• Users Online: 50735
  • Home
  • Print this page
  • Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2020| March  | Volume 68 | Issue 3  
    Online since February 14, 2020

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
EDITORIAL
Electronic medical records – The good, the bad and the ugly
Santosh G Honavar
March 2020, 68(3):417-418
DOI:10.4103/ijo.IJO_278_20  PMID:32056991
  3,978 561 13
ORIGINAL ARTICLE
Big data and the eyeSmart electronic medical record system - An 8-year experience from a three-tier eye care network in India
Anthony Vipin Das, Priyanka Kammari, Ranganath Vadapalli, Sayan Basu
March 2020, 68(3):427-432
DOI:10.4103/ijo.IJO_710_19  PMID:32056994
Purpose: To assess the demographic details and distribution of ocular disorders in patients presenting to a three-tier eye care network in India using electronic medical record (EMR) systems across an 8-year period using big data analytics. Methods: An 8-year retrospective review of all the patients who presented across the three-tier eye care network of L.V. Prasad Eye Institute was performed from August 2010 to August 2018. Data were retrieved using an in-house eyeSmart EMR system. The demographic details and clinical presentation and ocular disease profile of all the patients were analyzed in detail. Results: In an 8-year period, a total of 2,270,584 patients were captured on the EMR system with 4,730,221 consultations. More than half of the patients presented at tertiary centers (n = 1,174,643, 51.73%), a quarter at the secondary centers (n = 564,251, 24.85%) followed by the vision centers (n = 531,690, 23.42%). The ratio of males and females was 1.18:1. Most common states of presentation were Andhra Pradesh (n = 1,103,733, 48.61%) and Telangana (n = 661,969, 29.15%). In total, 3,721,051 ocular diagnosis instances were documented in the patients. Most common ocular disorders were related to cornea and anterior segment (n = 1,347,754, 36.22%) followed by refractive error (n = 1,133,078, 30.45%). Conclusion: This study depicts the demographic details and distribution of various ocular disorders in a very large cohort of patients. There is a need to adopt digitization in geographies that cater to large populations to enable insightful research. The implementation of EMR systems enables structured data for research purposes and the development of real-time analytics for the same.
  3,430 380 73
REVIEW ARTICLE
Trabeculectomy in pregnancy: Case studies and literature review
Nandini R Banad, Nikhil Choudhari, Siddharth Dikshit, Chandrasekhar Garudadri, Sirisha Senthil
March 2020, 68(3):420-426
DOI:10.4103/ijo.IJO_638_19  PMID:32056993
Glaucoma management during pregnancy is a challenge for the patient and doctor. During pregnancy, the intraocular pressure (IOP) decreases. However, some women with preexisting glaucoma have elevated IOP requiring enhanced medical treatment. Glaucoma refractory to medical treatment combined with disease progression may necessitate laser trabeculoplasty or surgical intervention. Surgery during pregnancy has potential risks for both the mother and fetus. The challenges include problems with anesthesia, positioning for surgery, difficulties in the surgical procedure, potential risk with antimetabolites, and concerns with the management of postoperative complications. We report two case scenarios that highlight the challenges associated with trabeculectomy in pregnant women and the modifications that can be adopted to improve safety and the efficacy of glaucoma filtering surgery during pregnancy.
  2,673 426 2
ORIGINAL ARTICLES
Corneal endothelium in unilateral Fuchs heterochromic iridocyclitis
N Geetha Sravani, Ashik Mohamed, Sunita Chaurasia, Shravya Sri Durgam, Somasheila I Murthy
March 2020, 68(3):447-449
DOI:10.4103/ijo.IJO_869_19  PMID:32056999
Purpose: To assess the corneal endothelium in patients with Fuchs heterochromic iridocyclitis (FHI) and compare it with the normal fellow eye. Methods: Retrospective, observational, cross-sectional study of 31 patients seen between Jan 2016 to Dec 2018, with clinical diagnosis of Fuchs heterochromic iridocyclitis, was performed. Specular microscopic examination was documented in both eyes. The affected eyes formed the study group and the fellow healthy eyes served as controls. Results: The mean age of the patients was 29.9 ± 8.2 years. The endothelial cell density (P = 0.0001) was significantly lower, whereas average cell size (P = 0.0001), coefficient of variation (P = 0.004), and maximum cell area (P = 0.01) were significantly higher in the affected eye compared to the control eye. In three patients, the affected eye showed guttae, while the healthy fellow eye revealed a normal specular mosaic. Conclusion: Specular microscopic analysis shows endothelial alterations in the affected eyes in FHI.
