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   2019| September  | Volume 67 | Issue 9  
    Online since August 22, 2019

 
 
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OPHTHALMIC IMAGES
Ophthalmological signet ring sign by a glaucoma implant
Sunny Chi Lik Au, Simon Tak Chuen Ko
September 2019, 67(9):1477-1477
DOI:10.4103/ijo.IJO_470_19  PMID:31436203
  89,244 85,783 -
REVIEW ARTICLE
Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review
Santhan K S Gopal, Jai Kelkar, Aditya Kelkar, Abhishek Pandit
September 2019, 67(9):1392-1399
DOI:10.4103/ijo.IJO_11_19  PMID:31436180
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
  8,430 1,499 18
ORIGINAL ARTICLES
Observer-masked trial comparing efficacy of topical olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) in mild to moderate allergic conjunctivitis
Lakshey Dudeja, Anuja Janakiraman, Ishani Dudeja, Kaustubh Sane, Manohar Babu
September 2019, 67(9):1400-1404
DOI:10.4103/ijo.IJO_2112_18  PMID:31436181
Purpose: With increasing environmental pollution, the incidence of allergic conjunctivitis is increasing. Newer anti-allergic medications with combined anti-histaminic and mast cell stabilization action can help reducing the use of topical steroids for milder form of disease. There is no study directly comparing olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) for mild to moderate allergic conjunctivitis cases. Hence, we decided to methodically study the efficacy of three topical medications. Methods: Prospective, observer-masked clinical trial enrolled 45 patients with 15 patients in each of the three groups. Patients with mild to moderate allergic conjunctivitis were sequentially assigned to respective groups, and relief of symptoms and signs were noted upto 1-month follow-up. Results: All three topical medications faired almost equally in resolving symptoms of the patients with mild to moderate allergic conjunctivitis, and most of them reported complete relief after 1 week of use of medication. Few cases with limbal or palpebral papillae reported symptomatic relief after use of medication, but the resolution of these signs was not noted in all three groups. Conclusion: We concluded similar efficacy of three medications in relieving symptoms and inefficacy in regressing palpebral and limbal papillae in cases of allergic conjunctivitis.
  4,538 830 6
A comparison of posterior capsular opacification after implantation of three different hydrophobic square edge intraocular lenses
H Vijaya Pai, Atiya Pathan, Yogish Subraya Kamath
September 2019, 67(9):1424-1427
DOI:10.4103/ijo.IJO_219_19  PMID:31436185
Purpose: To compare the posterior capsular opacification (PCO) after implantation of three types of hydrophobic square edge intraocular lenses (IOLs). Methods: A single-center, hospital-based, cross-sectional, observational study was conducted wherein patients with senile cataract who had undergone phacoemulsification by a single surgeon, with the implantation of three different types of square edge, hydrophobic IOLs [Group 1: enVista, Bausch and Lomb; Group 2: Tecnis 1 ZCBOO, AMO and Group 3: Acrysof IQ SN60WF, Alcon], and followed up for 12 months were included. The PCO was graded clinically and scored using the EPCO 2000 software. Results: 90 eyes of 90 patients were included. There was no significant difference in the PCO with respect to age, gender, or associated presence of systemic disease. The median PCO score was 0.035, 0.045 and 0.085 in groups 1, 2 and 3, respectively. The PCO grade and score differences between the groups were statistically significant with P < 0.001. Conclusion: The hydrophobic nature and posterior square edge design in the IOLs probably contributed to the minimal visually-significant PCO in all the groups, in our study. However, PCO scores were lesser in the square edge IOLs having a continuous 360 degrees posterior enhanced barrier, than those without this feature.
