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  Citation statistics : Table of Contents
   2009| September-October  | Volume 57 | Issue 5  
    Online since August 14, 2009

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Fibrin glue in ophthalmology
Anita Panda, Sandeep Kumar, Abhiyan Kumar, Raseena Bansal, Shibal Bhartiya
September-October 2009, 57(5):371-379
DOI:10.4103/0301-4738.55079  PMID:19700876
Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.
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Determinants of glaucoma awareness and knowledge in urban Chennai
Ramesh Ve Sathyamangalam, Pradeep G Paul, Ronnie George, Mani Baskaran, Arvind Hemamalini, Raj V Madan, J Augustian, Raju Prema, Vijaya Lingam
September-October 2009, 57(5):355-360
DOI:10.4103/0301-4738.55073  PMID:19700873
Aim: To assess the awareness and knowledge levels about glaucoma and its determinants in an urban population of Chennai in south India. Materials and Methods: Chennai glaucoma study (CGS) was a population based prevalence study to estimate the prevalence of glaucoma in a rural and urban south Indian population. A total of 3850 subjects aged 40 years or above participated in the urban arm of CGS. A systematic random sample of 1926 (50.0%) subjects completed a questionnaire that assesses their awareness and knowledge level of glaucoma. Respondents "having heard of glaucoma" even before they were contacted/recruited for the study were defined as "aware" and respondents having some understanding of the eye disease were defined as "knowledgeable". Results: Overall 13.5% were aware of glaucoma, the age-gender adjusted rate for awareness was 13.3% (95% CI: 11.57 to 15.03). Two clinicians graded knowledge on glaucoma, based on the subject's knowledge of risk factors, definitions and treatment aspects of glaucoma. Overall 8.7% had some knowledge about glaucoma. Among those who had knowledge 0.5% had good knowledge about glaucoma, 4% had fair knowledge and 4.2% had poor knowledge. We observed a very good agreement between the clinicians in grading knowledge (k =0.92). Determinants of glaucoma awareness and knowledge were higher levels of education, females, age, religion and family history of glaucoma. Conclusion: Awareness and knowledge about glaucoma was very low among the urban population of Chennai. We have found that younger subjects and men were less aware of glaucoma. Subjects with lower levels of education were less aware and knew less about glaucoma than their counterparts. The study findings stress the need for health education for effective prevention of blindness due to glaucoma.
  63 7,538 1,008
Application of tele-ophthalmology in remote diagnosis and management of adnexal and orbital diseases
Malay Verma, Rajiv Raman, Ravindra E Mohan
September-October 2009, 57(5):381-384
DOI:10.4103/0301-4738.55078  PMID:19700877
Purpose: To assess the feasibility of making a diagnosis of adnexal and orbital diseases by Tele-ophthalmological means. Materials and Methods: Tele-consultation for eye diseases was done for 3497 patients from remote areas of Tamilnadu as part of the rural tele-ophthalmology project of a tertiary eye care hospital during a period of nine months from October 2004 to June 2005. These patients were comprehensively examined on-site by optometrists. Using digitized images sent by store and forward technique and videoconferencing, the ophthalmologist made a diagnosis and advised treatment. Results: Adnexal or orbital diseases were detected in 101 out of 3497 patients (2.88%). Medical treatment was advised to 13 of 101 patients (12.8%). Surgery was advised in 62 of 101 patients (61.28%) whereas 18 of 101 patients (17.8%) required further investigations at a tertiary center. Conclusion: It was feasible to apply the satellite based tele-ophthalmology set-up for making a presumptive diagnosis and planning further management of adnexal and orbital diseases based on live interaction and digital still images of the patients.
  29 6,843 625
Antibacterial properties of cyanoacrylate tissue adhesive: Does the polymerization reaction play a role?
