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   2017| April  | Volume 65 | Issue 4  
    Online since May 17, 2017

 
 
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REVIEW ARTICLE
Imaging in tuberculosis-associated uveitis
Reema Bansal, Soumyava Basu, Amod Gupta, Narsing Rao, Alessandro Invernizzi, Michal Kramer
April 2017, 65(4):264-270
DOI:10.4103/ijo.IJO_464_16  PMID:28513488
Intraocular tuberculosis (TB) can have several clinical presentations, affecting nearly every tissue of the eye. These clinical signs have specific imaging characteristics which help in associating them with tuberculous etiology. This review enumerates the conventional and emerging imaging techniques for intraocular TB and highlights their clinical application for diagnosis and management of specific clinical presentations.
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ORIGINAL ARTICLES
Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population
Divya Kesarwani, Syed Wajahat Ali Rizvi, Adeeb Alam Khan, Abadan Khan Amitava, Shaista Manan Vasenwala, Ziya Siddiqui
April 2017, 65(4):301-304
DOI:10.4103/ijo.IJO_939_15  PMID:28513494
Purpose: Ophthalmic complications in diabetes such as retinopathy, cataract, and infections have been extensively studied. Recently, attention has been drawn toward ocular surface changes in diabetes mellitus (DM). This study has been carried out to investigate the tear film and ocular surface abnormalities in type II DM patients. Materials and Methods: A total of 83 participants (130 eyes) were enrolled: 53 diabetics (80 eyes) and 30 healthy controls (50 eyes). Of the 53 diabetics, 24 patients (42 eyes) had some diabetic retinopathy. The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT), keratoepitheliopathy score (KES), Rose Bengal Staining (RBS) test, and conjunctival impression cytology. Results: When compared with the healthy controls, diabetics showed significantly reduced Schirmer, TBUT measurements and the higher grades of KES and RBS test (P < 0.001). Impression cytology analysis showed goblet cell loss and conjunctival squamous metaplasia in diabetics. Conclusion: Tear film abnormality is a significant feature of diabetic ocular surface diseases. These abnormalities are likely on account of poor quality and function of tears, combined with the subnormal ocular surface. Therefore, all diabetic patients especially those with evidence of retinopathy changes should undergo routine early examination and follow-up of tear function and ocular surface parameters.
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Repeatability and agreement of five imaging systems for measuring anterior segment parameters in healthy eyes
Mukesh Kumar, Rohit Shetty, Chaitra Jayadev, Harsha L Rao, Debarun Dutta
April 2017, 65(4):288-294
DOI:10.4103/ijo.IJO_729_16  PMID:28513492
Purpose: The purpose of this study is to assess the repeatability and agreement of five imaging devices, namely, the Pentacam (Oculus), Sirius (CSO), Orbscan IIz (Bausch and Lomb), Corvis (Oculus), and ultrasound pachymetry (UP, Tomey) in measuring steep keratometry (sKm), flat keratometry (fKm), central corneal thickness (CCT), thinnest corneal thickness (TCT), and anterior chamber depth (ACD) in healthy individuals. Design: This was prospective, comparative study. Subjects: Forty-six healthy Indian patients. Materials and Methods: Forty-six eyes of 46 healthy participants underwent three consecutive scans on each device by a single examiner. Within-subject standard deviation, test–retest repeatability (TRT), and coefficient of variation (COV) for assessing repeatability and Bland–Altman plots for the agreement between the mean measurements of each machine were analyzed. Main Outcome Measures: The repeatability and agreement between the five devices for the measurements of sKm, fKm, CCT, TCT, and ACD. Results: The TRT of sKm measurements ranged between 0.23 diopter (D) (with Pentacam) and 0.83 D (with Orbscan). The same of fKm, TCT, ACD, and CCT measurements ranged between 0.28 D (with Pentacam) and 0.74 D (with Sirius), 7.78 μm (Sirius) and 19.81 μm (Orbscan), 0.05 mm (Orbscan) and 0.07 (Sirius), and 7.36 μm (Sirius) and 18.02 μm (Orbscan), respectively. The TRT of sKm and fKm measurements with Pentacam was significantly lower than those with Orbscan and Sirius. The TRT of TCT measurement with Sirius was significantly lower than that with Pentacam (4.53 μm) and Orbscan (7.15 μm). There were statistically significant differences in the mean measurements of all parameters between the devices. The 95% limit of agreement on the Bland–Altman analysis was wide for the measurement pairs with all the devices. Significant proportional bias in the agreement was detected for TCT measurements with all the device pairs and for the ACD measurements between Sirius and Pentacam. Conclusions: The repeatability estimates of sKm, fKm, TCT, ACD, and CCT measurements with Pentacam, Orbscan, Sirius, Corvis, and UP in Indian eyes were good. However, the differences in the measurements between the devices were statistically significant and the same cannot be used interchangeably for anterior segments measurements.
