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  Citation statistics : Table of Contents
   2009| March-April  | Volume 57 | Issue 2  
    Online since February 17, 2009

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Corneal collagen cross-linking with riboflavin and ultraviolet - A light for keratoconus: Results in Indian eyes
Vinay B Agrawal
March-April 2009, 57(2):111-114
DOI:10.4103/0301-4738.44515  PMID:19237783
Aim: To assess the results of corneal collagen cross-linking with riboflavin using ultraviolet - A light for keratoconus at one year in Indian eyes. Materials and Methods: Sixty-eight eyes of 41 patients with progressive keratoconus were included in this retrospective study. All eyes completed was 12 months of follow-up and 37 eyes had a one-year follow-up. The maximum follow-up was 16 months. Ocular examinations including refraction, best corrected visual acuity (BCVA), corneal topography, were recorded at each visit. Results: The mean age was 16.9 ± 3.5 years (range 12-39 years) and the mean follow-up was 10.05 ± 3.55 months (range six to 16 months). Thirty seven eyes with a follow-up of at least 12 months were analyzed. The preoperative values on the day of treatment were compared with postoperative values of the 12-month examination. This showed that BCVA improved at least one line in 54% (20/37) of eyes and remained stable in 28% (10/37) of eyes ( P =0.006). Astigmatism decreased by a mean of 1.20 diopter (D) in 47% (17/37) of eyes ( P =0.005) and remained stable (within ± 0.50 D) in 42% (15/37) of eyes. The K value of the apex decreased by a mean of 2.73 D in 66% (24/37) of eyes ( P =0.004) and remained stable (within ± 0.50 D) in 22% (8/37) of eyes. The maximum K value decreased by a mean of 2.47 D in 54% (20/37) of eyes ( P =0.004) and remained stable (within ± 0.50 D) in 38% (14/37) of eyes. Corneal Wavefront analysis revealed that spherical and higher-order aberrations did not show significant variations in the follow-up period. The coma component showed a very significant reduction at six months after treatment and persisted throughout the follow-up period ( P =0.003) Conclusion: The results show a stabilization and improvement in keratoconus after collagen cross-linking in Indian eyes. This suggests that it is an effective treatment for progressive keratoconus.
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A case of bilateral presumed chikungunya neuroretinitis
G Mahesh, A Giridhar, Archis Shedbele, Ram Kumar, SJ Saikumar
March-April 2009, 57(2):148-150
DOI:10.4103/0301-4738.45508  PMID:19237792
Chikungunya fever is a relatively rare from of vector-borne viral fever caused by chikungunya virus and spread by bites of the Aedes aegypti and Aedes albopictus mosquito. Epidemics of chikungunya fever have been reported in the past from different parts of the world. Although the virus had been passive for quite some time, recent reports of outbreaks of chikungunya fever in several parts of Southern India have confirmed the re-emergence of this virus. Symptoms of this infection include abrupt onset of fever, chills, and headache, rash, severe joint pain, conjunctival injection and photophobia. Ocular manifestations have been recently reported with this infection. We report a case of a 48-year-old female patient, who presented with defective vision two weeks after a serology proven chikungunya infection. There was bilateral neuroretinitis with peripapillary cotton wool spots. These findings should be kept in mind as an ocular manifestation of chikungunya virus infection.
  16 4,328 590
Orbital lymphoma: Role of radiation
BS Yadav, SC Sharma
March-April 2009, 57(2):91-97
DOI:10.4103/0301-4738.44516  PMID:19237780
The purpose of this article is to review the literature for clinical presentation, treatment, outcome and complications of using radiotherapy for the treatment of orbital lymphoma. For this, MEDLINE, EMBASE, and the Cochrane Library were searched through January 2007 for published data on primary non-Hodgkin's lymphoma (NHL) of the orbit. The search was conducted in all document types, using the following terms "Non-Hodgkin's lymphoma, MALT (mucosa associated lymphoid tissue) and orbit". Data extracted were based on age, sex, therapeutic methods and outcome of treatment. When full articles were not available, abstracts were used as a source of information. Only those articles whose abstracts or full text were available in English were included in table. The review of reports of NHL of the orbit, in general, served as a source of information about its clinical behavior, treatment and overall prognosis. Fifty-six publications were identified, including six in languages other than English. There was no randomized trial. All the studies were retrospective. The studies were heterogeneous in patient number (3 to 112), histology, disease stage (IE to IV), radiotherapy doses used (4 to 53.8Gy), local control rates (65 to 100%), distant relapse rates (0 to 67%, from low grade to high grade) and five-year survival rates (33 to 100%). Three of the studies with a good number of patients also demonstrated clinical benefit with radiotherapy in terms of superior efficacy or less toxicity. Available data support the acceptance of radiotherapy as a standard therapeutic option in patients with low to intermediate grade orbital lymphoma. Toxicity of radiotherapy is mild if delivered precisely.
