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   2017| January  | Volume 65 | Issue 1  
    Online since March 16, 2017

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Residency evaluation and adherence design study: Young ophthalmologists' perception of their residency programs II: Academics and Research dissertation
Parikshit Madhav Gogate, Partha Biswas, Sundaram Natarajan, Barun Kumar Nayak, Santhan Gopal, Yogesh Shah, Samar K Basak
January 2017, 65(1):12-18
DOI:10.4103/ijo.IJO_668_16  PMID:28300734
Purpose: To know the perception of young ophthalmologists about their dissertation and academics during residency training in order to improve the research output during present residency programs in India. Methods: A survey was conducted by Academic and Research Committee of the All India Ophthalmological Society, the world's second largest ophthalmic professional's organization, in 2014–2016 of young ophthalmologists (those who completed residency between 2005 and 2012) to gauge usefulness of dissertation or thesis during postgraduate residency. Results: There were 1005 respondents, of whom 531 fulfilled inclusion criteria. On a scale of 0–10, residents rated level of supervision of their dissertation as adequate (mean 5.9/10, standard deviation [SD] = 3.1, median = 6). The level of infrastructure available was for dissertation rated as 5.9/10 (median = 7, SD = 3.1), and 6.2/10 was the score that residents said about value added by the dissertation (median = 7). The dissertation was presented at local (33.5%), state (28.1%), national (15.4%), and international (4%) levels. Students, not supervisors, did most of the local and state level presentations. It was published in some forms at local 210 (39.5%), state (140, 26.4%), national (94, 17.7%), and international (39, 7.3%) levels. On a scale of 0–4, seminars (3/4) and case presentations were (3/4) rated higher than didactic lectures (2.2/4), journal clubs (2.2/4), and wet laboratory (1.1/4). Conclusion: Peer-reviewed publications from Indian residency training dissertations were few. Residents felt dissertation added value to their training, but there was a huge range among the responses. Journal clubs and wet laboratories were not graded high in academic programs, unlike seminars and case presentations.
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Imiquimod 5% cream for the treatment of large nodular basal cell carcinoma at the medial canthal area
Gamze Ozturk Karabulut, Pelin Kaynak, Can Ozturker, Korhan Fazil, Osman Bulut Ocak, Muhittin Taskapılı
January 2017, 65(1):48-51
DOI:10.4103/ijo.IJO_958_16  PMID:28300740
Context (Background): Imiquimod (IMQ) 5% cream is an immunomodulatory and antitumorigenic agent, which was used as a topical treatment regimen, who had periocular basal cell carcinoma (BCC). Aim: This study aims to present three cases with large BCC at the medial canthal area treated with IMQ 5% cream. Materials and Methods: IMQ 5% cream was used in three patients with ages 45, 49, and 73 who preferred medical treatment over surgery. Following incisional biopsy IMQ cream was used once a day, 5 times a week and the patients were followed up weekly during 12 week treatment period and monthly after the clearance of the lesion. Results: Erythema and erosion on the surface of the lesion, injection of conjunctiva, burning and itching sensation, epiphora and punctate keratitis were seen in all patients during the treatment period. The ophthalmic side effects could be managed by topical lubricating eye drops and the inflammatory reactions resolved within 1 month after cessation of therapy. The patients were followed up for at least 3 years without tumor recurrence and the biopsies taken from the suspected area were found to be tumor free. Conclusion: Surgical excision of carcinoma of the eyelid at medial canthal area can be difficult without causing damage to the lacrimal system and reconstruction of the defect may need grafts or flaps. IMQ may provide an alternative therapy to surgery in certain cases.
  2,992 298 -
Setting up of a cerebral visual impairment clinic for children: Challenges and future developments
Swetha Sara Philip
January 2017, 65(1):30-34
DOI:10.4103/0301-4738.202303  PMID:28300737
Aim: The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. Materials and Methods: The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. Results: One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Conclusions: Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service.