  2,624 329 -
Intra-arterial chemotherapy for retinoblastoma: Two-year results from tertiary eye-care center in India
Pukhraj Rishi, Tarun Sharma, Minal Sharma, Aditya Maitray, Abhinav Dhami, Vishvesh Aggarwal, Saravanan Munusamy, R Ravikumar, Satheesh Ramamurthy
April 2017, 65(4):311-315
DOI:10.4103/ijo.IJO_843_16  PMID:28513496
Aim: The aim of this study is to describe treatment outcomes and complications of selective intra-arterial chemotherapy (IAC) for intraocular retinoblastoma (RB). Materials and Methods: A retrospective, interventional series of 10 eyes with RB which underwent IAC using melphalan (5 mg/7.5 mg) and topotecan (1 mg), or melphalan (5 mg/7.5 mg) alone. Treatment outcomes were evaluated in terms of tumor control, vitreous seeds (VS) and subretinal seeds (SRS) control, and globe salvage rates. Results: Ten eyes of 10 patients underwent 38 IAC sessions (mean = 3.8; median = 4; range = 3–5 sessions). Following IAC, complete regression of main tumor was seen in 9 eyes (90%) and partial regression in 1 (10%). All four eyes with SRS showed complete regression (100%). Of 5 eyes with VS, 3 eyes (60%) showed complete regression, 1 eye (20%) showed relapse, while 1 eye (20%) showed no response. Globe salvage was achieved in 8 of 10 eyes (80%). Complications included transient ophthalmic artery narrowing (n = 2), branched retinal vein occlusion (n = 1), forehead skin pigmentation (n = 1), and vitreous hemorrhage (n = 2). There was no case of stroke, hemiplegia, metastasis, or death. Transient hematological changes included relative pancytopenia (n = 4), relative leukopenia (n = 5), and relative thrombocytopenia (n = 4). Mean follow-up was 26 months (median = 28, range = 13–36) from the initiation of first IAC. Conclusions: IAC is an effective therapy for globe preservation in eyes with intraocular RB, in the setting of a developing country like India. Larger studies with longer follow-up are required to validate these results.
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The influence of corneal collagen cross-linking on anterior chamber in keratoconus
Nihat Polat, Abuzer Gunduz, Cemil Colak
April 2017, 65(4):271-275
DOI:10.4103/ijo.IJO_948_16  PMID:28513489
Aims: This study aimed to evaluate the effect of the corneal changes following corneal cross-linking (CXL) on the anterior chamber in keratoconus patients. Materials and Methods: Forty-five eyes of 32 patients who had been diagnosed with progressive keratoconus and had undergone CXL were included in this retrospective study. The thinnest corneal thickness of the progressive keratoconus patients included in the study was >400 μ. The preoperative (T0), postoperative 6th month (T1), and postoperative 1st year (T2) anterior chamber volume (ACV), anterior chamber angle (ACA), and anterior chamber depth (ACD) scheimpflug imaging values were obtained for each eye. Results: The mean T0 ACV value was 182.79 ± 36.68 mmwhile the T1 value was 201.25 ± 41.73 mm3 and the T2 value was 208.40 ± 42.69 mm3 with a statistically significant difference between the periods (P = 0.001). The mean T0 ACA value was 38.64° ±5.85°, increasing to 41.45° ±4.83° in the T1 and 42.10° ± 4.84° in the T2. The T0 value was significantly lower than the post-CXL values (P = 0.003). The mean ACD value was 3.73 ± 0.29 mm at the T0 and 3.82 ± 0.38 mm at the T1 and 3.84 ± 0.36 mm at the T2. The pre-CXL values were significantly lower than the post-CXL values (P = 0.001). Conclusions: The improvement of corneal parameters by CXL in keratoconus patients can have a positive effect on anterior chamber parameters as well. This effect becomes marked at the postoperative first 6-month evaluation.