Ivana L Romero, Joao B N S Malta, Cely B Silva, Lycia M J Mimica, Kaz H Soong, Richard Y Hida
September-October 2009, 57(5):341-344
DOI:10.4103/0301-4738.55065  PMID:19700870
Purpose: To ascertain if the polymerization reaction also contributes additionally to the antibacterial effects of two commonly used cyanoacrylate tissue adhesives. Materials and Methods: Fresh liquid ethyl-cyanoacrylate (EC) and N-butyl-cyanoacrylate (BC) adhesives were applied onto 6-mm sterile filter paper discs. In the first group, the adhesive-soaked discs were immediately placed onto confluent monolayer cultures of bacteria, allowing the polymerization reaction to proceed while in culture. In the second group, the adhesive-soaked disc was allowed to first polymerize prior to being placed onto the bacterial cultures. Four types of bacteria were studied: Staphylococcus aureus , Streptococcus pneumoniae , Escherichia coli , and Pseudomonas aeruginosa . Immediately after the discs were applied, the cultures were incubated at 35° C for 24 h. Bacterial inhibitory halos were measured in the cultures at the end of the incubation period. Results: For EC, exposure of the bacteria to the cyanoacrylate polymerization reaction increased the bacterial inhibitory halos in Streptococcus pneumonia, Staphylococcus aureus and Escherichia coli. For BC, it increased the bacterial inhibitory halos in Staphylococcus aureus and Streptococcus pneumoniae . No inhibitory halos were observed in Pseudomonas aeruginosa. The bactericidal effect was higher in actively polymerizing EC, compared to previously polymerized EC in Staphylococcus aureus , Streptococcus pneumoniae, and Escherichia coli ; however, no such differences were observed for BC. Conclusions: The polymerization reaction may also be an important factor in the antibacterial properties of EC and BC.
  29 5,195 1,329
The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes
Jitendra K S Parihar, Devendra P Vats, Rakesh Maggon, Vijay Mathur, Anirudh Singh, Sanjay K Mishra
September-October 2009, 57(5):345-350
DOI:10.4103/0301-4738.55068  PMID:19700871
Aim: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes. Settings and Design: Retrospective interventional case series study. Materials and Methods : Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months Results: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV. Conclusion: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.
  13 4,955 1,402
Multimodality treatment approach in management of primary peripheral primitive neuroectodermal tumor of the orbit
Usha R Kim, Vipul Arora, J Devanand, Hadi M Khazei
September-October 2009, 57(5):395-398
DOI:10.4103/0301-4738.55067  PMID:19700883
Primitive neuroectodermal tumor is a small round cell malignancy which rarely involves the orbit. We report a case of a two-year old male child presenting as unilateral eccentric proptosis with extraconal and intraconal mass, diagnosed as primary peripheral primitive neuroectodermal tumor (pPPNET) on histopathology and immunohistochemistry. There is no defined consensus in the management of these tumors due to its rare presentation. We describe its distinguishing features with emphasis on multimodal and aggressive treatment approach which ensures appropriate management of these cases.
  9 2,984 424
Mefenamic acid-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment
Parag Vishwakarma, Ganesh V Raman, P Sathyan
September-October 2009, 57(5):398-400
DOI:10.4103/0301-4738.55066  PMID:19700884
Drug-induced secondary angle closure is quite common and in the majority of cases simply stopping the medication leads to rapid reversal of the condition and resolution of glaucoma. We describe here a patient who presented with secondary angle closure glaucoma and myopia following mefenamic acid ingestion which was managed successfully by stopping the medication, symptomatic treatment and reassurance.
  9 2,961 514
Primary primitive neuroectodermal tumor of the orbit
Dipankar Das, Ganesh Chandra Kuri, Panna Deka, Kasturi Bhattacharjee, Harsha Bhattacharjee, Akshay C Deka
September-October 2009, 57(5):391-393
DOI:10.4103/0301-4738.55071  PMID:19700881
Primitive neuroectodermal tumor (PNET) is a small round cell malignant tumor of neuroectodermal origin. Most of the PNETs occur in the central nervous system (CNS). PNETs recognized outside of CNS are diagnosed as peripheral PNET (pPNET). This tumor which expresses MIC-2 gene (CD99) seems to be least aggressive after complete tumor resection. We describe a rare case of PNET in a young girl.