  2,864 198 3
ORIGINAL ARTICLE
Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years
Prashant Borde, Priyanka , Kavita Kumar, Brijesh Takkar, Bhavana Sharma
March 2020, 68(3):476-481
DOI:10.4103/ijo.IJO_1724_18  PMID:32057007
Purpose: To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies. Methods: This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis. Results: A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%). Conclusion: Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).
  2,401 264 3
ONE MINUTE OPHTHALMOLOGY
Cystoid macular edema in a child
Jordan Hamburger, Xiaolu Yang, Carol L Shields
March 2020, 68(3):419-419
DOI:10.4103/ijo.IJO_2244_19  PMID:32056992
  1,923 384 -
ORIGINAL ARTICLES
A prospective cohort study on the epidemiology of ocular trauma associated with closed-globe injuries in pediatric age group
Shreya M Shah, Mehul A Shah, Romi Singh, Chetan Rathod, Ranuq Khanna
March 2020, 68(3):500-503
DOI:10.4103/ijo.IJO_463_19  PMID:32057012
Purpose: To study the epidemiology of mechanical ocular trauma and closed globe injury using the Birmingham Eye Trauma Terminology System in patients belonging to the pediatric age group. Methods: This work involved a prospective cohort study of all ocular trauma patients (pediatric age group) registered between 2002 and 2017 at the ocular trauma care center. The data were collected using the international ocular trauma society form through our online MIS data and exported to the Excel sheet. The statistical analyses including the univariate analysis and cross tabulation were carried out using SPSS 22 software. Results: Our cohort consisted of 12687 patients with mechanical ocular trauma. There were 7546 (59.4%) eyes with open globe ocular injuries and 5328 (41.9%) with closed globe injuries. Of all closed globe injury patients, 1010 (19.0%) belonged to the pediatric age group (0-18 years), including 690 males (68.3%) and 320 females (31.7%). The mean age of the patients was 10.2 ± 5.1 years. Of all closed globe injuries, 692 (68.5%) were closed globe contusion and 318 (31.5%) were lamellar laceration. Conclusion: Closed globe injury is an important in cause of vision loss in children (24% <1/60). The condition is more prevalent in males and >51.7% in children under 10 years of age. The treatment has significant impact on the visual outcome in patients belonging to the pediatric age group.
  2,055 230 11
Outcome of therapeutic deep anterior lamellar keratoplasty in advanced Acanthamoeba keratitis
Bhupesh Bagga, Prashant Garg, Joveeta Joseph, Ashik Mohamed, Paavan Kalra
March 2020, 68(3):442-446
DOI:10.4103/ijo.IJO_307_19  PMID:32056998
Purpose: To report and analyze the outcomes of therapeutic deep anterior lamellar keratoplasty (DALK) in patients with advanced Acanthamoeba keratitis (AK). Methods: Medical records of microbiologically confirmed AK, underwent DALK from 2004 to 2017, were reviewed and the data related to early and late outcome including complications were retrieved. Outcome of cases with largest diameter of infiltrate ≥8 mm at the time of surgery (advanced keratitis) were analyzed and compared with those with less severe keratitis (infiltrate size less than 8 mm). Results: Out of 23 patients of AK in whom DALK was performed, ten (43.4%) patients had advanced keratitis. Mean age of these patients was 38.7 ± 8.6 years (range, 25 to 56). Median visual acuity at presentation was 2.78 (IQR, 1.79–3.0) that improved to 1.79 (IQR, 0.70–2.78) postoperatively. Early complications included recurrence of AK in 2 (20%), Descemet's membrane detachment in 5 (50%), and persistent epithelial defect in 3 (30%) cases. Overall, 6 (60%) grafts failed, whereas 4 (40%) patients had clear graft at their last follow-up. Median follow-up of these cases was 5 months (IQR, 1.4–11.4). One graft developed stromal rejection, which resolved with increased dose of corticosteroids. In comparison, DALK performed for less severe keratitis (N = 13) had 1 (7.6%) recurrence and 2 (15.8%) grafts failure (OR, 8.25). The probability of one-year graft survival and eradication of infection was 32% and 74.1%, respectively, in advanced cases compared to 91.6% and 83.9% in less severe cases. Conclusion: Outcome of DALK in advanced Acanthamoeba keratitis is less favorable compared to those carried out for less severe keratitis cases.