  1,944 302 -
Inflammatory choroidal neovascularization in Indian eyes: Etiology, clinical features, and outcomes to anti-vascular endothelial growth factor
Rupak Roy, Kumar Saurabh, Aditya Bansal, Amitabh Kumar, Anindya Kishore Majumdar, Swakshyar Saumya Paul
April 2017, 65(4):295-300
DOI:10.4103/ijo.IJO_262_16  PMID:28513493
Background and Objectives: The aim was to study the clinical profile of inflammatory choroidal neovascularization (CNV) and its treatment response to intravitreal bevacizumab or ranibizumab on pro re nata (PRN) basis in Indian eyes. Materials and Methods: This was a retrospective case series of consecutive patients with inflammatory CNV treated with anti-vascular endothelial growth factor (anti-VEGF) in a tertiary eye care center in Eastern India between 2009 and 2014. The data about clinical features, investigations, treatment, and outcomes were obtained from the medical records. We included patients with active inflammatory CNV but with no evidence of inflammation and were treated with anti-VEGF alone, with a minimum follow-up of 6 months. Main outcome measures were a clinical and etiological profile of inflammatory CNV in Indian eyes and their response to treatment. Results: Thirty eyes of 28 patients were included in the study. The mean follow-up was 17.93 ± 14.28 months (range 6–53 months). In our cohort, seven (23.33%) eyes had inflammatory CNV secondary to idiopathic choroiditis, four (13.33%) eyes had toxoplasmosis, idiopathic panuveitis, and Vogt Koyanaki Harada's disease each. Three (10%) eyes had geographic helicoid peripapillary choroidopathy and tubercular choroiditis each. Remaining two (6.66%) eyes had punctate inner choroidopathy, while multifocal choroiditis with panuveitis, resolved endogenous endophthalmitis and Hansen's diseases were the etiology in one (3.33%) case of inflammatory CNV each. The mean number of injections were 2.76 (range 1–5). Among thirty eyes of inflammatory CNV, 16 (53.3%) eyes showed improvement, eight (26.6%) maintained the same vision, whereas six (20%) eyes showed deterioration of vision. Interpretations and Conclusion: Idiopathic choroiditis was the most common cause of inflammatory CNV and PRN intravitreal anti-VEGF (ranibizumab or bevacizumab) appears to have effective treatment response.
  1,734 262 -
Coexistence of herpes simplex virus infection in microsporidial stromal keratitis associated with granulomatous inflammation
Ruchi Mittal, Praveen K Balne, Srikant Sahu, Sujata Das, Savitri Sharma
April 2017, 65(4):276-281
DOI:10.4103/ijo.IJO_761_15  PMID:28513490
Background: Microsporidial stromal keratitis poses several diagnostic challenges. Patients may present with corneal ulceration, marked stromal thinning, or even as a quite corneal scar. The presentation of microsporidial stromal keratitis commonly mimics viral keratitis. Microbiology scrapings are usually helpful; however, scraping and culture-negative cases pose a significant diagnostic dilemma. Histopathological examination is diagnostic but shows varying degree of inflammation, predominantly composed of polymorphonuclear leukocytes. Granulomatous inflammation, in microsporidial stromal keratitis, is never well described, and the authors in this article aim to describe the presence of granulomatous inflammation in microsporidial stromal keratitis, in patients with associated herpes simplex virus (HSV) keratitis. Methods: This was a retrospective and observational study conducted at a tertiary eye care center. Results: Of 263 patients who underwent therapeutic penetrating keratoplasty for infectious keratitis, during 2011–2013, seven patients were diagnosed as microsporidial stromal keratitis. Microsporidial spores could be demonstrated on microbiological scrapings in 5/7 (71%) of cases, but identified on histopathological examination and also confirmed on polymerase chain reaction (PCR) for microsporidium in 100% of cases. There was evidence of diffuse stromal necrosis with markedly severe degree of polymorphonuclear leukocytic infiltrates, with granulomatous inflammation in 42% of cases. Interestingly, these were positive for HSV-1 DNA on PCR. Review of medical records revealed much severe clinical presentations in patients with granulomatous inflammation, in comparison to cases without granulomatous inflammation. Conclusions: The authors hereby recommend that severe clinical presentation in patients with microsporidial stromal keratitis, markedly dense polymorphonuclear leukocytic infiltrates or the presence of granulomatous inflammation on the histopathological examination, should be investigated further for the presence of HSV-1 DNA for better patient management and good visual outcome.