  9 3,285 455
Ophthalmic complications including retinal detachment in hyperimmunoglobulinemia E (Job's) syndrome: Case report and review of literature
Vipul Arora, Usha R Kim, Hadi M Khazei, Shivayogi Kusagur
September-October 2009, 57(5):385-386
DOI:10.4103/0301-4738.55076  PMID:19700878
Hyperimmunoglobulinemia E (Job's) syndrome is characterized by markedly increased levels of immunoglobulin E, recurrent cutaneous and systemic pyogenic infections, atopic dermatitis, and peripheral eosinophilia. Although ocular involvement in Job's syndrome is rare, there are reports of keratoconus, staphylococcal chalazia with blepharitis, and endophthalmitis by various authors. We present the first case report of retinal detachment with complicated cataract in Job's syndrome.
  8 3,707 460
Delleman Oorthuys syndrome: 'Oculocerebrocutaneous syndrome'
Vipul Arora, Usha R Kim, Hadi M Khazei
September-October 2009, 57(5):387-389
DOI:10.4103/0301-4738.55074  PMID:19700879
Delleman Oorthuys syndrome (oculocerebrocutaneous syndrome) is a rare, congenital sporadic disorder affecting the skin and central nervous system. We present the case of a one-month-old male who presented with an orbital cyst in the left eye since birth along with other manifestations of this syndrome. The manifestations of this syndrome resemble other developmental disorders like Goldenhar and Goltz syndrome. Conservative management of the orbital cyst in these cases have been described. The need to diagnose this rare congenital anomaly with cerebral malformations as a separate entity is crucial in the management of these children.
  8 3,566 501
Effective pupil dilatation with a mixture of 0.75% tropicamide and 2.5% phenylephrine: A randomized controlled trial
Adisak Trinavarat, Auengporn Pituksung
September-October 2009, 57(5):351-354
DOI:10.4103/0301-4738.55070  PMID:19700872
Purpose: To compare the efficacy in pupil dilatation between a mixture containing 0.75% tropicamide and 2.5% phenylephrine and the alternate application of 1% tropicamide and 10% phenylephrine eye drops. Material and Methods : Patients requiring pupil dilatation were randomized to receive one drop of the mixture every 10 min for four times or our standard application of one drop of 1% tropicamide alternating with one drop of 10% phenylephrine every 10 min for two cycles. Pupil size was measured under bright light with the pupil gauge before, and every 5 min after initial application for 40 min. Application of the drops was discontinued once the pupil diameter reached 7 mm. Blood pressure and pulse rate were monitored every 15 min. Results: Of 40 patients (age 57.3±10.9 years, range 35-70 years), 22 were randomized into the mixture group and 18 into the alternate drug group. Baseline pupil sizes were 1.7±0.5 mm in the mixture group and 1.8±0.4 mm in the alternate drug group. The pupils were successfully dilated to 7 mm within 40 min in 17 patients of the mixture group compared to seven patients in the alternate drug group ( P =0.004, Log Rank test). The mean pupil sizes at 40 min were 6.6±0.8 and 6.0±0.9 mm in the mixture and alternate drug groups respectively ( P =0.050, t-test). Blood pressure and pulse rate were stable and similar in both groups. Conclusions: The mixture of 0.75% tropicamide and 2.5% phenylephrine is superior to our standard application of 1% tropicamide alternating with 10% phenylephrine. It provides faster and more successful pupil dilatation within 40 min.
