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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 57 | Issue 2
Page Nos. 103-192

Online since Tuesday, September 10, 2019

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EDITORIAL  

The Wounded Healer p. 103
Sharmila Devi Vadivelu
DOI:10.4103/tjosr.tjosr_64_19  
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ORIGINAL ARTICLES Top

Surgically induced astigmatism in manual small-incision cataract surgery: A comparative study between superotemporal and temporal scleral incisions p. 105
Machireddy R Sekharreddy, Venkatesh Sugantharaj, Shruti Prabhat Hegde
DOI:10.4103/tjosr.tjosr_23_19  
Purpose: The purpose of this study is to compare the surgically induced astigmatism between superotemporal and temporal approaches in manual small-incision cataract surgery (MSICS). Materials and Methods: This was a prospective, hospital-based, interventional study with two groups each consisting of 50 patients. Patients in Group A underwent superotemporal MSICS and those in Group B underwent temporal MSICS. Statistical analyses of the results obtained were done with the SPSS software version 20, and data sets were compared using an independent sample t-test. Results: Astigmatism induced by superotemporal incision was 0.8032 ± 0.322 D, whereas astigmatism induced by temporal incision was 0.3826 ± 0.142 D with the difference being statistically significant. Both the groups showed significant improvement in postoperative uncorrected visual acuity. Conclusions: This study showed that the temporal MSICS induces lesser astigmatism as compared to the superotemporal approach. However, unaided postoperative visual acuity was comparable and good in both the groups.
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Topical nepafenac in the treatment of center involving diabetic macular edema p. 109
TP Vignesh
DOI:10.4103/tjosr.tjosr_12_19  
Purpose: To assess the efficacy of topical nepafenac 0.1% in the treatment of center-involving diabetic macular edema (DME). Design: A prospective, interventional case series. Methods: Fourteen eyes of thirteen patients with center-involving DME were included in the study, and they were administered topical nepafenac eye drops 0.1% thrice daily, for 6 months. Vision and foveal thickness were recorded at the baseline and 2nd, 4th, and 6th month follow-up visits. Results: The mean baseline and final LogMAR visual acuity were 0.35 and 0.18, respectively, and the mean baseline and final foveal thickness were 463.4 μm and 291.8 μm, respectively, both showing a statistically significant improvement (P < 0.05). Conclusion: Topical nepafenac is effective in the treatment of center-involving DME in this small case series; however, a large randomized study is warranted.
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A study on the safety and efficacy of posterior chamber phakic intraocular lens (refractive implantable lens) in high myopia p. 113
Sivaviganesh Subramanian, Sharmila Devi Vadivelu, M Ananda Babu, B Meenakshi, Jiz Mary Santhosh
DOI:10.4103/tjosr.tjosr_45_19  
Background: Myopia is the most common refractive error worldwide causing visual impairment in children and adults. The prevalence of high myopia varies with age and ethnicity. High myopia has been found to be visually debilitating and affects day-to-day activities of the individual. Aim: This study aimed to analyze the efficacy and visual outcomes of posterior chamber phakic intraocular lens-refractive implantable lens (RIL) in high-myopia patients. Methods: This prospective study was conducted in a tertiary care center during February 2017–February 2018. Results: This study included 50 eyes of 34 patients, which showed 82% of eyes had uncorrected visual acuity equal or better than preoperative best-corrected visual acuity and 52% eyes had visual acuity of 6/6. No incidence of cataract was observed in this study. Conclusion: Refractive results after RIL implantation are found to be safe and satisfactory and has favorable visual outcome.
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Subthreshold micropulse yellow laser in the treatment of central serous chorioretinopathy p. 118
TP Vignesh
DOI:10.4103/tjosr.tjosr_43_19  
Purpose: The objective was to study the safety and efficacy of subthreshold micropulse yellow laser in the treatment of central serous chorioretinopathy (CSCR). Materials and Methods: This is a retrospective interventional case series in a tertiary eye care center. Patients diagnosed to have CSCR were treated with subthreshold micropulse yellow laser, over the leaks identified by fundus fluorescein angiography. Subretinal fluid (SRF) level was measured by optical coherence tomography at baseline and the follow-up visits at 1, 3, and 6 months. Results: Twelve eyes of 12 patients were included, and there was a statistically significant improvement in visual acuity as well as reduction in SRF level between baseline and the follow-up visits. Conclusion: There was a beneficial effect of subthreshold micropulse yellow laser in the treatment of CSCR in this study, with complete resolution of SRF in ten out of 12 eyes (83.3%). However, a larger study is warranted.
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A study on evaluation of eyelid trauma in a tertiary care center p. 122
A Anuradha, Malarvizhi Raman, Jaya Jarika
DOI:10.4103/tjosr.tjosr_28_19  
Aim: This study aims to evaluate traumatic eyelid injuries and assess functional outcome following treatment. Materials and Methods: A prospective study of 30 cases of lid injury was conducted at Orbit and Oculoplasty Department, Regional Institute of Ophthalmology and Government Ophthalmic Institute, Egmore, Chennai, Tamil Nadu, for 12 months from February 01, 2017, to February 01, 2018. Data collected were entered into Excel Spreadsheet and analyzed using STATA statistical software package release 11. Results: The incidence of lid injuries was more in males (63%) compared to females (37%). The most common mode of injury of the eyelid was accidental fall (36.7%) and assault (23.3%). Majority of the cases presented within 6 h of injury. Full-thickness involvement was seen in 20 patients (66.7%). Involvement of the eyelid margin was seen in 18 patients (60%) and was managed by three-layer margin suturing canalicular involvement in 8 cases (26.7%) underwent monocanalicular stent placement. About 40% of patients complained of epiphora and were not satisfied with cosmetic results. Conclusion: This study reveals that young adult males, most of whom were workers, were more prone to eyelid injuries. Timely meticulous management of the eyelid injury with minimal debridement of the wound and tension-free suturing gives better cosmetic outcome. Epiphora, notching of lid margin, or ectropion was the most common complication postoperatively.
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Outcome of early and late vitrectomy for retinal detachment associated with von Hippel–Lindau-related retinal capillary hemangioma p. 128
Karthik Kumar, Piyush Kohli, Naresh Babu, Soumya Jena, Kim Ramasamy
DOI:10.4103/tjosr.tjosr_24_19  
Aim: The aim of this study was to report the outcome of early and late vitrectomy for retinal detachment-associated with von Hippel–Lindau (VHL)-related retinal capillary hemangioma (RCH). Materials and Methods: Records of patients diagnosed with VHL-related RCH, from 2016 to 2018, were retrospectively analyzed for patients' age, gender, family history, systemic disorders, previous treatment taken, clinical characteristics of RCH, associated complications, timing of surgery, and surgical outcome. The treatment of RCH depends on its location, size, and clinical expressions. Results: Twenty-one eyes of 15 patients with a median age of 40 years (range, 22–65 years) were seen. Nine patients had central nervous system hemangioblastomas, eight had associated renal complications (four – renal cell carcinoma and four – multiple renal cysts), four had pancreatic cysts, while one had testicular cyst and pheochromocytoma each. Four eyes presented with no perception of light. Eight eyes presented with retinal detachment (RD). Four eyes underwent a combination treatment, four underwent cryotherapy, five underwent laser, and two underwent transpupillary thermotherapy, while four underwent intravitreal bevacizumab. Of eight eyes with tractional RD (TRD), four presented with no perception of light (NPL) . The other four eyes underwent surgery. Of the eyes that underwent surgery, two underwent early vitrectomy for extramacular TRD, whereas the other two underwent surgery in late stage. The two eyes that underwent early vitrectomy gained best-corrected visual acuity (BCVA) of 20/20, and the retina was attached in single surgery. The other two eyes that underwent surgery at an advanced stage had to undergo multiple surgeries and gained BCVA <10/200. Conclusion: Early vitrectomy is a safe and effective modality of treatment for VHL-related RCH complicated with TRD.
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MAJOR REVIEW Top