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Pattern of uveitis in North East India: A tertiary eye care center study
Dipankar Das, Harsha Bhattacharjee, Pankaj Kumar Bhattacharyya, Lokesh Jain, MJ Panicker, Kalyan Das, Akshay C Deka
March-April 2009, 57(2):144-146
DOI:10.4103/0301-4738.45506  PMID:19237790
We conducted an institutional-based retrospective study on 308 uveitic patients and analyzed the pattern of uveitis in Northeastern India. Anterior uveitis was the most common type (47.07%) followed by posterior (29.87%), intermediate (12.98%) and panuveitis (10.06%). Toxoplasmosis (40.21%) had the highest incidence among posterior uveitis cases. Harada's form of Vogt Koyanagi Harada's disease is a frequent occurrence in this subset of the population.
  11 3,901 538
Paradoxical reaction in tubercular meningitis resulting in involvement of optic radiation
Parveen K Monga, Upreet Dhaliwal
March-April 2009, 57(2):139-141
DOI:10.4103/0301-4738.45504  PMID:19237788
A 25-year-old woman was diagnosed to have tubercular meningitis (TBM) with a right parietal infarct. She responded well to four-drug anti-tubercular treatment (ATT), systemic steroids and pyridoxine. Steroids were tapered off in one and a half months; she was put on two-drug ATT after two months. Six months after initial diagnosis she presented with sudden, bilateral visual loss. Vision was 3/200 with afferent pupillary defect and un-recordable field in the right eye; vision was 20/60 in the left eye, pupillary reaction was sluggish and the field showed a temporal hemianopia. On reintroduction of systemic corticosteroids vision improved (20/120 in right eye and 20/30 in left eye) within three days; the field defects improved sequentially to a left homonymous hemianopia, then a left homonymous inferior quadrantonopia. A diagnosis of TBM, on treatment, with bilateral optic neuritis, and right optic radiation involvement was made. Since the patient had been off ethambutol for four months, the optic neuritis and optic radiation lesion were attributed to a paradoxical reaction to tubercular allergen, corroborated by prompt recovery in response to corticosteroids. This is the first report of optic radiation involvement in a paradoxical reaction in neuro-tuberculosis in a young adult.
  10 4,064 353
Ocular morbidity prevalence among school children in Shimla, Himachal, North India
Madhu Gupta, Bhupinder P Gupta, Anil Chauhan, Ashok Bhardwaj
March-April 2009, 57(2):133-138
DOI:10.4103/0301-4738.45503  PMID:19237787
Background: Data on eye diseases among school children is not readily available. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. Aim: To estimate the prevalence of ocular morbidity among school children of age 6-16 years. Settings: Government and private coeducational schools in urban area of Shimla. Design: Cross-sectional Materials and Methods: Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. Statistical analysis: The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. Results: Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P<0.5) more in government schools. Conclusion: A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.
  10 7,545 739
Primary mucinous carcinoma of eyelid: A rare clinical entity
Ashutosh Chauhan, Manomoy Ganguly, Puneet Takkar, Vibha Dutta
March-April 2009, 57(2):150-152
DOI:10.4103/0301-4738.45509  PMID:19237793
Primary cutaneous mucinous carcinoma of the eyelid, a rare pathologic entity, is an adenocarcinoma of the eccrine glands. Though it has low metastatic potential, it does have a significant recurrence rate. We present the occurrence, clinical and histological features, and management of this tumor in a 62-year-old male who presented with a recurrent, firm, nodular left lower lid lesion. He underwent excision with a 5 mm margin and the defect was repaired with a Mustarde's cheek rotation flap. A full oncological screening, including whole-body Positron Emission Tomography scan, excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. This case underscores the importance of considering this tumor in recalcitrant eyelid lesions and highlights the pathology of this tumor.