  2,838 409 5
Ocular surface status in patients with hemifacial spasm under long-lasting treatment with botulinum A toxin: A comparative fellow eye study
Marco Pellegrini, Costantino Schiavi, Leonardo Taroni, Stefano Sebastiani, Federico Bernabei, Matilde Roda, Fabiana Moscardelli, Giuseppe Giannaccare
September 2019, 67(9):1405-1409
DOI:10.4103/ijo.IJO_41_19  PMID:31436182
Purpose: The purpose of this study was to assess the effect of long-lasting botulinum A toxin injections on ocular surface parameters and to further investigate the relationship between these parameters and the duration of the treatment. Methods: In this retrospective study, patients with unilateral hemifacial spasm who were receiving botulinum A toxin injections for at least 1 year were analyzed. Healthy contralateral eyes acted as controls. The ocular surface examination included Ocular Surface Disease Index questionnaire, Schirmer test type I, tear film break-up time (TFBUT), tear osmolarity, corneal sensitivity, and corneal fluorescein staining. Results: Twenty-six patients (6 males and 20 females; mean age 76.4 ± 8.9 years) were included in the study. The mean duration of the treatment was 7.2 ± 5.4 years, and the mean frequency of injections was of one every 3.3 ± 0.4 months. TFBUT, Schirmer test, and corneal sensitivity were significantly lower in the eye homolateral to hemifacial spasm compared with the contralateral one (5.9 ± 3.2 vs 7.5 ± 4.2 s, P = 0.001; 6.2 ± 3.4 vs 9.2 ± 6.6 mm, P = 0.031; 50.8 ± 3.7 mm vs 52.3 ± 2.9 mm, P = 0.048, respectively). One month after the last injection, TFBUT further decreased from 5.9 ± 3.2 to 2.3 ± 1.2 s (P = 0.028). A significant positive correlation was found between the duration of treatment and tear osmolarity (ρ = 0.542, P = 0.025). Conclusion: Patients with hemifacial spasm under long-lasting treatment with serial botulinum A toxin injections showed a reduction in tear film production and stability, as well as corneal sensitivity in the treated eye compared with the contralateral one. Tear film stability further decreased 1 month after the last injection.
  2,728 289 8
Rotation versus non-rotation of intraocular lens for prevention of posterior capsular opacification
Rajesh S Joshi, Shrutika A Chavan
September 2019, 67(9):1428-1432
DOI:10.4103/ijo.IJO_1854_18  PMID:31436186
Purpose: To study the effect of rotation of intraocular lens (IOL) on posterior capsular opacification (PCO) in eyes with phacoemulsification. Methods: This was a prospective, comparative, randomized case series. One eye of each patient was randomized to one of two groups. The 360-degree rotation of IOL was carried out after its placement in the capsular bag (rotation group). The control group had no rotation of IOL. PCO was analyzed by an independent observer on EPCO computer analysis system at 6, 12, 24, and 36 months. Results: The study included 50 patients (100 eyes) with senile cataracts scheduled for phacoemulsification and IOL implantation. The median age in 2 groups was 66 years. 25% quartile age in both the group was 62 years (P = 0.06). There were 30 males, and 20 females. The median PCO score at 6, 12 and 24 months was significantly low in the rotation group (0.15, 0.13, 0.22) compared to the control group (0.22, 0.23, 0.25). There was no significant difference in PCO score between the two groups from 24-36 months. The median PCO score at 36 months was 0.2 in both the groups. At the end of three years, 4 eyes (8%) in the rotation group, and 10 eyes (20%) in the control group needed Nd:YAG capsulotomy (P = 0.04). Conclusion: Rotation of IOL in the capsular bag decreases PCO and Nd:YAG capsulotomy rate.
  2,427 416 6
CASE REPORTS
Management of head tilt in infantile nystagmus syndrome: A case report
Niranjan Pehere, Jagadeesh Sutraye
September 2019, 67(9):1479-1481
DOI:10.4103/ijo.IJO_1820_18  PMID:31436205
Management of head tilt in infantile nystagmus syndrome (INS) is a challenge. In this case report, we have described successful management of right-sided head tilt in a child with INS by operating on three oblique muscles (superior oblique anterior tenectomy in the right eye, Harada–Ito procedure in the left eye, and inferior oblique recession in the left eye). The child had complete correction of head tilt without causing any cyclovertical strabismus or torsional diplopia postoperatively.
  2,486 252 2
ORIGINAL ARTICLES
Gas permeable contact lens fitting in keratoconus: Comparison of different guidelines to back optic zone radius calculations
Sara Ortiz-Toquero, Guadalupe Rodriguez, Victoria de Juan, Raul Martin
September 2019, 67(9):1410-1416
DOI:10.4103/ijo.IJO_1538_18  PMID:31436183
Purpose: Compare the agreement between the finally fitted back optic zone radius (BOZR) of a spherical gas permeable (GP) contact lense (CL) with those proposed by different guidelines currently available to fit GP CLs in keratoconus. Methods: The BOZR fitted in 81 keratoconus eyes (46 patients) were recorded and compared with the BOZR calculated with ten different guidelines (identified after a literature review) proposed to calculate the first diagnostic lens BOZR to be fitted in keratoconus. Arithmetic and absolute mean difference between both BOZR were calculated (paired t-test). The success rate of each guideline (difference between both BOZR ≤0.05 mm) was calculated for different keratoconus stages (Amsler–Krumeich classification). Agreement between BOZR was evaluated using Bland-Altman analysis. Results: The BOZR proposed by all guidelines correlated with the final BOZR that was fitted (R2 > 0.71; P < 0.01). A statistically significant difference was found between the BOZR suggested by all guidelines and the BOZR that was prescribed (P < 0.05), except for three Guidelines (P ≥ 0.11). CALCULENS.com presented the best agreement (mean difference of 0.00 ± 0.12 mm), and 50.6% of cases showed ≤0.05 mm of difference with the BOZR that was fitted. However, the worst guideline showed an agreement of −0.38 ± 0.22 mm, and just 3.8% of cases had ≤0.05 mm of difference with the final fitted BOZR. Conclusion: BOZR calculated with most of the analyzed guidelines shows statistical differences with final fitted BOZR, suggesting a lack of clinical validation of these guidelines. The selection of the BOZR with CALCULENS.com could provide a better starting point for spherical GP CL fitting in keratoconus eyes.