Coexistent cataract and glaucoma – Causes and management p. 132
Seshadri J Saikumar, Manju Anup, Abhilash Nair, Namitha R Mathew
DOI:10.4103/tjosr.tjosr_7_19  
The optimal management of a glaucoma patient with cataract has always been a vexing issue. The prime concern has been to adequately control glaucoma while providing visual improvement and decreasing complications due to surgery. Advances in microsurgery techniques have improved surgical outcomes in recent years. However, numerous options exist and the management of an individual patient need to be personalized based on patient needs and surgical proficiency. This article aims to enlighten the reader regarding apt options in dealing with such individuals.
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REVIEW ARTICLE Top

Immunosuppressives and biologicals in uveitis: The way forward – Current concepts p. 139
Karpagam Damodaran, Sudharshan Sridharan
DOI:10.4103/tjosr.tjosr_14_19  
Uveitis constitutes a sight-threatening group of diseases, which includes infectious and noninfectious entities. In this review, we consider the current evidence base for treatments in noninfectious uveitis including immunosuppressives and biologicals. Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.
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CURRENT OPINION Top

Expert corner - diabetic retinopathy p. 146
R Kim, Atul Kumar, Rajiv Raman, Raja Narayanan, Manish Nagpal, Paisan Ruamviboonsuk, VG Madanagopalan
DOI:10.4103/tjosr.tjosr_44_19  
Diabetic retinopathy (DR) continues to be a challenge both to clinicians and patients. The systemic variables involved, local mediators implicated, and the coexistence of other ocular conditions such as cataract requires careful planning and delivery of treatment. With the advent of antivascular endothelial growth factor agents, there has been a paradigm shift in the management of DR. Nevertheless, other treatment options such as retinal laser therapy, intravitreal steroids, and vitreoretinal surgery are equally important in selected clinical scenarios. We have a stellar panel of experts who are world-renowned experts in the field of DR. For the benefit of our readers, they distill the essence of evidence-based medicine and share their expertise with particular focus on real-world scenarios in DR.
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CASE REPORTS Top

A rare case of subclinical scotoma: When the infrared read it better p. 152
Vaibhav Sethi, Aditya Sethi, Arun Sethi, Sahebaan Sethi, Reena Sethi
DOI:10.4103/tjosr.tjosr_25_19  
Commotio retinae (CR) are a disorder of the outer retina, typically following a blunt trauma to the eye. CR leads to visual disturbances mainly in the form of a scotoma. CR clinically presents as a transient gray-white discoloration of the retina and is diagnosed with ease. There are reports of CR presenting without any retinal discoloration but confirmed on optical coherence tomography, or infrared retinal reflectance termed subclinical scotoma. We present one such rare case of subclinical CR without clinical findings, which was diagnosed on infrared reflectance overlay showing a characteristic distinct hyporeflectance pattern.
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A rare case report of congenital bilateral complete ankyloblepharon p. 155
Hemanandini Mangalanathan, Savithiri Visvanathan, Geetha Periasamy, Fathima Sheerin Ayubkhan
DOI:10.4103/tjosr.tjosr_34_19  
Congenital ankyloblepharon describes an eyelid condition when the fused eyelid folds fail to separate and the child is born with completely or partially joined eyelids. Ankyloblepharon is categorized into three types: complete, partial, and interrupted. We report a case of congenital bilateral complete ankyloblepharon in a 1-day-old female neonate who presented with inability to open her eyes since birth. Congenital complete type of ankyloblepharon is extremely rare, and to our knowledge, this is the first case being reported in India. On examination, no other congenital anomalies were noted. The adhesions were incised, and the eyelids were separated. Early diagnosis and management of congenital ankyloblepharon prevent stimulus deprivation amblyopia, and the child should be screened for associated systemic abnormalities.
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A rare and unusual case of cycle pedal in the orbit p. 158
Malarvizhi Raman, A Anuradha, K Vasumathi, S Sheela, C Nisha
DOI:10.4103/tjosr.tjosr_33_19  
A 58-year-old male presented with injury in the left eye by falling over a cycle pedal. On presentation to the casualty, the cycle pedal was found penetrating onto the superomedial aspect of the left orbit. The cycle pedal was removed in toto, and computed tomography brain with orbital cuts revealed fracture in the orbital floor, maxilla, and nasal bone. Upper-lid tear was sutured, and visual acuity was 20/30 no improvement in glass, no improvement in pinhole (NIG, NIP). Thus, immediate extraction of the foreign body resulted in better visual and cosmetic outcome.