  2,469 393 -
Clinical profile of the patients with pediatric epiphora in a tertiary eye care center
Rebika Dhiman, Bhavna Chawla, Mahesh Chandra, Mandeep S Bajaj, Neelam Pushker
January 2017, 65(1):2-6
DOI:10.4103/0301-4738.202306  PMID:28300732
Purpose: To study the clinical profile of children aged <10 years presenting with epiphora at a tertiary eye care center, to compare the clinical profile between the early onset (<3 years) and the late-onset (≥3 years) group, and to study the success of different treatment modalities. Materials and Methods: A prospective nonrandomized observational study was conducted in 209 eyes of 167 patients (42 bilateral cases). The main outcome measure was postoperative relief of presenting symptoms and signs at 3 months follow-up. Results: Fifty-five percent cases (92 of 167) were early-onset cases, and 45% (75 of 167) were late onset. The male:female ratio was 1.9:1. Seventy-five percent cases were unilateral. The etiological profile was –76% cases of congenital nasolacrimal duct obstruction (NLDO), 18% traumatic/surgical, 4% acquired NLDO, and 2% punctal causes. The overall success rate of all the treatment modalities in our study was 80% (167/208) –82% for sac massage, 77% for probing, 79% for intubation dacryocystorhinostomy, and 100% for punctal surgery. A significant association was noted between the treatment outcome and laterality (P = 0.04), presence of infection (P = 0.032), symptom severity (P = 0.027), history of previous treatment (P = 0.024), and age. No significant association was found between the treatment outcome and gender (P = 0.73), socioeconomic status (P = 0.43), etiology (P = 0.45), and treatment modality (P = 0.33). Conclusion: This study describes the complete range of causes and treatment modalities for pediatric epiphora and highlights the etiology, signs and symptoms, treatment, and the comparative outcome between the early versus the late-onset group and analyses the factors predictive of the outcome.
  2,403 314 -
Congenital dystrophic medial rectus muscles
Ramesh Murthy
January 2017, 65(1):62-64
DOI:10.4103/ijo.IJO_537_15  PMID:28300745
We report two patients, one with congenital dystrophic medial rectus muscles and one with absence of the medial rectus muscles; in addition, one of them had absence of the lateral rectus muscles. While absence of the superior oblique and superior rectus has been more commonly reported in literature, especially with craniofacial syndromes, our patients were nonsyndromic. Considering the risk of anterior segment ischemia, correction of the large-angle exotropia was performed by horizontal rectus muscle surgery where possible, along with transfer of the superior oblique tendon to the superior part of the normal medial rectus muscle insertion area to create a tethering effect with a good outcome.
  2,496 147 -
A correlation analysis of cone characteristics and central keratometric readings for the different stages of keratoconus
Alvin Jeffrey Munsamy, Vanessa Racquel Moodley
January 2017, 65(1):7-11
DOI:10.4103/ijo.IJO_980_15  PMID:28300733
Background: Knowledge of the cone characteristics for the different stages of keratoconus may potentially assist practitioners in diagnosing and managing keratoconic patients. Aim: This study aims to determine if any correlation exists between the central keratometric readings and the cone characteristics for the different stages of keratoconus. Setting: A university eye clinic. Materials and Methods: In this retrospective study, a saturated sample of 190 eyes from 106 cases of previously diagnosed keratoconic patient files was analyzed. The stage of keratoconus and cone characteristics, namely, cone location, cone decentration, topographical patterns, and morphology were analyzed using an Oculus 3M corneal topographer. Results: Analysis revealed a correlation between cone decentration and stage of keratoconus (P = 0.007). The association was found to exist when central K-readings were between 45D and 52D and with an apical cone decentration of 3–4 mm. No correlations were obtained for the stage of keratoconus and the cone location; topography and morphology. Conclusion: It can be concluded that cone apices are not central in all stages. Practitioners should consider the peripheral cornea when diagnosing and managing keratoconic patients. No correlation between stage, morphology or topography was respectively revealed.
