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   Table of Contents - Current issue
January-March 2020
Volume 58 | Issue 1
Page Nos. 1-60

Online since Wednesday, March 4, 2020

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Scalpel tales p. 1
Sharmila Devi Vadivelu
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Quo Vadis? p. 3
NV Arulmozhi Varman
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Clinical Profile and Management Outcomes of Periocular Molluscum Contagiosum Highly accessed article p. 5
Bipasha Mukherjee, Harshit Vaidya, Md Shahid Alam
Purpose: To study the clinical profile and management outcomes of histopathologically proven cases of eyelid molluscum contagiosum (MC). Materials and Methods: A retrospective analysis of the medical records of patients presenting to a tertiary eye care center between January 1995 and December 2018 was carried out. Of 67 patients clinically suspected of harboring molluscum lesions of the eyelids, 32 were confirmed on histopathology. Results: Mean age of the patients was 7 years (1.3–69). Of 32 patients, 17 (53%) were males and 15 (47%) were females. Eyelid mass lesion was the most common complaint (87.5%). Lower eyelid was the most common site (14/44%). Eighteen (56%) patients had a solitary lesion whereas 14 (44%) had multiple lesions. Characteristic umbilication was seen in 14 (44%) cases. Associated ocular surface findings were observed in 21 (66%) patients, of which most commonly noted were follicles, papillae, and eyelid edema. Lymphadenopathy was observed in two patients. Excision with or without cautery was performed in all patients. One patient had a recurrence after 5 months. None of the patients were immunocompromised. Most common misdiagnosis was sebaceous cyst (5), chalazia (2), and viral warts (2). A positive clinicopathological correlation was found in 59.34% cases. Conclusion: MC is a common infectious eyelid lesion in immunocompetent children. Characteristic central umbilication of the lesion provides a clue to clinical diagnosis; however, it can mimic many other eyelid lesions. Complete excision offers cure in almost all cases.
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Assessment of visual prognosis using Ocular Trauma Score in open globe injury at a tertiary care center p. 9
Gomathi Nayagam, Malarvizhi Raman, A Anuradha, S Sheela, Nisha Chakravarthy
Aims and Objectives: The aim and objective of this study was to assess the visual prognosis in open globe injury patients using the “Ocular Trauma Score (OTS).” Methodology: A prospective study of 100 patients with open globe injury attending a tertiary referral eye care center, Chennai, was carried out for a period of 12 months from February 1, 2018, to February 1, 2019. Results: The mean age of presentation was 40 years. Males (75%) were more commonly injured compared to females (11%). The right eye (65%) was more commonly injured than the left eye (35%). Out of the 100 patients, 96 patients underwent surgical management and 4 patients were managed conservatively. Out of the 96 patients, 26% had globe ruptures, 11% had relative afferent pupillary defect, 10% had perforating injuries, 8% had retinal detachment, and 4% had endophthalmitis. OTS was 1 in 9% of patients, 2 in 30%, 3 in 35% patients, 4 in 15% patients, and 5 in 11% patients, indicating that most of the patients had poor visual acuity at the time of presentation with an OTS value of 1–3. At the end of 6 weeks, 18% of the patients had a vision of no perception of light, 21% had a vision of percentage of light/hand movements, 25% had 1/200–19/200, 18% had 20/200–20/50, and 18% had >20/40. Majority of the patients had a visual acuity between 1/200 and 19/200. The results were analyzed with the OTS value chart. Conclusion: OTS is a comprehensive score to predict final visual outcome in patients with open globe injury, which can be widely used for counseling ocular trauma victims. OTS calculated at the initial evaluation has predictive value in patients with open globe injury.
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The clinical pattern of orbital mucormycosis in a tertiary eye care hospital p. 14
M.V.S. Prakash, P Ashok Kumar, TG Umamaheswari, V Harivanzan
This study aimed to report the clinical profile of patients with rhino-orbital mucormycosis at a tertiary eye care center in Tamil Nadu. This was a single-center, retrospective case series of patients who were diagnosed as rhino-orbital mucormycosis between January and December 2018. The study included nine patients of rhino-orbital mucormycosis with a mean age of 53.33 ± 8.3 years (range: 35–61 years), comprising five males and four females. All the cases were unilateral in presentation. Uncontrolled diabetes mellitus was the most common underlying predisposing factor. Four patients presented with proptosis, two patients complained of headache, and five patients had defective vision. Computed tomography scan showed pansinusitis in six patients. Total ophthalmoplegia was noted in four patients. All patients received parenteral therapy with amphotericin B. Rhino-orbital mucormycosis is a rare, life-threatening, and insidious fungal infection. Uncontrolled diabetes mellitus and immunosuppression are the most important risk factors. The orbital findings may range from orbital pain to ophthalmoplegia and blindness. We present this case series to emphasize the importance of early diagnosis and treatment of rhino-orbital mucormycosis.
