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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 56 | Issue 3
Page Nos. 143-207

Online since Tuesday, October 23, 2018

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EDITORIALS  

From the editor's desk Highly accessed article p. 143
T Nirmal Fredrick
DOI:10.4103/tjosr.tjosr_87_18  
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From the next editor Dr. V. Sharmila Devi p. 145
V Sharmila Devi
DOI:10.4103/tjosr.tjosr_91_18  
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ORIGINAL ARTICLES Top

Patterns of pseudoexfoliation deposits and its relation to intraocular pressure and retinal nerve fiber layer defects p. 146
Gargi Sathish, Ebitha Kalarikkal Elias
DOI:10.4103/tjosr.tjosr_67_18  
Aims: The aims were to study various patterns of pseudoexfoliation (PXF) deposits over anterior lens capsule and its relation with intraocular pressure (IOP) and peripapillary retinal nerve fiber layer (RNFL) defects. Settings and Design: A cross-sectional study was conducted in the outpatient department of a tertiary care center. Subjects and Methods: Newly detected cases of PXF not on any antiglaucoma medications were selected. Central corneal thickness-corrected IOP was recorded with applanation tonometry. The four patterns that were made out are– three ring pattern (3R), two ring with no central disc (2R), radial pigmentary (RP) with multiple radial lines and combined (CR) pattern. RNFL thickness with optical coherence tomography was recorded. Statistical Analysis Used: Frequency calculation and analysis were done using t-test and Chi-square test as applicable using SPSS software. Sensitivity, specificity, and diagnostic accuracy of ring pattern in detecting high IOP and RNFL defects were calculated. Results: Out of 40 eyes with PXF, 17 and 15 eyes had 3R and 2R patterns, respectively. When out of 32 eyes with ring pattern, 8 recorded IOP >20 mmHg and 18 had RNFL defect. Sensitivity, specificity, and diagnostic accuracy of ring pattern in detecting RNFL thinning were 56.25%, 100%, and 65%, respectively. Conclusions: PXF is a severe form of glaucoma, with about 45% having severe disc damage even at presentation. Detection of ring pattern mandates early treatment and follow-up even with borderline IOP. RP pattern also requires regular follow-up as progression to severe damage may occur with age.
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Central macular thickness in diabetics without retinopathy p. 150
Sindhuja Murugesan, Kirti Nath Jha, Srikanth Krishnagopal, G Ezhumalai
DOI:10.4103/tjosr.tjosr_69_18  
Background: Diabetic maculopathy is the major cause for blindness in type 2 diabetics. Slit-lamp biomicroscopy with +90 D lens has been the traditional method for diagnosis. Neurodegenerative changes precede clinical retinopathy. Optical coherence tomography (OCT) is a newer tool for diagnosis of such subtle changes in the macula. Aim: This study aimed to compare the central macular thickness (CMT) in type 2 diabetics without clinical retinopathy and normal controls. Subjects and Methods: This prospective case–control study was conducted at a rural tertiary care center after obtaining clearance from the Institutional Human Ethics Committee. CMT was measured using spectral-domain OCT among the type 2 diabetics without clinical retinopathy and control group. CMT was correlated with duration of diabetes and glycemic control using Pearson's correlation. Results: This study included 170 patients (85 cases and 85 controls). The average age in cases and controls was 52 ± 10.2 years and 51 ± 8.1 years, respectively; this difference was statistically not significant. Duration of diabetes ranged from newly diagnosed to 15 years. Mean glycosylated hemoglobin (HbA1c) in the study and control groups were 8.93 ± 2.54% and 4.57 ± 0.56% respectively. Mean CMT in type 2 diabetics without clinical retinopathy was 198.47 ± 17.98 μm and in control group, it was 235.68 ± 11.25 μm (P = 0.00). CMT among male diabetics was thicker than that of female diabetics (P = 0.00). CMT did not correlate with duration of diabetes (r = 0.54) or with the glycemic control (r = 0.09). Conclusion: CMT was thinner among type 2 diabetics without clinical retinopathy than healthy controls. CMT did not correlate with duration of diabetes or with the glycemic control.
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A study of effect of intracameral use of preservative-free lignocaine (1%) for pupillary dilatation during phacoemulsification surgery p. 155
Pravda Chaturvedi, Punit Kumar Singh, Arvind Chauhan
DOI:10.4103/tjosr.tjosr_72_18  
