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   2020| June  | Volume 68 | Issue 6  
    Online since May 25, 2020

 
 
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ORIGINAL ARTICLES
The impact of COVID-19 related lockdown on ophthalmology training programs in India – Outcomes of a survey
Deepak Mishra, Akshay Gopinathan Nair, Rashmin Anilkumar Gandhi, Parikshit J Gogate, Satanshu Mathur, Prashant Bhushan, Tanmay Srivastav, Hemendra Singh, Bibhuti P Sinha, Mahendra Kumar Singh
June 2020, 68(6):999-1004
DOI:10.4103/ijo.IJO_1067_20  PMID:32461413
Purpose: In 2020, in response to the emergence and global spread of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV, the government of India ordered a nationwide lockdown for 21 days, which was then extended to a total of over 50 days. The aim of this study is to assess the effect of the lockdown on ophthalmic training programs across India. Methods: An online survey was sent across to trainee ophthalmologists across India through various social media platforms. Results: In all, 716 trainees responded; the average age was 29.1 years. Results showed that majority of the respondents were enrolled in residency programs (95.6%; 685/716) and the others were in fellowship programs. About 24.6% (176/716) of the trainees had been deployed on 'COVID-19 screening' duties. Nearly 80.7% (578/716) of the trainees felt that the COVID-19 lockdown had negatively impacted their surgical training. Furthermore, 54.8% (392/716) of the trainees perceived an increase in stress levels during the COVID-19 lockdown and 77.4% (554/716) reported that their family members had expressed an increased concern for their safety and wellbeing since the lockdown began. In all, 75.7% (542/716) of the respondents felt that online classes and webinars were useful during the lockdown period. Conclusion: Our survey showed that majority ophthalmology trainees across the country felt that the COVID-19 lockdown adversely affected their learning, especially surgical training. While most found online classes and webinars useful, the trainees' perceived stress levels were higher than normal during the lockdown. Training hospitals should take cognizance of this and reassure trainees; formulate guidelines to augment training to compensate for the lost time as well as mitigate the stress levels upon resumption of regular hospital services and training. Going ahead, permanent changes such as virtual classrooms and simulation-based training should be considered.
  86,918 1,231 70
LETTERS TO THE EDITOR
Sustaining academics during COVID-19 pandemic: The role of online teaching-learning
Soujanya Kaup, Rashmi Jain, Siddharudha Shivalli, Suresh Pandey, Soumya Kaup
June 2020, 68(6):1220-1221
DOI:10.4103/ijo.IJO_1241_20  PMID:32461490
  16,064 1,496 107
ORIGINAL ARTICLES
Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India
Rohit C Khanna, Santosh G Honavar, Asha Latha Metla, Amritendu Bhattacharya, Pallab K Maulik
June 2020, 68(6):994-998
DOI:10.4103/ijo.IJO_1458_20  PMID:32461412
Purpose: To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India. Methods: An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. Conclusion: A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.
  11,875 1,269 90
ORIGINAL ARTICLE
Presence of viral RNA of SARS-CoV-2 in conjunctival swab specimens of COVID-19 patients
Kiran Kumar, Akshata A Prakash, Suresh Babu Gangasagara, Sujatha B L Rathod, K Ravi, Ambica Rangaiah, Sathyanarayan Muthur Shankar, Shantala Gowdara Basawarajappa, Shashi Bhushan, TG Neeraja, Srinivas Khandenahalli, M Swetha, Priyam Gupta, UC Sampritha, Guru N S Prasad, Chakravarthy Raghunathan Jayanthi
June 2020, 68(6):1015-1017
DOI:10.4103/ijo.IJO_1287_20  PMID:32461418
Purpose: To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimens of coronavirus disease-19 (COVID-19) patients. Methods: Forty-five COVID-19 patients positive for real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Results: Out of 45 patients, 35 (77.77%) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23%) out of 45 patients was positive for RT-PCR SARS-CoV-2 in the conjunctival swab. Conclusion: This study shows that SARS-CoV-2 can be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Though the positivity rate of detecting SARS-CoV-2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID-19.
  5,716 925 58
PREFERRED PRACTICE
Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era
Vishali Gupta, Anand Rajendran, Raja Narayanan, Shobhit Chawla, Atul Kumar, Mahesh Shanmugam Palanivelu, NS Muralidhar, Chaitra Jayadev, Rajeev Pappuru, Manoj Khatri, Manisha Agarwal, Ajay Aurora, Pramod Bhende, Muna Bhende, Prashant Bawankule, Pukhraj Rishi, Anand Vinekar, Hemant Singh Trehan, Jyotirmay Biswas, Rupesh Agarwal, S Natarajan, Lalit Verma, Kim Ramasamy, A Giridhar, Ekta Rishi, Dinesh Talwar, Avinash Pathangey, Rajvardhan Azad, Santosh G Honavar
June 2020, 68(6):962-973
DOI:10.4103/ijo.IJO_1404_20  PMID:32461407
The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.
  4,894 762 24
CURRENT OPHTHALMOLOGY
Sanitizer aerosol-driven ocular surface disease (SADOSD)—A COVID-19 repercussion?
Rohit Shetty, Chaitra Jayadev, Aishwarya Chabra, Sonia Maheshwari, Sharon D'Souza, Pooja Khamar, Swaminathan Sethu, Santosh G Honavar
June 2020, 68(6):981-983
DOI:10.4103/ijo.IJO_1308_20  PMID:32461409
Since the onset of the COVID-19 pandemic, there has been an advisory for regular and thorough cleaning of hands besides other measures such as social distancing and self-isolation. The rationale for the same is to prevent the transfer of the virus from hands that have come in contact with fomites. While both alcohol-based hand rubs (ABHR) or washing with soap and water are claimed to have been effective, hand sanitizers have gained more popularity due to the ease of use. The increased frequency of ABHR use and the aerosols generated pose a potential threat to the skin and exposed mucosal surfaces, especially that of the eye due to the proximity of use. The adverse effects of alcohol in these sanitizers can be manifold. An allergic or inflammatory response can occur depending on the predisposing or preexisting conditions. This article describes the risks, underlying mechanisms, and preventive measures for sanitizer aerosol-driven ocular surface disease.
  4,754 628 8
PREFERRED PRACTICE
All India Ophthalmological Society - Oculoplastics Association of India consensus statement on preferred practices in oculoplasty and lacrimal surgery during the COVID-19 pandemic
Mohammad Javed Ali, Raghuraj Hegde, Akshay Gopinathan Nair, Mandeep S Bajaj, Subhash M Betharia, Kasturi Bhattacharjee, Apjit K Chhabra, Jayanta K Das, Gagan Dudeja, Ashok K Grover, Santosh G Honavar, Usha Kim, Lakshmi Mahesh, Bipasha Mukherjee, Anita Sethi, Mukesh Sharma, Usha Singh
June 2020, 68(6):974-980
DOI:10.4103/ijo.IJO_1415_20  PMID:32461408
Oculoplastic surgeries encompass both emergency surgeries for traumatic conditions and infectious disorders as well as elective aesthetic procedures. The COVID-19 pandemic has brought about a drastic change in this practice. Given the highly infectious nature of the disease as well as the global scarcity of medical resources; it is only prudent to treat only emergent conditions during the pandemic as we incorporate evidence-based screening and protective measures into our practices. This manuscript is a compilation of evidence-based guidelines for surgical procedures that oculoplastic surgeons can employ during the COVID-19 pandemic. These guidelines also serve as the basic framework upon which further recommendations may be based on in the future, as elective surgeries start being performed on a regular basis.
  4,305 463 11
ORIGINAL ARTICLE
Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India
Anthony V Das, Padmaja K Rani, Pravin K Vaddavalli
June 2020, 68(6):1007-1012
DOI:10.4103/ijo.IJO_1089_20  PMID:32461415
Purpose: To describe the experience of tele-consultations addressed at the centre of excellence of a multi-tier ophthalmology hospital network in India during the ongoing novel coronavirus (COVID-19) lockdown. Methods: This cross-sectional hospital-based study included 7,008 tele-consultations presenting between March 23rd and April 19th 2020. A three-level protocol was implemented to triage the calls. The data of patient queries were collected using a Google Form/Sheets and the tele-calls were returned using the patient information retrieved from the electronic medical record system. Results: Overall, 7,008 tele-calls were addressed, of which 2,805 (40.02%) patients where a clinical-related query was answered were included for analysis. The most common queries were related to redness/pain/watering/blurring of vision (31.52%), closely followed by usage of medications (31.05%). The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). Less than one-fifth of the patients were from the lower socio-economic class (16.08%) and one-fourth were new patients (23.96%). The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). Emergency requests requiring further evaluation by an ophthalmologist accounted for a small percentage (16.36%) of patients. Conclusion: Tracking of tele-consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID-19 pandemic. The current experience provided valuable insights to the possibility of managing patient follow-up visits remotely in the future.