  2,289 347 -
Pathophysiology of dilatation of pupils due to scorpion and snake envenomation and its therapeutic value: Clinical observations
Himmatrao S Bawaskar, Parag H Bawaskar, Pramodini H Bawaskar
January 2017, 65(1):67-70
DOI:10.4103/ijo.IJO_329_16  PMID:28300747
Dilated nonreacting pupils are routinely taken as a sign of irreversible brain damage. Alpha-receptor stimulation (scorpion sting) and presynaptic acetylcholine receptor blocker (krait bite) may result in dilation of pupils without involvement of the brain. This study was aimed to clinically evaluate the response of pupils in scorpion sting and krait bite. Victims of scorpion sting and krait bite were chosen from Raigad district. Scorpion sting and krait bite cases were admitted to hospital and were clinically evaluated in detail regarding neurological manifestations. Both cases had nonreacting dilation of pupils, complete neurological recovery accompanied with reverse of pupillary size and its response to light. In scorpion sting and krait bite poisoning, dilated nonreacting pupils are not the signs of irreversible brain damage.
  2,238 201 -
Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns
Ritu Arora, Pallavi Dokania, Aditi Manudhane, Jawahar Lal Goyal
January 2017, 65(1):35-40
DOI:10.4103/0301-4738.202312  PMID:28300738
Purpose: To compare the safety, efficacy, and clinical outcomes of simple limbal epithelial transplantation (SLET) with conjunctival-limbal autologous transplantation (CLAU) in severe unilateral ocular chemical burns. Materials and Methods: Twenty patients of unilateral chronic ocular burns with more than 270° limbal stem cell deficiency and a healthy fellow eye were divided into two groups – ten patients of Group A underwent SLET while ten patients of Group B were operated for CLAU. Patients were followed up for 6 months and assessed for a stable epithelialized ocular surface, extent of reduction in vascularization and forniceal reconstruction, improvement in corneal clarity and visual acuity. Results: A stable epithelialized corneal surface was obtained in all patients, with a significant reduction in the mean clock hours of vascularization in both the groups (P < 0.001). The mean symblepharon score showed a statistically significant reduction from 1.80 ± 1.14 to 0.30 ± 0.63 in Group A and 1.70 ± 1.06 to 0.15 ± 0.24 in Group B at 6 months. Corneal clarity, as well as best-corrected visual acuity, showed a statistically significant improvement in both the groups. Conclusion: Both the procedures, SLET and CLAU, were equally effective in achieving a stable ocular surface, forniceal reconstruction, and regression of corneal vascularization. The requirement of minimal donor tissue in SLET makes it a preferred option over CLAU in cases of uniocular chronic ocular burns.
  2,001 379 -
A modified-simple technique of removing the lens cortex during cataract surgery
Kyung Eun Han, Se Hoon Han, Dongkwon Lim, Min Chul Shin
January 2017, 65(1):59-61
DOI:10.4103/ijo.IJO_456_14  PMID:28300744
We describe here a surgical technique of removing the remaining cortex after phacoemulsification without performing the conventional irrigation/aspiration (I/A) procedure. In this technique, the remaining cortex attached to the posterior capsule was separated and dissected into several pieces by continuous irrigation with balanced salt solution, which was supplied through a syringe attached to a bent, blunt-tip needle. Approximately, 10 s of manual irrigation separated most of the remaining cortex from the posterior capsule. Then, the capsular bag was inflated with an ophthalmic viscoelastic device (OVD), and this pushed the separated cortex toward the capsular fornix mechanically. An intraocular lens was inserted into the capsular bag, following which the remaining cortex and OVD were removed concomitantly using an automated I/A handpiece. This technique is a simple and easy maneuver to remove the cortex from all areas, including the subincisional area, and reduce the possibility of a posterior capsule tear.
  1,563 233 -
The Melaka Hospital cataract complications study analysis of 12,992 eyes
Thanigasalam Thevi, Zin Maizura, Adinegara Lutfi Abas
January 2017, 65(1):24-29
DOI:10.4103/ijo.IJO_452_16  PMID:28300736
Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.