  9 3,608 274
Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection
Tansu Erakgun, Sait Egrilmez
March-April 2009, 57(2):105-109
DOI:10.4103/0301-4738.44514  PMID:19237782
Aims: To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases. Settings and Design: Ege university hospital ophthalmology department. Retrospective case series. Materials and Methods: Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated. Statistical analysis used: Paired Student's t-test. Results: Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively ( P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) ( P<0.001). Conclusions: Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.
  8 4,372 505
A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas
Gowri J Murthy, Praveen R Murthy, Krishna R Murthy, Vinay V Kulkarni, KR Murthy
March-April 2009, 57(2):127-132
DOI:10.4103/0301-4738.45502  PMID:19237786
Background: Endoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas. Aim: To evaluate the safety and efficacy of ECP in the management of refractory glaucomas. Settings and Design: Prospective interventional non-comparative study. Materials and Methods: Fifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP £ 22 mmhg, with or without use of medications. Statistical analysis used: Student's t test and repeated measures ANOVA were used to evaluate change in IOP and Student's t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications. Results: Patients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 ± 9.16 mmHg to 13.96 ± 7.71 mmHg at last follow-up ( P <0.001, student's t test). BCVA was significantly improved in the postoperative period ( P <0.001, student's t test). The average number of antiglaucoma medications decreased from 2.51 ± 0.97 to 1.09 ± 1.16 ( P <0.001, Wilcoxon signed rank test). ECP had a success rate of 82.2%. Conclusion: Endoscopic cyclophotocoagulation is an effective procedure in this subset of refractory glaucomas.
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Safety and efficacy of Intacs in Indian eyes with keratoconus: An initial report
Rohit Shetty, Kannan M Narayana, Kurian Mathew, D Anand, Prerna Mhaske, Bhujang K Shetty
March-April 2009, 57(2):115-119
DOI:10.4103/0301-4738.44517  PMID:19237784
Context: In contact lens-intolerant keratoconus patients, intrastromal placement of Intacs is becoming a promising new modality of treatment. Aims: To study the safety and efficacy of implantation of microthin corneal inserts (Intacs) in Asian-Indian keratoconus patients. Settings and Design: Retrospective interventional case series, in the cornea and refractive surgery service, at a tertiary care eye hospital in South India, between May 2006 and July 2007. Materials and Methods: Intacs (Addition Technology, USA) were successfully implanted by mechanically creating tunnels, in 12 eyes of 12 keratoconus patients, who were contact lens-intolerant. The patients (mean age 25.58 years, nine male and three female) had a minimum follow-up of six months. Five patients had severe keratoconus (mean K > 53 D) and nine had central cones. Results: All patients improved or retained visual acuity. The uncorrected visual acuity (UCVA) improved from a mean value of 0.06, (SD ± 0.08) to 0.19 postoperatively (SD± 0.15) ( P = 0.01). The change in mean best corrected visual acuity (BCVA) was from 0.51, (SD ± 0.24), to 0.69, (SD ±0.00) ( P = 0.01) postoperatively. The average central keratometry reading was 52.55 D. The change in mean K from 52.84 to 49.16 and 49.15 at one and six months respectively, was statistically significant. We did not have any major intra- or early postoperative complications. Eight of 12 eyes became contact lens-tolerant post-surgery. Conclusion: The procedure of Intacs implantation appears to be safe and effective in a small group of Indian population at an intermediate follow-up.