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A rare pediatric case of probable Vogt–Koyanagi–Harada syndrome p. 160
Malarvizhi Raman, K Vasumathi, A Anuradha, S Sheela, C Nisha
DOI:10.4103/tjosr.tjosr_37_19  
We report a rare case of probable Vogt–Koyanagi–Harada (VKH) syndrome in a 10-year-old child who presented with visual acuity of only perception of light present in both eyes. The anterior segment examination showed cells, flare (4+), fine keratic precipitates over back of the cornea, posterior synechiae, posterior subcapsular cataract, and fundus showing hyperemic disc with blurred margins. B-scan showed shallow retinal detachment and choroidal thickening. Bilateral panuveitis with normal serological and systemic screening was favoring a diagnosis of probable VKH syndrome. The patient was treated with intravenous methylprednisolone followed by oral prednisolone. Visual acuity improved to 6/24 BE.
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Encephalocraniocutaneous lipomatosis: A rare neurocutaneous disorder p. 163
Antony Arokiadass Baskaran, Tanuja Britto
DOI:10.4103/tjosr.tjosr_38_19  
A 5-year-old boy presented with the left eye epibulbar choristomas, upper lid coloboma, small periocular papules, and lipomatous swelling in the frontoparietal area with patchy alopecia on the left parietal side of the scalp. Neuroimaging showed left-sided cerebral hemiatrophy and ex vacuo dilation of the ventricle. The case was diagnosed as a case of encephalocraniocutaneolipomatosis based on the Moog's criteria. On follow-up after 4 years, the clinical features remained the same with no other systemic issues.
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Isolated anterior-chamber fungal flocculosus in a healthy child with seeding through the trabecular meshwork p. 167
Manjula Jayakumar, Akshaya Parthasarathy
DOI:10.4103/tjosr.tjosr_36_19  
We report a case of isolated anterior-chamber (AC) fungal hyphae in a healthy child following injury with a broomstick with no evidence of obvious intraocular penetration, a rare presentation of isolated traumatic AC mycoses. In our case, although there was no obvious intraocular penetration, a broom bristle could have injured the trabecular meshwork acting as a conduit for the seeding of the fungal growth. Ours is a peculiar case of seeding through the trabecular meshwork so far not cited in literature.
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Iridocele, total aniridia, and subconjunctival pseudomelanosis following blunt ocular trauma: An interesting case report with a new finding p. 170
Isha Agarwalla, Harsha Bhattacharjee, Dipankar Das, Diva Kant Misra
DOI:10.4103/tjosr.tjosr_41_19  
A patient presented with traumatic globe rupture, pseudomelanosis of the conjunctiva, total traumatic aniridia, and subconjunctival iridocele, which was detected following wound exploration. This visually devastating condition of traumatic aniridia, iridocele, and melanosis with complete iris tissue extraction from the anterior chamber is reported for the first time.
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Isolated superior oblique palsy as a complication of pansinusitis following root canal treatment – An unusual scenario p. 173
Muthukrishnan Vallinayagam, Tintu Susan Joy, Shravya Choudhary Balla, Srikanth Krishnagopal, P Karthikeyan
DOI:10.4103/tjosr.tjosr_39_19  
Isolated superior oblique (SO) palsy has been reported in cavernous sinus thrombosis, pituitary microadenoma, tuberculous meningitis, following intraoral local anesthesia, and inferior alveolar nerve block. A 14-year-old boy presented with right SO palsy. There was a history of facial cellulitis, following dental root canal treatment (RCT) 2 weeks back. Magnetic resonance imaging revealed right pansinusitis and breach of the lamina papyracea, with extension of inflammation into the orbit. Complete recovery was noted 1 week after functional endoscopic sinus surgery. The association of SO palsy with sinusitis can be explained by the anatomical proximity of the trochlear nerve to the paranasal sinus or by the extension of infection into the superior orbital fissure. Trochlear nerve is particularly vulnerable due to its location outside the annulus of Zinn. Although multiple ocular nerve palsy following sinusitis is well recognized, isolated SO palsy in pansinusitis following dental RCT has not been reported. An inflammatory etiology carries a favorable prognosis.
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CLINICAL PRACTICE GUIDELINES/RECOMMENDATION Top