  2,467 265 2
ONE MINUTE OPHTHALMOLOGY
Bilateral granulomatous uveitis in an elderly female
Jyoti Kattige, Vinaya Kumar Konana, Kalpana Babu
September 2019, 67(9):1391-1391
DOI:10.4103/ijo.IJO_1427_19  PMID:31436179
  2,240 471 1
ORIGINAL ARTICLES
Ocular biometry characteristics and corneal astigmatisms in cataract surgery candidates at a tertiary care center in North-East India
Tanie Natung, Wakaru Shullai, Benjamin Nongrum, Lanalyn Thangkhiew, Prasenjit Baruah, Mary L Phiamphu
September 2019, 67(9):1417-1423
DOI:10.4103/ijo.IJO_1353_18  PMID:31436184
Purpose: The purpose of this study is to determine the ocular biometry characteristics and corneal astigmatisms using partial coherence laser interferometry in patients aged 40 years or above undergoing cataract surgery in a medical college in North-East India. Methods: In a hospital-based cross-sectional study, ocular biometry characteristics such as axial length (AL), anterior chamber depth (ACD), white-to-white (WTW) diameter, corneal power (K), and corneal astigmatisms (D) of consecutive eligible cataract patients in a medical college in North-East India between January 2015 and December 2017 were determined using the intraocular lens (IOL) master. Height and weight were also measured. Results: A cross-sectional study evaluated ocular biometry characteristics of 641 eyes in 641 eligible patients. The mean age was 64.04 ± 10.81 years. The mean AL, ACD, WTW, corneal power, IOL power, and body mass index (BMI) were 23.34 ± 1.12 mm, 3.12 ± 0.39 mm, 11.92 ± 0.54 mm, 44.41 ± 1.50 diopter (D), 20.53 ± 2.79 D, and 26.12 ± 4.32, respectively. Against-the-rule, with-the-rule, and oblique astigmatisms were 48.4%, 33.2%, and 18.4%, respectively. Corneal astigmatism of ≥1 D was found in 292 eyes (45.55%) and >1.5 D in 182 eyes (28.39%). AL had statistically significant correlation with ACD, WTW, K, IOL power, height and weight but not with age. By multivariate analysis, AL was found to be associated with ACD, WTW, K and IOL power (P ≤ 0.05). The mean AL was negatively correlated with the mean K (R-square 0.138). Conclusion: This study is likely to provide the initial normative data for ocular biometry values in Indian adults 40 years or above, because such data is lacking in Indians using the IOL master. This will also help ophthalmologists in planning and improving the quality of surgical outcomes in phacoemulsification and phacorefractive surgeries by choosing the appropriate IOL and incision location.
  2,355 287 9
CASE REPORTS
Bilateral asymmetrical partial heterochromia of iris and fundus in Waardenburg syndrome type 2A with a novel MITF gene mutation
Devesh Kumawat, Vinod Kumar, Pranita Sahay, Grisilda Nongrem, Parijat Chandra
September 2019, 67(9):1481-1483
DOI:10.4103/ijo.IJO_181_19  PMID:31436206
A 3-year-old girl presented with bilateral asymmetrical partial heterochromia of iris and fundus. The parents also complained of bilateral hearing loss in the child. Suspecting an auditory-pigmentary syndrome, systemic and genetic evaluation was performed. The child had profound sensory-neural hearing loss. Targeted gene sequencing revealed a novel nonsense variation in exon 9 of the MITF gene (chr3:70008440A>T) that was pathogenic for Waardenburg syndrome (WS) type 2A. This case highlights the characteristics of the iris and fundus hypochromia, which may provide a clue toward the diagnosis of WS.
