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  Citation statistics : Table of Contents
   2010| January-February  | Volume 58 | Issue 1  
    Online since December 22, 2009

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Current approach in diagnosis and management of anterior uveitis
Rupesh V Agrawal, Somasheila Murthy, Virender Sangwan, Jyotirmay Biswas
January-February 2010, 58(1):11-19
DOI:10.4103/0301-4738.58468  PMID:20029142
Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.
  53 19,847 2,987
Intravitreal anti-vascular endothelial growth factor agents as an adjunct in the management of Coats' disease in children
Shalini Kaul, Mahesh Uparkar, Kruti Mody, Jaydeep Walinjkar, Mihir Kothari, S Natarajan
January-February 2010, 58(1):76-78
DOI:10.4103/0301-4738.58480  PMID:20029154
We describe the role of intravitreal anti-vascular endothelial growth factor (VEGF) agents in Coats' disease in children. In a prospective, interventional, non-randomized case series, three patients (three eyes) aged 16, seven and two years were diagnosed to have Coats' disease. In Case 1 (16 yr/ male) with macular edema, previous laser photocoagulation being unsuccessful, intravitreal pegaptanib sodium (Macugen™) was tried. Case 2 (seven yr/ male) and Case 3 (two yr/ female) were diagnosed to have Stage 4 Coats' and underwent external needle drainage, laser photocoagulation, SF6 gas injection and intravitreal injection of bevacizumab (Avastin™). Reduction of exudation and attached posterior pole (Cases 2 and 3) was seen at a follow-up of six months and two months respectively. Intravitreal anti-VEGF agents may be successfully used as adjunct treatment in select cases of Coats' disease in childhood.
  30 4,139 452
Intermediate uveitis
B Manohar Babu, SR Rathinam
January-February 2010, 58(1):21-27
DOI:10.4103/0301-4738.58469  PMID:20029143
Intermediate uveitis (IU) is described as inflammation in the anterior vitreous, ciliary body and the peripheral retina. In the Standardization of Uveitis Nomenclature (SUN) working group's international workshop for reporting clinical data the consensus reached was that the term IU should be used for that subset of uveitis where the vitreous is the major site of the inflammation and if there is an associated infection (for example, Lyme disease) or systemic disease (for example, sarcoidosis). The diagnostic term pars planitis should be used only for that subset of IU where there is snow bank or snowball formation occurring in the absence of an associated infection or systemic disease (that is, "idiopathic"). This article discusses the clinical features, etiology, pathogenesis, investigations and treatment of IU.
  29 18,621 2,449
Inflammatory choroidal neovascular membrane in posterior uveitis-pathogenesis and treatment
Narendra Dhingra, Susan Kelly, Mohammed A Majid, Claire B Bailey, Andrew D Dick
January-February 2010, 58(1):3-10
DOI:10.4103/0301-4738.58467  PMID:20029141
Choroidal neovascular membrane (CNVM) formation is a well-documented sight-threatening complication of posterior segment intraocular inflammation (PSII). The aim of this article is to review the basic and clinical science literature on the pathogenesis of CNVM formation in PSII and to present results of a case series. We searched the literature using the mesh terms- inflammation, CNVM, age-related macular degeneration, immunosuppression, photodynamic therapy, steroids, vascular endothelial growth factors and posterior uveitis. Additionally, we evaluated the visual outcome of and clinical response to our standard treatment protocol involving a combination treatment for young patients with inflammatory CNVM. The development of CNVM in PSII is promulgated by infiltrating myeloid cells as well as choroidal and retinal myeloid cell activation, subsequent vascular endothelial growth factors, cytokine and chemokine production and complement activation acting in consort to mediate angiogenic responses. No clear standard of care currently exists for the treatment of inflammatory CNVM and various combinations have been tried. Using our combination treatment, visual acuity improved in four, stabilized in one and worsened in four patients. Though significant advances have occurred in the understanding of the pathogenesis and management of this condition, optimizing therapeutic regimens will require further well-constructed prospective cohort series.
  28 7,730 942
Current approach in the diagnosis and management of posterior uveitis
S Sudharshan, Sudha K Ganesh, Jyotirmay Biswas
January-February 2010, 58(1):29-43
DOI:10.4103/0301-4738.58470  PMID:20029144
Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.
