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  Citation statistics : Table of Contents
   2010| July-August  | Volume 58 | Issue 4  
    Online since June 7, 2010

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A study on the incidence, microbiological analysis and investigations on the source of infection of postoperative infectious endophthalmitis in a tertiary care ophthalmic hospital: An 8-year study
Malathi Jambulingam, Suresh Kumar Parameswaran, Sagar Lysa, Margarita Selvaraj, Hajib N Madhavan
July-August 2010, 58(4):297-302
DOI:10.4103/0301-4738.64132  PMID:20534919
Background: The objective of the study was the determination of the incidence of culture-proven postoperative endophthalmitis and probable sources of infection. Materials and Methods: It was a prospective study on the microbiology, incidence and probable sources of infection in patients with postoperative infectious endophthalmitis carried out in a tertiary care eye hospital. Consecutive patients diagnosed with postoperative infectious endophthalmitis during the years 2000-2007 were investigated for the causative infective agent and possible sources of infection. The surgical data and microbiological data including the investigations performed to trace the source were recorded in a specific formatted form and were gathered and compiled for analysis. Results: Data of analysis showed that 98 (0.042%) out of 2,31,259 patients who underwent intra-ocular surgery developed infectious endophthalmitis. Among these, 70 (0.053%) occurred after cataract, 10 (0.5%) after penetrating keratoplasty (PK) and 18 (0.018%) following other types of intra-ocular surgeries. The predominant infectious agents isolated were bacteria (89.7%), with equal proportions of Gram-positive and Gram-negative bacteria. Polymicrobial infection was noted in four and fungi in seven patients. Occurrence of postoperative endophthalmitis was sporadic and not related to any specific part of period in a year. Sources of infection were donor corneal rim in six post-PK patients and phaco probe in one who had postphacoemulsification endophthalmitis Conclusions: Overall incidence of postoperative endophthalmitis over an 8-year period was quite low. The sources of infection could be established in six post-PK endophthalmitis patients and in a postcataract surgery.
  26 5,454 668
Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries
Lavanya G Rao, Anju Ninan, Krishna A Rao
July-August 2010, 58(4):321-323
DOI:10.4103/0301-4738.64116  PMID:20534923
A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.
  18 2,963 414
Is inclusion of Sabouraud dextrose agar essential for the laboratory diagnosis of fungal keratitis?
Sujata Das, Savitri Sharma, Sarita Kar, Srikant K Sahu, Bikash Samal, Aparajita Mallick
July-August 2010, 58(4):281-286
DOI:10.4103/0301-4738.64122  PMID:20534916
Purpose: To determine whether the inclusion of Sabouraud dextrose agar (SDA) is essential in the diagnosis of fungal keratitis. Materials and Methods: Corneal scrapings of 141 patients with microbial keratitis were smeared and cultured. Sheep blood agar (BA), chocolate agar (CA), SDA, non-nutrient agar (NNA) with Escherichia coli overlay, and brain heart infusion broth (BHI) were evaluated for time taken for growth and cost. The media were also evaluated experimentally for rate of growth and time taken for identification. Results: Twenty-six of 39 patients positive for fungus in corneal scrapings by microscopy were culture-positive. Fungus grew on BA in 22/39, on CA in 18/39, on SDA in 17/39, on NNA in 17/39, and on BHI in 13/39 cases. Growth on SDA was higher in ulcers with larger infiltrate (6/18 versus 9/13, P = 0.04). Estimated saving with inclusion of only BA/CA was Rs. 600 per patient. Performance of all media was similar in in vitro experiment although the characteristic spores and color were seen earlier on SDA. Conclusion: Fungal keratitis can be reliably confirmed on BA or CA, which support growth of both bacteria and fungus.