  4,112 649 19
LETTERS TO THE EDITOR
COVID-19 and eye banking
Sunita Chaurasia, Namrata Sharma, Sujata Das
June 2020, 68(6):1215-1216
DOI:10.4103/ijo.IJO_1033_20  PMID:32461487
  2,908 457 15
ORIGINAL ARTICLES
Efficacy and safety of dropless cataract surgery
Narayan Bardoloi, Sandip Sarkar, Ashu Pilania, Himangshu Das
June 2020, 68(6):1081-1085
DOI:10.4103/ijo.IJO_1186_19  PMID:32461434
Purpose: To evaluate the clinical outcome following intraoperative transzonular intravitreal injection of triamcinolone acetonide and moxifloxacin in patients undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation. Methods: In this prospective, non-randomized, clinical, interventional study, a total of 200 eyes were enrolled. Patients who voluntarily gave their consent after being informed about dropless cataract surgery along with its pros and cons were included. Those who had glaucoma or were known steroid responders as well as those who were lost to follow-up were excluded. 0.1 ml each of moxifloxacin (500 mg) and triamcinolone acetonide (4 mg) were injected transzonularly following IOL implantation in phacoemulsification cataract surgery with the help of 27G curved cannula. Slit-lamp examination was done to detect cells, visual acuity was noted, and intraocular pressure was measured postoperatively on day 1, 7, 30, 60, and 90. Results: Uncorrected visual acuity (UCVA) greater than 6/9 was achieved in 96% of patients at the end of 3 months. The mean IOP was found to be normal in all the cases at every visit. Twenty patients complained of floaters on postoperative day 1 (D1), which decreased to zero after 60 days (D60). None of the patients needed any eye drop during the entire postoperative period. Conclusion: The study demonstrates that this procedure is advantageous and safe.
  3,044 303 12
GUEST EDITORIAL
COVID-19 crisis and residency education: A moment to seize the opportunity and create a new road map!
Ashok Kumar Grover
June 2020, 68(6):959-960
DOI:10.4103/ijo.IJO_1498_20  PMID:32461405
  2,718 599 11
ORIGINAL ARTICLE
A prospective study to assess the role of vitamin D individually and in combination with cyclosporine in the treatment of dry eye in patients with deficient serum 25(OH)D levels
Palak Watts, Anshu Sahai, P Ratan Kumar, Mohd. Abid Shamshad, Gopal Krishan Trivedi, Lokendra Tyagi
June 2020, 68(6):1020-1026
DOI:10.4103/ijo.IJO_1492_19  PMID:32461420
Purpose: To study the efficiency of vitamin D3 (buccal spray) alone and combination of vitamin D3 with cyclosporine in the treatment of dry eye disease (DED) in patients with deficient serum 25(OH)D levels. Methods: Around 90 patients with DED with deficient serum 25(OH)D levels were included and randomized into three groups and were given treatment for dry eye (Group A- 0.5% carboxymethylcellulose (CMC), Group B- 0.5% CMC + 2000 IU vitamin D through buccal spray, Group C- 0.5% CMC + 2000 IU vitamin D through buccal spray + 0.05% cyclosporine). The patients were followed at day-15, day-30, and day-90 for improvement in tear breakup time (TBUT) and Schirmer's, and ocular surface disease index (OSDI) score. Improvement in serum vitamin D level was assessed at day-90. One way ANOVA test, paired t-test, and Chi-square test were used for analysis. Results: Group B and Group C had significantly higher in Schirmer's test-I values as compared to Group A (P = 0.001, P < 0.001, P < 0.001 at day-15, day-30, and day-90, respectively). Significantly higher values of TBUT and mean serum vitamin D levels were obtained in Group B and Group C as compared to Group A at day-90 (P < 0.05). OSDI scores of patients significantly decreased in all three groups at all follow-up visits (P < 0.05). Overall, Group C and Group B were found statistically better than Group A. Group C showed better results than Group B but they were nonsignificant. Conclusion: Vitamin D supplementation leads to earlier and significant improvement in TBUT, Schirmer's, and OSDI score in patients with vitamin D deficient DED.
  2,981 289 9
ORIGINAL ARTICLES
Corneal tattooing for esthetic purposes in patients with corneal opacities
Derya Doganay, Selim Doganay, Cem Cankaya
June 2020, 68(6):1033-1036
DOI:10.4103/ijo.IJO_1502_19  PMID:32461424
Purpose: This study evaluated corneal tattooing for esthetic purposes in patients with corneal opacification. Methods: Eight eyes of eight patients were included in the study (four males and four females). Corneal tattooing was achieved by stromal puncture in five patients, femtosecond laser-assisted corneal tattooing in two patients, and femtosecond laser-assisted corneal tattooing and stromal needling (combined procedure) in one patient. In six of the patients, the entire cornea was stained black; in one patient, the center of the cornea (3 mm) was stained black and the periphery was stained dark brown; and in the last patient, the corneal periphery was stained dark brown. Patient satisfaction was evaluated on the first day after surgery and at the last visit as follows: Very satisfied (4), satisfied (3), moderately satisfied (3), and not satisfied (1). Results: The patients ranged in age from 11–80 years. The mean satisfaction score of the patients was 4 and 3.5 on the first postoperative day and at the last visit, respectively. No complication occurred during or after surgery. Conclusion: Corneal tattooing for esthetic purposes was successful in both blind eyes and seeing eyes.
  2,850 250 7
LETTERS TO THE EDITOR
COVID-19: Ophthalmic prophylactic and therapeutic measures
Shrikant Waikar, Avadhesh Oli
June 2020, 68(6):1223-1224
DOI:10.4103/ijo.IJO_883_20  PMID:32461492
  2,683 366 5
ORIGINAL ARTICLES
Use of augmented reality technology for improving visual acuity of individuals with low vision
Sarika Gopalakrishnan, Sanjana Chouhan Suwalal, Gnanapoonkodi Bhaskaran, Rajiv Raman
June 2020, 68(6):1136-1142
DOI:10.4103/ijo.IJO_1524_19  PMID:32461448
Purpose: The objective of this study was to analyze the visual acuity improvement in patients with low vision using augmented reality device who presented to the low vision care (LVC) clinic at a tertiary eye care center. Methods: A prospective study of 100 patients with low vision who were referred to the LVC clinic between July and December 2018 was done. Demographic data and visual acuity improvement assessed using augmented reality (AR) technology paired with Samsung Gear headset were documented. Results: Out of 100 patients, 74 were male and 26 were female. The median age of the overall patients was 36 (25.5) years. In 100 patients, 21% patients were found to have central field loss (CFL), 35% patients have peripheral field loss (PFL), and 44% patients were found to have overall blurred vision (OBV). Majority of the subjects with CFL (47%) and OBV (37%) has a moderate visual impairment and in PFL group (26%), severe visual impairment was more. Cone dystrophy (9%) was found to be the major cause of CFL group, retinitis pigmentosa (22%) in the case of PFL group, and optic atrophy (10%) in the case of OBV group. The median distance visual acuity 0.9 log MAR improved to 0.2 log MAR (P < 0.0001) and median near visual acuity 0.4 log MAR improved to 0.1 log MAR with a P value of < 0.0001 using AR device. Conclusion: The use of an AR device can help patients with low vision to improve their residual vision for better visual performance.
  2,679 244 6
COMMENTARIES
Commentary: Gamifying teleconsultation during COVID-19 lockdown
John D Akkara, Anju Kuriakose
June 2020, 68(6):1013-1014
DOI:10.4103/ijo.IJO_1495_20  PMID:32461417
  2,540 348 5
ORIGINAL ARTICLES
The rare phenomenon of Marcus-Gunn jaw winking without ptosis: Report of 14 cases and review of the literature
Md. Shahid Alam, Shruti Nishanth, Srikanth Ramasubramanian, Meenakshi Swaminathan, Bipasha Mukherjee
June 2020, 68(6):1132-1135
DOI:10.4103/ijo.IJO_1099_19  PMID:32461447
Purpose: To report a rare case series of 14 patients of the Marcus-Gunn jaw-winking phenomenon (MGJWP) without ptosis. Methods: This was a retrospective noninterventional case series. The medical records of all patients diagnosed with MGJWP over the past 10 years were retrieved. Patients with documented evidence of absence of ptosis were segregated and analyzed for visual acuity, the severity of Marcus-Gunn, the presence of squint and amblyopia, and the presence of other aberrant regenerations. Results: A total of 207 patients were diagnosed with MGJWP, out of which 14 (6.76%) patients had isolated MGJWP without blepharoptosis. The mean age of presentation was 9.5 years and males and females were equally affected. The left eye was involved more commonly (57.2%) than the right eye. Twelve patients were congenital and two were presumed to be of traumatic origin. The most common refractive error in this cohort was astigmatism (10, 71.42%), followed by hyperopia (5, 35.71%). One patient had anisometropic amblyopia. Marcus-Gunn was found to be mild (≤2 mm of lid excursion) in all cases. None of the patients had strabismus or any other aberrant innervations. None of the patients underwent surgery and did not develop ptosis or worsening or improvement of Marcus-Gunn after a mean follow-up period of 2.3 years. Conclusion: Isolated MGJWP in the absence of ptosis is a very rare entity and this is the largest series to date to report such an occurrence. All patients had a mild form of MGJWP with no intervention required in any of the cases.
  2,669 190 5
EDITORIAL
Navigating the new normal in ophthalmology
Santosh G Honavar
June 2020, 68(6):957-958
DOI:10.4103/ijo.IJO_1649_20  PMID:32461404
  2,173 464 7
REVIEW ARTICLE
Posterior segment complications following glaucoma surgeries
Saurabh Verma, Shorya V Azad, Brijesh Takkar, Shreyas Temkar, Rohan Chawla, Pradeep Venkatesh
June 2020, 68(6):988-993
DOI:10.4103/ijo.IJO_1040_19  PMID:32461411
The present review describes the posterior segment complications following surgical management of glaucoma. Although the majority of glaucoma cases are managed medically, still a large number of patients may require surgery. Moreover, with the advent of newer surgical techniques and adjuncts, encountering retinal complications post-surgery is not uncommon. The incidence, signs, management, and prognosis of common complications such as anesthesia-related retinal toxicity, vitreous loss, suprachoroidal hemorrhage, serous choroidal detachment, hypotonic maculopathy, vitreous hemorrhage, retinal detachment and endophthalmitis will be discussed in detail. Awareness of these complications is necessary as their proper and timely management can save vision in an already compromised eye.
  2,072 551 7
ORIGINAL ARTICLES
Severity of thyroid eye disease and type-2 diabetes mellitus: Is there a correlation?
