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   Table of Contents - Current issue
October-December 2018
Volume 56 | Issue 4
Page Nos. 213-285

Online since Tuesday, February 19, 2019

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Editorial p. 213
Sharmila Devi Vadivelu
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Experience with keratoprosthesis at a tertiary eye care center: A report from North-East India p. 215
Saurabh Deshmukh, Jnanankar Medhi, Balmukund Agarwal, Prafulla Sarma, Krati Gupta
Aim: To evaluate the preservation of visual acuity (VA) and the development of complications after keratoprosthesis (KPro) implantation (Boston KPro and Auro KPro) over a long follow-up period at a tertiary eye center in North-East India. Materials and Methods: This was a single-center retrospective case series. The records of all patients who underwent KPro implantation between March 2013 and August 2017 were analyzed. The preoperative characteristics, postoperative outcomes, complications, its management, and retention rates were reviewed. Results: Ten cases were included in the study. Preoperative VA ranged from counting finger close to face to hand movement close to face. The cause for KPro implantation included multiple graft failures (5 eyes, 50%), chemical injury (3 eyes, 30%), and Stevens–Johnson syndrome (2 eyes, 20%). Mean follow-up duration was 26.9 months (range, 12–54 months). At 1-month follow-up, eight patients had a vision ≥6/60 (80%). At 1-year follow-up, eight patients had a VA ≥6/24. Glaucoma was newly diagnosed in three eyes (30%); progression was noted in one eye (10%). Glaucoma drainage device was implanted in one eye (10%). Retroprosthetic membrane formed in seven eyes (70%) and one eye (10%) underwent KPro replacement. The initial KPro was retained in nine eyes (90%). Conclusions: KPro is an effective and a viable option for treating end-stage corneal diseases for salvaging vision. A significant number of patients lose vision following KPro implantation due to glaucoma and corneal melts. Our study reiterates the importance of regular and long-term follow-up and a comprehensive team approach for management of postoperative complications.
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Clinico-microbial profile of fungal keratitis and detection of Pythium insidiosum: A pilot study p. 219
Prasoon Garg, Rakesh Singh, Ramesh Babu
Background: Infectious keratitis is a leading cause of blindness, more so in developing countries where rates of corneal ulceration are much more than those of industrialized countries. The organisms responsible for infectious keratitis differ regionally, with bacterial organisms more common in temperate climates and fungal organisms more common in tropical climates. A large fraction of infectious corneal ulcers that are referred to tertiary care centers in South India is fungal in etiology. Methods: Parameters studied were age, sex, residential district, occupation, risk factor, clinical presentation, microscopic examination of the sample, fungal culture, and Pythium insidiosum. Results: History of trauma was observed in half the cases. History of contact lens usage or diabetes mellitus was not seen in any case. Hypopyon was seen in 50% of the cases of which 33.33% were immobile. KOH preparation for all the samples was negative. Of the 15 samples sent for culture, 12 grew no fungus and 2 were contaminated. One fungus grew and was identified as Aspergillus terreus. P. insidiosum could not be isolated.
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Perspective about blindness and vision 2020-national program for control of blindness among students of different disciplines and general population p. 222
Annamalai Sowmiya, Sankar Muthuramalingam, Krishnamoorthy Ilango
Objectives: To study the awareness about causes of blindness, Eye donation, NPCB and Vision 2020 among students of Medical, Paramedical, Engineering College and General Public in a semi-urban centre. Materials and Methods: A cross sectional descriptive study was conducted at the Velammal Medical College Hospital in 4 months duration, which recruited around 2000 individuals from general public, students from various disciplines. A semi structured Questionnaire was presented and responses were recorded. They were analysed statistically. Results: Almost half of the respondents were not aware about existence of NPCB programme and awareness about existence of programme is high among Nursing Students (96.92%). Awareness about causes of blindness is significantly higher among Medical students (99.23%).Awareness about eye donation is only about 74.5%. Awareness about various aspects of Childhood eye diseases is about 70-80%. Conclusion: There is an improper utilisation of NPCB programme services due to lack of awareness about the same. Some of the strategies that the students were willing to participate were widespread awareness programmes in media and outreach programmes at gross root level. So we should utilise the resources and potential of student community in educating the public.
