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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 57 | Issue 3
Page Nos. 197-265

Online since Monday, November 11, 2019

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EDITORIAL  

Two Hundred Glorious Years of Ophthalmology Highly accessed article p. 197
Sharmila Devi Vadivelu
DOI:10.4103/tjosr.tjosr_94_19  
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ORIGINAL ARTICLES Top

Awareness about diabetic retinopathy among doctors not specialized in ophthalmology p. 199
Ramya Chelliah, Ravikumar Rangasamy, Karthikeyan Mahalingam, Sheela Ramani, Soundarya N Sriram, V Ganesh
DOI:10.4103/tjosr.tjosr_56_19  
Introduction: Diabetic retinopathy is the most common microvascular complication of diabetes mellitus. Proper screening for diabetic retinopathy(DR) and appropriate management could prevent the occurrence of blindness. As doctors treating diabetes patients play a vital role in referring the patients to ophthalmologists for retinopathy screening, we decided to assess the level of awareness about DR. Methods and Materials: We conducted a cross-sectional study among doctors working in a tertiary care hospital with at least 2 years of experience. A set of questionnaire regarding DR was presented to participants to choose the answer of their choice. Analysis was done using SPSS software version 23. Results: Only 18.4% of them have referred all diabetic patients for retinopathy screening. Only 19 to 35% of participants were aware of the correct screening time for DR. 90 to 97% of the participants knew that DR is the most common microvascular complication of diabetes, and that it can even lead to blindness. 85 to 95 % of the participants were aware that both duration and level of glycemic control is associated with development of DR and glycemic control is the first step to prevent its progression. Conclusion: This study emphasizes the fact that awareness programs are necessary not only for diabetic patients, but also for the first contact health care professionals.
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Knowledge and awareness of glaucoma in South India p. 203
Zeeshan Ahmed, Krishnagopal Srikanth, AR Rajalakshmi
DOI:10.4103/tjosr.tjosr_1_19  
Background: Glaucoma is one of the leading causes of preventable blindness worldwide. It is estimated that by 2020, India will become the second largest population affected with glaucoma. Despite the various efforts by government and NGO agencies in conducting various out-reach and screening programmes the burden of glaucoma seems to be rising in India. Aims and Objectives: Our study was aimed to find the awareness about glaucoma and the level of knowledge and the various reasons for the lack of its knowledge. Materials and Methods: A questionnaire based study was done on 1311 participants above 40 years of age attending the OPD. Participants who were aware of the condition glaucoma were further asked about the basic knowledge of the condition pertaining to its symptoms, treatment options and its visual prognosis. Results: The awareness of glaucoma was found to be poor. Around 10% of the aware population had good to excellent knowledge about glaucoma. Relatives of people affected by glaucoma were the most aware and knowledgable. Conclusion: Our study showed that the awareness and knowledge about glaucoma and its risk factors and treatment were poor, especially in a population with lower economic status and literacy levels.
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Study of meibomian gland dysfunction and hypercholesterolemia p. 208
Ashwin Segi, Kirti Nath Jha, Krishnagopal Srikanth
DOI:10.4103/tjosr.tjosr_17_19  
Background: Hypercholesterolemia is a risk factor for ischemic heart disease and cerebrovascular disease. Increased cholesterol in the meibomian gland secretion has been considered necessary for development of meibomian gland dysfunction (MGD). Aim: To study the association of MGD with hypercholesterolemia in adults aged 20-60 years age. Setting and Design: Observational case-control study. Methods and Materials: We studied one hundred and twenty individuals aged 20-60 years divided into two groups; sixty cases of MGD and no known hypercholesterolemia; sixty controls with neither MGD nor hypercholesterolemia. Examination included anterior segment examination, tear film break-up time (TBUT), Schirmer's test and assessment of meibomian gland function. MGD was graded based on quality of meibum secretion and meibomian gland function (expressibility). Other investigations included lipid profile, random blood sugar, serum creatinine and body mass index (BMI). Statistical Analysis: We calculated proportion, mean, standard deviation, 95% confidence interval (CI), Z- test, and paired t-test for comparison between groups. Results: Hypercholesterolemia (i.e. serum cholesterol ≥ 200 mg/dl) was found in 39 (65%) and 31 (51.67%) among cases and control respectively. Hypercholesterolemia was found in 17 (44.7%) cases with grade 2 meibomian gland function (i.e. expressibility) (p=0.038) and 26 (68.4%) cases with grade 2 meibomian gland secretion (p = 0.037), these associations were statistically significant. Conclusions: Moderate MGD (i.e. grade 2 expressibility and secretion) is associated with elevated level of total cholesterol (i.e. serum cholesterol level ≥ 200 mg/dl).
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CURRENT OPINION Top