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Flash Box - A pragmatic tool to hone surgical skills of residents during postgraduate curriculum in ophthalmology p. 17
Abha Shukla, Prabha Gupta
Purpose: To introduce a novel pragmatic tool (FLASH BOX) to help students learn, practice, and improve surgical skills during postgraduate curriculum in ophthalmology, especially small incision cataract surgery (SICS). Materials and Methods: Surgical training and transfer of surgical skills to the ophthalmology residents who will be our future lineage is the need of a good residency program. Animal eyes, postmortem human eyes, simulators, devices, teaching tools such as Kitaro dry lab and wet lab system kit are currently available to learn and practice surgical steps. Their availability in teaching institutes is really grueling. Flash box is a simple intraocular lens box freely available in each operation theater in all set ups and can be used freely to learn and master various steps of SICS. Results: Practicing on Flash box allows residents to get familiar with various surgical steps, operating microscope, and ophthalmic microsurgical instruments in a stress-free environment and helps to nurture surgical skills in residents. Conclusion: Flash box will help in the transformation of the surgical mindset of residents and can be a very helpful option for learning surgical steps of various ophthalmic surgeries.
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Ocular ischemic syndrome p. 20
S Balamurugan, B Manohar Babu, Bharat Gurnani, Annamalai Odayappan, Mikeen Shah, Kirandeep Kaur
Carotid occlusive disease is frequently associated with ocular involvement among which ocular ischemic syndrome (OIS) is one of the most challenging. OIS is a severe form of chronic ischemia of the anterior, posterior segments of the eye, and other orbital structures supplied by the ophthalmic artery. The diagnosis of OIS may be difficult to make because of its variable presentations. In patients with known cerebrovascular or cardiovascular disease, a careful examination should be done to look for the presence of ocular involvement. Once identified, a variety of noninvasive and invasive techniques may be employed to determine the degree of stenosis, and an appropriate treatment plan can be initiated. The first signs of carotid occlusive disease may be observed in the eye before they are observed in the cerebrovascular system, and thus, the ophthalmologist has a major role in the proper diagnosis and prompt referral. Although the prognosis for OIS is poor, early recognition and treatment of patients with carotid occlusive disease may help reduce mortality. In this article, we aim to present an overview of the current knowledge on OIS based on an extensive review of recent studies.
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Pressure-induced stromal keratopathy after laser-assisted In situ keratomileusis with high intraocular pressure in disguise p. 27
KS Siddharthan, CM Pooja, GV Prabhakar
Here, we report the case of a 28-year-old male patient who underwent uncomplicated laser-assisted in-situ keratomileusis (LASIK) in both eyes 10 days earlier and came with complaints of blurring of vision in the left eye with vision of 20/20. The patient gave a history of not tapering steroids as advised. His intraocular pressure (IOP) measured with rebound tonometer was 15 mmHg in the right eye and 25 mmHg in the left eye. On slit-lamp examination, the LASIK flap was intact in both the eyes, but the cornea appeared hazy in the left eye. Optical coherence tomography shows a central thickness of 524 μ in the left eye. The patient was diagnosed to have pressure-induced stromal keratopathy. The patient was switched to low-potency steroids, and anti-glaucoma drugs were given. On follow-up on slit-lamp examination, there was a significant decrease in haze in the left eye clear vision of 20/20 in both the eyes. It is important to recognize and treat PISK appropriately, as untreated elevated IOP can lead to optic nerve damage even over a brief period of several weeks.
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CM T – Flex intraocular lens an innovative design for aphakia secondary to postcataract surgery p. 30
M Nivean, Pratheeba Devi Nivean, Nishanth Madhivanan, P.A.P. Aysha
Here, we report a case of 66-year-old female who came with a history of secondary aphakia due to the complication of cataract surgery in the left eye with a vision of HM + which is improving with pinhole to 6/9 and right eye PCIOL with a vision of 6/6, managed with new foldable acryflex T IOL (CM T FLEX) scleral fixated intraocular lens (IOL). Two partial-thickness limbal-based scleral flaps of 2.5 mm × 2.5 mm were created 180° apart; sclerotomies were made using 23G needle 1.5 mm away from the limbus. The new acryflex T–flex IOL implantation was performed through the 2.8 mm clear corneal tunnel incision, and T-shaped IOL haptics were externalized with the 23G forceps under the scleral flap. Fibrin glue was used to close the scleral flaps and conjunctiva. Postoperative period was uneventful; at the end of 1 month, the patient regained a good visual acuity of 6/6 (P) with a good stable centration of IOL.
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Case reports of orbital hematoma: Surgical intervention or observation p. 34
Malarvizhi Raman, A Anuradha, K Vasumathi, S Sheela, AD Abinaya
We are reporting two cases of orbital hematoma, one who underwent surgical intervention and another case was observed. A 14-year-old boy presented to us with proptosis and features of optic nerve compression following trauma. Imaging revealed globe tenting, and the patient underwent hematoma aspiration with canthotomy. After 6 weeks, proptosis resolved with 6/6 vision and full extraocular rectus muscles (EOM). An 11-year-old girl presented to us with proptosis and diplopia following a trivial fall. Computed tomography orbit revealed a large variable dense lesion located at the intraconal and medial aspect of extraconal space. Since there were no features of optic nerve compression, the child was treated with oral steroids and was observed. After 2 weeks, proptosis resolved with full EOM.