  1,681 263 -
Effect of post crosslinking haze on the repeatability of Scheimpflug-based and slit-scanning imaging devices
Rohit Shetty, Aarti Agrawal, Rashmi Deshmukh, Luci Kaweri, Harsha L Rao, Harsha Nagaraja, Chaitra Jayadev
April 2017, 65(4):305-310
DOI:10.4103/ijo.IJO_690_16  PMID:28513495
Purpose: The aim of this study was to analyze the effect of postcollagen crosslinking (CXL) haze on the measurement and repeatability of pachymetry and mean keratometry (Km) of four corneal topographers. Materials and Methods: Sixty eyes of sixty patients with progressive keratoconus who had undergone accelerated CXL (ACXL) underwent imaging with a scanning slit imaging device (Orbscan II) and three Scheimpflug imaging devices (Pentacam HR, Sirius, and Galilei). Post-ACXL haze was measured using the densitometry software on the Pentacam HR. Readings of the thinnest corneal thickness (TCT) and Km from three scans of each device were analyzed. Effect of haze on the repeatability of TCT and Km measurements was evaluated using regression models. Repeatability was assessed by coefficient of variation. Results: Corneal densitometry in different zones affected the repeatability of TCT measurement of Orbscan (P < 0.05) significantly but not the repeatability of TCT with Pentacam HR and Sirius (P = 0.03 and 0.05, respectively). Km values were affected by haze when measured with the Pentacam HR (P < 0.05). The repeatability of Km readings for all devices was unaffected by haze. In the anterior 0–2 mm and 2–6 mm zone, TCT (P = 0.43 and 0.45, respectively), Km values (P = 0.4 and 0.6, respectively), repeatability of TCT (P = 0.1 in both zones), and Km (P = 0.5 and 0.1, respectively) with Galilei were found to be the most reliable. Conclusion: Galilei measurements appear to be least affected by post-ACXL haze when compared with other devices. Hence, topography measurements in the presence of haze need to be interpreted with caution.
  1,635 252 -
Results of a new “mirror tuck technique” for fixation of lacrimal bypass tube in conjunctivodacryocystorhinostomy
Ruchi Goel, Divya Kishore, Smriti Nagpal, Sushil Kumar, Neha Rathie
April 2017, 65(4):282-287
DOI:10.4103/ijo.IJO_741_16  PMID:28513491
Context: Conjunctivodacryocystorhinostomy (CDCR) is the procedure of choice for proximal canalicular blocks. However, the complications of tube migration and extrusion limit its widespread practice. Aim: The aim of this study is to evaluate the efficacy and complications of the new “mirror tuck technique” for fixation of lacrimal bypass glass tube without holes in proximal canalicular blocks in laser CDCR. Materials and Methods: A prospective interventional study was conducted in forty consecutive eyes of adult patients, undergoing 980 nm diode laser CDCR for proximal canalicular blocks. After creating the tract under endoscopic guidance, the collar of the glass tube was fixed to the conjunctiva with 6-0 prolene suture by “mirror tuck technique.” Success was defined as the absence of extrusion of tube with patent tract and relief in epiphora at 1 year of follow-up. Results: Both anatomical and functional success was achieved in 39 (97.5%) cases. Tube displacement occurred in one patient suffering from allergic conjunctivitis in which the tube had to be removed. A temporary heaviness was reported by 5 (12.5%) patients till about 2 weeks. Conjunctival overgrowth over the tube occurred in 1 (2.5%) eye at 5 months which was excised and treated with application of 0.02% mitomycin C with no subsequent recurrence. There were no cases of suture abscess or suture intolerance warranting tube removal. Conclusion: “Mirror tuck technique” is an effective method for tube fixation (for tube without holes) in CDCR. However, it is important to position the conjunctival opening so as to leave sufficient space for passage of sutures for anchorage medially.
  1,540 207 -
LETTERS TO THE EDITOR
Ocular surface burn secondary to smart phone battery blast
Purvasha Narang, Vikas Mittal, Ruchi Mittal, Anurag Mathur
April 2017, 65(4):326-326
DOI:10.4103/ijo.IJO_495_16  PMID:28513501
  1,337 192 -
BRIEF COMMUNICATIONS
Role of mini-scleral lens in mucous membrane pemphigoid
Mukesh Kumar, Rohit Shetty, Chaitra Jayadev
April 2017, 65(4):320-322
DOI:10.4103/ijo.IJO_730_16  PMID:28513499
This study aims to report the use of mini-scleral contact lens in the management of mucous membrane pemphigoid (MMP) with persistent epithelial defects. A 68-year-old male with a history of ocular pain and declining visual acuity was referred to our clinic with a diagnosis of MMP. His corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/100 in the left eye. Despite being on lubricants, topical steroids and intravenous cyclophosphamide, the patient developed persistent corneal epithelial defects in both eyes. He was then given a trial of mini-scleral lenses. Within 4 weeks, corneal epithelial defects healed, and at 6 months, the CDVA had improved to 20/50 in the right eye and 20/40 in the left eye. By improving the corneal surface integrity and visual function, mini-scleral lenses can play a role in the visual rehabilitation of patients with MMP.