  2,379 238 4
EDITORIAL
External ophthalmic videography – Tools and techniques
Santosh G Honavar
September 2019, 67(9):1389-1390
DOI:10.4103/ijo.IJO_1522_19  PMID:31436178
  2,120 452 -
CASE REPORT
Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm
Navya Cherukuri, Bhavik Panchal, Hrishikesh Kaza, Shreyansh Doshi, Avinash Pathengay
September 2019, 67(9):1494-1496
DOI:10.4103/ijo.IJO_177_19  PMID:31436212
A 46-year-old male presented with best corrected visual acuity (BCVA) of 20/125 in his right eye. Fundus showed disc edema, multiple yellow outer retinal crops, macular edema and a live motile worm in the subretinal space. Diagnosis of diffuse unilateral subacute neuroretinitis (DUSN) was made and pattern scanning laser photocoagulation (PSLP) was performed along with administration of oral albendazole, diethylcarbamazine and corticosteroids. Complete disappearance of the worm was observed at 2 weeks. At last follow up, final BCVA improved to 20/30. Herein, we report role of PSLP in the management of DUSN.
  2,350 192 2
CASE REPORTS
Rare cause of floaters: A motile live worm in vitreous cavity
Renu P Rajan, Soumya Jena, N Obuli Ramachandran, Piyush Kohli
September 2019, 67(9):1490-1492
DOI:10.4103/ijo.IJO_79_19  PMID:31436210
Ocular filariasis commonly presents as subconjunctival or eyelid nodules. We report a rare case of a live, motile worm causing floaters. The worm was isolated from the vitreous cavity and revealed to be Dirofilaria repens. Correct recognition of the worm is necessary as human dirofilariasis does not present as microfilaremia and does not require systemic therapy; in contrast to other causes of ocular filariasis, which require systemic therapy. As ophthalmologist may be the first physician to encounter such patients, a high index of suspicion is required for timely and adequate management.
  2,277 216 2
ORIGINAL ARTICLES
Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction
Surinder Singh Pandav, Natasha Gautam Seth, Atul Arora, Faisal Thattaruthody, Ajay Jurangal, Sushmita Kaushik, Srishti Raj
September 2019, 67(9):1433-1438
DOI:10.4103/ijo.IJO_1917_18  PMID:31436187
Purpose: The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in IOP [19.1 ± 18.00% (18.8) in PACS (P < 0.01), 8.55 ± 17.9% (10) in PAC (P = 0.04), 22.82 ± 15.45%(14.3) in PACG (P < 0.01), 18.27 ± 15.99% (14.5) in advanced PACG (P = 0.01) and 36.56 ± 14.58% (28.57) in medically uncontrolled glaucoma (P < 0.01)] and AGM [51.85% (1) in PAC, 32.35% (2) in PACG, 17.71% (2) in advanced PACG, and 40.74% (1.5) in medically uncontrolled PACD] at median follow-up of 1, 2.5, 1, 1.3, and 1 year. Eleven PACG patients, who were on systemic medication preoperatively, were off systemic therapy at final follow-up, while six other PACG eyes (10.9%) required glaucoma surgery. Conclusion: Cataract surgery leads to significant drop in IOP across the spectrum of ACD with visually significant cataract. Cataract surgery may be considered initially for IOP control even in advanced or medically uncontrolled PACG followed by glaucoma surgery later if required.
  2,115 353 6
PHOTO ESSAY
Ciliochoroidal effusion in topiramate-induced bilateral acute angle closure glaucoma
Aniruddha Agarwal
September 2019, 67(9):1466-1467
DOI:10.4103/ijo.IJO_245_19  PMID:31436195
  2,060 277 4
OPHTHALMIC IMAGES
Anterior capsular phimosis
Shilpi Harshal Narnaware, Prashant K Bawankule
September 2019, 67(9):1476-1476
DOI:10.4103/ijo.IJO_392_19  PMID:31436202
  1,983 214 3
PHOTO ESSAY
Goltz syndrome: Primary diagnosis by an ophthalmologist
Ekta Rishi, Preet Sodhi, Meenakshi Swaminathan, Pukhraj Rishi
September 2019, 67(9):1467-1468
DOI:10.4103/ijo.IJO_724_18  PMID:31436196
  1,975 215 1
SURGICAL TECHNIQUE
A “flexible tripod” mounted video camera: An economical and effective method to record oculoplastic surgeries
Akshay Gopinathan Nair, Saurabh Kamal, Swati Singh
September 2019, 67(9):1460-1462
DOI:10.4103/ijo.IJO_1702_18  PMID:31436193
Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.