Lakshmi B Ramamurthy, Viji Rangarajan, Neha Srirao, Bindu Malini, Renu Bansal, Kavitha Yuvarajan
June 2020, 68(6):1127-1131
DOI:10.4103/ijo.IJO_1443_19  PMID:32461446
Purpose: To study the correlation between thyroid eye disease (TED) with type-2 diabetes mellitus. Methods: A cross-sectional cohort study was conducted from Jan 2018 to Dec 2018, in patients presenting with thyroid eye disease to orbit and oculoplasty clinic of a tertiary eye care hospital. A total of 105 patients were included in the study. All patients underwent detailed ophthalmic evaluation and thyroid eye disease workup. Patients were categorized into mild, moderate, and severe/sight-threatening TED based on EUGOGO classification. Systemic history of diabetes was noted. RBS was done in all patients. Results: Mild disease was noted 61 patients of which 11 were diabetics, moderate in 26 patients (8 diabetics), and severe disease in 18 patients (14 diabetics). All patients were treated accordingly. Among the TED patients, the percentage of diabetic patients was noted to be in increasing order toward the severity spectrum of TED. The prevalence of severe TED was found to be much higher in diabetic patients accounting upto 77.77% of 18 patients. A statistically significant correlation was noted (P = 0.014) between severe TED and type-2 diabetes mellitus. In addition, early onset of thyroid eye disease was noted in type-2 diabetes patients. Even though female preponderance was noted, severe TED was more in men (66.6%). Conclusion: An autoimmune etiology for the association of thyroid and type-1diabetes has been well established. This study shows that type-2 diabetic patients can have more severity in the clinical presentation of TED. Therefore, the presence of type-2 DM in patients with TED can be a predictive factor for onset, progression, and severity of disease. Hence, a high concern of interest among treating ophthalmologists and endocrinologists regarding this entity would help in early prediction and decreased morbidity among such patients.
  2,229 219 14
Small incision cataract surgery with trabeculectomy versus phacoemulsification trabeculectomy in pseudoexfoliation glaucoma
S Ramyashri, Aparna Rao, Debanand Padhy, Gopinath Das
June 2020, 68(6):1090-1094
DOI:10.4103/ijo.IJO_1319_19  PMID:32461436
Purpose: This study aims to evaluate efficacy and outcomes of manual small incision cataract surgery with trabeculectomy (Group 1) and phacoemulsification with trabeculectomy (Group 2) in pseudoexfoliation glaucoma (PXG). Methods: In this retrospective comparative observational case series, All patients with PXG who underwent either small incision cataract surgery or phacoemulsification with trabeculectomy from 2011-2015 were studied. Data compared included best corrected visual acuity (BCVA), intraocular pressure (IOP), total surgical time, and incidence of intra/postoperative complications. Results: A total of 82 (Group 1) and 64 (Group 2) subjects were included for the study. The baseline IOP and anti-glaucoma medications in both groups were comparable pre-operatively (group 1 = 26 ± 10.3 mmHg, group 2 = 23 ± 13.9 mmHg, P = 0.1). The IOP at final follow up between the two groups was not statistically significant (group 1 = 12 ± 3.2 mmHg, group 2 = 14 ± 1.8 mmHg, P = 0.2).The average total time of surgery (group 1 = 40 ± 21.6 min, group 2 = 34 ± 14.8 min, P = 0.4) was not statistical significant between groups. The incidence of post-operative complications were similar in both groups (P = 0.95). Conclusion: Manual small incision cataract surgery with trabeculectomy is noninferior in PXG patients with comparable surgical outcomes, when compared with phacoemulsification with trabeculectomy.
  2,174 228 3
CASE REPORTS
Penetrating ocular trauma by nail of a badminton feather shuttle cock: A rare case report
Sudipta Das, Veer Singh, Kumar Saurabh
June 2020, 68(6):1209-1211
DOI:10.4103/ijo.IJO_1681_19  PMID:32461485
Sports-related ocular traumas may be rare, but can have devastating and disabling consequences. The causes of eye-related injuries depend on the type of sports popular in a particular area or country. Badminton is a popular sport played by all age groups and socioeconomic segments and is popular in many parts of the world. It is most popular in South-East Asia, accounting for two-thirds of all ocular sports injury in Malaysia. In India, badminton has become quite popular in recent years. Shuttlecocks in badminton have been shown to be responsible for a high number of outpatient ocular sports-related, mostly blunt injuries. We report an unusual case of penetrating ocular injury due to a feather shuttlecock and its surgical management.
  2,250 150 4
LETTERS TO THE EDITOR
Managing intravitreal injections in adults in COVID-19 and post-COVID-19 era- Initial experiences
Divya Agarwal, Atul Kumar
June 2020, 68(6):1216-1218
DOI:10.4103/ijo.IJO_1391_20  PMID:32461488
  2,092 303 9
SURGICAL TECHNIQUE
Alternate iris bypass technique of iridodialysis repair
R Balamurugan, Parul Chawla Gupta, Vijay Kumar Sharma, Surbhi Khurana, Jagat Ram
June 2020, 68(6):1143-1147
DOI:10.4103/ijo.IJO_1765_19  PMID:32461449
We describe a novel technique “alternate iris bypass technique” of iridodialysis repair in four patients experiencing traumatic iridodialysis along with cataract. In these cases, we have combined iridodialysis repair with phacoemulsification and intraocular lens implantation. The main advantage of this technique is that edges of the iridodialysis can be visible till the end of the repair by bypassing the iris tissue in alternate bites which helps in minimizing the corectopia of the pupil and localized iris clumping.
  2,163 171 3
COMMENTARY
Commentary: Restructuring residency training in ophthalmology during COVID-19 era: Challenges and opportunities
Atul Kumar, Divya Agarwal
June 2020, 68(6):1005-1006
DOI:10.4103/ijo.IJO_1462_20  PMID:32461414
  2,016 305 6
ORIGINAL ARTICLES
Are high-efficiency particulate air (HEPA) filters and laminar air flow necessary in operating rooms to control acute post-operative endophthalmitis?
Shalinder Sabherwal, Deepali Chaku, Umang Mathur, Virender S Sangwan, Atanu Majumdar, Arpan Gandhi, Suneeta Dubey, Ishaana Sood
June 2020, 68(6):1120-1125
DOI:10.4103/ijo.IJO_1493_19  PMID:32461444
Purpose: To compare the five-year incidence of acute post-operative endophthalmitis following cataract surgery, between centers with and without laminar air flow and high-efficiency particulate air (HEPA) filters in operating rooms. Methods: Retrospective analysis of medical records of patients operated in a single network of a tertiary and four secondary hospitals across north India. Cases of endophthalmitis were identified from the records between January 2013 and June 2018. Protocols and consumables were standardized across all hospitals. The only infrastructural difference being the presence of laminar air flow and high energy particulate air filters in operating rooms of the tertiary center. The type of surgery, along with the demographic and socio-economic details, were captured and analyzed, using z-test for proportions and logistic regression. Results: Out of 88,297 cataract surgeries conducted, 36 cases of endophthalmitis were reported. The incidence of endophthalmitis across the network was estimated to be 0.041%, (95% CI: 0.027 to 0.054). There was no statistically significant difference between the incidence of POE at the tertiary (0.042%) and secondary centers (0.039%). Certain risk factors for high endophthalmitis incidence were identified, namely patients undergoing small incision cataract surgery and belonging to lower socio-economic status. However, for both factors the difference was not statistically significant. Conclusion: The five-year incidence of acute post-operative endophthalmitis in our network was found comparable to the best reported in literature. Incidence at secondary centers, without laminar air flow and high energy particulate air filters was found comparable to that in the tertiary center having these facilities.
  2,058 222 3
ONE MINUTE OPHTHALMOLOGY
Choroidal lymphoma or something else?
Diego Esteban Arias, Sara Lally, Carol Shields
June 2020, 68(6):961-961
DOI:10.4103/ijo.IJO_2233_19  PMID:32461406
  1,854 389 -
CASE REPORTS
Very late onset corneal haze in a photorefractive keratectomy patient associated with presumed viral keratoconjuctivitis
Karmiris Efthymios, Machairoudia Genovefa, Armenis John, Magoulas Michael
June 2020, 68(6):1186-1188
DOI:10.4103/ijo.IJO_1789_19  PMID:32461475
We report a rare case of very late-onset haze triggered by viral conjunctivitis, > 20 years after treatment of moderate myopia with photorefractive keratectomy (PRK), and its successful management.
  2,009 132 1
ORIGINAL ARTICLES
All India Ophthalmological Society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection
Dheepak Sundar, Taraprasad Das, Jay Chhablani, Atul Kumar, Namrata Sharma
June 2020, 68(6):1095-1098
DOI:10.4103/ijo.IJO_1602_19  PMID:32461437
Purpose: The aim of this paper is to report the results of an on-line survey to evaluate the practice pattern of Indian retina specialists in administering intravitreal anti-vascular endothelial growth factor injection. Methods: A structured questionnaire on the intravitreal injection (IVI) procedure protocols was sent online to all members of the All India Ophthalmological Society (AIOS) with a request to the retina specialists to respond. A unique link that directed to the web-based questionnaire page allowed a single response only. Participating physicians were masked from each others' responses. The responses were categorized into pre-injection patient preparation, injection aliquoting, injection administration, and post-injection care. The results were compared with similar surveys in Europe, the UK, and the USA. Results: Response was received from 741 of 1016 (73%) retina specialists (of 16,000 AIOS ophthalmologists). The survey showed: 43.5% evaluated patient's cardiac risk factors, 60% used prophylactic topical antibiotic, 90.9% performed injection under topical anesthesia, 55% aliquoted from the bevacizumab vial at the eye care facility, 66.2% used a single puncture technique, 91.4% injected in the main operating room, 98% wore masks and sterile gloves during the procedure, 96% used lid speculum, and 89.3% advised topical antibiotic after the procedure. Peri procedure antibiotic use, injection in the min operating room, wearing of gloves and mask were higher than practices in other countries. Conclusion: Ophthalmologists in India practice asepsis in IVI procedure. There is no uniform protocol for aliquoting bevacizumab. Single use bevacizumab vial for exclusive ophthalmic use will further improve the safety of the procedure.