  17 4,879 582
Visual prognosis, intraocular pressure control and complications in phacomorphic glaucoma following manual small incision cataract surgery
R Ramakrishanan, Devendra Maheshwari, Mohideen Abdul Kader, Rita Singh, Neelam Pawar, M Jayahar Bharathi
July-August 2010, 58(4):303-306
DOI:10.4103/0301-4738.64136  PMID:20534920
Aims: To evaluate intraocular pressure (IOP) control, visual prognosis and complications following manual small incision cataract surgery among eyes with phacomorphic glaucoma. Materials and Methods: This prospective, non-randomized interventional consecutive case series included all patients with phacomorphic glaucoma who presented to a tertiary eye care referral center in South India between March 2006 and April 2007. All patients underwent slit-lamp bio-microscopy, applanation tonometry and gonioscopy of the other eye to rule out angle closure. Small incision cataract surgery with intraocular lens implantation was performed in all affected eyes. Complete ophthalmic examination was done at each follow-up visit. Results: A total of 74 eyes with phacomorphic glaucoma were included in this study. The preoperative mean IOP was 38.4±14.3 mmHg and mean IOP at last follow-up was 12.7±2.4 mmHg. There was a statistically significant difference between IOP at presentation and IOP at last follow-up (P< 0.001). None of the eyes required long-term antiglaucoma medication. No significant intraoperative complications were noted. The final postoperative best corrected visual acuity was 20/40 or better in 51 patients. Eighteen eyes had corneal edema and 36 eyes had anterior chamber inflammation. Both conditions resolved with standard medical therapy. Conclusion: Manual small incision cataract surgery is safe and effective in controlling IOP and achieving good functional visual acuity with minimal complications in the management of phacomorphic glaucoma in developing countries.
  15 4,358 569
Misleading Goldmann applanation tonometry in a post-LASIK eye with interface fluid syndrome
Sirisha Senthil, Varsha Rathi, Chandrasekhar Garudadri
July-August 2010, 58(4):333-335
DOI:10.4103/0301-4738.64133  PMID:20534929
A 21-year-old myope presented with decreased vision and corneal edema following vitreoretinal surgery for retinal detachment. While intraocular pressure (IOP) measurement with Goldmann applanation tonometer (GAT) was low, the digital tonometry indicated raised pressures. An interface fluid syndrome (IFS) was suspected and confirmed by clinical exam and optical coherence tomography. A tonopen used to measure IOP through the peripheral cornea revealed elevated IOP which was the cause of the interface fluid. Treatment with IOP-lowering agents resulted in complete resolution of the interface fluid. This case is being reported to highlight the fact that IFS should be suspected when there is LASIK flap edema and IOP readings using GAT are low and that GAT is not an optimal method to measure IOP in this condition. Alternative methods like tonopen or Schiotz tonometry can be used.
  13 3,371 267
Ocular aberrations after wavefront optimized LASIK for myopia
Prema Padmanabhan, Subam S Basuthkar, Roy Joseph
July-August 2010, 58(4):307-312
DOI:10.4103/0301-4738.64139  PMID:20534921
Purpose: To study the change in ocular aberrations after wavefront optimized (WFO) laser in situ keratomileusis ( Lasik ) for correction of myopia and to analyze causative factors that may influence them. Materials and Methods: This was a prospective case series. WFO Lasik was performed for the correction of myopia, using the hansatome (Bausch and Lomb) microkeratome to create the flap and the Allegretto laser (Wavelight Technologie) to perform the ablation. The Allegretto wave analyser (Tscherning-type) measured the ocular aberrations prior to Lasik , one month and six months postoperatively. Results: The mean age of the 59 patients included in the study was 25±5.64 years and the mean spherical equivalent of the 117 eyes that underwent Lasik0 was -5.33±1.22 preoperatively and -0.21±0.38 postoperatively. Hundred and two eyes of 117 (87%) achieved uncorrected visual acuity (UCVA) of 20/20 or better after WFO Lasik and 104 of 117 eyes (89%) were within ±0.5D of the attempted refractive correction. There was a 1.96-fold increase in total root-mean-square of higher order aberrations. Induced changes in seven of the 22 higher order Zernike terms showed a significant linear correlation with the refractive correction attempted. Larger ablation zones induced less spherical aberration. Conclusion: In spite of an excellent visual outcome, WFO Lasik induces significant higher order aberrations. Large ablation zones reduce the induction of spherical aberration.