  8 4,776 665
Salient features of the National Program for Control of Blindness during the XI th five-year plan period
R Jose, AS Rathore, V Rajshekar, Sandeep Sachdeva
September-October 2009, 57(5):339-340
DOI:10.4103/0301-4738.55064  PMID:19700869
  6 5,434 1,390
Use of tissue adhesives in ophthalmology
Rajesh Sinha, Chandrashekhar Kumar, Namrata Sharma
September-October 2009, 57(5):409-413
  6 5,129 929
An unusual intraorbital foreign body: A brake lever
Mohammad Hosein Nowroozzadeh
September-October 2009, 57(5):400-401
DOI:10.4103/0301-4738.55063  PMID:19700885
Orbital trauma usually affects the bony parts of the orbit; however, in rare cases foreign bodies are found within the orbit. In this report, we introduce a case with unusual large intraorbital foreign bodies (two parts of a brake lever) after a motorcycle accident. Although one of the foreign bodies was located in the posterior orbit, they required only one simple operation for retrieval. We will discus the management strategy.
  4 2,458 399
Clinical measurement and categorization of optic disc in glaucoma patients
Harsha B L Rao, GC Sekhar, Ganesh J Babu, Rajul S Parikh
September-October 2009, 57(5):361-364
DOI:10.4103/0301-4738.55075  PMID:19700874
Background: Assessment of optic disc size is an important component of optic nerve head examination. Agreement between different methods of disc size measurements is not very good. Purpose: To assess the agreement between the disc size assessed by Heidelberg retina tomograph (HRT) and stereobiomicroscopy with a 90 diopter (D) lens. To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs categorized by HRT disc areas. Setting and Design: Observational study of subjects examined in the glaucoma clinic of a tertiary eye institute. Materials and Methods: Seventy-five eyes of 75 glaucoma subjects were studied. Disc diameter was measured using stereobiomicroscopy and HRT. The agreement between the two sets of measurements was assessed by intraclass correlation coefficient (ICC). Discs were classified into small (<1.6 mm 2 ), average (1.6-2.6 mm 2 ) and large (>2.6 mm 2 ) depending on cutoffs provided by the manufacturers of HRT. The means (95% CI) of the corresponding vertical disc diameter in these groups were assessed. Statistical Analysis: ICC, Bland and Altman plots. Results: ICC for measurements of clinical and HRT horizontal disc diameter was 0.518 and for vertical disc diameter measurement was 0.487. The mean difference between the clinical and HRT measurements as analyzed by the Bland and Altman plot was 0.17 (95% CI, 0.13- 0.47) for horizontal and 0.22 (95% CI, 0.11- 0.54) for vertical disc diameter. Of the 75 eyes, 3 eyes had small discs, 54 average and 18 large discs. The mean clinical vertical disc diameter for small discs was 1.55 mm (95% CI, 1.2-1.7), for average discs was 1.91 mm (95% CI, 1.87-1.96) and for large discs was 2.15 mm (95% CI, 2.03-2.27). Conclusion: The agreement between clinical and HRT disc diameter measurements is moderate. Disc diameter measurement on stereobiomicroscopy can be used to categorize discs into small, average and large discs.
  4 4,631 666
Multiple myeloma presenting as bilateral orbital proptosis
Archana Malik, Subina Narang, Uma Handa, Sunandan Sood
September-October 2009, 57(5):393-395
DOI:10.4103/0301-4738.55069  PMID:19700882
A 58-year-old-man presented with painful rapidly progressive bilateral proptosis with restricted ocular movements of 15 days duration. There was history of significant weight loss in the recent past. Computed tomography scan of the head and orbit revealed bilateral multiple, well-defined, round, soft tissue masses, isointense with muscles in intraconal and extraconal space. Fine needle aspiration cytology and incision biopsy from the lesion, urine for Bence-Jones proteins and immunofixation clinched the diagnosis of multiple myeloma. Skeletal survey did not reveal any bony involvement. The diagnosis of multiple myeloma should be kept in mind in cases of bilateral proptosis. Bony involvement is not universal in cases of orbital myeloma. Early diagnosis can be established with extensive biochemical and histopathological investigations and timely treatment is life saving for these patients.