  1,317 162 -
Combination of phototherapeutic keratectomy and wavefront-guided photorefractive keratectomy for the treatment of Thiel-Behnke corneal dystrophy
Chia-Chieh Hsiao, Yu-Chih Hou
April 2017, 65(4):318-320
DOI:10.4103/ijo.IJO_683_16  PMID:28513498
Phototherapeutic keratectomy (PTK) has been used to treat anterior corneal dystrophy but may cause hyperopic shift or corneal high-order aberration. We describe the successful treatment of a case of a 43-year-old female with Thiel–Behnke corneal dystrophy, using PTK followed by wavefront-guided photorefractive keratectomy (PRK). The patient had high corneal aberration and hyperopic shift after PTK in both eyes. The corneal surface regularity index and surface asymmetric index increased after PTK and decreased after wavefront-guided PRK. Vision improved from preoperative 20/400 and 20/60 to postoperative 20/20 and 20/25 in the right eye and the left eye, respectively. Additional wavefront-guided PRK may enhance the effects of PTK by reducing irregular corneal surfaces and by correcting PTK-induced hyperopic shift.
  1,295 153 -
LETTERS TO THE EDITOR
Fundus findings in a case of Joubert syndrome
Rohan Chawla, Ravi Bypareddy, Laxman Vekaria, Pradeep Venkatesh, Venkatesh Hosur Ananthashayana
April 2017, 65(4):329-330
DOI:10.4103/ijo.IJO_441_16  PMID:28513504
  1,210 167 -
BRIEF COMMUNICATIONS
Rescue vitrectomy with blocked artery massage and bloodletting for branch retinal artery occlusion
Chun-Ju Lin, Cheng-Wen Su, Huan-Sheng Chen, Wen-Lu Chen, Jane-Ming Lin, Yi-Yu Tsai
April 2017, 65(4):323-325
DOI:10.4103/ijo.IJO_698_16  PMID:28513500
A 61-year-old male suffered from sudden blurred vision and superior visual field defect oculus dexter. His vision was counting fingers at 20 cm. Fundoscopy demonstrated inferior pale retina and a large embolus located at the proximal inferior retinal artery. Branch retinal artery occlusion (BRAO) was diagnosed. Initial paracentesis, topical brimonidine tartrate, oral pentoxifylline, and hyperbaric oxygen therapy were performed but showed limited improvement. Hence, he received 25-gauge vitrectomy, artificial posterior vitreous detachment, blocked retinal artery massage, and bloodletting 5 days after onset. After the surgery, his vision improved to 20/25. Fundoscopy showed reperfused retina, and optical coherence tomography revealed resolved retinal edema. RAO is an ophthalmological emergency; however, no standard guideline is available. Vitrectomy with blocked retinal artery massage and bloodletting showed favorable results in this case of BRAO with a large embolus. More prospective clinical trials are needed for setting up the standard treatment.
  1,170 170 -
EDITORIAL
Every ending is a new beginning
Sundaram Natarajan
April 2017, 65(4):263-263
DOI:10.4103/ijo.IJO_357_17  PMID:28513487
  1,142 171 -
PHOTO ESSAY
Sialadenitis following blepharoplasty: An unusual sequelae
Harsha S Reddy, Phillip A Tenzel, Akshay Gopinathan Nair
April 2017, 65(4):316-317
DOI:10.4103/ijo.IJO_79_17  PMID:28513497
  1,112 165 -
LETTERS TO THE EDITOR
Comment on: To assess survival outcomes of combined femtosecond laser-assisted cataract surgery with 25-gauge vitrectomy surgery at a tertiary eye care center
Neeraj Ashok Israni, Minal Kanhere, Vidhi Kathiriya, Suresh Ramchandani
April 2017, 65(4):327-327
DOI:10.4103/ijo.IJO_961_16  PMID:28513502
  862 128 -
Authors' reply
Aditya Kelkar, Jai Kelkar, Sampada Chitale, Rachana Shah
April 2017, 65(4):328-328
DOI:10.4103/ijo.IJO_46_17  PMID:28513503
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