Nonsurgical management of periocular scars along with review of literature p. 213
Neha Shrirao, Bipasha Mukherjee
DOI:10.4103/tjosr.tjosr_69_19  
Introduction: Facial scars in the periocular region may cause cosmetic blemish as well as functional deficits. There are several treatment options available for scar management, but many of these are unsuitable for periocular region because of their potential to cause damage to the ocular structures. This article aims to present an ophthalmic plastic surgeon's perspective of managing these scars safely and effectively. Methods: An extensive literature search was done using PubMed (Medline), Cochrane, and Google Scholar with multiple combinations of search terms such as scar, facial scar, contracture, and keloid. Articles in English language published describing the existing and emerging modalities of treatment for periocular facial scars were reviewed. Results: The scarring pattern in the face and periocular area is different as wound healing in these areas differs from that of the rest of the body. Various techniques ranging from simple scar massage to laser and intralesional steroids and antimetabolites have been described with good results for managing scars in various parts of the body. However, safety of some of these modalities in periocular region has not been established unequivocally as yet. Conclusion: Effective scar management requires a multipronged therapeutic approach. Facial and periocular scars deserve special care due to their close proximity to the eyes. Hence, it is paramount that safety of any approach be ascertained prior to the procedure, especially in periocular areas.
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REVIEW ARTICLE Top

Interpreting HFA single field reports p. 220
Panda Smita, George Ronnie, Murali Ariga
DOI:10.4103/tjosr.tjosr_62_19  
Autoperimetry is a very important investigation for glaucoma diagnosis and management. This article deals with the basics and terminologies used in humphrey visual field analysis and deals with the interpretation of humphrey visual field analysis printout.
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CASE REPORTS Top

