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   2015| April  | Volume 63 | Issue 4  
    Online since June 3, 2015

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Spectral domain optical coherence tomography in the diagnosis and monitoring of dengue maculopathy
Mohsina Mehkri, Chaitra Jayadev, Namita Dave, Anand Vinekar
April 2015, 63(4):342-343
DOI:10.4103/0301-4738.158087  PMID:26044476
  16,490 205 -
Ophthalmic surgical training in Karnataka and Southern India: Present status and future interests from a survey of final-year residents
K Ajay, R Krishnaprasad, DS Divya
April 2015, 63(4):306-311
DOI:10.4103/0301-4738.158067  PMID:26044468
Settings and Design: This study documents a survey of final-year ophthalmology postgraduates on the subject of their surgical training and their future plans after residency. Purpose: This survey aimed to answer the question, "What is the present status of surgical training in ophthalmic training centers?" by obtaining information from students about (1) various methods used in surgical training (2) numbers and types of surgeries performed by them in the training centers (3) their plans after residency. Materials and Methods: A questionnaire containing 21 questions was distributed to 155 students attending an intensive 4-day teaching program. The questions related to orientation training, wet lab training, facilities for training, free surgical camps and detailed information about numbers and types of surgeries observed and performed. Completed questionnaires were collected, and responses analyzed. Results: One hundred and seven completed responses were analyzed. The majority had not received formal orientation training. More than half had undergone wet lab training. Most residents performed their first ophthalmic surgery during the 1 st year of residency and went to the operation theatre multiple times a week. Most of the students planned to undergo further training after residency. More than half of the students found their surgical training to be fair or satisfactory. Conclusions: The number and frequency of ophthalmic surgeries done by residents appear satisfactory, but further efforts from trainers on enhancing the quality and range of surgical training would benefit students and improve their satisfaction.
  6,967 300 -
Mitomycin-C in dacryocystorhinostomy: From experimentation to implementation and the road ahead: A review
Akshay Gopinathan Nair, Mohammad Javed Ali
April 2015, 63(4):335-339
DOI:10.4103/0301-4738.158082  PMID:26044474
Dacryocystorhinostomy (DCR) is the procedure of choice in patients with epiphora due to primary acquired nasolacrimal duct obstruction. The evolution of surgical tools, fiber-optic endoscopes, effective anesthesia techniques, and the adjunct use of antimetabolites intraoperatively; namely mitomycin-C (MMC) have significantly contributed to the advancement of DCR surgery. MMC is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. Even the cellular changes in the human nasal mucosal fibroblasts induced by MMC at an ultrastructural level have been documented. There, however, seems to be a lack of consensus regarding MMC: The dosage, the route of delivery/application, the time of exposure and subsequently what role each of these variables plays in the final outcome of the surgery. In this review, an attempt is made to objectively examine all the evidence regarding the role of MMC in DCR. MMC appears to improve the success rate of DCR.
  3,726 488 -
Intra-arterial chemotherapy for retinoblastoma: First Indian report
Pukhraj Rishi, Tarun Sharma, Vikram Koundanya, Nishat Bansal, M Saravanan, R Ravikumar, Satheesh Ramamurthy
April 2015, 63(4):331-334
DOI:10.4103/0301-4738.158076  PMID:26044473
Aim: To describe treatment outcomes and complications of selective intra-arterial chemotherapy (IAC) for retinoblastoma (RB) in Indian eyes. Materials and Methods: Single center, retrospective interventional case series of 6 eyes with RB who underwent IAC using Melphalan (3 mg/5 mg/7.5 mg) and topetecan (1 mg) (n = 4) or melphalan (3 mg/5 mg/7.5 mg) alone (n = 2) between December 2013 and June 2014. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seeds control and globe salvage rates. Results: IAC was employed as primary (n = 1) or secondary (n = 5) modality of treatment. Each eye received mean 3 IAC sessions (median: 3; range: 1-4 sessions). Eyes were classified according to international classification of RB as Group B (n = 1), C (n = 1), D (n = 2) and E (n = 2). Following IAC, complete regression of the main tumor was seen in 3 cases (50%), partial regression in 2 (33%), while 1 case (15%) showed no response. Of 4 eyes with subretinal seeds, 1 (25%) eye had complete regression while 3 (75%) eyes had partial regression. Of 5 eyes with vitreous seeds, 2 (40%) eyes had complete regression while 3 (60%) eyes had a partial response. Globe salvage was achieved in 5 of 6 eyes (83%). Diffuse choroidal atrophy and vitreous hemorrhage were observed in 1 (17%) eye, each. No hematologic toxicity or cerebro-vascular events were observed. Mean follow-up period was 5.5 months (median: 6 months, range: 1-6 months). Conclusion: IAC is an effective therapy for globe preservation in eyes with RB. Larger studies with longer follow-up are required to validate these results.