  2,021 226 9
Effects of preoperative doses of betamethasone acetate 0.1% on dry eye control after cataract surgery
Saeed Shokoohi-Rad, Seyedeh Zeinab Hashemi Javaheri, Fatemeh Zare Malekabad, Hamid Khakshoor, Mohammad Khajeh Daluee
March 2020, 68(3):450-454
DOI:10.4103/0301-4738.278367  PMID:32057000
Purpose: The aim of the present study was to compare the effects of the preoperative doses of betamethasone acetate 0.1% and placebo on controlling dry eye after cataract surgery. Methods: This randomized triple-blind clinical trial was conducted on 62 patients. For the purpose of the study, the participants were assigned into two groups of betamethasone (n = 28) and placebo (n = 34). The groups were administered with drops A or B three days before the operation, four times a day. These drops contained either betamethasone 0.1% or normal saline (placebo). Postoperative follow-up was performed 1, 7, and 30 days after the surgery. Dry eye symptoms were evaluated by means of the ocular surface disease index (OSDI) using the meniscometry test. Repeated measures analysis was also used to study the effect of the interaction between betamethasone and time on meniscometry and OSDI variables. Results: A total of 62 patients, including 51.6% female and 48.4% male, were investigated in this study with a mean age o 69.19 ± 12.80 years. The results of the analysis of variance of the repeated measures plot indicated that the OSDI and meniscometry dry eye variables were not affected by the interaction between time and betamethasone (P = 0.192 and P = 0.578, respectively). Conclusion: As the findings indicated, the use of betamethasone acetate 0.1% prior to cataract surgery had no significant effect on postoperative dry eye indices.
  1,809 270 8
ORIGINAL ARTICLE
Demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India
Manisha Singh, Abha Gour, Arpan Gandhi, Umang Mathur, Javed H Farooqui
March 2020, 68(3):434-440
DOI:10.4103/ijo.IJO_928_19  PMID:32056996
Purpose: To study the demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India. Methods: This retrospective case series included review of medical records of pediatric patients (0–16 years) diagnosed with infectious keratitis in a tertiary care center of North India during December 2011 to January 2017 was done. Demographic details, predisposing factors, microbiological investigations, and clinical outcomes were analyzed. Results: In this time period, 104 eyes of 104 children had a diagnosis of infectious keratitis. Culture was obtained for all 104 eyes and was positive in eighty eight eyes (84.2%). The most common causative factor was trauma, seen in 77 eyes (74%). Bacteria was the most common agent isolated in culture (54.2%) followed by fungi (40.8%) and acanthamoeba (2.1%). Successful healing of the keratitis with appropriate medical treatment occurred in 84 (80.7%) eyes, while 13 (12.5%) eyes required therapeutic keratoplasty. Of the 80 eyes with documentation of both preliminary and final visual acuity, improvement of two lines was seen in 35 eyes (43.7%), stayed the same in and worsened in 17 eyes (21%). Mean time to resolution of infection on medical treatment for bacteria was 23.65 ± 4.78 days, fungi 32 ± 5.19 days, and acanthamoeba 53.67 ± 4.78 days. Conclusion: Gram positive organism is the most common etiological agent of keratitis in children in our study population which is in contrast to pediatric infective keratitis study conducted by Aruljyothi et al. in South India (2011--2013). Though less in number than bacterial keratitis, fungus also remains an important causative agent. Along with early diagnosis and immediate medical intervention, it is important to identify regional profile of organisms and risk factors for good visual and anatomical outcome.