  1,968 206 1
Perfluoro-n-octane-assisted mega Weiss-ring technique for posterior vitreous detachment induction in retinal detachment
Naresh Babu, Jayant Kumar, Piyush Kohli, Kim Ramasamy
September 2019, 67(9):1463-1465
DOI:10.4103/ijo.IJO_2068_18  PMID:31436194
Induction of posterior vitreous detachment (PVD) is one of the most critical steps for the success of retinal detachment (RD) surgery. Failure to completely remove the vitreous can result in re-detachments. We describe a novel technique to induce PVD. After core vitrectomy, perfluorocarbon liquid (PFCL) is injected. The vitreous on the posterior pole is gently stroked, with a diamond-dusted membrane scraper, to create a defect in it. This defect is gradually enlarged to create a ring of rolled out vitreous. The entire vitreous is removed in form of a sheet by lifting the edges of the ring using an internal limiting membrane peeling forceps. PFCL naturally slides into the potential space, gradually extending the vitreous detachment peripherally. With this technique, the vitreous sheet in case of RD can easily, effectively and safely be removed with this technique.
  1,901 219 2
CASE REPORTS
Electric shock induced Purtscher-like retinopathy
Anuj Sharma, Y C Venu Gopal Reddy, Adheesh P Shetty, Syed Mohideen Abdul Kader
September 2019, 67(9):1497-1500
DOI:10.4103/ijo.IJO_1737_18  PMID:31436214
The most common ocular manifestation following electric shock injury is the development of cataract. Retinal manifestations can vary from development of macular holes to retinal detachments. Purtscher-like retinopathy following electrical injury has not been reported till date. We hereby present a case of a 19-year-old electrician who presented with grossly reduced vision in the right eye of 2 months following an electric shock. The fundus of the right eye showed macular ischemic degeneration, occluded vessels, cotton-wool spots, and hemorrhages. Optical coherence tomography angiography revealed presence of capillary drop-out in the para-foveal region, which was more pronounced in the deep capillary plexus. Electric shock injury can lead to a clinical picture simulating Purtscher's retinopathy. The electrical injury leads to a more extensive damage to the deep capillary plexus as compared with the superficial plexus.
  1,894 209 6
OPHTHALMIC IMAGES
En-face optical coherence tomography of unilateral myopic retinoschisis
Ritesh Narula, Mithun Thulasidas, Rupin Dang, Avnindra Gupta
September 2019, 67(9):1478-1478
DOI:10.4103/ijo.IJO_260_19  PMID:31436204
  1,833 165 -
CASE REPORTS
Fungal retinitis following influenza virus type A (H1N1) infection
Nitin K Menia, Surya P Sharma, Reema Bansal
September 2019, 67(9):1483-1484
DOI:10.4103/ijo.IJO_1691_18  PMID:31436207
A 43-year-old male presented with left eye foveal retinits causing an acute visual loss following influenza virus type A infection (H1N1 infection or Swine flu). Considering viral (influenza) etiology, a prompt treatment with oral corticosteroids was started. But an initial poor response prompted an immediate diagnostic vitrectomy, which revealed Candida albicans. The retinitis healed with scar formation following anti-fungal therapy. This case highlights that even in the setting of an acute retinitis in an immunocompetent patient with recent history of viral systemic illness, a high index of suspicion of a fungal (rather than viral) infection should be kept in mind.
