  2,227 223 4
Authors' reply
Arun K Jain, Reema Bansal, A Rajwanshi
September-October 2007, 55(5):404-405
DOI:10.4103/0301-4738.33844  
  1,796 147 -