  12 4,274 450
A bibliometric study of publications by Indian ophthalmologists and vision researchers, 2001-06
R Kumaragurupari, Pamela C Sieving, Prajna Lalitha
July-August 2010, 58(4):275-280
DOI:10.4103/0301-4738.64117  PMID:20534915
Objective: The objective was to conduct a bibliometric analysis of Indian ophthalmic papers published from 2001 to 2006 in the peer-reviewed journals, to assess productivity, trends in journal choice, publication types, research funding, and collaborative research. Materials and Methods: We searched PubMed for articles indicating both vision-related content and author affiliation with an Indian research center. We identified research collaborations and funding from indexing for research support, and classified articles as reporting basic science, clinical science, or clinically descriptive research. Impact factors were determined from Journal Citation Reports for 2006. Results: The total number of published articles that were retrieved for the years 2001 to 2006 was 2163. During the six-year period studied, the annual output of research articles has nearly doubled, from 284 in 2001 to 460 in 2006. Two-thirds of these were published in international journals; 41% in vision-related journals with 2006 impact factors; and 3% in impact factor journals which were not vision-related. Fifty percent of the publications came from nine major eye hospitals. Clinical science articles were most frequently published whereas basic science the least. Publications resulting from international collaborations increased from 3% in 2001 to 8% in 2006. The focus of the journal with the highest number of publications corresponds to the most common cause of bilateral blindness in India, cataract. Conclusion: This bibliometric study of publications of research from India in the field of ophthalmic and vision research shows that research productivity, as measured in both the number of publications in peer-reviewed journals and qualitative measures of those journals, has increased during the period of this study.
  12 3,591 578
Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: Short-term results
Yoshinori Mitamura, Masayasu Kitahashi, Mariko Kubota-Taniai, Shuichi Yamamoto
July-August 2010, 58(4):291-296
DOI:10.4103/0301-4738.64130  PMID:20534918
Aims: To compare the short-term therapeutic effects of intravitreal bevacizumab (IVB) to those of photodynamic therapy (PDT) for polypoidal choroidal vasculopathy (PCV). Materials and Methods: Retrospective interventional case study. Eighty-nine eyes of 89 patients with symptomatic PCV were treated by IVB or PDT. Eighteen eyes were treated with a single injection of IVB (s-IVB group), 22 eyes with three consecutive monthly IVB injections (m-IVB group), and 49 eyes with PDT alone (PDT group). The best-corrected visual acuity (BCVA) and OCT-determined central foveal thickness (CFT) were evaluated before, and one and three months after the treatment. For statistical analyses, one-factor ANOVA and Chi-square test were used. Results: The differences in the BCVA and CFT among the three groups at the baseline were not significant (P=0.992, P=0.981, respectively). Three months after the treatment, the BCVA improved by >0.2 logMAR units in two out of 18 eyes (11%) in the s-IVB group, three out of 22 eyes (14%) in the m-IVB group, and 15 out of 49 eyes (31%) in the PDT group (P=0.124). A decrease in the CFT by >20% was achieved in six out of 18 eyes in the s-IVB group, ten eyes (46%) in the m-IVB group, and 35 eyes (71%) in the PDT group (P=0.009). The resolution of polyps was achieved in three out of 18 eyes in the s-IVB group, one eye (5%) in the m-IVB group and 35 eyes (71%) in the PDT group (P<0.001). Conclusion: The better short-term therapeutic outcomes in the PDT group than in the s-IVB and m-IVB groups indicate that PDT may be more effective than IVB in short term after treatment for PCV.
  11 3,043 309
Central posterior capsule pigmentation in a patient with pigment dispersion and previous ocular trauma: A case report
Hani S Al-Mezaine
July-August 2010, 58(4):336-337
DOI:10.4103/0301-4738.64135  PMID:20534930
We report a 55-year-old man with unusually dense, unilateral central posterior capsule pigmentation associated with the characteristic clinical features of pigment dispersion syndrome, including a Krukenberg's spindle and dense trabecular pigmentation in both eyes. A history of an old blunt ocular trauma probably caused separation of the anterior hyaloid from the back of the lens, thereby creating an avenue by which pigment could reach the potential space of Berger's from the posterior chamber.