  1,721 208 5
ORIGINAL ARTICLES
Learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model: Implications for future clinical trials
Vivek Pravin Dave, Praveen Joseph Susaimanickam, Irfan Ahamad Mir, Indumathi Mariappan, Sayan Basu, Bhanuprakash G Reddy, Rajeev Reddy Pappuru, Subhadra Jalali, Taraprasad Das
September 2019, 67(9):1455-1458
DOI:10.4103/ijo.IJO_317_19  PMID:31436191
Purpose: The sub-retinal injections are not very commonly performed procedures in vitreoretina, but form a crucial step in any cell replacement therapy for retinal diseases. The purpose of this study is to describe the learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model and its implications in future clinical trials. Methods: This is an in-vivo retrospective animal study using Wistar rats. All ARVO guidelines regarding animal handling were followed. After anesthetization, aspectic preparation and dilating the pupils with 1% tropicamide eye drops, subretinal injection of 10 μl saline was done via a limbal entry. Data recorded included time taken for the procedure, success of injection, associated complications, post-operative infections and complications. The rats were followed up for 1 month post procedure. A trend analysis was done for the above factors to look for improvement in ease of procedure, reduction in procedure time and reduction in complications for the clinician using a novel objective scale. Results: About 20 eyes were studied. Mean weight of the rats was 188 ± 12.82 gram. Mean time taken for the procedure was 14.1 ± 5.07 minutes. There was a significant inverse co-relation between the serial number of the eye and time taken for the procedure (r = −0.89, P < 0.0001). Comparative complications noted between the first ten and the last ten eyes were: conjunctival tear 30% versus 10% (P = 0.27), lens touch 50% versus 10% (P = 0.05), subretinal hemorrhage 40% versus 0% (P = 0.13), vitreous loss 30% versus 0% (P = 0.06). The successful subretinal injection without intraocular complications was achieved in 40% versus 90% (P = 0.02). There was a significant co-relation between the serial number of the eye and ease of the procedure (r = 0.87, P < 0.0001). Post operatively none of the eyes had any infection. Six eyes (12%) developed cataract and 3 eyes (6%) had non-resolving retinal detachment at the last examination visit. Conclusion: Subretinal injections in rats have a definite learning curve even for a trained vitreoretinal surgeon. This should be accounted for and resources allocated accordingly to achieve good technical comfort and negate confounding by the surgeon factor in the results of future clinical trials
  1,712 201 6
CASE REPORTS
Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis
Parthopratim Dutta Majumder, Lakshmi Mayilvakanam, Amit H Palker, Sudharshan Sridharan, Jyotirmay Biswas
September 2019, 67(9):1487-1490
DOI:10.4103/ijo.IJO_1795_18  PMID:31436209
With a resurgence of syphilis with human immunodeficiency virus (HIV) infection in last few years, various ocular manifestations of syphilis have been described in literature. This case report described an HIV-positive patient on anti-retroviral therapy who was diagnosed and treated for posterior uveitis secondary to ocular syphilis in the recent past presented to our clinic with cystoid macular edema (CME). CME, which did not respond to periocular corticosteroid, resolved with intravitreal sustained release dexamethasone implant. There was a recurrence CME 9 months later and repeat injection of intravitreal implant showed complete resolution. A long-term follow-up did not reveal reactivation of the infection with intravitreal corticosteroid. Intravitreal sustained release dexamethasone implant can be an effective treatment for refractory CME in patients with regressed syphilitic uveitis.
  1,678 207 3
A rare case of giant subretinal migration of cysticercosis cyst with extensive epiretinal membrane and subretinal fibrosis
Madhu Kumar, Swarnalatha Poluri, Vinaya Kumar Konana, Ishfaq Ahmed Sofi, Jayamadhury Gudimetla, Parag Anil Bagad
September 2019, 67(9):1485-1487
DOI:10.4103/ijo.IJO_1734_18  PMID:31436208
Cysticercosis is caused by cysticercus cellulosae, the larval form of pork tapeworm. In intraocular cysticercosis the cyst enters the subretinal space via the choroid and then gains entry into the vitreous cavity by piercing the retina. It is well established that the cyst can incite extensive intraocular inflammation. Other complications such as epiretinal membrane and cataract have been reported in the literature. Thus far, epiretinal membrane in intraocular cysticercosis has been reported at the site of entry of the cyst into the vitreous cavity. The data on the extent of epiretinal membrane is sparse. We report a rare case of migrating subretinal cysticercosis with extensive epiretinal membrane and subretinal fibrosis.
  1,700 171 1
PHOTO ESSAY
Post-traumatic suprachoroidal dislocation of crystalline lens and its management
Mahesh P Shanmugam, Payal Shah, R Rajesh, Divyansh K Mishra, Pradeep Sagar, Abhishek Sheemar
September 2019, 67(9):1469-1470
DOI:10.4103/ijo.IJO_1656_18  PMID:31436197
  1,641 207 1
ORIGINAL ARTICLES
Internal limiting membrane peel: Does it change the success rate of primary vitrectomy without belt buckle in rhegmatogenous retinal detachments?