  1,512 214 -
Circumpapillary ganglion cell complex thickness to diagnose glaucoma: A pilot study
Yoshiyuki Kita, Norihisa Soutome, Daisuke Horie, Ritsuko Kita, Gaborá Hollό
January 2017, 65(1):41-47
DOI:10.4103/ijo.IJO_437_16  PMID:28300739
Purpose: The purpose of this study is to evaluate the applicability of a new optical coherence tomography parameter, the circumpapillary ganglion cell complex (cpGCC) thickness for glaucoma diagnostics. Subjects and Methods: The RS-3000 Advance SD-OCT (NIDEK, Aichi, Japan) was used to measure global and sector macular GCC (mGCC) thickness, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, cpGCC, and circumpapillary total retina (cpTR) thickness in 1 eye of 48 preperimetric/early perimetric primary open-angle glaucoma patients and 28 healthy Japanese participants. Area under the receiver-operating characteristic (AUROC) curves were used for between-method comparisons. Results: All global and sector parameters except for the nasal sector differed significantly between the patient groups (P ≤ 0.009). The AUROC for global mGCC (0.917) was significantly higher (P < 0.01) than that for global cpRNFL (0.760), global cpGCC (0.828), and global cpTR (0.812). The AUROC values of global and temporal cpGCC were significantly higher than those of the corresponding cpRNFL parameters (P < 0.05). Correlation between the visual field means deviation and each of the global thickness parameters was similar (r: 0.418–0.473, P< 0.001). At >90% specificity, the cpGCC, cpTR, and cpRNFL were able to detect 4%, 10%, and 0% of glaucoma eyes that were not detected by the mGCC thickness. Conclusions: In Japanese eyes, the diagnostic accuracy of cpGCC is lower than that of mGCC but higher than that of cpRNFL. Our results suggest that the use of cpGCC may not improve glaucoma diagnostics when there is no macular disease but may be of benefit when macular diseases prevent successful mGCC measurements.
  1,369 218 -
Four-dimensional microscope- integrated optical coherence tomography to enhance visualization in glaucoma surgeries
Neel Dave Pasricha, Paramjit Kaur Bhullar, Christine Shieh, Christian Viehland, Oscar Mijail Carrasco-Zevallos, Brenton Keller, Joseph Adam Izatt, Cynthia Ann Toth, Pratap Challa, Anthony Nanlin Kuo
January 2017, 65(1):57-59
DOI:10.4103/ijo.IJO_412_16  PMID:28300743
We report the first use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT) capable of live four-dimensional (4D) (three-dimensional across time) imaging intraoperatively to directly visualize tube shunt placement and trabeculectomy surgeries in two patients with severe open-angle glaucoma and elevated intraocular pressure (IOP) that was not adequately managed by medical intervention or prior surgery. We performed tube shunt placement and trabeculectomy surgery and used SS-MIOCT to visualize and record surgical steps that benefitted from the enhanced visualization. In the case of tube shunt placement, SS-MIOCT successfully visualized the scleral tunneling, tube shunt positioning in the anterior chamber, and tube shunt suturing. For the trabeculectomy, SS-MIOCT successfully visualized the scleral flap creation, sclerotomy, and iridectomy. Postoperatively, both patients did well, with IOPs decreasing to the target goal. We found the benefit of SS-MIOCT was greatest in surgical steps requiring depth-based assessments. This technology has the potential to improve clinical outcomes.
  1,421 162 -
Comparison of femtosecond laser-assisted descemetic and predescemetic lamellar keratoplasty for keratoconus
Yan Lu, Ana Beatriz Diniz Grisolia, Yi-Rui Ge, Chun-Yan Xue, Qian Cao, Li-Ping Yang, Zhen-Ping Huang
January 2017, 65(1):19-23
DOI:10.4103/ijo.IJO_688_16  PMID:28300735
Purpose: The purpose of this study is to compare the outcomes following femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK) with 75% of stromal dissection (predescemetic group) and femtosecond laser-assisted DALK using big-bubble technique with total stromal resection (descemetic group) for the treatment of keratoconus. Subjects and Methods: Twenty eyes of 17 patients with keratoconus were studied. There were 10 eyes of 9 patients in predescemetic group and 10 eyes of 8 patients in descemetic group. The postoperative best-corrected visual acuity (BCVA), manifest refraction, keratometry, endothelial cell density (ECD), and central corneal thickness (CCT) were analyzed. Results: All surgeries were performed uneventfully. At 1 year after surgery, the BCVA, corneal astigmatism, keratometry, CCT, and ECD between two groups were not statistically significant (all P > 0.05). However, the mean manifest refraction was −9.43 ± 7.44 diopter (D) and −1.03 ± 1.13D in predescemetic and descemetic groups, respectively, which was statistically significant between two groups (P < 0.05). Conclusions: The results of BCVA and corneal astigmatism, keratometry, ECD, and CCT were comparable between two groups. However, the mean postoperative manifest refraction was lower in descemetic group.