  2,746 413 -
Comparison of aqueous concentrations of angiogenic and inflammatory cytokines based on optical coherence tomography patterns of diabetic macular edema
Moosang Kim, Yonguk Kim, Seung-Jun Lee
April 2015, 63(4):312-317
DOI:10.4103/0301-4738.158069  PMID:26044469
Purpose: The purpose was to compare aqueous inflammatory and angiogenic cytokine levels in diabetic macular edema (DME). Materials and Methods: Aqueous samples were obtained from 50 eyes with DME and 12 normal eyes (control group). DME was classified according to the morphologic pattern based on optical coherence tomography: Diffuse retinal thickening (DRT; n = 19), cystoid macular edema (CME; n = 17), or serous retinal detachment (SRD; n = 14). Aqueous samples were collected just before intravitreal injection and at the beginning of cataract surgery in the control group. Interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) levels were measured by multiplex bead assay. Results: The IL-6, IL-8, IP-10, and PDGF-AA levels differed significantly among the three groups of DME (P = 0.014, P = 0.038, P = 0.021, and P = 0.041, respectively). However, there were no differences between groups in aqueous concentration levels of MCP-1 and VEGF (P = 0.205 and P = 0.062, respectively). IL-6 (P = 0.026) and IL-8 (P = 0.023) correlated positively with central foveal thickness (CFT) in the CME group. None of the cytokine levels correlated significantly with CFT in any of the DRT and SRD groups. Conclusions: Aqueous concentrations of cytokines varied according to the morphologic pattern of DME, which might explain the variable response to treatments such as intravitreal bevacizumab or triamcinolone injection.
  2,549 463 -
Bilateral macular colobomata: Temporal dragging of optic disc
David J Mathew
April 2015, 63(4):348-350
DOI:10.4103/0301-4738.158090  PMID:26044479
A 13-year-old male presented with decreased vision and squint from childhood. He had bilateral large colobomata at the macula in each eye, the one on the right being larger than the left. The disc was dragged temporally with straightening of the temporal retinal vessels. This is a case report of bilateral large macular coloboma and serves to report its association with a temporally dragged disc and straightened temporal retinal vessels. A dragged disc if present with a colobomatous defect at the macula may strengthen the case for diagnosis of macular coloboma and help exclude other differentials.
  2,195 175 -
Reproducibility of retinal nerve fiber layer measurements across the glaucoma spectrum using optical coherence tomography
Jayesh Vazirani, Sushmita Kaushik, Surinder Singh Pandav, Pramod Gupta
April 2015, 63(4):300-305
DOI:10.4103/0301-4738.158064  PMID:26044467
Purpose: The purpose was to determine intra-session and inter-session reproducibility of retinal nerve fiber layer (RNFL) thickness measurements with the spectral-domain Cirrus optical coherence tomography (OCT) ® (SD-OCT) in normal and glaucomatous eyes, including a subset of advanced glaucoma. Materials and Methods: RNFL measurements of 40 eyes of 40 normal subjects and 40 eyes of 40 glaucomatous patients including 14 with advanced glaucoma were obtained on the Cirrus OCT ® (Carl Zeiss Meditec, Dublin, CA, USA) five times on 1-day (intra-session) and on five separate days (inter-session). Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability (TRT) values were calculated for mean and quadrant RNFL in each group separately. Reproducibility values were correlated with age and stage of glaucoma. Results: For intra-session reproducibility, the ICC, COV, and TRT values for mean RNFL thickness in normal eyes were 0.993, 1.96%, and 4.02 µm, respectively, 0.996, 2.39%, and 3.84 µm in glaucomatous eyes, and 0.996, 2.41%, and 3.70 µm in advanced glaucoma. The corresponding inter-session values in normal eyes were 0.992, 2.16%, and 4.09 µm, 0.995, 2.62%, and 3.98 µm in glaucoma and 0.990, 2.70%, and 4.16 µm in advanced glaucoma. The mean RNFL thickness measurements were the most reproducible while the temporal quadrant had the lowest reproducibility values in all groups. There was no correlation between reproducibility and age or mean deviation on visual fields. Conclusions: Peripapillary RNFL thickness measurements using Cirrus OCT ® demonstrated excellent reproducibility in normal and glaucomatous eyes, including eyes with advanced glaucoma. Mean RNFL thickness measurements appear to be the most reproducible and probably represent the best parameter to use for longitudinal follow-up.