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Ophthalmological and medical long-term follow-up of patients with central retinal vein occlusion p. 226
Shadi Alashwal, Vittoria Murro, Andrea Sodi, Gianni Virgili, Rossella Marcucci
Purpose: The purpose of this study was to evaluate the ophthalmological and medical aspects of patients with a history of central retinal vein occlusion (CRVO) after a long-term follow-up. Design: This was a retrospective case–control study. Materials and Methods: Twenty-seven consecutive CRVO patients (29 eyes) were enrolled between April 2011 and April 2012, each participant underwent a comprehensive and detailed interview and also they had an ophthalmic examination with investigations such as color retinography and optical coherence tomography. Finally, medical and cardiologic examinations, including the laboratory analysis of blood specimens, were performed to all participants. Results: Our data confirm the significant association of CRVO with age (P = 0.025) and with ischemia (P = 0.022) and also treatment with low-molecular-weight heparin. Main risk factors of developing CRVO were as follows: hypertension (59.0%), dyslipidemia (48.0%), blood diseases (15.0%), and high body mass index (15.0%). There was no any significant association between all of the thrombophilic factors (laboratory parameters) and visual acuity (VA), except IgG anticardiolipin antibodies (P = 0.004). Two patients had myocardial infarction during the follow-up period. There was a parallel reduction of VA and foveal thickness during a long follow-up period. Conclusions: VA and central foveal thickness decreased during the follow-up period probably because of a progressive atrophy of the central retinal area, which suggest an early treatment of the macular edema prior an unfavorable evolution of the clinical situation, only one laboratory parameter had association with VA, small minority of patients developed serious cardiovascular events during the follow-up period after CRVO; these data suggest no overall association of CRVO with cardiovascular events.
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Pediatric intraocular lens power calculation p. 232
Sandra Chandramouli Ganesh, Shilpa G Rao, Farhadul Alam
Pediatric cataracts pose multiple challenges in terms of management and postoperative rehabilitation. Difficulties in obtaining accurate measurements for axial length and keratometry are encountered due to poor cooperation in children and instrumentation errors. There exist multiple formulae for intraocular lens (IOL) power calculation, which are based on various factors and have varying degrees of accuracy. Children exhibit a tendency for myopic shift due to the anatomical differences from adult eyes and due to the growth of eyeball, as a result of which they require undercorrection, when IOL implantation is planned.
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Scleral-fixated intraocular lenses p. 237
VG Madanagopalan, Parveen Sen, Prabu Baskaran
Scleral-fixated intraocular lenses (SFIOLs) are important tools for an ophthalmologist when dealing with the eyes that have inadequate capsular support. Since the time of its introduction, SFIOLs and techniques for their implantation have seen many innovations. Initially, sutured SFIOLs were widely performed. In the last two decades, sutureless SFIOLs are gaining popularity. Both these methods and the different surgical techniques to perform them offer unique advantages to the surgeon. Therefore, careful consideration is to be given to the choice of technique and steps to be employed for a particular eye. In this article, we aim to provide an overview of the commonly used techniques in SFIOL surgery and provide certain surgical tips that may help the surgeon in the operating room.
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Cerebral visual impairment p. 244
Meenakshi Swaminathan, Yamini Patial
In developing countries like India, cerebral visual impairment (CVI) is becoming common cause of visual impairment due to better neonatal care and advancement in technology. CVI is characterized by visual malfunction due to the retrochiasmal and visual association pathway pathology. The visual malfunction can present in any combination and any severity in the setting of developing brain functions. Higher centers damage may lead to cognitive dysfunction. Most common cause of CVI is hypoxic ischemic encephalopathy, due to reduced blood flow in immature brain blood vessels in watershed zones. Early identification of impairment and early intervention help these children to achieve higher level of vision. Customized and integrated approach needed between ophthalmologist, paediatrician and other interventional professional. Counselling of parents also have very important role in the treatment.
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Bilateral inferior lens coloboma in a case of Marfan's syndrome p. 247
Krati Gupta, Saurabh Deshmukh, Damaris Magdalene
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Foveal simple hamartoma of retinal pigment epithelium p. 249
Prabu Baskaran, Nagesha Chokahalli, Pratyusha Ganne
Congenital anomalies of retinal pigment epithelium (RPE) are rare entities among which simple hamartoma of RPE is extremely rare. Majority of reported cases of congenital simple hamartoma were extrafoveal and patients were asymptomatic. These lesions may pose diagnostic challenge if not aware. Here, we present two cases of simple congenital hamartoma involving fovea presenting with diminished vision and also discuss the review of literature in brief.
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Combined penetrating keratoplasty with extraocular needle-guided haptic insertion technique p. 251
Prabu Baskaran, Seema Ramakrishnan, Pratyusha Ganne, Nagesha Chokahalli Krishnappa, Rengaraj Venkatesh
Scleral fixation of intraocular lens (SFIOL) is a challenge in eyes with opaque corneas. It is preferable to implant the IOL before performing penetrating keratoplasty. Most techniques described so far involve SFIOL following corneal trephination (open sky) which increases the risk of expulsive choroidal hemorrhage. Extraocular needle-guided haptic insertion technique involves extraocular docking of the IOL haptic into a bent 26-gauge needle followed by its exteriorization. Since this crucial step of SFIOL surgery is completely extraocular, this method can be used to safely place an SFIOL in a well-formed globe even before corneal trephination. Use of a silicone stopper over the leading haptic prevents intraocular rebound of the haptic.