Aim: The aim of the study was to assess the effect of intracameral preservative-free lignocaine (1%) on the dilatation of pupil while doing phacoemulsification surgery. Materials and Methods: A prospective study carried out on 21 patients in a tertiary care hospital. The pupil diameter was measured just before instilling intracameral preservative-free lignocaine, after 1 min and 5 min, respectively. Any mydriatic was not used either before or during the surgery. Effects were compared between male and female patients and between light- and dark-colored irides patients. Results: The diameter of pupil after instillation of intracameral lignocaine was significantly higher. The effect was more pronounced in light-colored irides. There was no difference in the pupillary diameter between both the sexes. Conclusion: Intracameral preservative-free 1% lignocaine has a fast and effective mydriatic property and with more studies, can be used as a safe alternative to topical and intracameral mydriatic while phacoemulsification.
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Long-term results of primary intraocular lens implantation in infants: Our experience p. 158
A Sasikala Elizabeth, S Kalpana Narendran, Sandra Ganesh
DOI:10.4103/tjosr.tjosr_77_18  
Objective: The main objective of this study is to analyze the long-term outcome in children who underwent cataract surgery for congenital cataract with intraocular lens (IOL) implantation <24 months of age. Materials and Methods: The study involves a retrospective analysis of children, <24 months who had undergone phacoaspiration, primary posterior capsulorhexis, anterior vitrectomy, and primary IOL implantation in our institution, between January 2009 and December 2013 with minimum of 4-year follow up. Results: Thirty-nine eyes of thirty children were analyzed. Mean age at surgery was 13.6 months. 46.1% achieved visual acuity logMAR 0.47 or better. Mean visual acuity in the last visit was logMAR 0.77. Mean visual acuity in unilateral cataracts was logMAR 1.07 when compared to logMAR 0.3 in bilateral cataracts. Mean visual acuity in children operated <12 months and 13–24 months of age are logMAR 1 and 0.6, respectively. The shift in mean spherical equivalence was 4.43D at 2-week postoperative to − 1.02D at the latest visit. Mean myopic shift being 5.91D. Comparison between children operated <12 months and 13–24 months of age for the myopic shift and visual acuity in the last visit had very high statistical significance (P = 0.0003). Conclusion: Refractive results after primary IOL implantation in children <2 years are variable. Limited data exist about their long-term outcome. Our study suggests that it is surgically safe and has a favorable long-term outcome for primary IOL implantation in these children.
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Correlation between modifiable risk factors and age-related macular degeneration: A Case–control study p. 163
Dhaval Patel, Harsha Bhattacharjee, Saloni Shah, Krati Gupta, Rupal Chaudhari, Kamla Sadia, Saurabh Deshmukh
DOI:10.4103/tjosr.tjosr_79_18  
Aim: The aim of the study is to find the correlation between modifiable risk factors such as body mass index (BMI), waist circumference (WC), and smoking with age-related macular degeneration (AMD). Materials and Methods: In this hospital-based, observational, case-control study, 100 patients presenting to our outpatient department over a period of 1 year were included in the study. The selected participants were grouped into the AMD group which included 50 eyes with nonneovascular AMD and neovascular AMD along with 50 eyes as a control group. All participants underwent comprehensive ophthalmological examination along with measurement of weight, height, and WC. Results: Fifty eyes of 50 patients diagnosed to have AMD and 50 eyes of 50 age-matched controls were included in this study. The mean age was 66 years (49–85 years). The mean BMI in patients with neovascular AMD was 27.74 kg/m2 ± 4.93 (n = 19). The mean BMI in patients with nonneovascular AMD was 25.58 kg/m2 ± 2.90 (n = 31), whereas mean BMI in the control group was 23.85 kg/m2 ± 3.31 (n = 50). There was a statistically significant difference between the two AMD groups and the control group with respect to BMI (ANOVA; F = 8.605; DF = 2; P < 0.001). The mean WC in patients with neovascular AMD was 104.63 cm ± 5.78 (n = 19). The mean WC in patients with nonneovascular AMD was 102.6 cm ± 6.1 (n = 31), whereas mean WC in the control group was 91.7 cm ± 6.7 (n = 50), and the difference was statistically significant (ANOVA; F = 42.70; DF = 2; P < 0.001). Statistically significant difference was observed between the smokers belonging to case and control groups (ANOVA; F = 13.967; DF = 2; P < 0.001). Conclusion: A statistically significant correlation exists between BMI, WC, smoking, and the severity of AMD.
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REVIEW ARTICLE Top