  1,848 202 1
COMMENTARY
Commentary: Exploring the transmission of COVID-19 through the ocular surface
Joveeta Joseph
June 2020, 68(6):1018-1019
DOI:10.4103/ijo.IJO_1493_20  PMID:32461419
  1,731 313 2
ORIGINAL ARTICLES
Overall clinical outcomes of Descemet membrane endothelial keratoplasty in 600 consecutive eyes: A large retrospective case series
Samar K Basak, Soham Basak, Nidhi Gajendragadkar, Mrinmoyee Ghatak
June 2020, 68(6):1044-1053
DOI:10.4103/ijo.IJO_1563_19  PMID:32461427
Purpose: To analyze the overall clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in 600 consecutive cases. Methods: Retrospective, consecutive interventional case series operated by a single surgeon. Six hundred consecutive eyes of 524 patients with endothelial dysfunctions of different etiologies scheduled for DMEK were included in this study. All donor tissues were prepared by the operating surgeon during the procedure, using McCarey Kaufman medium or Cornisol-preserved cornea with endothelial cell density (ECD) of ≥2500 cells/mm2. Indications, postoperative best spectacle-corrected visual acuity (BSCVA), ECD, endothelial cell loss (ECL), and complications were analyzed postoperatively between 3 months and 2 years. Results: The commonest indication was post-cataract corneal edema/bullous keratopathy in 262 (43.7%) eyes followed by Fuchs' endothelial corneal dystrophy 218 (36.3%). Vision affected comorbidities were present in 91 (15.2%) eyes. In phakic eyes with cataract (222; 37%), DMEK was combined with cataract surgery (Triple-DMEK). BSCVA of ≥20/25 was achieved in 41.0%, 46.4%, 49.2%, and 48.7% of eyes at 3, 6, 12, and 24 months, respectively and stabilized at 6 months (P = 0.54). Mean ECD decreased from 2884 ± 178 cells/mm2 (n = 600) before surgery to 2223 ± 321 (n = 597), 2099 ± 354 (n = 524), 1918 ± 373 (n = 374), and 1772 ± 439 cells/mm2 (n = 158) at 3, 6, 12, and 24 months respectively. The corresponding mean ECL was 22.9 ± 11.4%, 27.2 ± 12.4%, 33.5 ± 13.0%, and 38.6 ± 14.3%, respectively (P < 0.05 for all-time points). The commonest complication was DM detachment in 59 (9.8%) eyes of which 23 (3.8%) eyes required rebubbling. Three (0.5%) eyes had primary graft failure. Endothelial rejection occurred in 7 (1.2%) eyes until the last follow-up. Conclusion: DMEK is a safe and effective procedure in different types of endothelial diseases with encouraging surgical and clinical outcomes. Complications are less and ECL percentage up to 2 years is acceptable.
  1,844 179 15
LETTERS TO THE EDITOR
Silent casualty of COVID-19: Training and education
Javed Hussain Farooqui, Sima Das, Shalinder Sabherwal, Umang Mathur, Sana Iqbal
June 2020, 68(6):1218-1219
DOI:10.4103/ijo.IJO_1372_20  PMID:32461489
  1,779 211 1
Resurgence of “bow and arrow” related ocular trauma: Collateral damage arising from COVID-19 lockdown in India?
Maneesh M Bapaye, Akshay Gopinathan Nair, Pankaj P Mangulkar, Charuta M Bapaye, Meena M Bapaye
June 2020, 68(6):1222-1223
DOI:10.4103/ijo.IJO_901_20  PMID:32461491
  1,747 227 11
ORIGINAL ARTICLES
Evaluation of retrobulbar circulation in type 2 diabetic patients using color Doppler imaging
K Divya, Vikrant Kanagaraju, B Devanand, C Jeevamala, A Raghuram, D Sundar
June 2020, 68(6):1108-1114
DOI:10.4103/ijo.IJO_1398_19  PMID:32461442
Purpose: To investigate the retrobulbar circulatory parameters in type 2 diabetes mellitus patients with color Doppler imaging (CDI) and compare the results with nondiabetic controls. Methods: This prospective study included 50 type 2 diabetic patients and 50 age-matched controls. Seven field stereo fundus photography was used to diagnose and classify diabetic retinopathy (DR). Diabetic patients were further divided into two: Group 1, consisted of patients with no DR, mild and moderate non-proliferative DR (n = 36); Group 2, severe nonproliferative and proliferative DR (n = 14). CDI was performed using Philips iU22 xMATRIX ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatile index (PI) of ophthalmic (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) along with central retinal vein (CRV) were recorded. Results: RI in the ophthalmic artery was significantly higher in both DR groups than the control group (P = 0.000). Diabetic Group 1 had decreased blood flow velocity (PSV and EDV) in PCA compared to controls (P = 0.046 and P = 0.010, respectively). Group 2 DR had significantly reduced EDV and increased RI in CRA compared to Group 1 (P = 0.015). Binary logistic regression analysis revealed glycosylated hemoglobin and RI of OA to be independent risk factors of DR. Conclusion: Significant changes in resistivity index and flow velocities were observed in the retrobulbar vessels, especially in ophthalmic artery in diabetics compared to controls. CDI with results of increased resistance or decreased flow could be useful to predict individuals at higher risk for developing severe DR.
  1,795 173 15
ORIGINAL ARTICLE
Ectasia after keratorefractive surgery: Analysis of risk factors and treatment outcomes in the Indian population
B Soundarya, Gitansha Shreyas Sachdev, Shreyas Ramamurthy, Ramamurthy Dandapani
June 2020, 68(6):1028-1031
DOI:10.4103/ijo.IJO_1580_19  PMID:32461422
Purpose: To analyze the risk factors in eyes developing ectasia following keratorefractive procedures. In addition, the study assessed visual outcomes following various treatment modalities for ectasia. Methods: In this retrospective study, data of patients who underwent keratorefractive procedures, presenting to the refractive services of a tertiary eye care hospital in South India between January 2016 and May 2019 was analyzed. Of these, the eyes that developed ectasia were noted and the possible risk factors were determined. Visual outcomes following treatment with corneal collagen crosslinking (CXL) with or without intracorneal ring segment implantation (ICRS) or topography-guided corneal ablation (T-PRK) were analyzed. Results: Forty eyes of 26 patients developed ectasia following keratorefractive procedures, with a mean interval of 73.1± 45.4 months between primary procedure and ectasia development. Of these, 14 patients had bilateral presentation. Identifiable risk factors included ablation depth > 75 μm (59.25%), percentage of tissue altered (PTA) > 40% (48.14%), residual stromal bed <300 μm (22.22%), mean refractive spherical equivalent > 8 D (25.92%), inferior–superior (I–S) asymmetry > 1.4D (7.40%), central corneal thickness (CCT) <500 μm (7.40%), Belin Ambrosio Display (BAD) > 2.5 (7.40%), posterior float elevation maximum ≥18 μm (3.70%), and pellucid marginal degeneration (PMD; 3.70%). Conclusion: Our study shows that only 70% of the eyes demonstrated an identifiable risk factor for the development of ectasia. Ablation depth of > 75 μm and the PTA > 40% were the most common risk factors. Treatment following CXL with ICRS or T-PRK demonstrated significantly better visual outcomes in comparison with CXL alone.
  1,705 238 4
ORIGINAL ARTICLES
A new technique for fitting of tricurve rigid gas-permeable contact lens in penetrating keratoplasty eyes using Scheimpflug imaging
Pratik Gogri, Faiza A Bhombal
June 2020, 68(6):1057-1060
DOI:10.4103/ijo.IJO_936_19  PMID:32461429
Purpose: Rigid gas-permeable (RGP) contact lens fitting after penetrating keratoplasty (PK) is challenging due to significant irregular astigmatism. The aim of the study was to determine a guideline for selecting the initial base curve (BC) of the RGP contact lens fitting in post PK eyes. Methods: The data of patients who had tricurve RGP contact lens fitting post PK were collected retrospectively. The following data were collected: best-corrected visual acuity with glasses and contact lenses; contact lens parameters which included the BC and diameter; corneal topography parameters which included steep keratometry value (K), flat-K, and mean-K; and anterior best fit sphere (BFS) measured using Scheimpflug imaging. Results: The median age of the 40 subjects (46 eyes) who met the inclusion criteria was 37.5 years (IQR 26.7–45.5). The spherical equivalent was –3.00 diopter (D) (–8.31 to –1.56). The median steep-K, flat-K, and mean-K in them were 6.76 mm (6.28–7.07), 7.78 mm (7.37–8.14), and 7.26 mm (6.93–7.46), respectively. The median anterior BFS value of the transplanted cornea was 6.96 mm (6.6–7.37). The median BC of the final RGP lens was 7.0 mm (6.7–7.23) and the median diameter was 9.8 mm (9.4–10.4). Among all the Scheimpflug imaging parameters, the BFS correlated well with the final BC of the RGP contact lens dispensed (R 0.742, P < 0.0001). Conclusion: The anterior corneal surface BFS value can be used as a reference in selecting the initial BC of tricurve RGP contact lens to achieve the best fitting and reducing the chair time of patients after PK.