How to use pubmed to your advantage? p. 176
Prabu Baskaran
DOI:10.4103/tjosr.tjosr_48_19  
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PHOTO IMAGES Top

Unilateral megalocornea associated with Fuchs' heterochromic iridocyclitis p. 180
Muthukrishnan Vallinayagam, Kannegolla Anudeep, Shravya Choudhary Balla, Juhi Sahu
DOI:10.4103/tjosr.tjosr_31_19  
Fuchs' heterochromic iridocyclitis is an atypical form of chronic nongranulomatous anterior uveitis and is almost always unilateral. It presents with cataract, mild anterior chamber reaction, diffuse stellate keratic precipitates, absence of posterior synechiae, iris hypochromia and glaucoma. It is usually bilateral but may be asymmetrical. Unilateral megalocornea has been reported in a case of lamellar icthyosis. Slit lamp evaluation of right eye of a 70 year old revealed diffusely distributed fine, stellate white keratic precipitates, mild anterior chamber reaction and hypermature morgagnian cataract. Examination also revealed large cornea in right eye with normal pachymetry and keratometry values.
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Posterior communicating artery aneurysm presenting with ipsilateral oculomotor nerve palsy p. 182
Reddy Ravikanth, Kanagasabai Kamalasekar
DOI:10.4103/tjosr.tjosr_22_19  
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Subconjunctival emphysema p. 184
Antony Arokiadass Baskaran, Latha Balasubramaniam, Tanuja Britto, Philip A Thomas
DOI:10.4103/tjosr.tjosr_30_19  
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JOURNAL REVIEW Top

Journal scan p. 186
Nivetha Gandhi, Sharmila Devi Vadivelu, Shruti Nishanth
DOI:10.4103/tjosr.tjosr_59_19  
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PHOTO QUIZ Top

Orbit and Oculoplasty Quiz p. 188
Kavitha Ramakrishnan
DOI:10.4103/tjosr.tjosr_60_19  
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Answers to photo quiz 2 p. 191
M Sivakami
DOI:10.4103/tjosr.tjosr_63_19  
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