Prashant K Bawankule, Shilpi H Narnaware, Dhananjay V Raje, Moumita Chakraborty
September 2019, 67(9):1448-1454
DOI:10.4103/ijo.IJO_1685_18  PMID:31436190
Purpose: To compare the anatomic success of pars plana vitrectomy (PPV) after internal limiting membrane (ILM) peeling at macular area and macular plus peripapillary area versus no peeling in rhegmatogenous retinal detachments (RRD). Methods: A prospective observational study between July 2014 and March 2017 conducted on 289 eyes of 287 patients with RRD were randomly assigned to three treatment procedures, viz., PPV with no ILM peeling, PPV with macular peeling, and PPV with macular plus peripapillary peeling. Recurrent RD (ReRD) was treated as an event and accordingly the overall primary (PS) and final success (FS) rates were obtained. The risk of ReRD associated with peeling procedures after adjusting for risk factors were obtained using Cox-proportional hazard analysis. Results: The PS percentage for no peel, macular, and macular plus peripapillary procedures were 77.78% (70/90), 82.18% (83/101), and 94.89% (93/98; maximum), respectively, which was statistically significant with a P value of 0.003. The FS percentage for no peel, macular, and macular plus peripapillary were 93.33%, 95.04%, and 100%, respectively, which was significantly different with a P value of 0.048. With reference to no peeling, the adjusted hazard ratio for macular peeling was 0.841 [95% CI: 0.44–1.60] while 0.235 [95% CI: 0.088–0.626] for macular plus peripapillary peeling. Conclusion: The anatomic success rate of PPV with macular plus peripapillary ILM peeling was significantly higher as compared to no peel category. The hazard of ReRD in patients undergoing macular plus peripapillary peel was significantly reduced as compared to no peel procedure.
  1,599 231 3
CASE REPORTS
Coastline like peripheral chorioretinal degeneration as a suspected cause of nasal retinal dialysis
Dheepak Sundar, Arpith Sharma, Rohan Chawla, Nasiq Hasan
September 2019, 67(9):1500-1502
DOI:10.4103/ijo.IJO_167_19  PMID:31436215
Retinal dialysis is mostly associated with blunt trauma or at times spontaneous. A patient presented to us with fresh rhegmatogenous retinal detachment with no telltale history or signs of trauma. The causative break was retinal dialysis noted on the superonasal periphery. A characteristic peripheral chorioretinal degeneration simulating a coastline almost extending six clock hours was seen in both the eyes. We have discussed this rare presentation and the possibilities of the association between this newly identified lesion and spontaneous retinal dialysis in the following case report.
  1,571 155 -
PHOTO ESSAY
Branch retinal artery occlusion with embolic movements
Xinyan Xu, Lei Gao, Xiaowei Yang
September 2019, 67(9):1472-1473
DOI:10.4103/ijo.IJO_389_19  PMID:31436199
  1,520 186 -
CASE REPORTS
Structural-functional correlation using adaptive optics, visual fields, optical coherence tomography and multifocal electroretinogram in a case of torpedo maculopathy
Ramesh Venkatesh, Naresh K Yadav, Shivani Sinha, Ruchir Mehta, Mukunda C Akkali
September 2019, 67(9):1502-1505
DOI:10.4103/ijo.IJO_2044_18  PMID:31436216
We present a case of a 37-year-old gentleman with a rare diagnosis of Torpedo maculopathy (TM). We describe the multimodal imaging features of torpedo maculopathy using adaptive optics, visual fields, OCT and multifocal ERG, and understand the clinical and structural-functional correlation in TM. According to us, this is the first case report to describe the adaptive optics imaging findings in Torpedo maculopathy in English Medical literature.
  1,504 188 4
ORIGINAL ARTICLES
Factors related to filtration-bleb morphology after Ex-PRESS® surgery
Naoki Tojo, Atsushi Hayashi, Mitsuya Otsuka
September 2019, 67(9):1439-1446
DOI:10.4103/ijo.IJO_2121_18  PMID:31436188
Purpose: We investigated the factors influencing the morphology of filtration blebs after Ex-PRESS® surgery. We analyzed the thickness of the bleb wall and the height and the volume of blebs. Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, we analyzed the cases of 145 consecutive patients (180 eyes) who underwent trabeculectomy with Ex-PRESS® for the first time at Toyama University Hospital and were followed for >1 year. We used anterior segment optical coherence tomography to analyze the morphology of the blebs after Ex-PRESS surgery. We also examined potential influencing factors including age, central corneal thickness, type of glaucoma (primary open-angle glaucoma [POAG] or pseudo-exfoliation glaucoma [PEXG]), preoperative intraocular pressure (IOP), postoperative IOP, history of trabeculotomy, and operation method: Ex-PRESS surgery only, or simultaneous cataract surgery. Results: Ex-PRESS surgeries significantly decreased the IOP from 24.5 ± 8.8 mmHg to 11.1 ± 3.4 mmHg after 1 year (P < 0.001). The cases with higher blebs, larger volume of blebs, and thinner bleb wall had better surgical outcomes. Conclusion: Advanced age, higher postoperative IOP, PEXG, and simultaneous cataract surgeries were found to decrease the volume and height of blebs. Younger age, higher postoperative IOP, POAG, and simultaneous cataract surgeries were found to thicken the wall of blebs. Among the younger patients, there were many cases in which surgery was unsuccessful in spite the large volume of blebs. The reason for this may be that the wall of the bleb is thick.