  1,767 172 2
PERSPECTIVE
International Association of Contact Lens Educators: Exceptional education—Exponential impact
Lakshmi Shinde, Nilesh Thite, Shehzad A Naroo, Alison Ewbank
June 2020, 68(6):984-987
DOI:10.4103/ijo.IJO_2065_19  PMID:32461410
The International Association of Contact Lens Educators (IACLE) is the leading provider of educational and information resources essential to contact lens educators worldwide. The New IACLE Contact Lens Course is its most important resource, used by members around the world to teach their students, the contact lens practitioners of the future. In 2019, IACLE celebrated the 40th Anniversary of its founding meeting. In this article, we trace the early years of the organization and describes its impact on contact lens education in India.
  1,761 141 1
COMMENTARIES
Commentary: Telemedicine: The unsung corona warrior
Partha Biswas, Sneha Batra
June 2020, 68(6):1012-1013
DOI:10.4103/ijo.IJO_1491_20  PMID:32461416
  1,673 207 3
Commentary: All India Ophthalmological Society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection
Giridhar Anantharaman
June 2020, 68(6):1099-1099
DOI:10.4103/ijo.IJO_44_20  PMID:32461438
  1,702 112 -
LETTERS TO THE EDITOR
Sanitization of glaucoma clinic instruments in COVID-19 era
Rajul S Parikh, Ronnie George, Shefali R Parikh
June 2020, 68(6):1225-1225
DOI:10.4103/ijo.IJO_1423_20  PMID:32461493
  1,533 204 1
ORIGINAL ARTICLES
Use of white light in vivo confocal microscopy for the detection of spatial changes in the corneal nerves in cases of early-stage Acanthamoeba keratitis with radial keratoneuritis
Kuo-Chi Hung, Chia-Ju Lu, Hsin-Yu Liu, Yu-Chih Hou, I-Jong Wang, Fung-Rong Hu, Wei-Li Chen
June 2020, 68(6):1061-1066
DOI:10.4103/ijo.IJO_1313_19  PMID:32461430
Purpose: Radial keratoneuritis (RK) is a common feature of Acanthamoeba keratitis (AK). In vivo confocal microscopy (IVCM) is noninvasive and provides real-time images for the diagnosis of corneal diseases by allowing the visualization of corneal structures and morphologies of living organisms at the cellular level. Images of AK with RK obtained using commercial white light IVCM devices have not been frequently evaluated. In the present study, a white light IVCM device was used to evaluate the corneal findings and describe spatial changes in the corneal nerves at different depths in cases of early-stage AK with RK. Methods: In this retrospective, observational study, white light IVCM images focused on RK were evaluated for Acanthamoeba cysts/trophozoites, corneal deposits, and altered corneal nerves, with special emphasis on three-dimensional spatial changes in the corneal nerves at different depths. Results: Seventeen eyes of 17 patients exhibiting early-stage AK with RK were included in the study. Acanthamoeba cysts/trophozoites were observed in the corneal epithelium of 13 eyes and stroma of 7 eyes. Alterations in the corneal nerve morphology and density were observed from the basal epithelial layer to the stromal layer in 12 eyes. Acanthamoeba trophozoites were attached to the corneal stromal nerves in five eyes. Conclusion: These findings suggest that white light IVCM can identify consistent corneal findings, particularly spatial changes in the corneal nerves, in cases of early-stage AK with RK.
  1,590 142 4
Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane
Surabhi S Sane, Mohammad Hasnat Ali, Baruch D Kuppermann, Raja Narayanan
June 2020, 68(6):1103-1107
DOI:10.4103/ijo.IJO_1045_19  PMID:32461441
Purpose: To investigate if use of adjunctive intravitreal dexamethasone implant during pars plana vitrectomy (PPV) leads to faster visual recovery and reduction of retinal thickness in idiopathic epiretinal membrane (ERM). Methods: In this non-randomized, comparative, interventional study 30 eyes (from 30 patients with idiopathic ERM) were enrolled. In the control group (n = 15), patients underwent 25-G pars plana vitrectomy (PPV) and ERM peeling. In the study group (n = 15), each patient underwent the same procedure as those in the control group, and also received an additional dexamethasone implant. Primary outcome after treatment was mean gain in best corrected visual acuity (BCVA), and secondary outcome was reduction in central retinal thickness (CRT). Data were analyzed using Fisher's exact test, Wilcoxon rank sum test, and two-sample t-test. Results: The mean gain in BCVA (logMAR) from baseline at 1-month follow-up was significantly higher in the study group (median = -0.3, IQR = -0.4, -0.1) than in the control group (median = 0, IQR = -0.1, 0.3; P < 0.008). However, no significant difference in mean gain in BCVA between the two groups was detectable at the 6-month follow-up (P < 0.55). At 1-month follow-up, one and seven patients in the control and study groups gained ≥15 letters of BCVA (P < 0.05), respectively. The mean reductions in CRT at the 1-month follow-up were significantly higher in the study group than in the control group (Mean = -60 μm, SD = 92.1; P < 0.014; 95% CI = 19.75–156.54). The difference in mean reduction of CRT at 6 months was not significant (P < 0.24). Conclusion: Adjunctive dexamethasone implant can aid faster visual recovery after PPV in idiopathic ERM, although the implants do not affect long-term gains in visual acuity.
  1,495 180 5
COMMENTARY
Commentary: Dry eye syndrome and vitamin D deficiency
Uma Sridhar, Koushik Tripathy
June 2020, 68(6):1026-1027
DOI:10.4103/ijo.IJO_398_20  PMID:32461421
  1,476 196 1
ORIGINAL ARTICLES
Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease
N Geetha Sravani, Ashik Mohamed, Sushma Nandyala, Sunita Chaurasia
June 2020, 68(6):1054-1056
DOI:10.4103/ijo.IJO_1465_19  PMID:32461428
Purpose: To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD). Methods: Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively. Results: Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK. Conclusion: The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.
  1,503 107 2
PHOTO ESSAY
Spontaneous unilateral hyphema from a strand of persistent pupillary membrane
Vineet Agarwal, Arijit Mitra, Sumit Choudhury, Suchanda Sar, Debarpita Chaudhury
June 2020, 68(6):1158-1159
DOI:10.4103/ijo.IJO_1732_19  PMID:32461456
  1,453 117 3
SURGICAL TECHNIQUE
A modified technique for intraluminal stenting of glaucoma drainage devices: The guide-wire technique
Nicholas H Andrew, Sonia G Huang, Jamie E Craig
June 2020, 68(6):1151-1153
DOI:10.4103/ijo.IJO_1570_19  PMID:32461452
Glaucoma drainage tubes have become increasingly popular in the surgical management of uncontrolled glaucoma. Flow restriction is essential to prevent early postoperative hypotony with non-flow restrictive glaucoma drainage devices. Herein, we describe a new way of using a 3–0 Supramid suture as an intraluminal stent. This technique confers no risk of stent exposure, can be removed ab interno without disturbing the conjunctiva, and aids insertion of the tube into the anterior chamber through a scleral tunnel.
  1,413 137 1
COMMENTARY
Commentary: Role of sterile air in ophthalmic surgery operation theater
Divya Agarwal, Atul Kumar
June 2020, 68(6):1126-1126
DOI:10.4103/ijo.IJO_143_20  PMID:32461445
  1,370 142 -
ORIGINAL ARTICLES
Study of retinal nerve fiber layer analysis using optical coherence tomography in different demyelinating diseases and its correlation with the severity of visual impairment
Preeti Rawat, Archana Bhange, Varun Upadhyay, Vijay Bhaisare, Shweta Walia, Neetu Kori
June 2020, 68(6):1115-1119
DOI:10.4103/ijo.IJO_258_19  PMID:32461443
Purpose: This purpose of this study was to find the association between severity of visual impairment and retinal nerve fiber layer (RNFL) thickness loss in different demyelinating diseases using optical coherence tomography (OCT) and, simultaneously, assess the fellow eye for subclinical RNFL thickness loss. Methods: This cross-sectional, observational study included 60 eyes of 30 patients above the age of 20 years with diagnosed cases of multiple sclerosis (MS), neuromyelitis optica (NMO), and clinically isolated syndrome (CIS) who had history of (h/o) optic neuritis (ON) attack were included. Participants included in the study group underwent best-corrected visual acuity (BCVA) measurement, color perception, swinging flashlight test, slit-lamp examination, and dilated fundus examination (DFE). RNFL thickness was measured using spectral domain OCT (SD-OCT) (Optovue RTVue-V6.11 A Fourier). Intergroup analysis of RNFL thickness was done using a Chi-square test (P < 0.05 was considered significant). Spearman's rank correlation coefficient (Spearman'sρ) was used for association (ρ < 0.963 was considered significant). Results: RNFL thickness was significantly reduced in patients with NMO than MS, while all patients of CIS had the highest RNFL thickening (P = 0.00048). Lower visual function scores correlated with reduced average overall RNFL thickness, and this association was statistically significant in affected (R = 0.942) and fellow eyes (R = 0.963). Conclusion: The severity of visual impairment significantly correlated with the severity of axonal loss in affected as well as the fellow eye. NMO is associated with more widespread axonal injury in the affected optic nerve. Hence, RNFL thickness is an indicator of the progression of visual impairment in demyelinating diseases and OCT can help distinguish the etiology and, therefore, may be useful as a surrogate marker of axonal involvement in demyelinating diseases.