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Comparison of corneal endothelial cell loss during phacoemulsification using continuous anterior chamber infusion versus those using ophthalmic viscosurgical device: Randomized controlled trial
BK Nayak, Elesh Kumar Jain
March-April 2009, 57(2):99-103
DOI:10.4103/0301-4738.45500  PMID:19237781
Aim: We conducted this study to evaluate and compare corneal endothelial cell loss between phacoemulsification with continuous anterior chamber infusion using anterior chamber maintainer (ACM) and phacoemulsification using ophthalmic viscosurgical device (OVD). Materials and Methods: This was a prospective, randomized controlled trial. Fifty eyes of 47 patients of senile cataract undergoing phacoemulsification were included. Patients were randomly allocated into two groups of 25 eyes each. Cataract surgery was performed by phacoemulsification with anterior chamber (AC) continuous infusion with balanced salt solution (BSS) plus and ACM without OVD in Group A, and in Group B, phacoemulsification was performed using OVD with BSS plus. Corneal endothelial cell count and pachymetry were performed preoperatively and postoperatively on day 1, day 7, and day 30. Results: The mean increase in pachymetry was 4.86%, 2.94%, and 1.94%, (Group A) and 5.95%, 3.94%, and 0.51%, (Group B) on first, seventh, and 30 th postoperative day respectively. The difference between the percentage increase in pachymetry between the two groups was not significant at day 1 ( P = 0.441), day 7 ( P = 0.298), and day 30 ( P =0.174) postoperatively. The density of endothelial cells decreased postoperatively (day 30) by 7.38% (Group A) and 7.47% (Group B) without any significant statistical difference ( P = 0.983) between two groups. Conclusion: Use of ACM for continuous AC infusion and omission of OVD during phacoemulsification did not cause significant difference in corneal swelling or endothelial cell loss in the immediate postoperative period up to one month.
  7 6,301 893
Gains beyond cosmesis: Recovery of fusion and stereopsis in adults with longstanding strabismus following successful surgical realignment
Tarannum Fatima, Abadan K Amitava, Saba Siddiqui, Mohammad Ashraf
March-April 2009, 57(2):141-143
DOI:10.4103/0301-4738.45505  PMID:19237789
We evaluated recovery of binocularity in 15 chronically strabismic, non-fusing (with neutralizing prisms) adults following successful surgical alignment. We included ≥12-year-olds, with best corrected visual acuity (BCVA) ≥20/60, and excluded those with: anisoacuity >2 lines-Snellen; failed realignment judged by >10 prism diopters (PD) horizontal and >4 PD vertical. Six-week outcomes were: fusion by Worth Four-Dots (WFDT) and Bagolini striated glasses (BSG) and stereopsis by Titmus test and the Netherlands organisation for applied scientific research (TNO) test. Baseline data in medians (range): age 18 (12-40) years, strabismus 45 (19-95) PD, duration 14 (0.5-24) years, 12 females; 12 exotropes, three esotropes; visual acuity was 20/20 in 10, while none had BCVA <20/60. Postoperative strabismus measured 6 PD (range:0-10). By six weeks none suppressed: WFDT findings showed eight fused at distance and 13 at near; and on BSG figures were 10 and 13 respectively. Stereopsis was demonstrated by 13 on Titmus and by 10 on TNO tests.  It is concluded that longstanding strabismic adults with good vision can recover fusion and stereopsis following successful squint surgery.
  5 3,747 321
Evaluation of single-stage adjustable strabismus surgery under conscious sedation
Pradeep Sharma, Anurag Julka, Ritu Gadia, Anjolie Chhabra, Maya Dehran
March-April 2009, 57(2):121-125
DOI:10.4103/0301-4738.45501  PMID:19237785
Purpose: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia. Materials and Methods: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared. Results: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd) ±9.0, -38.93 pd ±11.05 and -41.87 pd ±8.91 ( P =0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I ( P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5) in all groups. Intraoperative pain ( P <0.001) and time taken for surgery ( P <0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5). Conclusions: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.
  5 3,513 377
Ocular decompression retinopathy after trabeculectomy with mitomycin-C for angle recession glaucoma
Atul Bansal, US Ramanathan
March-April 2009, 57(2):153-154
DOI:10.4103/0301-4738.45510  PMID:19237794
A 45-year-old male presented with intractable glaucoma following 360-degree angle recession after blunt trauma. He underwent an uncomplicated trabeculectomy with mitomycin-C (MMC). Adequate precautions were taken to reduce the chances of sudden lowering of intraocular pressure (IOP). He did not have any intraoperative shallowing of the anterior chamber or postoperative hypotony, but still developed ocular decompression retinopathy. On detailed review of the previously reported cases we discovered that besides a large IOP drop after surgery, either the preoperative rise of IOP in all these cases was over a relatively short period or the course of their glaucomatous process was likely to have exposed them to intermittent spikes of high IOP. To our knowledge this factor has not been previously postulated in the pathophysiology of ocular decompression retinopathy. We illustrate this with a rare case of ocular decompression retinopathy after trabeculectomy with MMC for post-traumatic angle recession glaucoma.