  3 3,451 431
Amalric sign and central retinal artery with lateral posterior ciliary artery occlusion
Natesh Sribhargava, K Harsha, Savitha Prasad, Bhujang K Shetty
September-October 2009, 57(5):403-404
DOI:10.4103/0301-4738.55060  PMID:19700886
  2 2,316 399
Retinal nerve fiber layer thickness analysis in suspected malingerers with optic disc temporal pallor
Mustafa Civelekler, Ismail Halili, Fatih C Gundogan, Gungor Sobaci
September-October 2009, 57(5):365-370
DOI:10.4103/0301-4738.55077  PMID:19700875
Purpose: To investigate the value of temporal retinal nerve fiber layer (RNFL temporal ) thickness in the prediction of malingering. Materials and Methods: This prospective, cross-sectional study was conducted on 33 military conscripts with optic disc temporal pallor (ODTP) and 33 age-and sex-matched healthy controls. Initial visual acuity (VA i ) and visual acuity after simulation examination techniques (VA aset ) were assessed. The subjects whose VA aset were two or more lines higher than VA i were determined as malingerers. Thickness of the peripapillary RNFL was determined with OCT (Stratus OCT™, Carl Zeiss Meditec, Inc.). RNFL temporal thickness of the subjects were categorized into one of the 1+ to 4+ groups according to 50% confidence interval (CI), 25% CI and 5% CI values which were assessed in the control group. The VAs were converted to LogMAR-VAs for statistical comparisons. Results: A significant difference was found only in the temporal quadrant of RNFL thickness in subjects with ODTP ( P =0.002). Mean LogMAR-VA increased significantly after SETs ( P <0.001). Sensitivity, specificity, positive and negative predictive values of categorized RNFL temporal thickness in diagnosing malingering were 84.6%, 75.0%, 68.8%, 88.2%, respectively. ROC curve showed that RNFL temporal thickness of 67.5 µm is a significant cut-off point in determining malingering ( P =0.001, area under the curve:0.862). The correlations between LogMAR-VAs and RNFL temporal thicknesses were significant; the correlation coefficient for LogMAR-VA i was lower than the correlation for LogMAR-VA aset (r=-0.447, P =0.009 for LogMAR-VA i ; r=-0.676, P <0.001 for LogMAR-VA aset ). Conclusions: RNFL temporal thickness assessment may be a valuable tool in determining malingering in subjects with ODTP objectively.
  2 4,934 446
Interrelationship between optic disc edema, spontaneous venous pulsation and intracranial pressure
Nikhil S Choudhari, Rajiv Raman, Ronnie George
September-October 2009, 57(5):404-406
DOI:10.4103/0301-4738.55061  PMID:19700887
  1 3,902 0
A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas
Seemant Raizada, Khalid Al Sabti
September-October 2009, 57(5):406-407
DOI:10.4103/0301-4738.55062  PMID:19700888
  1 2,345 386
An unusual case of total ophthalmoplegia
Ravindra Kumar Chowdhury, Navnit Gupta, Krishna Charan Padhy
September-October 2009, 57(5):389-391
DOI:10.4103/0301-4738.55072  PMID:19700880
An eight-year-old male child presented with drooping of the left eyelid with a history of penetrating injury of hard palate by an iron spoon seven days ago, which had already been removed by the neurosurgeon as the computed tomography scan revealed a spoon in the left posterior ethmoid and sphenoid bone penetrating into the middle cranial fossa. On examination, visual acuity was 20/20 in each eye and left eye showed total ophthalmoplegia. Oral cavity revealed a hole in the left lateral part of the hard palate. We managed the case with tapering dose of systemic prednisolone. The total ophthalmoplegia was markedly improved in one month. Cases of foreign bodies in the orbit with intracranial extension are not unusual, but the path this foreign body traveled through the hard palate without affecting the optic nerve, internal carotid artery or cavernous sinus makes an interesting variation.
  - 4,007 460
Authors' reply
Gowri J Murthy, Praveen R Murthy, Krishna R Murthy, Vinay V Kulkarni, KR Murthy
September-October 2009, 57(5):407-407
  - 1,896 253