  1,291 200 -
CASE REPORTS
Successful management of persistent macular hole after macular hole surgery with intravitreal triamcinolone acetonide: A case report
Alok C Sen, Gaurav M Kohli, Ashish Mitra, Dinesh Talwar
June 2020, 68(6):1193-1196
DOI:10.4103/ijo.IJO_1511_19  PMID:32461478
We present a case of persistent macular hole (MH) having an apical diameter of 140 microns and a basal diameter of 530 microns following a combined phacoemulsification and MH surgery. Considering post-operative cystoid macular edema (CME) as the possible reason for the failure of the initial surgery, a trial of IVTA was given. The synergistic effect of mechanical plugging of the hole by TA, coupled with resolution of cystoid changes and falling back of the macular hole resulted in the successful closure of the persistent macular hole with improvement in vision from 20/250 to 20/63.
  1,359 129 2
ORIGINAL ARTICLES
Comparing the effect of three Descemet membrane endothelial keratoplasty injectors on endothelial damage of grafts
Elizabeth Shen, Adam Fox, Brian Johnson, Marjan Farid
June 2020, 68(6):1040-1043
DOI:10.4103/ijo.IJO_1280_19  PMID:32461426
Purpose: Various injectors are commercially available for Descemet membrane endothelial keratoplasty (DMEK) but not all injectors have been studied for endothelial damage of grafts. The aim of the study was to compare endothelial damage in pre-stripped DMEK tissue from three clinically used injector devices: the modified Jones tube, the STAAR intraocular (IOL) injector, and the Geuder glass cannula in a laboratory setting. Methods: Twenty-four human donor corneas were used for this study, eight for each study arm. Each endothelial graft was pre-stripped, trephined to 8.0 mm diameter, then loaded into either the modified Jones tube, the STAAR IOL injector, or the Geuder glass cannula by an eye bank technician who had no prior experience with any of the injectors. Grafts were then ejected, stained with Calcein acetoxymethyl (AM), and quantitatively analyzed using FIJI image software. The primary outcome was the percent of endothelial damage from injector loading and injection. Donor demographics were analyzed using Fisher's exact test. The percentage of endothelial cell loss was compared across groups using the Kruskal–Wallis test. Results: The mean percent of endothelial damage from after injection of the graft was 37.8% (±SD 12.2%) for the modified Jones tube, 37.0% (±SD 13.9%) for the STAAR IOL injector, and 23.5% (±SD 5.1%) for the Geuder cannula (P = 0.008). Conclusion: DMEK injectors contribute to intraoperative endothelial damage of transplanted grafts. The Geuder glass cannula may offer increased ease of use and less endothelial damage compared to the modified Jones tube or STAAR IOL injector for the novice user in early cases.
  1,332 151 4
PHOTO ESSAY
Importance of neuroimaging in normal tension glaucoma
Jaideep Sharma, Anshul Jain, Purvi R Bhagat
June 2020, 68(6):1163-1165
DOI:10.4103/ijo.IJO_1577_19  PMID:32461459
  1,293 154 2
CASE REPORTS
Bilateral acute depigmentation of the iris in a child following exposure to insecticide spray
Swati Singh, Shilpi Diwan, Mahipal Singh Sachdev
June 2020, 68(6):1191-1193
DOI:10.4103/ijo.IJO_1676_19  PMID:32461477
Bilateral acute depigmentation of the iris (BADI) is a rare disease of unkown etiology. We report a case of BADI in a 10-year-old child after accidental exposure to a herbal insecticide. Spontaneous iris repigmentation was observed during the follow-up period.
  1,330 108 3
SURGICAL TECHNIQUE
Management of dislocated transscleral fixated intraocular lens with one-side broken polypropylene suture
Basavaraj Tigari, Bruttendu Moharana, Mohit Dogra, Simar Rajan Singh, Ankur Singh, Bhukya Ravikumar, Ramandeep Singh
June 2020, 68(6):1148-1149
DOI:10.4103/ijo.IJO_1512_19  PMID:32461450
This video demonstrates the successful surgical technique for refixation of the same intraocular lens (IOL) by tying the same IOL to the sclera with the help of 9-0 polypropylene suture. A 62-year-old male patient presented with sudden loss of vision in the left eye. He had a history of undergoing transscleral fixation of intraocular lens (TSFIOL) using 10-0 polypropylene suture 13 years back for posttraumatic-dislocated nucleus. On examination, we noticed that he had IOL dislocation due to spontaneous breakage of suture of one of the haptic. The other haptic suture was intact. The long-term complication associated with TSFIOL procedure is breakage of the polypropylene suture leading to subluxation or dislocation of the IOL. We used closed-globe approach to successfully fixate the involved haptic of the same IOL. No intraoperative or postoperative complication was encountered in three such cases.
  1,292 143 1
PHOTO ESSAY
Acquired conjunctival sessile hemangioma
Devashish Dubey, Rajesh Ramanjulu, Mahesh P Shanmugam, Divyansh K Mishra
June 2020, 68(6):1155-1156
DOI:10.4103/ijo.IJO_1978_19  PMID:32461454
  1,275 147 3
ORIGINAL ARTICLES
Clinical application of bicylindric intraocular lens power calculation method
Jorge A Calvo-Sanz, Cristina Bonnin-Arias, Alfonso Arias-Puente
June 2020, 68(6):1073-1078
DOI:10.4103/ijo.IJO_1237_19  PMID:32461432
Purpose: To analyze the reliability of the refractive results prediction obtained in intraocular lens (IOL) calculation using bicylindric power calculation method, with the use of steep and flat keratometry readings compared with the classical mean keratometry calculation method. Methods: Fifty-seven eyes of 57 subjects who underwent cataract surgery were included in this prospective study. Optical biometry was performed with IOLMaster 700 and IOL power calculation was performed using both keratometry readings and the surgically induced astigmatism. Four weeks after surgery, subjective refraction was done. Finally, results obtained with both IOL calculation methods were compared. Results: Mean spherical equivalent using bicylindric IOL power calculation method was -0.082 ± 0.296D, and achieved mean spherical equivalent using classical IOL power method with Haigis formula was -0.088 ± 0.405D. Achieved mean spherical equivalent obtained in subjective refraction after surgery was -0.101 ± 0.265D. Linear correlation between bicylindric method spherical equivalent calculation and achieved spherical equivalent was statistically significant (r = 0.761, P < 0.001), also correlation between Haigis spherical equivalent calculation and achieved spherical equivalent was statistically significant (r = 0.339, P = 0.010). Emmetropia was achieved in 49 of 57 (85.86%) subjects and bicylindric method calculated that 49 of 57 (85.86%) of subjects would get emmetropia (P = 1.000). Classical IOL power calculation estimated that 38/57 subjects would get emmetropia (66.67%) (P = 0.026). Conclusion: The IOL power calculation including both keratometry readings and surgically induced astigmatism seems to be more accurate and provides more precision in refractive prediction than classical calculation method.
  1,295 120 1
CASE REPORTS
Ocular decompression retinopathy following intracameral bevacizumab injection in a case of proliferative diabetic retinopathy with neovascular glaucoma
Shubakar Reddy, Shreyansh Doshi, Avinash Pathengay, Bhavik Panchal
June 2020, 68(6):1206-1209
DOI:10.4103/ijo.IJO_1401_19  PMID:32461484
A 49-year-old diabetic female was diagnosed to have both eyes proliferative diabetic retinopathy (PDR) and neovascular glaucoma (NVG [rubeosis stage in the right eye and angle-closure stage in the left eye]). The right eye anterior and posterior segment new vessels regressed 2 weeks following intravitreal bevacizumab (IVB) injection. The left eye fundus revealed fibrovascular proliferation (FVP) for which panretinal photocoagulation (PRP) was started and subsequently intracameral bevacizumab (ICB) was injected. Following this intervention, the left eye new vessels of iris regressed but fundus showed multiple peripapillary white-centered intraretinal and subhyaloid hemorrhage suggestive of decompression retinopathy. Ocular decompression retinopathy presents as retinal hemorrhages following the acute lowering of the intraocular pressure (IOP). This case describes the rare occurrence of ocular decompression retinopathy following ICB in a case of PDR with NVG.
  1,273 140 2
Intravitreal bevacizumab for iatrogenic choroidal neovascular membrane following vitreoretinal surgery for retinal detachment
Ramya Appanraj, Hema Duraiswamy, Veerappan Saravanan, George Manayath, Narendran Venkatapathy
June 2020, 68(6):1201-1203
DOI:10.4103/ijo.IJO_1486_19  PMID:32461482
We report the successful use of intravitreal bevacizumab in the iatrogenic choroidal neovascular membrane (CNVM) following vitreoretinal surgery. A 69-year-old male underwent vitrectomy surgery with silicone oil (SO) tamponade for rhegmatogenous retinal detachment. During fluid air exchange, there was an accidental retinal touch at an area in the papillomacular bundle with the silicone tip cannula. He had persistent subretinal bleed at the area 1 month after surgery. The optical coherence tomography (OCT) showed a subretinal elevated lesion and fluorescein angiography (FFA) showed an active CNVM. The patient was treated with intravitreal bevacizumab in the SO-filled eye. At 1-month postinjection, the OCT revealed reduction in the size of CNVM. The patient underwent SO removal with the second dose of intravitreal bevacizumab. CNVM regressed with no recurrence on follow-up at 1 year. Iatrogenic CNVM is a rare complication following successful vitreoretinal surgery. Prompt diagnosis and treatment with intravitreal bevacizumab may be required for a favorable outcome. Iatrogenic choroidal neovascular membrane (CNVM) is an uncommon condition usually associated with retinal laser or iatrogenic trauma during vitrectomy. Very few cases of iatrogenic CNVM have been reported in the literature, and the functional outcome has generally been poor in these reports despite treatment with laser photocoagulation, intravitreal bevacizumab, photodynamic therapy, and surgical removal of neovascular membranes. We report this case to highlight this rare complication following vitrectomy and its response to antivascular endothelial growth facor (VEGF) therapy.