  4 3,221 361
Investigative modalities in infectious keratitis
Prashant Garg
March-April 2009, 57(2):159-159
DOI:10.4103/0301-4738.45512  PMID:19237797
  3 2,360 386
Pneumatic displacement and intravitreal bevacizumab: A new approach for management of submacular hemorrhage in choroidal neovascular membrane
Shobhit Chawla, Vishal Misra, Mohit Khemchandani
March-April 2009, 57(2):155-157
DOI:10.4103/0301-4738.45511  PMID:19237795
Choroidal neovascular membrane (CNVM) is one of the most common causes of submacular hemorrhage (SMH). Conventional treatment involves management of the SMH with pneumatic displacement with or without tissue plasminogen activator (TPA) followed by intravitreal injection of bevacizumab in a second sitting. We decided to assess the efficacy of treating SMH secondary to CNVM with pneumatic displacement using sulphur hexafluoride (SF6) gas and intravitreal bevacizumab. Four patients with SMH secondary to CNVM were included in this study. Intravitreal bevacizumab, 0.05 ml, along with 0.5 ml of SF6 was injected through the pars plana into the vitreous cavity. Postoperative best corrected visual acuity improved in all eyes with complete or partial displacement of SMH out of the foveal area.
  2 2,786 322
Marching ahead…
Barun Kumar Nayak
March-April 2009, 57(2):89-90
DOI:10.4103/0301-4738.45499  PMID:19363835
  1 1,878 355
Herpes zoster ophthalmicus or Herpes zoster maxillaris?
Shivcharan Lal Chandravanshi, MK Rathore
March-April 2009, 57(2):163-164
DOI:10.4103/0301-4738.45517  PMID:19237800
  1 2,655 311
Evaluation of medical college departments of ophthalmology in India
KS Santhan Gopal
March-April 2009, 57(2):159-160
DOI:10.4103/0301-4738.45513  PMID:19237796
  1 1,573 208
Breakthrough vitreous hemorrhage after ICGA guided PDT for PCV
Pukhraj Rishi, Aradhana Kadekar, Ekta Rishi
March-April 2009, 57(2):160-161
DOI:10.4103/0301-4738.45514  PMID:19237798
  1 1,837 224
Status of pediatric eye care in India
Mihir Kothari, Bhavesh Mithiya, Reena Gautam
March-April 2009, 57(2):162-162
DOI:10.4103/0301-4738.45515  PMID:19237799
  1 2,243 225
Surgical choroidal neovascular membrane removal in the era of anti-vascular endothelial growth factor agents
Manish Nagpal, Kamal Nagpal, Vikram Mehta
March-April 2009, 57(2):146-148
DOI:10.4103/0301-4738.45507  PMID:19237791
Intravitreal anti-vascular endothelial growth factor (VEGF) agents have obtained acceptance as the mainstay in the management strategy of subfoveal choroidal neovascular membranes (CNVM) due to varying etiologies. Few drawbacks include need for repeated intravitreal injections, with its adjunct risks, and the lack of a predefined treatment end point, which can cause doubts and uncertainty in the mind of the patient. Furthermore, it remains a significant financial burden for the patient. Herein we report our data of three patients who were reluctant for further re-injections of anti-VEGF agents and were therefore offered surgical removal of the CNVM by submacular surgery as an alternative treatment plan.
  - 2,021 241
Phakic intraocular lenses
Rajesh Sinha, Chandrashekhar Kumar, Jeewan S Titiyal
March-April 2009, 57(2):165-169
  - 3,170 580
Authors' reply
Jyotirmay Biswas, S Sudharshan
March-April 2009, 57(2):164-164
  - 1,217 157
Authors' reply
GVS Murthy, N John, SK Gupta, P Vashist, GV Rao
March-April 2009, 57(2):162-163
  - 1,395 160