  1,817 250 11
ORIGINAL ARTICLES
Verion digital marking versus smartphone-assisted manual marking and isolated manual marking in toric intraocular lens implantation
Zain Irfan Khatib, Suhas S Haldipurkar, Vijay Shetty
March 2020, 68(3):455-458
DOI:10.4103/ijo.IJO_987_19  PMID:32057001
Purpose: To compare the accuracy of isolated manual marking and smartphone-assisted manual marking with the Verion image-guided system for toric intraocular lens (IOL) implantation. Methods: In this prospective observational study, 42 eyes of 36 patients planned for phacoemulsification with toric IOL implantation with corneal astigmatism >1D as measured on Lenstar LS 900 optical biometer were included. Patients were preoperatively registered and photographed on the Verion image-guided system. In the operating room, the patient's eye was manually marked at the 6 o′ clock limbus (Manual axis-90°) on slit-lamp in sitting position. Next, using the smartphone android app—iToric Patwardhan, the exact mark axis was confirmed (Smartphone axis). Following this, the patient was taken on the operation table where the mark axis was confirmed with Verion digital overlay on an external screen (Verion axis). The absolute angular deviation of manual axis from Verion was compared with the absolute angular deviation of the smartphone axis from Verion as the primary outcome measure. Results: The mean absolute angular deviation between the smartphone axis and the Verion axis was 2.62°, which was significantly lower (P < 0.05) than that between the manual axis and Verion axis (4.60°). Moreover, the intraclass correlation coefficient between the smartphone axis and Verion axis was 0.88 indicating a strong agreement between the two. Conclusion: Smartphone-assisted manual marking significantly improves the accuracy of manual marking alone when comparing with the Verion Digital Marker system for toric IOL implantation.
  1,736 195 5
Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children
Divya Balakrishnan, Avadhesh Oli, Remya M Paulose, Hasnat Ali
March 2020, 68(3):466-470
DOI:10.4103/ijo.IJO_1120_19  PMID:32057004
Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ≈ 20/200) and post BCVA was 0.40 (±0.50) (Snellen ≈ 20/50). The mean preoperative refraction was − 9 D (±8D) (range: −5 D to −23D) and postoperative was −1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.
  1,681 148 3
Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age
Pradhnya Sen, Kriti Chandra, Elesh Jain, Alok Sen, Amit Kumar, Amit Mohan, Chintan Shah
March 2020, 68(3):460-465
DOI:10.4103/ijo.IJO_1138_19  PMID:32057003
Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.
  1,593 220 6
Age-related changes in macular vessels and their perfusion densities on optical coherence tomography angiography
Amar Pujari, Rohan Chawla, Ashish Markan, Pooja Shah, Suneel Kumar, Nasiq Hasan, Anu Sharma, Atul Kumar
March 2020, 68(3):494-499
DOI:10.4103/ijo.IJO_521_19  PMID:32057011
Purpose: To evaluate age-related changes in macular vessels and their perfusion densities using optical coherence tomography angiography (OCTA). Methods: A total of 108 eyes of 54 healthy subjects between the age group of 11 to 60 years having unaided visual acuity of 20/20 were studied on spectral domain OCTS using 3 * 3 mm macula protocol. These subjects were divided into 5 groups; Group 1: 11–20 years, Group 2: 21–30 years, Group 3: 31–40 years, Group 4: 41–50 years, and Group 5: 51–60 years. An early treatment diabetic retinopathy study (ETDRS) grid overlay at the macula was used to calculate changes in different quadrants of the superficial retinal plexus. Results: A total of 98 eyes of 49 patients were considered for the final analysis. The vessel density values decreased from the second to the sixth decade in all four quadrants (except the third decade, where a slight increase was noted). The total vessel density decreased from 168 ± 78 mm-1 (group 1) to 131.47 ± 18.32 mm-1 (group 5). A similar reduction pattern in perfusion density was seen in each quadrant from the second to the sixth decade. The total perfusion density reduced from 309 ± 15.63% (group 1) to 283.05 ± 45.23% (group 5). The foveal avascular zone area was 0.18 ± 0.09 mm2 in group 1, 0.33 ± 0.13 mm2 in group 2, 0.30 ± 0.10 mm2 in group 3, 0.38 ± 0.05 mm2 in group 4, and 0.46 ± 0.06 mm2 in group 5. Conclusion: In our population, macular vessel density appears to decrease noticeably from the fourth decade onwards but a statistically significant decrease was observed only from the fifth decade onwards. However, it was not uniform along with all the quadrants. Similarly, the percentage of perfusion density dropped from the fourth decade but these values also varied among the different quadrants.