  1,999 351 -
Comparison of intraocular pressure measurement with Scheimpflug-based noncontact tonometer with and without hydrogel contact lenses
Mukesh Kumar, Rohit Shetty, Chaitra Jayadev, Debarun Dutta, Maneck D Nicolsan, Sriharsha Nagaraj, Rajesh S Kumar
April 2015, 63(4):323-326
DOI:10.4103/0301-4738.158072  PMID:26044471
Objectives: The objective was to determine the repeatability of intraocular pressure (IOP) measurements made through a soft contact lens (CL) using the Scheimpflug noncontact tonometry in healthy subjects. Methods: This prospective, randomized, single-center study included one eye of 88 subjects (40 male and 48 female). Only participants without glaucoma or any other ocular pathology were included in this study. Three consecutive IOP measurements by the Scheimpflug noncontact tonometry were performed with and without daily disposable hydrogel CLs (−0.50 DS) (Dailies-nelfilcon A, 69% water, 8.7 mm base curve, 14 mm diameter, center thickness 0.10 mm) by a single operator. To avoid any bias arising from diurnal variation, all measurements were made at a similar time of day (11 am ± 1 h). The repeatability of IOP measurements using the Scheimpflug noncontact tonometry with and without CLs was evaluated using Pearson's correlation analysis. Bland-Altman plotting was used to assess the limits of agreement between the measurements with and without CLs. Results: The mean (± standard deviation) IOPs with and without CL were 13.80 ± 2.70 and 13.79 ± 2.54 mm of Hg respectively. The mean difference was 0.01 ± 0.16 (95% confidence interval, +1.97 to − 2.00) mm Hg. Statistical analysis via paired t-test showed no statistical difference between the two groups with (P = 0.15). A good correlation was found for IOP measurements with and without CL (r = 0.93, P < 0.001). Good test-retest reliability was found when IOP was measured with and without CL. Conclusion: There was no significant difference between IOP measured with and without CLs by Scheimpflug noncontact tonometry.
  1,819 211 -
Plagiarism - one disease, many manifestations
Sundaram Natarajan
April 2015, 63(4):299-299
DOI:10.4103/0301-4738.158060  PMID:26044466
  1,619 295 -
In vivo confocal microscopy of meibomian glands and palpebral conjunctiva in vernal keratoconjunctivitis
Qiaoling Wei, Qihua Le, Jiaxu Hong, Jun Xiang, Anji Wei, Jianjiang Xu
April 2015, 63(4):327-330
DOI:10.4103/0301-4738.158073  PMID:26044472
Purpose: To investigate the correlations between conjunctival inflammatory status and meibomian gland (MG) morphology in vernal keratoconjunctivitis (VKC) patients by using in vivo confocal microscopy (CM). Materials and Methods: Nineteen VKC patients (7 limbal, 7 tarsal, and 5 mixed forms) and 16 normal volunteers (controls) were enrolled. All subjects underwent CM scanning to obtain the images of upper palpebral conjunctiva and MGs. Inflammatory cell (IC) density in palpebral conjunctival epithelial and stromal layers, Langerhans cell (LC) density at lid margins and the stroma adjacent to the MG, and MG acinar unit density (MGAUD) were recorded. The longest and shortest diameters of MG acinar were measured. The Kruskal-Wallis test was used to compare the parameter differences whereas the Spearman's rank correlation analysis was applied to determine their correlations. Results: Among all groups, no significant statistical differences were found in epithelial and stromal IC densities, mean values of MG acinar unit densities, or longest and shortest diameters. Both LC parameters in the tarsal-mixed groups were significantly higher than those in the limbal and control groups. All LC densities of VKC patients showed a positive correlation with MGAUD and shortest diameter. Conclusions: In VKC patients, the conjunctival inflammatory status could be associated with the MG status. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface.