  1,467 196 3
OPHTHALMIC IMAGES
Epithelial ingrowth following LASIK managed with Nd:YAG laser
Mayank A Nanavaty
September 2019, 67(9):1474-1474
DOI:10.4103/ijo.IJO_1825_18  PMID:31436200
  1,415 211 1
PHOTO ESSAY
Multimodal imaging in a case of choroideremia
Sugandha Goel, Kumar Saurabh, Rupak Roy
September 2019, 67(9):1470-1471
DOI:10.4103/ijo.IJO_218_19  PMID:31436198
  1,409 206 1
LETTERS TO THE EDITOR
Bacterial isolates in microbial keratitis: Three-year trend analysis from North India
Manisha Acharya, Javed Hussain Farooqui, Aastha Singh, Arpan Gandhi, Umang Mathur
September 2019, 67(9):1508-1509
DOI:10.4103/ijo.IJO_678_19  PMID:31436220
  1,384 193 10
COMMENTARY
Commentary: Learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model: Implications for future clinical trials
Atul Kumar, Divya Agarwal
September 2019, 67(9):1459-1459
DOI:10.4103/ijo.IJO_779_19  PMID:31436192
  1,425 148 -
OPHTHALMIC IMAGES
Intrastromal cyst in Terrien's marginal degeneration
Deepali Singhal, Prakhyat Roop, Prafulla Kumar Maharana
September 2019, 67(9):1475-1475
DOI:10.4103/ijo.IJO_2097_18  PMID:31436201
  1,338 161 -
COMMENTARY
Commentary: Seeing a worm in the eye - Is it enough?
Jyotirmay Biswas
September 2019, 67(9):1492-1493
DOI:10.4103/ijo.IJO_708_19  PMID:31436211
  1,342 153 -
LETTERS TO THE EDITOR
Comparison of central corneal thickness measurements using different imaging devices and ultrasound pachymetry
Tarannum Mansoori
September 2019, 67(9):1508-1508
DOI:10.4103/ijo.IJO_582_19  PMID:31436219
  1,222 190 -
COMMENTARY
Commentary: Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm
Chitaranjan Mishra
September 2019, 67(9):1496-1497
DOI:10.4103/ijo.IJO_757_19  PMID:31436213
  1,252 151 -
Commentary: Decoding the Ex-PRESS® implant
Manish Panday
September 2019, 67(9):1447-1447
DOI:10.4103/ijo.IJO_686_19  PMID:31436189
  1,209 148 -
ERRATUM
Erratum: A rare masquerade of chalazion: Adenoid cystic carcinoma

September 2019, 67(9):1513-1513
DOI:10.4103/0301-4738.265130  PMID:31436223
  1,112 217 -
LETTERS TO THE EDITOR
Commentary: Clinical presentations and comparative outcomes of primary versus deferred intraocular lens explantation in delayed-onset endophthalmitis
Lingam Gopal
September 2019, 67(9):1506-1507
DOI:10.4103/ijo.IJO_529_19  PMID:31436217
  1,105 145 2
Primary orbital low-grade fibromyxoid sarcoma
Mahmood Dhahir Al-Mendalawi
September 2019, 67(9):1507-1507
DOI:10.4103/ijo.IJO_583_19  PMID:31436218
  1,104 144 -
A challenging case of a large orbitocranial wooden foreign body in a child
Ajay Dudani, Harsha Pawar, Anupam A Dudani, Krish Dudani, Anadya Dudani
September 2019, 67(9):1510-1512
DOI:10.4103/ijo.IJO_1878_18  PMID:31436221
  1,095 149 3
Update: Juxtapapillary choroidal excavation with polypoidal choroidal vasculopathy - An unusual association
Maitreyi Chowdhury, Pukhraj Rishi
September 2019, 67(9):1510-1510
DOI:10.4103/ijo.IJO_487_19  PMID:31436222
  1,043 121 -
ERRATUM
Erratum: Intravitreal aflibercept injection in Indian eyes with retinopathy of prematurity
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September 2019, 67(9):1513-1513
DOI:10.4103/0301-4738.265131  PMID:31436224
  943 111 -