  1,600 196 9
Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema
Santosh Kumar Mahapatra, Swati Kumari
March 2020, 68(3):490-493
DOI:10.4103/ijo.IJO_620_19  PMID:32057010
Purpose: To evaluate the long-term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy. Methods: A hospital-based prospective, non-comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software. Results: 30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 μm at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow-up. Conclusion: Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.
  1,476 266 7
CASE REPORTS
Bilateral panophthalmitis following toxic epidermal necrolysis: A case report
Sharad Haribhau Shegaonkar
March 2020, 68(3):538-540
DOI:10.4103/ijo.IJO_1208_19  PMID:32057029
A 70 year old man presented with systemic signs of toxic epidermal necrolysis (TEN) following consumption of diclofenac tablets for a prodromal illness a week back. Ophthalmic evaluation showed no perception of light in both eyes along with lid edema, total corneal sloughing, and pus-filled anterior chamber. An amniotic membrane transplant was planned but within a few hours, both eyes developed panophthalmitis with restricted extraocular movements and mild proptosis and had to be eviscerated. This is perhaps the first case showing such devastating sequelae of TEN.
  1,487 224 2
COMMENTARY
Commentary: Electronic medical record system – should complement but not replace traditional health care
Atul Kumar, Dheepak Sundar, Divya Agarwal
March 2020, 68(3):432-433
DOI:10.4103/ijo.IJO_1474_19  PMID:32056995
  1,540 163 4
CASE REPORTS
Bilateral Chandler's syndrome: Uncommon entity diagnosed by ultrasound biomicroscopy and confocal microscopy
Parul Ichhpujani, Sushmita Kaushik, Amit Gupta, Surinder S Pandav
March 2020, 68(3):528-529
DOI:10.4103/ijo.IJO_1123_19  PMID:32057025
A 22‑year‑old female presented with bilateral, progressive diminution of vision. Slit‑lamp examination revealed bilateral sectoral corneal edema. Gonioscopy showed broad‑based peripheral anterior synechiae and a membrane obscuring angle structure in both the eyes. On ultrasound biomicroscopy (UBM), a membrane extending from corneal endothelium to anterior iris surface causing traction was seen. Confocal microscopy showed an "epithelium‑like" transformation of the corneal endothelium. This case demonstrates a bilateral Chandler variant of the iridocorneal endothelial (ICE) syndrome where the diagnosis of Chandler's disease was confirmed by confocal microscopy, after the mechanism of secondary angle closure was demonstrated by the UBM.
  1,479 167 1
ORIGINAL ARTICLES
Accuracy of noncycloplegic photorefraction using Spot photoscreener in detecting amblyopia risk factors in preschool children in an Indian eye clinic
Manasvini Sharma, Suma Ganesh, Shailja Tibrewal, Shalinder Sabharwal, Neha Sachdeva, Mohd Adil, Jyotsana Chaudhary, Zeeshan Siddiqui
March 2020, 68(3):504-509
DOI:10.4103/ijo.IJO_701_19  PMID:32057013
Purpose: To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor in detecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, to derive appropriate cutoff values for screening to obtain maximum sensitivity and specificity of the device in detecting ARF. Methods: This was a cross-sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner. The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age. Results: The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection, the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from −5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction. Conclusion: The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.