Potentially life-threatening consequences of peribulbar anesthesia p. 231
Shahinur Tayab, Susmita Paul, Prafulla Sarma
DOI:10.4103/tjosr.tjosr_72_19  
Peribulbar anaesthesia is the most commonly used anaesthesia for intraocular surgeries, especially glaucoma and vitreoretinal surgeries. We present a case of a 70 years old man who became unconscious and developed other signs of brainstem anaesthesia following peribulbar block for a combined glaucoma and cataract surgery. Complications with peribulbar anaesthesia are remote but possible. Patients undergoing ocular surgeries under peribulbar anaesthesia should be closely monitored and facilities to tackle such life threatening complications must be available in the operation theatre.
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Augmented inverse knapp procedure with inferior rectus plication – A treatment option for large hypertropia p. 233
Sandra C Ganesh, DS Srushti, Easha Ramawat, Kalpana Narendran
DOI:10.4103/tjosr.tjosr_42_19  
In this case report, we present a novel surgical technique of combining horizontal recess–resect procedure with an inverse Knapp procedure and augmenting the desired effect using augmentation sutures. Apart from improvement in the field of binocular vision, this procedure had the added advantage of preserving the anterior ciliary circulation by involving not more than two rectus muscles (inferior rectus plication being a vessel-sparing procedure). This could be a helpful option in large hypertropia with negative forced duction/generation test (for vertical recti).
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Intraoperative ciliary body inflammation as a masquerade for postoperative wound leak following manual small-incision cataract surgery p. 237
Bharat Gurnani, Kirandeep Kaur, Manas Nath, Prasanth Gireesh
DOI:10.4103/tjosr.tjosr_18_19  
This case highlights the postoperative management of a patient with hypotony who masqueraded as wound leak following manual small-incision cataract surgery (MSICS). A 66-year-old male patient underwent uneventful MSICS in the left eye. He developed postoperative hypotony following surgery. B-scan revealed a small peripheral shallow serous choroidal detachment. There was a mild conjunctival retraction which masqueraded as postoperative wound leak. Postoperative hypotony resolved after conservative management.
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Aftermath of topiramate: An interesting case report and literature review p. 240
Vijayalakshmi A Senthilkumar, Sharmila Rajendrababu
DOI:10.4103/tjosr.tjosr_73_19  
We report an interesting case report on idiosyncratic reaction of topiramate causing bilateral secondary acute angle-closure glaucoma with glaukomflecken, which mimicked acute primary angle closure (APAC) with nongranulomatous uveitis and choroidal effusions. After conservative management, signs and symptoms stabilized within 72 h, but the patient developed posterior synechiae with intermittent peripheral anterior synechiae (PAS) in BE, which was more prominent in LE. Here we report this case because presentation of topiramate-induced idiosyncratic reaction with glaukomflecken and subsequent resolution with posterior synechiae and PAS were rarely documented in literature. A detailed history taking and meticulous clinical evaluation helped us differentiate from APAC.
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A Case of bilateral agenesis of nasolacrimal ducts with posterior lenticonus p. 243
Pratheeba Devi Nivean, Bipasha Mukherjee
DOI:10.4103/tjosr.tjosr_71_19  
Congenital absence of nasolacrimal ducts is a rare presentation of nasolacrimal obstruction in children, but a frequent cause of failure of probing, especially if endoscopic examination is not undertaken. We report a rare association of bilateral absence of nasolacrimal ducts along with bilateral visually significant developmental cataracts with posterior lenticonus in a 1-year-old female child with dysmorphic features.
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REMEMBERING THE PAST Top

RIO GOH – A journey of 200 years p. 245
Jabeen Naz, Syed Arshad
DOI:10.4103/tjosr.tjosr_98_19  
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Elliot's Museum – A Thing of beauty p. 248
M Ananda Babu
DOI:10.4103/tjosr.tjosr_99_19  
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Ah, those were the days p. 250
K Vasantha
DOI:10.4103/tjosr.tjosr_97_19  
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Nostalgic journey of Regional Institute of Ophthalmology-Government Ophthalmic Hospital, Egmore – Bicentennial celebrations (1819–2019) p. 252
Gangadhara Sundar
DOI:10.4103/tjosr.tjosr_87_19  
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PHOTO IMAGES Top

“Two's company, three's a crowd”: Retinal vein occlusion in an eye with optic disc pit and uveal coloboma p. 254
Navya Cherukuri, Bhavik Panchal, Avinash Pathengay
DOI:10.4103/tjosr.tjosr_47_19  
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Opacification in hydrophobic and hydrophilic acrylic intraocular lenses p. 255
Sudhakar Potti, Akhil Bevara
DOI:10.4103/tjosr.tjosr_54_19  
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White eyed blowout fracture of orbit in elderly patient - An unusual presentation p. 256
V Muthukrishnan, R Senthil Prasad, Juhi Sahu, Shravya Choudhary Balla
DOI:10.4103/tjosr.tjosr_32_19  
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JOURNAL REVIEW Top

Journal scan p. 257
Amogh Laxman Jambagi, Sharmila Devi Vadivelu, M Sivakami
DOI:10.4103/tjosr.tjosr_92_19  
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LETTER TO THE EDITOR Top

Credit where credit's due p. 259
Aditya Pradhan
DOI:10.4103/tjosr.tjosr_53_19  
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REPLY TO THE LETTER Top

Reply to the Letter to the editor p. 260
Sharmila Devi Vadivelu
DOI:10.4103/tjosr.tjosr_76_19  
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PHOTO QUIZ Top

Photo quiz answers p. 261
Venkatesh N Prajna, Naveen Radhakrishnan
DOI:10.4103/tjosr.tjosr_75_19  
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Answers to orbit and oculoplasty quiz p. 263
Kavitha Ramakrishnan
DOI:10.4103/tjosr.tjosr_77_19  
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