  1,284 126 4
COMMENTARY
Commentary: Management of dislocated and subluxated intraocular lens
Kamaljeet Singh
June 2020, 68(6):1150-1150
DOI:10.4103/ijo.IJO_2071_19  PMID:32461451
  1,275 115 -
OPHTHALMIC IMAGES
Enantiomorphism - Cornea for a cornea, eye for an eye
Amber Amar Bhayana, Priyanka Prasad, Anita Gupta
June 2020, 68(6):1181-1181
DOI:10.4103/ijo.IJO_1785_19  PMID:32461470
  1,240 147 1
LETTERS TO THE EDITOR
Comments on: Risk factors for orbital implant exposure after evisceration: A case-control study of 93 patients
Yadalla Dayakar, Joy Anupama, Rajagopalan Jayagayathri
June 2020, 68(6):1228-1228
DOI:10.4103/ijo.IJO_1962_19  PMID:32461496
  1,274 94 -
CASE REPORTS
Perineuritis or infiltration of optic nerve sheath? A presentation of diffuse large B cell Gastric lymphoma
Swati Phuljhele, Divya Agarwal, Prashant P Ramteke, Adarsh Shashni, Pradeep Sharma
June 2020, 68(6):1212-1214
DOI:10.4103/ijo.IJO_711_19  PMID:32461486
Optic perineuritis is an inflammatory disorder involving the optic nerve sheath. It is currently considered as a part of idiopathic orbital inflammatory disease which also includes dacryoadenitis, orbital myositis, superior orbital fissure, and cavernous sinus syndrome (Tolosa hunt syndrome). As it is idiopathic, it is considered a diagnosis of exclusion. Another important differential is optic nerve lymphoma. Isolated optic nerve lymphoma associated with systemic involvement has been described in literature. We report a case that presented as third nerve palsy but later on developed central retinal vein occlusion and was ultimately diagnosed as primary gastric lymphoma of diffuse large B cell type.
  1,235 126 1
PHOTO ESSAY
Angiotensin receptor blocker-induced bilateral ciliochoroidal effusion
Kanika Aggarwal, Aniruddha Agarwal, Ashok Gupta, Reeti Saini, Amod Gupta
June 2020, 68(6):1168-1169
DOI:10.4103/ijo.IJO_1931_19  PMID:32461462
  1,190 153 -
LETTERS TO THE EDITOR
Comments on: Tool kit for survival: How to run and manage ophthalmic practices during the difficult time of COVID-19 crisis
Nipun Bagrecha, Abhishek R Kothari
June 2020, 68(6):1227-1227
DOI:10.4103/ijo.IJO_1105_20  PMID:32461495
  1,188 143 -
ORIGINAL ARTICLES
Scanning electron microscopic features of explanted degraded hydrophobic acrylic intraocular lenses which were in vivo for a prolonged period
Harsha Bhattacharjee, Suklengmung Buragohain, Henal J Javeri, Dipankar Das
June 2020, 68(6):1086-1089
DOI:10.4103/ijo.IJO_2168_19  PMID:32461435
Purpose: To study and document electron microscopic features in explanted hydrophobic microvacuoles affected acrylic intraocular lenses (IOL) which were in vivo for an average duration of 11 years. Methods: Scanning electron microscopic (SEM; Hitachi S 3000 N EXAX Genesis VP SEM) study of five explanted hydrophobic acrylic IOL which had clinically evident microvacuoles prior to explantation, was done. The IOLs were in vivo for a prolonged period and needed explantation for various indications. Only those hydrophobic acrylic IOLs which fulfilled the inclusion criteria were included. The findings were compared with control specimens. Results: The IOLs were in vivo for an average duration of 11.6 ± 4.21 years. The cause of explantation of IOL was subluxation in four cases and low visual acuity in one case. Bulk degradation and microvacuoles on cut sections throughout the IOL optics and undulating surface patterns over both the surfaces of the IOL has been documented in all the specimens. No such findings were noted in the control specimens where the surface and texture were homogenous. Conclusion: SEM findings of the structural changes in explanted IOL documented in the study demonstrate that hydrophobic acrylic IOL is degradable in vivo. Microvacuoles are a clinical manifestation of the structural changes that occur at a microscopic and molecular level. These changes are not seen in IOLs which have not undergone intraocular implantation. To our knowledge, a similar study of this kind has not been done.
  1,212 119 2
LETTERS TO THE EDITOR
More than meets the eye: Bioethics in ophthalmology
Tarannum Mansoori
June 2020, 68(6):1231-1232
DOI:10.4103/ijo.IJO_1963_19  PMID:32461500
  1,178 150 -
CASE REPORTS
Bilateral serous choroidal detachment in brucellosis and its management and outcome: Literature review and case report
Himabindu Adusumilli, Lakshmi Krupa, Nitin S Shetty, Sanjiv Rao
June 2020, 68(6):1204-1206
DOI:10.4103/ijo.IJO_1418_19  PMID:32461483
To report an unusual case of a 71-year-old livestock farmer with systemic brucellosis and ocular involvement. Examination showed vitreous haze with bilateral serous choroidal detachment. He was treated with topical antibiotics and corticosteroids, Tab rifampicin 600 mg and doxycycline 100 mg for 6 weeks with visual recovery and complete resolution of serous choroidal detachment in 2 weeks. This is the first case of bilateral serous choroidal detachment in a case of systemic brucellosis. Immune-mediated complex and direct microbial invasion of uveal tissue leading to serous choroidal detachment is the proposed pathogenesis that responds well to topical corticosteroids.
  1,207 118 2
COMMENTARY
Commentary: Newer insights into methods of intraocular lens power calculation
Samendra Karkhur, Deepak Soni, Bhavana Sharma
June 2020, 68(6):1079-1080
DOI:10.4103/ijo.IJO_37_20  PMID:32461433
  1,205 118 -
CASE REPORTS
B-HEX pupil expander in vitreoretinal surgery – A case series
Debdulal Chakraborty, Ayan Mohanta, Arup Bhaumik
June 2020, 68(6):1188-1191
DOI:10.4103/ijo.IJO_1675_19  PMID:32461476
We describe the successful use of the B-HEX pupil expansion device in four cases of combined phacovitrectomy with significant cataract, non-dilating pupil, and surgical vitreoretinal pathologies including vitreous hemorrhage, inferior retinal detachment (RD) with proliferative vitreoretinopathy in an oil filled eye, recurrent rhegmatogenous RD, and macular hole with RD localized to the posterior pole in an eye with uveitic sequelae. The B-HEX remained well engaged and maintained excellent mydriasis throughout the surgery despite wide fluctuations in intraocular pressure and anterior chamber fluidics. This is the first series describing use of B-HEX for combined phacovitrectomy due to myriad causes.
  1,186 106 2
OPHTHALMIC IMAGES
Kindler syndrome with unique ocular findings
Anchal Thakur, Ashish Kulshreshtha, Sheetanshu Kumar, Sunil Dogra, Amit Gupta
June 2020, 68(6):1182-1182
DOI:10.4103/ijo.IJO_2261_19  PMID:32461471
  1,169 119 -
CASE REPORT
Management of fovea-involving dry macular fold complicating retinal detachment surgery: Does delayed intervention influence outcome?
Naresh Babu, Jayant Kumar, Piyush Kohli, Pushpanjali Ramteke
June 2020, 68(6):1197-1199
DOI:10.4103/ijo.IJO_1843_19  PMID:32461480
Retinal folds are rare complications of rhegmatogenous retinal detachment surgery. They may be located in periphery or involve macula, with the latter ones being associated with severe visual loss. Due to the paucity of scientific reports, its management remains debatable. Most authors advocate an early surgical intervention for symptomatic macular folds (MF). We present 2 cases of symptomatic dry macular fold which were managed successfully after different time intervals. As evidence gets collected that late intervention also leads to good visual outcome, long standing MF should not be considered an absolute contraindication for surgical intervention.
  1,183 101 2
PHOTO ESSAY
Retinal injury following intravitreal injection of a dexamethasone implant in a non-vitrectimised eye
M Arvind Jain, Amishi Khanna, V Narendran
June 2020, 68(6):1178-1178
DOI:10.4103/ijo.IJO_1618_19  PMID:32461468
  1,159 113 -
Orbital floor fracture due to recreational cliff diving - A rare presentation
Athul S Puthalath, Neeraj Saraswat, Anupam Singh, Sreeram Jayaraj, Mahsa Jamil, Nisheeta Patnaik
June 2020, 68(6):1179-1180
DOI:10.4103/ijo.IJO_1487_19  PMID:32461469
  1,177 94 1
ORIGINAL ARTICLES
Validation of Mahajan's formula for scaling ocular higher-order aberrations by pupil size
Henry B Wallace, Stuti L Misra, James McKelvie
June 2020, 68(6):1067-1072
DOI:10.4103/ijo.IJO_773_19  PMID:32461431
Purpose: Zernike polynomials for describing ocular higher order aberrations are affected by pupil aperture. The current study aimed to validate Mahajan's formula for scaling Zernike polynomials by pupil size. Methods: Higher order aberrations for 3 intraocular lens models (AcrySof IQ IOL SN60WF, Technis ZA9003, Adapt Advanced Optics) were measured using the Zywave aberrometer and a purpose-built physical model eye. Zernike coefficients were mathematically scaled from a 5 mm to a 3 mm pupil diameter (5:3 mm), from a 5 mm to a 2 mm pupil diameter (5:2 mm), and from a 3 mm to a 2 mm pupil diameter (3:2 mm). Agreement between the scaled coefficients and the measured coefficients at the same pupil aperture was assessed using the Bland–Altman method in R statistical software. Results: No statistically significant mean difference (MD) occurred between the scaled and measured Zernike coefficients for 21 of 23 analyses after Holm-Bonferroni correction (P > 0.05). Mean differences between the scaled and measured Zernike coefficients were clinically insignificant for all aberrations up to the fourth order, and within 0.10 μm. Oblique secondary astigmatism (Z−24) was significantly different in the 5:3 mm comparison (MD = -0.04 μm, P < 0.01). Horizontal coma (Z13) was significantly different in the 3:2 mm comparison (MD = -0.07 μm, P = 0.03). There were borderline statistical differences in both vertical (Z−13) and horizontal coma (Z13) in the 5:3 mm comparison (MD = 0.02 μm, -0.09 μm, P = 0.05, 0.05, respectively). Conclusion: A formula for the scaling of higher order aberrations by pupil size is validated as accurate. Pupil scaling enables accurate comparison of individual higher order aberrations in clinical research for situations involving different pupil sizes.