  24 16,737 2,322
Resolution of macular edema in Coats' disease with intravitreal bevacizumab
Morteza Entezari, Alireza Ramezani, Ladan Safavizadeh, Nader Bassirnia
January-February 2010, 58(1):80-82
DOI:10.4103/0301-4738.58482  PMID:20029156
A 13-year-old boy was referred because of visual deterioration in his right eye. The visual acuity was two meters of counting fingers. Indirect ophthalmoscopy and biomicroscopy revealed exudative macular edema as well as tumor-like telangiectatic vessels and exudation in temporal periphery. With diagnosis of Coats' disease (stage II) confirmed by fluorescein angiography, three intravitreal injections of bevacizumab were performed at 6-week intervals. One year after the last injection, there was a significant resolution of macular edema as well as visual acuity improvement to 20/20. This is the first case report in which a distinct improvement in macular edema was observed with intravitreal bevacizumab in Coats' disease.
  20 3,973 361
Low-dose cyclosporine treatment for sight-threatening uveitis: Efficacy, toxicity, and tolerance
D Mathews, John Mathews, NP Jones
January-February 2010, 58(1):55-58
DOI:10.4103/0301-4738.58472  PMID:20029146
Aim : To ascertain the effectiveness, tolerability, and safety of low-dose cyclosporine in the management of sight-threatening uveitis. Materials and Methods: This was a retrospective clinical case series of patients using oral low-dose cyclosporine for the management of sight-threatening uveitis in the uvea clinic (UC). Patients receiving cyclosporine were identified from the clinic database. Main outcome measures were degree of intraocular inflammation, visual acuity and dose reduction of oral steroid for effectiveness and adverse symptoms, systemic hypertension, and raised serum creatinine for tolerability and safety. Results: Intraocular inflammation was improved or stable in 97% of patients, visual acuity was improved or stable in 91%, and oral steroid dosage was reduced in 73% (by half or more in 51%). Adverse symptoms were almost universal, the commonest being peripheral paresthesia/burning in 70% and fatigue in 67%. Significant systemic hypertension developed in 27% and raised creatinine in 30%, necessitating dose reduction. Cyclosporine was discontinued in 35%, being intolerable in 20% and ineffective in 15%. Conclusions: Cyclosporine was found to be effective in reducing inflammation and protecting vision in sight-threatening uveitis. It was safe with proper monitoring, including in children. It had a significant toxicity profile and a high incidence of adverse symptoms which required close supervision, and a prompt dose reduction or drug exchange.
  18 4,626 632
Disseminated orbital actinomycetoma: A case report
Nita Umesh Shanbhag, Sumita Karandikar, Pooja Anil Deshmukkh
January-February 2010, 58(1):60-63
DOI:10.4103/0301-4738.58474  PMID:20029148
Mycetoma is a chronic granulomatous infection. Lower extremities are commonly involved. A 20-year-old male came with complaints of multiple sinuses on scalp, left eyelid swelling with a sinus and dystopia, since one year. On examination there was relative proptosis in left eye of 2 mm. Computed tomography scan showed soft tissue swelling of the pre-septal area of the left upper eyelid with orbital involvement. Magnetic resonance imaging showed increased left orbital volume and evident dystopia. Microbiology testing of the erosive scalp and lid lesions showed genus Nocardia, suggestive of actinomycetoma. This case is presented as it shows an unusual involvement of the orbit.