  1,519 233 -
Isolated clival metastasis as the cause of abducens nerve palsy in a patient of breast carcinoma: A rare case report
Akhil Kapoor, Vimla Beniwal, Surender Beniwal, Harsh Mathur, Harvindra Singh Kumar
April 2015, 63(4):354-357
DOI:10.4103/0301-4738.158096  PMID:26044482
Metastatic lesions to the clivus have been reported in various cancers including lung cancer, prostate carcinoma, skin melanoma, and hepatocellular carcinoma. There have been only a few reports of breast cancer presenting with isolated clival metastasis. We report a case of 35-year-old lady, who was known case of breast carcinoma presented with diplopia as the only sign of clival metastasis. The etiology was established by magnetic resonance imaging which showed an enhancing lesion in the clivus. The diagnosis of clival metastasis from breast cancer was confirmed by transsphenoidal biopsy.
  1,534 172 -
Ligneous conjunctivitis in a patient of juvenile colloid milia: A rare association
Shubhangi Sudhir Bhave, Sanyogita Swapnil Joshi
April 2015, 63(4):350-352
DOI:10.4103/0301-4738.158091  PMID:26044480
We present to you, case of a 10-year-old female with h/o redness, watering since 8 months. Her vision was 20/30 in right eye and 20/70 in left eye. Conjunctiva had plenty of purulent discharge and palpebral conjunctiva was studded with membranous lesions. She was found to have multiple hyperpigmented papulopustular lesions over face, palms and legs. She was started with topical moxifloxacin and lubricating drops. Patient was followed-up after 15 days. At that time her conjunctiva had formation of a woody pseudomembrane. Excision of the lesions and skin biopsy was done and sent for hislopathological examination. Findings of histopathological examination were suggestive of ligneous conjunctivitis and juvenile colloid milia. We have started this patient with long-term cyclosporine drops and tear supplements. In next visit, the membrane was resolved. Hence, we continued with the same treatment, but again the woody membrane recurred.
  1,534 163 -
Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy
Pradeep Venkatesh, Varun Gogia, Shikha Gupta, Akshay Tayade, Neha Shilpy, Bhavin M Shah, Randeep Guleria
April 2015, 63(4):318-322
DOI:10.4103/0301-4738.158070  PMID:26044470
Purpose: To evaluate safety and efficacy of intravenous pulse cyclophosphamide (CyP) in acute macular serpiginous choroiditis (SC). Methods: Patients with acute macular SC with lesions threatening and/or involving fovea were enrolled. All patients received CyP (1 g/m 2 ) for 3 days followed by high-dose oral steroids (1.5 mg/kg) tapered over 6 months and monitored for visual acuity, response to treatment and systemic side effects. Results: Eight patients (seven unilateral and one bilateral) with median age of 27 years (range: 13-40 years) were recruited. Mean visual acuity at presentation was 0.71 ± 0.35 logarithm of the minimum angle of resolution while postpulse visual acuity was 0.40 ± 0.32. Final mean visual acuity at 1-year was 0.31 ± 0.23 (P ≤ 0.05). Three eyes had recurrence and 3 patients developed transient hair loss with no other adverse effect. Conclusion: Intravenous CyP provides rapid resolution of lesion activity and thereby helps in maintaining good functional acuity.
  1,437 235 -
A case of acute postoperative keratitis after deep anterior lamellar keratoplasty by multidrug resistant Klebsiella
Leena Bajracharya, Binita Sharma, Reeta Gurung
April 2015, 63(4):344-346
DOI:10.4103/0301-4738.158088  PMID:26044477
A healthy lady of 42 years underwent deep anterior lamellar keratoplasty for granular dystrophy. The very next day, it was complicated by development of infectious keratitis. The organism was identified as multidrug resistant Klebsiella pneumoniae. Donor corneal button may be implicated in the transmission of infection in an otherwise uneventful surgery and follow-up. Nosocomial infections are usually severe, rapidly progressive and difficult to treat. Finally, the lady had to undergo therapeutic penetrating keratoplasty for complete resolution of infection.