  4 2,064 176
Accommodative spasm in siblings: A unique finding
Robert P Rutstein
July-August 2010, 58(4):326-327
DOI:10.4103/0301-4738.64123  PMID:20534925
Accommodative spasm is a rare condition occurring in children, adolescents, and young adults. A familial tendency for this binocular vision disorder has not been reported. I describe accommodative spasm occurring in a brother and sister. Both children presented on the same day with complaints of headaches and blurred vision. Treatment included cycloplegia drops and bifocals. Siblings of patients having accommodative spasm should receive a detailed eye exam with emphasis on recognition of accommodative spasm.
  4 3,755 322
Prevalence and determinants of blindness, low vision, deafness and major bone fractures among elderly Omani population of Nizwa Wilayat (Nizwa elderly population study - 2005)
Rajiv Khandekar, Asiya Al Riyami, Mahmood Attiya, Magdi Morsi
July-August 2010, 58(4):313-320
DOI:10.4103/0301-4738.64143  PMID:20534922
Aim: We conducted a survey in 2005 to estimate the prevalence and determinants of visual and hearing impairment in a population aged 60 years and above, from the Nizwa Wilayat of Oman. We also correlated them with major bone fracture. Study Design: Cross-sectional survey. Materials and Methods: Vision was tested on Snellen's 'E' chart. Persons with vision less than 20/200 were reexamined by an ophthalmologist to find cause of impairment. Hearing was tested by a screening audiometer. Self-reported information on fracture of major bones was confirmed by review of case records. The prevalence, 95% confidence intervals (CI), and number of visually impaired individuals were calculated. Statistical Analysis: Univariate method and parametric tests were used for analysis. Results: We examined 1,639 (80.3%) Omani persons aged 60 years and above. The prevalence of blindness (vision less than 20/200 in the better eye) was 37.4% (95% CI 35.7-39.1). Blindness was significantly higher in females (Odd's Ratio = 2.1) but was similar in urban and rural Nizwa (OR = 0.73). The prevalence of vision impairment (20/60 to 10/200) was 36.0% (95% CI 34.3-37.7). Cataract was the principal cause in 50% of the blind. The prevalence of glaucoma, corneal opacity, and chronic trachoma was 3.1%, 66.8%, and 53.2%, respectively. Among participants, 36.1% had diabetes. Hearing impairment was noted in 33.5% and profound hearing loss was noted in 3.6% of participants. In the past year, 1.4% of participants had a major bone fracture. Conclusion: Visual and hearing impairment and blinding eye diseases were common among senior Omani citizens.
  4 3,848 342
Non-arteritic ischemic optic neuropathy followed by intravitreal bevacizumab injection: Is there an association?
Ali A Bodla, Prasad Rao
July-August 2010, 58(4):349-350
DOI:10.4103/0301-4738.64142  PMID:20534939
  4 1,687 219
Horizontal lang two-pencil test as a screening test for stereopsis and binocularity
Monisha E Nongpiur, Pradeep Sharma
July-August 2010, 58(4):287-290
DOI:10.4103/0301-4738.64125  PMID:20534917
Purpose: To assess the horizontal Lang two-pencil test as a bedside test to detect gross stereopsis. Materials and Methods: Eighty-four strabismic subjects divided into two groups based on the amount of deviation, and 40 normal subjects were studied. Sensory status examination including binocularity and stereopsis were evaluated with Bagolini, Titmus test and the Netherlands organisation for applied scientific research (TNO), Randot, synoptophore and horizontal Lang two-pencil test. Results: The subjects in the group with smaller deviation showed better performance on all the four stereo tests and over 90% demonstrated presence of fusion. When compared to TNO and Randot for determining presence of stereopsis, the horizontal Lang two-pencil test demonstrated sensitivity of 100% and 83.9%, specificity of 77.8% and 73.7%, and negative predictive value of 100% and 100% respectively. It also showed 100% specificity as a test for binocularity when compared with the Bagolini striated glass test. Conclusion: Horizontal Lang two-pencil test, an easily performed test with a high sensitivity and negative predictive value can be used as a screening test to detect gross stereopsis and binocularity.