  1,431 184 4
Interchangeability of retinal perfusion indices in different-sized angiocubes: An optical coherence tomography angiography study in diabetic retinopathy
Daleena Dalan, Prakash Nandini, Narayanswamy Angayarkanni, Kuppan Kaviarasan, Sadagopan Thanikachalam, Undurti N Das, Dhanashree Ratra
March 2020, 68(3):484-489
DOI:10.4103/ijo.IJO_783_19  PMID:32057009
Purpose: To evaluate the differences in vascular indices in different scan sizes of optical coherence tomography angiography (OCTA) images in normal persons versus persons with diabetic retinopathy. Methods: OCTA scans of diabetic patients and age-matched controls were performed by a single operator. Automated quantification of vascular indices of the superficial plexus was analyzed in two angiocubes of 3 × 3 mm and 6 × 6 mm, respectively. The agreement was analyzed with the intraclass correlation coefficient (ICC) and Bland–Altman plots. Results: Forty-eight eyes with DR, 36 eyes with no diabetic retinopathy (No DR), and 26 eyes of age-matched normals were scanned. The foveal avascular zone (FAZ) area and perimeter were highly reliable and interchangeable in both angiocubes of the healthy eyes (ICC 0.94, 0.75), No DR (ICC 0.92, 0.85), and DR eyes (ICC 0.97, 0.89). The vessel density (VD) and perfusion density (PD) showed excellent agreement in normal (ICC 0.89, 0.80) and No DR eyes (ICC 0.92, 0.81). But, only fair ICC was observed in DR eyes (0.56, 0.42). Conclusion: The FAZ area and perimeter showed excellent reproducibility. The macular perfusion parameters are not interchangeable despite automated estimation. The variability is more with changes in the vascular network like DR. This variability should be considered while comparing different scans.
  1,408 184 3
Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care center
Prasanna Venkataraman, Premanand Chandran, Mohamed Faheem, Vinoth Arunaachalam, Nabeed Aboobacker, Ganesh V Raman
March 2020, 68(3):471-474
DOI:10.4103/ijo.IJO_914_19  PMID:32057005
Purpose: To assess the quality and accuracy of glaucoma referrals from ophthalmologist. Methods: Retrospective review of patients chart with referral letter to a tertiary glaucoma center between January and December 2017. Patients aged <16 years, lens-induced glaucoma, uveitic glaucoma, and glaucoma following retinal and corneal surgery were excluded. Results: A total of 184 patients referred by 55 ophthalmologists were included. Mean patient age (SD) was 57.8 ± 14 years. Intraocular pressure was not documented in the referral letter in 113 (61%) patients, gonioscopy in 174 (95%) patients, disc findings in 149 (81%) patients, and visual fields in 175 (95%) patients. Thirteen (37%) of the 35 patients referred as open angle glaucoma were found to have angle closure glaucoma. Pseudoexfoliation glaucoma was diagnosed in 29 (16%) patients, of which 18 were missed by the referring ophthalmologist. Conclusion: In our study >90% of referral letter did not have the essential parameters. A standard template for glaucoma referral is suggested, which will help the patient to get better transfer of care.
  1,404 140 -
PHOTO ESSAY
Sequential optical coherence tomography images of early acute retinal necrosis
Aarti Jain, Giridhar Anantharaman, Mahesh Gopalakrishnan, Sandhya Narayanan
March 2020, 68(3):520-522
DOI:10.4103/ijo.IJO_255_19  PMID:32057019
  1,346 159 6
CASE REPORTS
Imaging of Muller cell sheen dystrophy
Haemoglobin Parida, Naresh B Kannan, SR Rathinam
March 2020, 68(3):533-535
DOI:10.4103/ijo.IJO_930_19  PMID:32057027
To report a rare case of Muller cell sheen dystrophy and to describe its clinical and diagnostic aspects. A 42-year-old woman presented with unilateral defective vision. Fundus evaluation revealed bilateral glistening retinal reflexes throughout the posterior pole with a wrinkled appearance in the right. Spectral Domain-OCT in the right showed abnormal internal limiting membrane, intraretinal schisis with serous detachment at macula. Angiography revealed staining along vessels. Electroretinogram in the affected eye was negative. At 4 months of follow up, vision dropped and intraretinal schisis increased. Family screening was negative.