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Calotropis-induced corneal toxicity in Indian medicinal use: A rare case report with review of literature p. 37
Vaibhav Kumar Jain, Divya Kesarwani, Vishal Yadav, Kumudini Sharma
The use of Calotropis plant is widespread in the Indian system of Medicine (Ayurveda) and for religious purpose as an offering to Hindu god. Having an advantage of growing abundantly in unfavorable and harsh atmosphere, this shrub is easily found in many Indian states. We report here a case, in which a young boy developed severe corneal edema in both eyes following the application of Calotropis latex over the scalp area for the treatment of alopecia as prescribed by some Ayurveda practitioner. Patient responded well with the treatment including topical steroids with a complete resolution of corneal edema and persistent endothelial cell loss at the end of 6 weeks. This case report highlights the possibility of Calotropis-induced corneal endothelial toxicity while using it as an Ayurveda remedy and its management. Public education is must regarding this particularly in India where the use and availability of Calotropis shrub is widespread.
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Postoperative tilting of a well-enclaved retropupillary iris claw intraocular lens: A rare complication p. 40
Shivkumar Chandrashekharan, Shweta V Sabnis, Ramakrishnan Rengappa
Here, we report a rare complication of the retropupillary iris claw intraocular lens (IOL) which in recent times has emerged as a good option for implantation in cases with inadequate capsular support following cataract surgery. Three weeks after undergoing iris claw IOL implantation, our patient presented with sudden decrease in visual acuity. On examination, we found the iris claw IOL to be tilted by 90° and lying perpendicular to the pupillary plane with the haptics still enclaved. Resurgery was done to reposition the IOL. The tremulousness of the iris causing an anterior movement of the iris diaphragm and IOL, aided by prolapse of vitreous could have caused the tilt.
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Enophthalmos as the presenting feature of electrical injury p. 43
Bipasha Mukherjee, Andrea Tongbram
A 34-year-old Asian–Indian male presented with a history of sustaining electrical injury with a high-tension wire 10 years ago following which his right arm was amputated. He also gave a history of progressive shrinkage of the right eyeball since then. The right eye showed a deep superior sulcus with an enophthalmos of 6 mm. The rest of the ocular examination was within the normal limits. Various ophthalmic complications have been reported after electrical injuries, cataracts being the most common. Enophthalmos without any intraocular changes has not been reported after electrical injury.
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Microphthalmia with pseudogliomatosis proliferation in the retina and orbital cyst p. 46
Bipasha Mukherjee, Daxa Sankadasariya, Kuldeep Bhadiyadara, S Krishnakumar
A 28-year-old systemically healthy male presented with a history of decreased vision in the right eye and a blind, undersized left eye since birth. On evaluation, the patient had typical inferonasal iris coloboma and retinochoroidal coloboma in the right eye and left disorganized microphthalmic globe with colobomatous cyst and contracted socket. The patient underwent left eye injection of 0.25 ml ethanolamine oleate injected into the cyst after aspiration of the cyst contents. The patient had persistent colobomatous cyst, for which he underwent left eye excision of the microphthalmic globe with orbital cyst. Histopathological examination revealed thickened cyst wall, multiple nodules of dysplastic retinal tissues without proper lamination and extensive surrounding fibrosis, deposition of eosinophilic material around the blood vessels and retina, and multiple foci of calcification without atypia and mitosis. The diagnosis of a unilateral microphthalmic phthisical eye with pseudogliomatosis proliferation in the retina and in the orbital cyst was made.
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Innovations in retinal diagnosis and surgery p. 49
VG Madanagopalan
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Intraocular lens opacification p. 50
Mayuri Borgohain, Shahinur Tayab, Prafulla Sarma, Chengchira A Sangma, Susmita Paul
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Bilateral senile true exfoliation of the lens capsule with chronic glaucoma p. 51
Vijayalakshmi A Senthilkumar, Shiva M Krishna
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A rare sighting: Xanthelasma in a 9-year-old child p. 52
Aditya Sethi, Sahebaan Sabharwal Sethi, Shenouda Girgis, Arun Sethi
Xanthelasma palpebrarum, a very common type of xanthoma seen in adults, is an extremely rare sighting in children. To date, less than five cases of the same have been reported in the literature. The purpose of this study is to report and describe the clinical findings in a patient with juvenile xanthogranuloma. We present one such case of the rare xanthelasma in a 9-year-old child who reported to our outpatient department.
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Bilateral spiderweb in the anterior chamber of the eye: Persistent pupillary membrane p. 54
Vijayalakshmi A Senthilkumar, Techi Dodum Tara
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A rare case of bilateral Franceschetti–Goldenhar syndrome manifesting as uniocular amblyopia p. 55
Bharat Gurnani, Kirandeep Kaur, Josephine Christy, Prasanth Gireesh
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Keyser–Fleischer ring with sunflower cataract: A clinching sign of Wilson's disease p. 57
Vaibhav Kumar Jain, Priya Singh, Sarswati , Anubha Ojha, Kumudini Sharma
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Topiramate features: Mnemonic p. 58
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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Journal scan p. 59
Niranjan Karthik Senthil Kumar, Sharmila Devi Vadivelu
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