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   2015| August  | Volume 63 | Issue 8  
    Online since November 17, 2015

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Effect of fluidics on corneal endothelial cell density, central corneal thickness, and central macular thickness after phacoemulsification with torsional ultrasound
Sudeep Das, Soumya Ganesh Nanaiah, Mathew K Kummelil, Somshekar Nagappa, Rohit Shetty, Bhujang K Shetty
August 2015, 63(8):641-644
DOI:10.4103/0301-4738.169786  PMID:26576520
Aim: To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound. Settings and Design: Prospective, randomized clinical trial based on a tertiary eye hospital. Subjects and Methods: The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively. Statistical Analysis Used: The Shapiro–Wilks test was used to assess the normality of the data. Mann–Whitney U-test with the P value set at 0.05 was used to compare the two groups. Results: Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks. Conclusions: No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon's preference, as both high and low flow parameters were found to have comparable postoperative outcomes.
  15,623 4,588 3
Anterior segment imaging in glaucoma: An updated review
Jessica S Maslin, Yaniv Barkana, Syril K Dorairaj
August 2015, 63(8):630-640
DOI:10.4103/0301-4738.169787  PMID:26576519
Anterior segment imaging allows for an objective method of visualizing the anterior segment angle. Two of the most commonly used devices for anterior segment imaging include the anterior segment optical coherence tomography (AS-OCT) and the ultrasound biomicroscopy (UBM). AS-OCT technology has several types, including time-domain, swept-source, and spectral-domain-based configurations. We performed a literature search on PubMed for articles containing the text "anterior segment OCT," "ultrasound biomicroscopy," and "anterior segment imaging" since 2004, with some pertinent references before 2004 included for completeness. This review compares the advantages and disadvantages of AS-OCT and UBM, and summarizes the most recent literature regarding the importance of these devices in glaucoma diagnosis and management. These devices not only aid in visualization of the angle, but also have important postsurgical applications in bleb and tube imaging.
  10,458 1,341 22
Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India
Jacob Koshy, M Joseph John, Satish Thomas, Gurvinder Kaur, Nitin Batra, Wilson J Xavier
August 2015, 63(8):659-664
DOI:10.4103/0301-4738.169789  PMID:26576524
Context: Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. Aims: This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Settings and Design: Subjects of leukemia presenting to a tertiary care center in India. Subjects and Methods: A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. Statistical Analysis Used: The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Conclusions: Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.
  9,232 706 24
Sutureless scleral buckle in the management of rhegmatogenous retinal detachment
P Mahesh Shanmugam, Tajinder Pal Singh, Rajesh Ramanjulu, Gladys Rodrigues, Srinivasulu Reddy
August 2015, 63(8):645-648
DOI:10.4103/0301-4738.169785  PMID:26576521
Purpose: To evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Design: Retrospective interventional case series. Materials and Methods: Retrospective analysis of 50 eyes of 49 patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2009 to March 2013. Results: Primary retinal re-attachment rate of 86% was achieved with single surgery, but final anatomical success was 94% with additional interventions in the form of intravitreal gas, buckle revision, and/or pars plana vitrectomy. Best corrected logarithm of minimum angle of resolution visual acuity improved from 1.44 ± 1.01 preoperatively to 0.50 ± 0.40 at a mean follow-up of 6.7 months.XS Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.
  3,521 447 6
Traumatic globe luxation: A case report
Ekta Kumari, Soumen Chakraborty, Biswarup Ray
August 2015, 63(8):682-684
DOI:10.4103/0301-4738.169795  PMID:26576530
Globe luxation is a rare clinical event. Most of the cases are usually traumatic, although spontaneous globe luxation has also been reported. The majority of the posttraumatic cases are usually associated with the injury or fracture of the bony orbit. We report here a case of globe luxation that occurred per se without any injury to the orbital or maxillo-facial bony structures.
  3,605 256 3
Changing pattern of utilization of human donor cornea in India
Varun Gogia, Shikha Gupta, Tushar Agarwal, Veena Pandey, Radhika Tandon
August 2015, 63(8):654-658
DOI:10.4103/0301-4738.169790  PMID:26576523
Purpose: To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011. Methods: A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty. Results: A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08). Conclusions: Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed.