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Congenital rubella syndrome p. 254
B Pramila, M Bharathi Mohan, K Kavitha
This is a report of a very rare case of congenital rubella syndrome with congenital sensorineural hearing loss, rubella retinopathy, and congenital heart disease with patent ductus arteriosus. After the introduction of the rubella vaccine in 1969, the number of babies born with congenital rubella is much less and rare. Not all the babies born with congenital rubella have the classical triad. Hence, our patient who has all the features of the classical triad is an extremely rare one. The baby underwent surgery for patent ductus arteriosus and cochlear implant procedure for sensorineural hearing loss. She is now under follow-up with us for pigmentary retinopathy.
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Misdiagnosis of missed diagnosis p. 257
Sadiqha S Banu, Malarchelvi Palani, Pratheeba Devi Nivean, M Nivean
Papilledema is swelling of the optic nerve head, a sign of increased intracranial pressure. It can have underlying life-threatening etiologies such as intracranial space-occupying lesions or meningitis. However, pseudopapilledema is elevation of the optic disc secondary to local underlying structural conditions. Distinguishing between papilledema and pseudopapilledema is needed to avoid subjecting the patient to unnecessary tests and anxiety associated with it. We report a case of an 18-year-old male who presented to us with the clinical suspicion of disc edema. Simple noninvasive investigations such as red-free fundus photography and ultrasound B-scan aided us to diagnose it as a case of pseudopapilledema-optic nerve head drusen. Thus, a high index of suspicion along with the ancillary tests is helpful in differentiating pseudopapilledema from true papilledema.
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A case of hypotony maculopathy after aqueous drainage implant p. 261
A Sudarvizhi, V Sharmila Devi, M Ananda Babu
A 60-year-old male presented with defective vision and low intraocular pressure (IOP) in the left eye (LE) following cataract surgery combined with aqueous drainage implant which was done elsewhere 2 months ago. In the right eye (RE), he presented with primary angle closure glaucoma and Grade 2 nuclear sclerosis. In LE, scleral patch graft with loose sutures with shallow anterior chamber and nonvalved aqueous drainage implant with fundus features suggestive of hypotony maculopathy were noted. The patient underwent tight compression suturing of scleral patch graft with intracameral sodium hyaluronate injection for LE and clear corneal phacoemulsification with trabeculectomy with releasable sutures with Mitomycin-C 0.02% for RE. Postoperatively, visual acuity and IOP in LE were improved and in RE postoperative outcome was successful with no complications.
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Caruncular dermoid: A report of a rare case p. 263
P Saravana Sankar, Shanmugam Rajeswari, K Kavitha
A dermoid is an overgrowth of normal, noncancerous tissue in an abnormal location. Dermoids occur all over the body. The one in and around the eye usually comprised skin, hair, and/or fat. Our patient had an unusual presentation of dermoid in caruncle of the left eye. The mass was excised and histology confirmed the diagnosis. The patient followed up postoperatively and was uneventful.
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Intraocular cilia – A rare case report p. 266
Malarvizhi Raman, A Anuradha, K Vasumathi, S Sheela, Gomathi Nayagam Subbiah
Intraocular cilium is a very rare intraocular foreign body. We report a middle-aged female patient who presented with a cilium in the anterior chamber of the right eye with iritis, following an injury with a stick. In view of anterior chamber reaction, the eyelash was removed. Postoperatively, the iritis resolved in 2 weeks with periocular and topical steroids.
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Expert corner: Cornea consultation p. 268
N Venkatesh Prajna, R Revathi, Sujatha Mohan, Bhaskar Srinivasan, Sharmila Devi Vadivelu
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Postgraduate's corner: Ocular trauma score p. 273
Akruti Desai, Bhavik Panchal
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Expert opinion on ocular trauma score p. 275
Gangadhara Sundar
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Anteriorly migrated dexamethasone implant p. 276
Premanand Chandran, Ganesh V Raman, Veerappan R Saravanan
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Lattice dystrophy in retroillumination p. 277
Naveen Radhakrishnan, Venkatesh N Prajna
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Journal scan p. 278
Shruti Nishanth, Murali Ariga
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Photo Quiz Questions p. 281
Jiz Mary Santhosh
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Answers to previous issue Photo Quiz p. 283
Shruti Nishanth, Atheek Shaik
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