  14 3,425 297
Current approach in the diagnosis and management of panuveitis
Reema Bansal, Vishali Gupta, Amod Gupta
January-February 2010, 58(1):45-54
DOI:10.4103/0301-4738.58471  PMID:20029145
Panuveitis is a generalized inflammation of not only the whole of the uveal tract but also involves the retina and vitreous humor. It differs from other anatomical sites of inflammation in terms of causes as well as distribution. The common causes of panuveitis in our population are tuberculosis, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia, Behcet's disease and sarcoidosis. A large number of cases still remain idiopathic. A stepwise approach is essential while evaluating these patients to be able to identify and treat the disease timely and correctly. Ancillary tests can be appropriately applied once the anatomic site of inflammation is identified. An exhaustive approach comprising a full battery of tests is obsolete. Only specific tailored investigations are ordered as suggested by the preliminary clinical and ocular examination. The mainstay of the treatment of uveitis is corticosteroids. Immunosuppressive agents are administered if the inflammation is not adequately controlled with corticosteroids. One of the recent breakthroughs in the treatment of refractory uveitis includes the introduction of immunomodulating drugs: Tumor necrosis factor-alpha antagonist and Interferon-alpha. Vitrectomy has been used in uveitis for over a few decades for diagnostic and therapeutic purposes. When compared to other anatomical sites of inflammation, panuveitis has poor visual outcome due to more widespread inflammation. The side-effects of the chronic treatment that these patients receive cannot be overlooked and should be specifically monitored under the supervision of an internist with special interest in inflammatory diseases.
  12 14,089 2,001
Intravitreal cysticercosis presenting as neovascular glaucoma
Dhanashree Ratra, Chekitaan Phogat, Maneesh Singh, Nikhil S Choudhari
January-February 2010, 58(1):70-73
DOI:10.4103/0301-4738.58478  PMID:20029152
We report two cases of intraocular cysticercosis which showed a peculiar presentation of neovascular glaucoma which is hitherto unreported. Two young adults presented with symptoms of raised intraocular pressure due to neovascular glaucoma. On dilated fundus examination both were found to have dead intravitreal cysticercosis. The cysts were removed by a three-port vitrectomy and intracameral injection of bevacizumab was given to help in the regression of rubeosis. Trabeculectomy had to be combined in one case. The intraocular pressure returned to normal. No recurrence of rubeosis was seen even after one year.
  10 3,380 340
Treatment of uveitis: Beyond steroids
Virender S Sangwan
January-February 2010, 58(1):1-2
DOI:10.4103/0301-4738.58466  PMID:20029140
  8 6,211 892
Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma
Harsha Bhattacharjee, Kasturi Bhattacharjee, Jnanankar Medhi, Sushobhan DasGupta
January-February 2010, 58(1):67-70
DOI:10.4103/0301-4738.58477  PMID:20029151
Phacoemulsification with implantation of single-piece acrylic foldable intraocular lens (IOL) in a 19-year-old boy with microspherophakia, high myopia and angle closure glaucoma is described. The associated myopia and angle closure glaucoma was severely compromising the quality of life. Post-surgical visual recovery was 20/20 with sustained normal intraocular pressure. Management of such cases at times calls for innovations in current surgical technique.
  5 5,873 563
Verteporfin photodynamic therapy of retinal capillary hemangioblastoma in von Hippel-Lindau disease
Harsha Bhattacharjee, Hemalata Deka, Satyen Deka, Manab Jyoti Barman, Mrinal Mazumdar, Jnanankar Medhi
January-February 2010, 58(1):73-75
DOI:10.4103/0301-4738.58479  PMID:20029153
An 18-year-old boy presented to us with bilateral retinal hemangioblastoma and von Hippel-Lindau disease with history of cerebral capillary hemangioblastoma and embryonic cell carcinoma of left testes. The vision in the right eye was already lost with development of secondary closed angle glaucoma, optic atrophy with subsequent development of bullous keratopathy. The multiple retinal angiomatous lesions in the seeing left eye were treated with various modalities like triple freeze thaw cryopexy, focal lasers and transpupillary thermo therapy in multiple sittings over a period of almost 20 years since detection. One particular angiomatous lesion in the left eye was showing resistance to all the above mentioned modalities and was finally successfully treated with verteporfin and photodynamic therapy to achieve complete regression without any post-treatment complication and with a sustained 20/20 vision till a follow-up of 15 months.
  5 4,159 320
Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings
Kalpana Babu, Vinay R Murthy, Veeresh P Akki, Venkatesh C Prabhakaran, KR Murthy
January-February 2010, 58(1):64-66
DOI:10.4103/0301-4738.58475  PMID:20029149
We report an interesting ocular finding of bilateral multiple coin-shaped epithelial lesions along with the confocal microscopy findings in a patient following an acute attack of erythema multiforme (EM) minor. A 30-year-old male presented with a history of watering and irritation in both eyes of three days duration. He was diagnosed to have EM minor and was on oral acyclovir. Slit-lamp examination revealed multiple coin-shaped epithelial lesions. Confocal microscopy showed a corresponding conglomerate of hyper-reflective epithelial lesions. The corneal lesions resolved over six weeks with oral steroids and acyclovir. An immunological mechanism is suspected.