  3,034 363 4
Primary orbital neuroblastoma with intraocular extension
Muthukrishnan Vallinayagam, Vasudev Anand Rao, Datta Gulnar Pandian, John Davis Akkara, Niruban Ganesan
August 2015, 63(8):684-686
DOI:10.4103/0301-4738.169784  PMID:26576531
Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.
  2,796 239 5
Transscleral fixation of closed loop haptic acrylic posterior chamber intraocular lens in aphakic nonvitrectomized eyes
Siddharth Agrawal, Vinita Singh, Sanjiv Kumar Gupta, Nibha Misra, Rajat M Srivastava
August 2015, 63(8):649-653
DOI:10.4103/0301-4738.169797  PMID:26576522
Purpose: To evaluate the outcome of transscleral fixation of closed loop haptic acrylic posterior chamber intraocular lens (PCIOL) in aphakia in nonvitrectomized eyes. Materials and Methods: Patients with postcataract surgery aphakia, trauma with posterior capsule injury, subluxated crystalline lens, and per operative complications where sulcus implantation was not possible were included over a 1-year period. Scleral fixation of acrylic hydrophilic PCIOL was performed according to the described technique, and the patients were evaluated on the day 1, 3, 14, and at 3 and 12 months postoperatively for IOL centration, pseudophakodonesis, change in best-corrected visual acuity (BCVA), and any other complications. Results: Out of twenty-nine eyes of 24 patients, who completed the study, 25 (86.2%) eyes had improved, 2 (6.9%) eyes showed no change, and 2 (6.9%) eyes had worsening of BCVA. Three (10.3%) eyes developed postoperative complications. A significant improvement in mean BCVA (P < 0.0001) was observed after the procedure. Mean duration of follow-up was 26.2 months (range 22–35 months). Conclusion: The use of closed loop haptic acrylic IOL for scleral fixation appears to be safe and effective alternative to conventional scleral fixated polymethyl methacrylate intraocular lenses.
  2,746 287 6
Lipoid proteinosis: A rare entity
Bipasha Mukherjee, Pratheeba N Devi
August 2015, 63(8):680-681
DOI:10.4103/0301-4738.169791  PMID:26576529
Urbach–Wiethe syndrome or lipoid proteinosis is a rare autosomal recessive disorder characterized histologically by infiltration of Periodic acid Schiff-positive hyaline material in the skin, upper aerodigestive tract, eyelids, and internal organs. Classical clinical features include scarring of the skin, beaded eyelid papules (moniliform blepharosis) and laryngeal infiltration leading to hoarseness of voice. Lipoid proteinosis can lead to life-threatening conditions such as acute respiratory distress and seizures. Awareness among ophthalmologists about this rare entity is crucial for appropriate management of these patients.
  2,665 220 3
Electron beam radiotherapy for the management of recurrent extensive ocular surface squamous neoplasia with orbital extension
Ramesh Murthy, Himika Gupta, Rahul Krishnatry, Siddhartha Laskar
August 2015, 63(8):672-674
DOI:10.4103/0301-4738.169798  PMID:26576526
Recurrent extensive ocular surface squamous neoplasia (OSSN) with orbital invasion can be successfully managed with external radiotherapy using electrons resulting in eye and vision salvage. We report a case of right eye recurrent OSSN in an immunocompetent adult Indian male, with extensive orbital involvement. The patient had two previous surgical excisions with recurrent disease. At this stage, conventionally exenteration is considered the treatment modality. However, he was treated with 5040 cGy radiotherapy (15eV electrons) resulting in complete disease regression. At the end of 3 years follow-up, the patient was disease free, maintained a vision of 20/25, with mild dry eye, well-managed with topical lubricants. Extensive OSSN with orbital invasion does not always need exenteration. External beam electron radiotherapy provides a noninvasive cure with organ and vision salvage and should be considered in extensive OSSN not amenable to simple excision biopsies. Long-term studies to evaluate the effect of radiation on such eyes are suggested.