Monitored anesthesia care in ophthalmic surgeries p. 167
Manickavasagan Rangaswamy, Jeyakumar Veeraiyan, Divya Malarvannan
DOI:10.4103/tjosr.tjosr_74_18  
Monitored anesthesia care (MAC) is a specific anesthesia service for diagnostic and therapeutic procedures. It includes safe conscious sedation, adequate pain relief, and measures to allay anxiety. Even though it involves minimal anesthetic intervention, it is essential for an anesthetist to know about the patient history. Many ophthalmic drugs have significant anesthetic implications, and many anesthetic drugs cause significant intraocular pressure changes. In this article, we have highlighted the importance of MAC in ophthalmic procedures and implications of various anesthetic agents in eye surgeries. The various ophthalmic blocks and their complications and the toxicity which can occur with the use of local anesthetics have also been touched upon.
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CASE SERIES Top

Fungal sinusitis: Sinuses and beyond p. 173
V Sumathi, D Ramesh, P Padmapriya, Murali Ariga
DOI:10.4103/tjosr.tjosr_70_18  
Fungal sinusitis poses a great diagnostic and treatment challenge to the otorhinolaryngologist. The increasing incidence of the disease, wide spectrum of clinical features, possibility of recurrence, invasion to vital structures such as orbit and brain, and treatment challenges make it a major health burden today. Often attributed to an immunoglobulin E-specific reaction or cell-mediated immune response to the fungal filaments, fungal sinusitis can be diagnosed by fungal stain and culture and histopathology (gold standard). Radiological studies help in assessing the disease extent and in planning management. We present our series of various forms of fungal sinusitis and the difficulties we faced in the management and the outcome. Each form of fungal sinusitis has distinctly different medical and surgical treatment which needs to be individualized, most often requiring radical surgical debridement along with adjunct long-term antifungals (polyene and triazole) playing an equally important role.
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CASE REPORTS Top