  1,410 198 -
Isolated superior oblique myositis causing acquired Brown's syndrome
R Muralidhar, K Gautam, D Christopher, N Vidhya, D Ramamurthy
April 2015, 63(4):340-341
DOI:10.4103/0301-4738.158085  PMID:26044475
  1,357 155 -
Bilateral optic disc pit with maculopathy in a patient with cleft lip and cleft palate
Anisha Seth, Rajat Gupta, Anika Gupta, Usha K Raina, Basudeb Ghos
April 2015, 63(4):346-348
DOI:10.4103/0301-4738.158089  PMID:26044478
Optic disc pit (ODP) is small, gray-white, oval depression found at the optic nerve head. It is a congenital defect that occurs due to imperfect closure of superior edge of the embryonic fissure. Cleft lip and palate are also congenital midline abnormalities occurring due to defect in the fusion of frontonasal prominence, maxillary prominence and mandibular prominence. There is only one case report describing the occurrence of ODP in a young patient with cleft lip and palate who also had basal encephalocele. We describe a 52-year-old patient with congenital cleft lip and palate with bilateral ODP with maculopathy but without any other midline abnormality.
  1,219 149 -
Full thickness macular hole following intravitreal ranibizumab injection for diabetic macular edema; a rare complication or coincidence?
Hasan Basri Arifoglu, Arzu Seyhan Karatepe Hashas, Tülay Ersekerci, Mustafa Atas
April 2015, 63(4):362-363
DOI:10.4103/0301-4738.158109  PMID:26044487
  1,074 176 -
Author response: Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery
Pukhraj Rishi, Sumanth Reddy, Ekta Rishi
April 2015, 63(4):364-364
  924 135 -
Considerations in the management of aphakia
Somdutt Prasad, Andrzej Grzybowski
April 2015, 63(4):358-358
DOI:10.4103/0301-4738.158098  PMID:26044483
  873 175 -
No evidence for a genetic blueprint: The case of the "complex" mammalian photoreceptor
G Kumaramanickavel, MJ Denton, M Legge
April 2015, 63(4):353-354
DOI:10.4103/0301-4738.158093  PMID:26044481
Despite the intensity of the search for genes causing inherited retinal degenerations over the past 3 decades, of the approximately 200 disease genes identified to date, all appear to be ordinary housekeeping genes specifying proteins playing basic structural and functional roles in the mature photoreceptor cells. No genes or genetic elements have been identified which can be construed as having a specific morphogenic role, directing the development of the cytoarchitecture of any particular retinal cell. The evidence suggests that the cytoarchitecture of the retinal photoreceptors, although enormously complex, arises from the self-organization of the cells constituents without any regulation or direction from an external genetic blueprint.
  893 117 -
Comparison of clinical outcomes, patient and surgeon satisfaction following topical versus peribulbar anesthesia for phacoemulsification: A randomized controlled trial
Parikshit Gogate
April 2015, 63(4):360-361
DOI:10.4103/0301-4738.158106  PMID:26044486
  802 187 -
Author reply to comment on subconjunctival limbus oblique incision for mature cataracts
Jun Yang, Pinghong Lai
April 2015, 63(4):361-362
  799 114 -
Comment on: Augmented surgical amounts for intermittent exotropia to prevent recurrence
Amit R Yadav, Pradhnya A Sen, Khushbu R Bhattad, Elesh B Jain
April 2015, 63(4):358-359
DOI:10.4103/0301-4738.158100  PMID:26044484
  725 125 -
Author's Reply
Supriya Chinta, Batriti Wallang, Virender Sachdeva, Amit Gupta, Preeti Patil-Chhablani, Ramesh Kekunnaya
April 2015, 63(4):360-360
  630 91 -
Etiology and clinical profile of childhood optic nerve atrophy at a tertiary eye care center in South India
Mahmood Dhahir Al-Mendalawi
April 2015, 63(4):359-360
DOI:10.4103/0301-4738.158102  PMID:26044485
  566 130 -
Bilateral optic neuropathy and intraretinal deposits after pars plana vitrectomy in amyloidosis: Erratum

April 2015, 63(4):365-365
DOI:10.4103/0301-4738.158111  PMID:26044489
  428 91 -