  2,497 243 6
Transplantation of cultured rhesus monkey vascular endothelial cells to allogeneic cornea concomitant with stripping of Descemet's membrane
Qin Zhu, Min Wu, Xiaomei Sun, Wenjia Zhang, Zhulin Hu, Hai Liu
August 2015, 63(8):665-671
DOI:10.4103/0301-4738.169788  PMID:26576525
Context: In cases of damaged corneal endothelium cells (CECs) of the eye, transplantation of cultured vascular endothelial cells (VECs) may be a viable method to restore transparency. Aims: To evaluate the viability of replacing damaged primate CECs with cultured allogeneic VECs. Subjects and Methods: Rhesus monkey VECs (RMVECs) were cultured and proliferating cells were labeled with bromodeoxyuridine (BrdU) in vitro. RMs of the experimental group (n = 6) underwent manual Descemettt membrane stripping with transplantation of RMVECs labeled with BrdU; those in the control group received manual Descemetnt membrane stripping without transplantation. Postoperative evaluations included the transparency and appearance of the corneal graft; distribution and ultrastructural changes of RMVECs on the inner surface of the cornea using scanning and transmission electron microscopy, and immunohistological identification of BrdU. Results: At 90 days postsurgery, the corneal grafts of the monkeys in the experimental group retained better transparency than those of the controls, without corneal neovascularization or bullous keratopathy. A layer of cells with positive BrdU staining was found on the posterior surface of the treated corneas in the experimental group, while there was no VEC structure in corneal grafts from the monkeys of the control group. Conclusions: RMVECs can grow on the posterior surface of the cornea without Descemet's membrane. Cultured and transplanted RMVECs appeared similar in ultrastructure. VECs can provide a barrier to maintain corneal dehydration and transparency to some extent.
  2,539 160 1
Metastatic adenocarcinoma of the cervix presenting as a choroidal mass: A case report and review of literature of cervical metastases to the eye
Akshay Gopinathan Nair, Haresh T Asnani, Vinod C Mehta, Siddharth V Mehta, Rima S Pathak
August 2015, 63(8):674-678
DOI:10.4103/0301-4738.169792  PMID:26576527
Cervical cancer is the most common cancer among females in India. Cervical cancer usually spreads by local extension and through the lymphatic drainage to the lymph nodes. Hematogenous spread, the mechanism responsible for distant metastases, is rarely seen in cervical malignancies. In this communication, we report a case of a 45-year-old woman who presented with unilateral decrease in vision of 3 months duration. She was found to have a serous retinal detachment with underlying diffuse, subretinal yellowish-cream colored infiltrates in the right eye, suspicious of choroidal metastases. Systemic evaluation showed disseminated systemic metastases arising from a primary adenocarcinoma of the cervix. In this communication, we review all the documented cases of metastases to the eye and adnexa arising from cervical cancer and their clinical characteristics. Unilateral choroidal metastasis arising from an adenocarcinoma of the cervix is extremely rare with only one previous documented case. Although uncommon, choroidal metastasis may be the presenting feature of primary cervical malignancy. Furthermore, cervical malignancy must be ruled out in women who present with orbital or choroidal metastases arising from unknown primary.
  2,279 218 4
Central retinal artery occlusion following orbital tumor resection: Is rapid intervention effective?
Mohammad Taher Rajabi, Mohammad Naderan, Seyed Ziaeddin Tabatabaei Mohammadi, Mohammad Bagher Rajabi
August 2015, 63(8):678-680
DOI:10.4103/0301-4738.169796  PMID:26576528
A 52-year-old male patient presented at our hospital with unilateral proptosis and vision loss in his left eye. Imaging evaluations showed orbital tumor, so the patient underwent surgery. About an hour later after tumor removal, patient developed sudden vision loss and became no light perception. Fundus evaluation revealed central retinal artery occlusion (CRAO). The patient was treated immediately with ocular massage and anterior chamber paracentesis as well as systemic therapy with mannitol and intravenous administration of acetazolamide. After thirty minutes, he recovered perception to light and then hand motion and 2 h later, it was improved to 1 m counting finger. CRAO following orbital tumor has not been reported before. We recommend ocular examination in all patients that undergo orbital surgery immediately to 2–3 h after surgery.
  2,256 203 4
Evaluation of choroidal thickness via enhanced depth-imaging optical coherence tomography in patients with systemic hypertension
Kai Xiong Cheong, Colin S Tan
August 2015, 63(8):687-687
DOI:10.4103/0301-4738.169793  PMID:26576532
  1,782 215 -
Generally speaking!
Sundaram Natarajan
August 2015, 63(8):629-629
DOI:10.4103/0301-4738.169799  PMID:26576518
  1,702 181 -
Author's reply
Mustafa Gök, V Levent Karabas, Ender Emre, Arzu T Aksar, Mehmet Ş Aslan, Dilek Ural
August 2015, 63(8):688-688
  648 109 -