  3 3,139 287
Isolated trochlear nerve palsy with midbrain hemorrhage
S Raghavendra, K Vasudha, S Ravi Shankar
January-February 2010, 58(1):66-67
DOI:10.4103/0301-4738.58476  PMID:20029150
Midbrain hemorrhage causing isolated fourth nerve palsy is extremely rare. Idiopathic, traumatic and congenital abnormalities are the most common causes of fourth nerve palsy. We report acute isolated fourth nerve palsy in an 18-year-old lady due to a midbrain hemorrhage probably due to a midbrain cavernoma. The case highlights the need for neuroimaging in selected cases of isolated trochlear nerve palsy.
  3 3,140 316
Evaluation of medical college departments of ophthalmology in India
Sohan Singh Hayreh
January-February 2010, 58(1):83-83
DOI:10.4103/0301-4738.58483  PMID:20029158
  2 1,951 299
Wound construction in manual small incision cataract surgery
Rupesh Agrawal
January-February 2010, 58(1):85-85
DOI:10.4103/0301-4738.58486  PMID:20029160
  2 2,720 407
Modified "temporal" sutureless vitrectomy
Cyrus M Shroff, AK Singh, Charu Gupta, Daraius N Shroff
January-February 2010, 58(1):86-87
DOI:10.4103/0301-4738.58489  PMID:20029161
  2 2,003 236
Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis
Kalpana Babu, Prashanta V Gundannavar, Vidya Satish, Venkatesh C Prabhakaran
January-February 2010, 58(1):78-80
DOI:10.4103/0301-4738.58481  PMID:20029155
We report a rare presentation of Melkersson-Rosenthal syndrome in a patient with tubercular panuveitis. A 45-year-old male being treated with antitubercular therapy for tubercular panuveitis presented with unilateral, non-pitting right upper eyelid edema. Excision biopsy showed granulomatous inflammation involving the lymphatics. Immunohistochemistry confirmed the presence of histiocytes around the lymphatics.
  1 2,919 283
Pseudo-gonio synechia: An artifact on two-mirror gonioscopy
Chandra Sekhar Garudadri
January-February 2010, 58(1):59-60
DOI:10.4103/0301-4738.58473  PMID:20029147
Gonioscopy is an important component of evaluation of any glaucoma patient. Goldmann two-mirror and Sussman or Zeiss four-mirror are the commonly used gonioscopes. Presence of synechia in the angle is diagnostic of angle closure disease in an occludable angle. A patient with pseudo-goniosynechia that disappeared on indentation gonioscopy with Sussman lens but persisted with manipulation gonioscopy with a Goldmann lens is reported.
  - 2,672 324
Newer investigations and management guidelines in uveitis
Rajesh Sinha, Prashant Naithani, Satpal Garg
January-February 2010, 58(1):88-91
  - 3,824 731
Nucleus management with blumenthal technique: Anterior chamber maintainer
Rupesh Agrawal
January-February 2010, 58(1):85-86
DOI:10.4103/0301-4738.58487  PMID:20029159
  - 2,104 266
Blumenthal technique and its modification: The glory of anterior chamber maintainer
Srikant Kumar Sahu, Sujata Das, Suryasnath Rath
January-February 2010, 58(1):86-86
DOI:10.4103/0301-4738.58488  PMID:20029162
  - 3,311 303
Intracameral use of 2% lignocaine with preservative: Is it really safe?
Shivcharan L Chandravanshi, Sujata Lakhtakia, Mahesh K Rathore
January-February 2010, 58(1):83-84
DOI:10.4103/0301-4738.58484  PMID:20029157
  - 2,666 292
Authors' reply
Sanjiv Kumar Gupta, Ajay Kumar, Deepak Kumar, Swati Agarwal
January-February 2010, 58(1):84-84
  - 3,719 162