  1,345 141 -
SURGICAL TECHNIQUE
Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema
Siddhi Goel, Pranita Sahay, Deepali Singhal, Prafulla K Maharana, Jeewan S Titiyal, Namrata Sharma
March 2020, 68(3):510-512
DOI:10.4103/ijo.IJO_1329_19  PMID:32057014
Purpose: To describe the outcome of microscope integrated optical coherence tomography (MiOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of the crystalline lens and corneal edema. Methods: MiOCT-guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal edema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MiOCT. Results: In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication such as Descemet tear or worsening in corneal edema. Improvement in visual acuity was noted in all cases with resolution in corneal edema by 1 week. Conclusion: MiOCT-guided ILLA can be extremely useful in cases of lenticulo-corneal adhesion especially in cases with corneal edema.
  1,256 126 2
CASE REPORTS
Dual lesion margins on fundus autofluorescence associated with paradoxical worsening following treatment for tubercular serpiginous-like choroiditis
Sai Bhakti Mishra, Ketan Saoji, Avinash Pathengay
March 2020, 68(3):536-538
DOI:10.4103/ijo.IJO_536_19  PMID:32057028
A 31-year-old male presented with decreased vision in the right eye associated with an active plaque-like serpiginoid choroiditis. The lesion showed a unique feature of dual margins of hyperautofluorescence of the lesion on fundus autofluoresence (FAF) imaging. Systemic investigations suggested a tubercular etiology. He was started on antitubercular treatment and a conventional dose of oral corticosteroids (1mg/kg body weight). However, the lesions showed paradoxical worsening and required increased immunosuppression in the form of local steroids and oral immunomodulators. The presence of dual margins of hyperautofluorescence could suggest increased inflammatory activity leading to paradoxical worsening on treatment requiring increased immunosuppression.
  1,205 126 4
OPHTHALMIC IMAGES
Swiss-cheese macula
Kunal K Shah, Pramod S Bhende
March 2020, 68(3):526-526
DOI:10.4103/ijo.IJO_1425_19  PMID:32057023
  1,116 168 -
COMMENTARY
Commentary: Pediatric infectious keratitis
Manpreet Kaur, Jeewan S Titiyal
March 2020, 68(3):440-441
DOI:10.4103/ijo.IJO_47_20  PMID:32056997
  1,149 134 -
PHOTO ESSAY
Management of severe Acanthamoeba keratitis and complicated cataract following laser in situ keratomileusis
NV Annapurna, Bhupesh Bagga, Prashant Garg, Joveeta Joseph, Savitri Sharma, Paavan Kalra, Ruchi Mittal
March 2020, 68(3):515-516
DOI:10.4103/ijo.IJO_492_19  PMID:32057016
  1,144 139 3
OPHTHALMIC IMAGES
Peripapillary staphyloma
Manavi D Sindal, M Arthi
March 2020, 68(3):525-525
DOI:10.4103/ijo.IJO_1103_19  PMID:32057022
  1,097 162 1
COMMENTARY
Commentary: Moving towards “mark-less” toric IOL alignment
Jeewan S Titiyal, Manpreet Kaur
March 2020, 68(3):458-459
DOI:10.4103/ijo.IJO_28_20  PMID:32057002
  1,107 150 -
PHOTO ESSAY
Descemet stripping automated endothelial keratoplasty: An alternate surgical modality for Descemet's membrane detachment following hydrops in keratoglobus
Supriya Sharma, Merle Fernandes
March 2020, 68(3):513-514