  4 5,375 395
Atypical presentation of an unusual foreign body
Vipul Arora, Usha R Kim, Shashikant Shetty, Akash D Shah
July-August 2010, 58(4):338-339
DOI:10.4103/0301-4738.64138  PMID:20534931
A 14-year-old boy presented with intractable diplopia for 10 days following an assault. A thorough history revealed that he was unaware of any penetrating injury. However, imaging demonstrated a radiolucent foreign body between the globe and the orbital floor. On surgical exploration, it was found to be the proximal part of a ball point pen. Its removal resulted in complete resolution of diplopia. Thorough clinical and radiological examination is recommended when a foreign body is suspected in pediatric patients. Prompt diagnosis will aid in early intervention and prevention of long-term complications.
  3 2,067 215
Impact of a month-long training program on the clinical skills of ophthalmology residents and practitioners
Sushma Tejwani, Somasheila I Murthy, Chandra Sekhar Gadudadri, Ravi Thomas, Praveen Nirmalan
July-August 2010, 58(4):340-343
DOI:10.4103/0301-4738.64141  PMID:20534932
A cohort study was performed to assess the impact of an intensive, hands-on, supervised training program in ophthalmic clinical evaluation, for ophthalmology residents and private practitioners. All students underwent one-month training in comprehensive ophthalmology examination and investigations at a tertiary care center between January 2004 and January 2006. The training methodology included didactic lectures, video-demonstrations and hands-on training. The participants completed a self-assessment with a set of 23 questions designed to assess the level of confidence in various skills on the first and last day of the training. Of a total of 118 students, 67 (56.8%) were residents and 51 (43.2%) were practitioners. The mean score pre-training was 38.3 out of 92 (S.D. ±16.9), and was 70.6 out of 92 (S.D.± 10.1) post-training. The mean increase in the scores was 32.3 (P value < 0.001). We concluded that intensive, short-term training programs could improve the self-perceived level of confidence of ophthalmology residents and practitioners.
  3 2,098 228
Alcohol epitheliectomy with mechanical debridement in a case of granular corneal dystrophy with r555w homozygous mutation of TGF B1 gene
Prashant Garg, Aneeta Jabbar
July-August 2010, 58(4):328-329
DOI:10.4103/0301-4738.64126  PMID:20534926
An eight-year-old girl, an offspring of a consanguineous marriage presented with multiple anterior stromal geographic corneal opacities in both eyes. She was diagnosed to have superficial variant of granular dystrophy based on the family history, clinical features and mutation of TGF B1 gene. She was treated by alcohol-assisted removal of epithelium followed by mechanical debridement of abnormal deposits. Postoperatively, the cornea in both eyes was clear with no trace of opacity and the patient had an unaided visual acuity of 20/20 partial.
  2 2,149 172
Wildervanck syndrome associated with cleft palate and short stature
Anand Kumar, Anupam Sahu, Shashikant Shetty, P Vijayalakshmi
July-August 2010, 58(4):323-325
DOI:10.4103/0301-4738.64120  PMID:20534924
We report a case of Wildervanck syndrome exhibiting Klippel-Feil anomaly, Duane retraction syndrome and deafness. Since the first case was reported in 1952, there have been more reports describing this triad, either complete or incomplete. Our patient had the complete triad of the syndrome along with cleft palate and short stature. Also, a review of the literature regarding this syndrome is presented here.
  2 2,259 208
Ophthalmic research and publication in India: Where do we stand?