  1,122 131 -
PHOTO ESSAY
Herpetic stromal keratitis after collagen cross-linking for keratoconus: A unique presentation
Akhil Bevara, Sudhakar Potti
June 2020, 68(6):1156-1158
DOI:10.4103/ijo.IJO_1525_19  PMID:32461455
  1,125 126 1
OPHTHALMIC IMAGES
Bilateral macular ischemia following oral etoposide
Abhishek Das, Ratnesh Ranjan, Nikita Das, Parag K Shah
June 2020, 68(6):1184-1184
DOI:10.4103/ijo.IJO_1850_19  PMID:32461473
  1,127 121 4
PHOTO ESSAY
Multiple retinal vascular occlusions in Leriche syndrome
Ramesh Venkatesh, Ishank Gupta, Kushagra Jain, Arpitha Pereira, Aditya Aseem, Darshan Shah, Naresh Kumar Yadav
June 2020, 68(6):1171-1173
DOI:10.4103/ijo.IJO_1784_19  PMID:32461464
  1,121 114 -
LETTERS TO THE EDITOR
Comments on: All India Ophthalmic Society-Indian Journal of Ophthalmology Consensus statement on preferred practices during COVID-19 Pandemic
Raju Sampangi, BC Hemalatha
June 2020, 68(6):1226-1226
DOI:10.4103/ijo.IJO_1130_20  PMID:32461494
  1,103 131 -
ORIGINAL ARTICLES
Practical use of rubric for assessment of eye bank professionals for eye retrieval and its role in improving eye retrieval process in eye banks: An Indo-American experience
Javed Hussain Farooqui, Manisha Acharya, Ingrid Schunder, Renee Hinesley, Animesh Das
June 2020, 68(6):1037-1039
DOI:10.4103/ijo.IJO_1482_19  PMID:32461425
Purpose: To study the practical use of the Rubric for Assessment of Eye Bank Professionals for Eye Retrieval (RAEPER) as a competency assessment tool by organizing a workshop in two eye banks – one in India and other in America. Methods: Two-day workshop was conducted in two eye banks – named Shroff's Charity Eye Hospital (SCEH) in India and Miracles in Sight (MIS) in America. Day 1 of workshop comprised of didactic lectures and discussions and day 2 was eye retrieval assessment done on human eyes in a wet lab setting. Assessment was done using RAEPER by two independent senior eye bank managers. Results: MIS had 27 participants, 15 males and 12 females (mean age: 38.8 years, range: 28-55) and SCEH had 11 participants, 10 males and 1 female (mean age: 48 years, range: 22–68). All participants were in house technicians, who had a minimal experience of at least 150 eye retrievals. At MIS, step 19 (crystalline lens check) got a score of 3 (Competent) 93.5% of the time. At SCEH, step 6 (conjunctival removal) and step 4 (Irrigation of cornea with sterile saline) were high scoring with 90.11% and 72.7% scoring 3, respectively. Conclusion: India's cornea blind population is expected to reach 10 million by 2020. Steps need to be taken to improve cornea retrieval rates in the country and make various eye banks self-sufficient. Incorporating such training modules not only improves the cornea utilization rates, but also helps standardize the entire eye banking process.
  1,120 113 2
PHOTO ESSAY
Autosomal recessive bestrophinopathy with macular hole
Raj Shri Hirawat, CK Nagesha, Megha M Divakar
June 2020, 68(6):1173-1175
DOI:10.4103/ijo.IJO_1346_19  PMID:32461465
  1,089 107 3
COMMENTARY
Commentary: Neuro-ophthalmological conditions mimicking glaucoma – A diagnostic challenge
Srinivasan Kavitha
June 2020, 68(6):1165-1166
DOI:10.4103/ijo.IJO_2361_19  PMID:32461460
  1,073 122 -
COMMENTARIES
Commentary: Single-use bevacizumab: The final solution?
Raja Narayanan
June 2020, 68(6):1102-1102
DOI:10.4103/ijo.IJO_24_20  PMID:32461440
  1,058 125 -
PHOTO ESSAY
A rare presentation of bilateral dislocated lens in a patient with isolated microspherophakia
Thandra Sai Shreya, Vijayalakshmi A Senthilkumar, Chitaranjan Mishra, R Krishnadas
June 2020, 68(6):1161-1163
DOI:10.4103/ijo.IJO_1898_19  PMID:32461458
  1,069 106 -
COMMENTARY
Commentary: Ectasia after keratorefractive surgery: An ounce of prevention is worth a pound of cure
Purvasha Narang
June 2020, 68(6):1032-1032
DOI:10.4103/ijo.IJO_2385_19  PMID:32461423
  1,061 106 -
COMMENTARIES
Commentary: All India Ophthalmological Society members' survey: Practice pattern of intravitreal anti-vascular endothelial growth factor injection
Lingam Gopal, Su Xinyi
June 2020, 68(6):1100-1101
DOI:10.4103/ijo.IJO_16_20  PMID:32461439
  1,064 101 -
PHOTO ESSAY
Post-traumatic iris cyst mimicking a tumor: A solid pearl
Deepali Singhal, Arjun Desai, Prafulla K Maharana, Jeewan S Titiyal
June 2020, 68(6):1160-1161
DOI:10.4103/ijo.IJO_1807_19  PMID:32461457
  1,053 108 -
Wandering intravitreal worm of Brugia malayi from Central India
Gitumoni Sharma, Deepshikha Agrawal
June 2020, 68(6):1166-1167
DOI:10.4103/ijo.IJO_1660_19  PMID:32461461
  1,020 100 -
COMMENTARY
Commentary: Intraluminal stenting of non-flow restrictive glaucoma drainage devices
Sirisha Senthil
June 2020, 68(6):1153-1154
DOI:10.4103/ijo.IJO_30_20  PMID:32461453
  1,007 94 -
LETTERS TO THE EDITOR
Reply to comments on: Risk factors for implant exposure after evisceration: A case-control study of 93 patients
Roshmi Gupta, Parvathi Hari, Bhawna Khurana, Anjali Kiran
June 2020, 68(6):1228-1229
DOI:10.4103/ijo.IJO_787_20  PMID:32461497
  998 92 1
COMMENTARY
Commentary: Retinal folds: To operate or not to operate
Parveen Sen, Sneha Giridhar
June 2020, 68(6):1200-1201
DOI:10.4103/ijo.IJO_106_20  PMID:32461481
  983 101 2
OPHTHALMIC IMAGES
Full-thickness macular hole with pigment epithelial detachment
Shilpi H Narnaware, Prashant K Bawankule
June 2020, 68(6):1185-1185
DOI:10.4103/ijo.IJO_1591_19  PMID:32461474
  962 122 -
PHOTO ESSAY
Rubella retinopathy with choroidal neovascular membrane in a 7-year-old
Lubhavni Dewan, Nasiq Hasan, Neelima Aron, Rohan Chawla, Dheepak Sundar
June 2020, 68(6):1176-1177
DOI:10.4103/ijo.IJO_1469_19  PMID:32461467
  988 95 2
OPHTHALMIC IMAGES
Pigmentation of optic discs
Nitin Kumar, Reema Bansal
June 2020, 68(6):1183-1183
DOI:10.4103/ijo.IJO_1874_19  PMID:32461472
  942 118 -
LETTERS TO THE EDITOR
Comments on: Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review
Pramod K Pandey, Divya Kishore, Priya Saraf, Rupak B Chaudhary, Neha Sachdeva, Ipsita Muni
June 2020, 68(6):1229-1230
DOI:10.4103/ijo.IJO_2182_19  PMID:32461498
  944 99 -
COMMENTARY
Commentary: Persistent macular hole: A long way to go
Ekta Rishi, Pallavi Singh
June 2020, 68(6):1196-1197
DOI:10.4103/ijo.IJO_181_20  PMID:32461479
  952 86 -
PHOTO ESSAY
Intraocular osseous metaplasia
Md. Shahid Alam, Rajeev Priyadarshi
June 2020, 68(6):1175-1176
DOI:10.4103/ijo.IJO_1829_19  PMID:32461466
  934 99 -
Unique observations on swept source optical coherence tomography in a case of morning glory optic disc anomaly with associated retinal detachment
Dheepak Sundar, Aafreen Bari, Atul Kumar, Rohan Chawla, Nasiq Hasan
June 2020, 68(6):1170-1171
DOI:10.4103/ijo.IJO_1558_19  PMID:32461463
  898 116 1
LETTERS TO THE EDITOR
Commentary: School screening programme: Should it be universal and uniform?
V Kavitha, Mallikarjun M Heralgi
June 2020, 68(6):1232-1233
DOI:10.4103/ijo.IJO_2372_19  PMID:32461501
  857 89 2
Reply to comments on: Acute isolated medial rectus palsy due to infarction as a result of a hypercoagulable state
Arvind K Morya
June 2020, 68(6):1230-1231
DOI:10.4103/ijo.IJO_2414_19  PMID:32461499
  757 76 -