  1,297 234 -
A unique case of keratoconus with Cogan-Reese syndrome and secondary glaucoma
Lipi Chakrabarty
January 2017, 65(1):64-66
DOI:10.4103/ijo.IJO_986_15  PMID:28300746
Keratoconus (KC), though one of the most common corneal degeneration, still continues to be a mystique regarding its pathogenesis, diagnosis, associations, and management; with newer discoveries and evolutions being reported. We report, what we believe to be another new association of KC- Cogan Reese syndrome with secondary glaucoma. A 32-year-old male, diagnosed as bilateral KC, presented for examination. Unilateral Cogan-Reese syndrome and associated secondary glaucoma was identified. These associations had been missed by previous ophthalmologists. The patient was managed with a rigid contact lens for KC and topical antiglaucoma agents for glaucoma. He was advised regular reviews and is under observation till date. We describe the first case known to us of a new association with KC. This case not only highlights the ophthalmologist's need to look for multiple entities linked to KC; but may also pave way for future insights regarding pathogenesis and genetics of these associated diseases.
  1,290 167 -
Newly identified paired box 6 mutation of variant familial aniridia: Congenital iris ectropion with foveal hypoplasia
Woo Jin Kim, Jong Ha Kim, Nam Chun Cho
January 2017, 65(1):55-56
DOI:10.4103/0301-4738.202305  PMID:28300742
Congenital aniridia is a kind of eye disease characterized by complete or partial hypoplasia of the iris and is associated with other ocular anomalies including corneal opacity, glaucoma, and foveal hypoplasia. Heterozygous mutation of paired box 6 (PAX6) gene was identified in most cases of aniridia, with iatrogenic mutations accounting for about two-third of the cases and chromosomal rearrangements accounting for the other one-third. We report rare cases of variant aniridia, congenital iris ectropion associated with foveal hypoplasia in both a woman and her son with a mutation of PAX6 gene. To our knowledge, deletion c. 936delC in exon 8 of PAX6 gene has not been reported until now.
  1,261 171 -
Unusual route of a bullet: From scapula to eye
Elif Demirkilinc Biler, Melis Palamar Onay, Naim Ceylan, Bilge Yildirim Ceper
January 2017, 65(1):52-54
DOI:10.4103/ijo.IJO_84_16  PMID:28300741
Herein, an awkward case of globe perforation with a bullet-entering from the right posterior scapular region and leaving the body from the right orbit through the eye - is reported. Route of the bullet could be devastating - as it passed through the neck and the maxillofacial region-however by chance no vital damage occurred. Its path was assessed by plain radiography and computed tomography scans. Sometimes prediction of the trajectory is very difficult without additional radiological investigations. Especially, in the case of any high velocity projectile wounding, physician must be aware of the fact that the bullet's course will not be a linear but most probably a complicated one. Prognosis of the injury depends on the path of the bullet or shrapnel fragment, close clinical observation, an open-minded approach, and the multidisciplinary care. Moreover, even the crime investigation might be needed.
  1,143 133 -
A new beginning: New horizons
Sundaram Natarajan
January 2017, 65(1):1-1
DOI:10.4103/ijo.IJO_181_17  PMID:28300731
  1,125 147 -
Ocular surface squamous neoplasia inpatient with non-Hodgkin's lymphoma
Rajesh Subhash Joshi
January 2017, 65(1):71-72
DOI:10.4103/0301-4738.202315  PMID:28300748
  920 123 -
Nonpreference for the white coat in Pediatric Ophthalmology Department
Mihir T Kothari, Swapna Mulay
January 2017, 65(1):72-73
DOI:10.4103/0301-4738.202316  PMID:28300749
  807 114 -