Barun Kumar Nayak
July-August 2010, 58(4):273-274
DOI:10.4103/0301-4738.64115  PMID:20534914
  2 2,791 486
Late posterior subluxation of rollable intraocular lens after an uneventful microphacoemulsification cataract surgery
Aditya S Kelkar, Jai A Kelkar, Shreekant B Kelkar, Aarofil I Shaikh
July-August 2010, 58(4):350-351
DOI:10.4103/0301-4738.64144  PMID:20534940
  2 1,225 137
An unusual case of penetrating ocular trauma with metallic spoon
Gautam Bhaduri, Soumya Swarup Chattopadhyay, Rudra Prasad Ghosh, Kumar Saurabh, Mukesh Goyal
July-August 2010, 58(4):330-331
DOI:10.4103/0301-4738.64128  PMID:20534927
Ocular trauma is an important cause of vision loss. The agents incriminated in such injuries are diverse. We present a case of ocular trauma with a metallic spoon causing deep laceration of lid and temple region with sclerocorneal laceration. After assessment of the general condition and stabilization of the systemic parameters the operative procedure was undertaken on elective basis. Though the final visual outcome was not rewarding due to the severity of the injury, any potential hemostatic catastrophe was averted.
  1 2,395 233
Comment on: Corneal collagen cross-linking with riboflavin and ultraviolet: A light for keratoconus
Anand Parthasarathy
July-August 2010, 58(4):345-345
DOI:10.4103/0301-4738.64118  PMID:20534933
  1 1,676 231
Intralenticular subcapsular air
Sribhargava Natesh, Hima Bindu Adusumilli, Naresh Kumar Yadav, BV Priya
July-August 2010, 58(4):351-352
DOI:10.4103/0301-4738.64145  PMID:20534941
  1 1,630 148
Comment on: Utility of QuantiFERON tuberculosis gold test in a south Indian patient population of ocular inflammation
Jay Chhablani
July-August 2010, 58(4):346-346
DOI:10.4103/0301-4738.64121  PMID:20534934
  1 1,526 183
Cyanoacrylate tissue adhesive
Viroj Wiwanitkit
July-August 2010, 58(4):347-347
DOI:10.4103/0301-4738.64129  PMID:20534935
  1 1,406 193
Amyloidosis of lacrimal gland
Vinod Kumar, Neha Goel, Luke Nicholson, Jai Shankar
July-August 2010, 58(4):348-348
DOI:10.4103/0301-4738.64137  PMID:20534938
  1 1,300 134
Blow-in fracture of the orbital roof presenting as a case of non-resolving choroidal effusion
Bipasha Mukherjee, Muna Bhende
July-August 2010, 58(4):331-333
DOI:10.4103/0301-4738.64131  PMID:20534928
A 34-year-old male patient was referred to us as a case of non-resolving suprachoroidal hemorrhage. History revealed decrease in right eye vision following trauma to forehead. B scan ultrasonography (USG) of the right eye showed a high-reflective structure indenting the globe. It turned out to be an inferiorly displaced fracture fragment from the orbital roof on computerized tomography (CT) scan. The choroidal elevation disappeared after open reduction of the fracture fragment and patient had good recovery of vision. USG and CT scan were helpful in the diagnosis and management of this case.
  - 2,898 252
Management of keratoconus: A review
Rajesh Sinha, Noopur Gupta, Namrata Sharma, Raghav Gupta, Jeewan S Titiyal
July-August 2010, 58(4):353-358
  - 4,829 711
Comments on: Nuclear management in manual small incision cataract surgery by snare technique
Parthasarathi Roy
July-August 2010, 58(4):348-349
DOI:10.4103/0301-4738.64140  PMID:20534937
  - 1,245 163
Authors' reply
Ivana L Romero, Joao B N S Malta, Cely B Silva, Lycia M J Mimica, Kaz H Soong, Richard Y Hida
July-August 2010, 58(4):347-348
  - 1,105 87
Authors' reply
Kalpana Babu, Vidya Satish, S Satish, DK SubbaKrishna, Mariamma Philips Abraham, Krishna R Murthy
July-August 2010, 58(4):346-347
  - 1,232 110
Screening program of school-going children
Sourabh Aggarwal
July-August 2010, 58(4):347-347
DOI:10.4103/0301-4738.64127  PMID:20534936
  - 1,205 151
Author's reply
Vinay B Agrawal
July-August 2010, 58(4):345-345
  - 767 102