DOI:10.4103/ijo.IJO_1106_19  PMID:32057015
  1,083 136 1
OPHTHALMIC IMAGES
Early postoperative lumen blockage of ab-interno gel stent (XEN) cleared with Nd:YAG laser
Yarrow Scantling-Birch, Wassim Merzougui, Dan Lindfield
March 2020, 68(3):524-524
DOI:10.4103/ijo.IJO_1051_19  PMID:32057021
  1,079 126 9
CASE REPORTS
Safety of photodynamic therapy involving optic nerve head
George Joseph Manayath, Shishir Verghese, Nidhee Jain, Ratnesh Ranjan, Venkatapathy Narendran
March 2020, 68(3):530-533
DOI:10.4103/ijo.IJO_1081_19  PMID:32057026
We present a case of large peripapillary polypoidal choroidal vasculopathy treated with standard-fluence photodynamic therapy (PDT) as other treatment options were unsuccessful or not justified. Due to large lesion size, treatment spot included part of optic disc also. PDT resulted in regression of polyp and visual improvement (from 20/300 to 20/20) without any collateral damage to optic nerve as evidenced by visual-field test and visual-evoked potential with a follow-up till 2 years. This case highlights the role of PDT as a safe alternative for treatment of large peripapillary lesion, even though the treatment spot encompasses part of the optic nerve head.
  1,084 106 -
PHOTO ESSAY
Aborted bridge coloboma with scleral fistula
Debdulal Chakraborty, Dipankar Das
March 2020, 68(3):516-517
DOI:10.4103/ijo.IJO_1503_19  PMID:32057017
  1,058 127 -
ERRATUM
Erratum: Effects of preoperative doses of betamethasone acetate 0.1% on dry eye control after cataract surgery

March 2020, 68(3):544-544
DOI:10.4103/0301-4738.278337  PMID:32057032
  1,018 154 -
COMMENTARY
Commentary: Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years
Dipankar Das, Jyotirmay Biswas, Harsha Bhattacharjee
March 2020, 68(3):482-483
DOI:10.4103/ijo.IJO_1679_19  PMID:32057008
  1,019 112 -
OPHTHALMIC IMAGES
Autofluorescence in scleral buckle intrusion
Smriti Jain, Rajiv Raman
March 2020, 68(3):527-527
DOI:10.4103/ijo.IJO_1264_17  PMID:32057024
  961 115 -
PHOTO ESSAY
Apparent double macular hole caused by vitreomacular traction
Naresh Babu, Karthik Kumar, Piyush Kohli, Kim Ramasamy
March 2020, 68(3):518-519
DOI:10.4103/ijo.IJO_886_19  PMID:32057018
  922 127 1
OPHTHALMIC IMAGES
Accidental detection of left intranasal foreign body during probing of right congenital nasolacrimal duct obstruction
Smriti Bansal
March 2020, 68(3):523-523
DOI:10.4103/ijo.IJO_1178_19  PMID:32057020
  908 138 -
LETTERS TO THE EDITOR
Situs inverses of blind spot on Humphrey visual fields: Can we trust what we see?
Tarannum Mansoori
March 2020, 68(3):542-543
DOI:10.4103/ijo.IJO_1159_19  PMID:32057031
  875 110 -
ERRATUM
Erratum: Iridocorneal endothelial syndrome: Evaluation of patient demographics and endothelial morphology by in vivo confocal microscopy in an Indian cohort
..
March 2020, 68(3):544-544
DOI:10.4103/0301-4738.278338  PMID:32057033
  883 80 -
COMMENTARY
Commentary: Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care centre
Sushmita Kaushik
March 2020, 68(3):474-475
DOI:10.4103/ijo.IJO_2310_19  PMID:32057006
  867 94 1
LETTERS TO THE EDITOR
Managing media during ophthalmic crisis
Ragini Bhatia, Deepika Singhal
March 2020, 68(3):541-541
DOI:10.4103/ijo.IJO_1781_19  PMID:32057030
  831 110 -