Acquired pit of the optic nerve in primary angle-closure glaucoma p. 177
Sadiqha Banu Shaik, Kavitaa Ramamoorthy, Pratheeba Devi Nivean, Murali Ariga
DOI:10.4103/tjosr.tjosr_64_18  
Herein, we report a case of acquired optic nerve pit in a 46-year-old Indian male, a known case of primary angle closure glaucoma (PACG) compatible with treatment for the past 15 years. He presented to our clinic with complaints of recent decrease in vision; on examination, his visual acuity was found correctable to 6/6 and 6/12 in the right and left eye, respectively. Fundoscopy revealed glaucomatous cupping in both the eyes and subretinal fluid in macula of the left eye. Swept-source optical coherence tomography macula and retinal nerve fiber layer disclosed acquired pit of the optic nerve (APON) in the left eye. The patient was under continuous follow-up and maculopathy spontaneously resolved. An APON may indicate progression of glaucoma and was more commonly reported in cases of primary open-angle glaucoma; we aimed to report an unusual presence of APON in a case of PACG.
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Mass casualty from chemical fumes among filmmakers p. 180
Prasanna Venkatesh Ramesh, Kirti Nath Jha, Anugraha Balamurugan
DOI:10.4103/tjosr.tjosr_66_18  
Chemical fumes are known to cause eye injury resulting in disablement. A mass casualty (group of 17 filmmakers) reported with severe irritation, watering, redness, photophobia, and blepharospasm in their eyes following approximately 12 hours after exposure to fumes of Japan black mixed with kerosene after film shooting with intense arc light. Examination revealed chemical conjunctivitis, keratoconjunctivitis, dermatitis, and eyelid edema. Symptoms resolved within 48 hours in all except 1, with supportive treatment, lubricant eye drops, and rest in the darkened room. This case report underlines the need for healthy industrial practices to avoid chemical injuries from volatile chemicals among filmmakers.
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Posttraumatic zonular dialysis and phacodonesis p. 183
Saurabh Deshmukh, Harsha Bhattacharjee, Krati Gupta
DOI:10.4103/tjosr.tjosr_63_18  
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Ocular manifestation of whooping cough in a vaccinated child p. 185
Saurabh Deshmukh, Damaris Magdalene, Krati Gupta
DOI:10.4103/tjosr.tjosr_75_18  
Pertussis is an infection of the respiratory tract caused by Bordetella pertussis commonly affecting the infants and the young children. Diphtheria-pertussis-tetanus vaccine is available for the prevention of the disease. However, pertussis has been reported in vaccinated individuals. It is characterized by paroxysms of cough, leading to various ocular manifestations such as subconjunctival hemorrhage, lid ecchymosis, and retinal hemorrhage. We report a case of a vaccinated boy who presented with ocular complaints and later diagnosed to be suffering from pertussis and treated successfully for the same.
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Small eyes, big problems: Cataract surgery in nanophthalmos p. 188
PV Tejaswi Prasad, Nivean Madhivanan, Murali Ariga, Abhinaya Sridhar
DOI:10.4103/tjosr.tjosr_76_18  
Nanophthalmos is characterized by bilateral and symmetrical small eyes with shortened axial length of 20 mm or less (two standard deviation below average axial length), high lens-to-eye volume ratio with shallow anterior chamber, enophthalmos, and narrow palpebral fissures. All these features make it challenging for cataract surgery, in this case report, we suggest few necessary steps taken for an uncomplicated outcome.
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Left middle cerebral artery territory infarction due to intravitreal injection of ranibizumab p. 191
Shambo Samrat Samajdar, Shatavisa Mukherjee, Sukalyan Saha Roy, Santanu Kumar Tripathi
DOI:10.4103/tjosr.tjosr_80_18  
Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with marked side effects. The present case describes a 75-year-old female with known complications of hypertension, Type II DM, and hypothyroidism, who received intravitreal injections of Lucentis (ranibizumab) due to diabetic macular edema. After 10 days, the patient admitted with chief complaints of slurred speech. Further, radiological and clinical investigations conferred the case to be a left middle cerebral artery territory infarct with right-sided hemiparesis and aphasia. Although well-designed randomized clinical trials have shown the efficacy of these agents in visual improvement in various retinal diseases, each intravitreal injection poses the risk of postinjection- and drug class-associated adverse events. Clinicians should be more vigilant as patients receiving intravitreal injections are at a small risk of developing complications, which is often unrecognized or underreported.
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SHORT COMMUNICATION Top

Postoperative endophthalmitis: Preventive measures p. 194
R Vasumathi
DOI:10.4103/tjosr.tjosr_71_18  
Although rare, postoperative endophthalmitis is one of the most feared complications of cataract surgery. It may significantly compromise visual function and even the anatomical integrity of the eye. Despite the significant reduction in recent years, considering the millions of people who undergo cataract surgery each year, postoperative endophthalmitis still poses a significant public health issue, and every step should be taken to reduce its occurrence. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound and use of prophylactic intracameral antibiotics play a mojor role in reducing the incidence of postoperative endophthalmitis.
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JOURNAL REVIEW Top

Journal scan p. 197
R Vasumathi
DOI:10.4103/tjosr.tjosr_61_18  
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PHOTO QUIZ/IMAGE Top

Visualization of the anterior hyaloid membrane in the eye p. 201
Saurabh Deshmukh, Harsha Bhattacharjee, Krati Gupta
DOI:10.4103/tjosr.tjosr_78_18  
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Photo quiz p. 203
Shruti Nishanth, Atheek Shaik
DOI:10.4103/tjosr.tjosr_57_18  
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PHOTO QUIZ ANSWERS Top

Answers to previous issue photo quiz p. 205
N Malathi
DOI:10.4103/tjosr.tjosr_58_18  
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LETTERS TO THE EDITOR Top

Peanuts: A common migraine trigger p. 206
R Vasumathi
DOI:10.4103/tjosr.tjosr_73_18  
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Journey of the journal - Article by T. Nirmal Fredrick and Rachula Daniel p. 207
G Seethapathy
DOI:10.4103/tjosr.tjosr_88_18  
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