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   2018| April-June  | Volume 56 | Issue 2  
    Online since August 6, 2018

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Operation theaters and sterilization requirements — Design consideration and standards for infection control
T Nirmal Fredrick, Murugesan Kumaran
April-June 2018, 56(2):84-90
An operation theater (OT) complex is the “heart” of any hospital. An operating theater, operating room (OR), surgery suite, or a surgery center is a room within a hospital where surgical and other operations are carried out. The patient is the center point of a functioning OT complex. He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital functions, prevent infections/promote healing with safety, comfort, and economy. A “civil-mechanical-electrical-electronic-biomedical” combo effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining an OT. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air-conditioning system (HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should follow aseptic protocols. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load in the environment and in the instrument brought into the sterile field during the surgery.
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Approach to headache in ophthalmic practice
R Vasumathi
April-June 2018, 56(2):91-97
Headache is one of the most commonly experienced of all the physical discomforts. About half of the adults have a headache in a given year. Headaches can occur as a result of many conditions. Ophthalmologists are often the first physicians to evaluate patients with headaches, eye pain, and headache-associated visual disturbances. The evidence in the literature for a strong association between oculovisual problems and headache is weak. Still, patients who believe that appropriate ocular examination and treatment help to lessen their headache visit ophthalmologists very frequently. Although ophthalmic causes are sometimes diagnosed, eye pain and visual disturbances are often neurologic in origin. Many primary headache disorders have ophthalmic features, and secondary causes of headache frequently involve the visual system. Both afferent and efferent symptoms and signs are associated with headache disorders. Moreover, the frontal or retroorbital pain of some primary ophthalmic conditions may be mistaken for a headache disorder, particularly if the ophthalmologic examination is normal. This review summarizes the common causes of headache encountered in ophthalmic practice and the red flag signs which need referral to other specialists.
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Posterior staphyloma
Baskararajan Gopalakrishnan, Bhuvanasundari Baskarajajan
April-June 2018, 56(2):76-83
Introduction: Very high myopia is usually associated with posterior staphyloma. The pathology, management and our experience reported in the article. Methods: We studied a total of 3737 student population in schools and colleges in the year 2001 — 2002 with the help of the Principals and teachers. High myopic patients treated in our hospital (242 patients) who underwent B—Scan and surgical management in two stages, posterior scleral support operation followed by low power intraocular lens implantation, have been included in the study(14). Discussion: High myopia and keratoconus have opposite effect in the anatomy of eye ball. In high myopia, the anterior segment of the eye is usually normal or there may be slight variation in the depth of anterior chamber whereas in keratoconus the posterior segment is normal. Staphyloma, usually occurs in the posterior pole of the eye ball involving the macular region can also expand anteriorly leading to thinning of sclera to be observed as bluish bulging. As the posterior staphyloma progresses, the retina undergoes degenerative changes due to stretching in the macular region, around the ora-serrata and around the optic disc also. In the posterior pole, the thinning of sclera and retina leads to a decrease in the functional efficiency of the retina which is often misconstrued as amblyopia especially in uni-ocular high myopes. In majority of such cases, surgical compression of the posterior pole by preserved donor sclera from behind reverses the damage and restores full vision when followed by low power intra ocular lens implantation. Results and Conclusion: 242 high myopes, among which 212 patients with Bilateral and 30 patients with unilateral involvement were included in this report and final visual outcome analyzed. In the surgical management of very high myopes, it is mandatory to manage the posterior staphyloma to get good visual outcome. To arrest the myopic progression, P.S.S.O. should be performed in young age itself.
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Profile of brain tumors having ocular manifestations in a Tertiary Eye Care Institute: A retrospective study
Saurabh Deshmukh, Dipankar Das, Harsha Bhattacharjee, Ganesh Ch Kuri, Damaris Magdalene, Krati Gupta, Prabhjot Kaur Multani, Vivek Paulbuddhe, Shriya Dhar
April-June 2018, 56(2):71-75
Aim: To form a profile of brain tumors having ocular manifestations presenting to a tertiary eye care institute. Materials and Methods: The medical records of patients diagnosed with primary brain tumors between January 2012 and December 2017 were reviewed. Patients underwent a detailed ocular examination and neuroimaging to confirm the diagnosis. Results: Out of the 17 patients, 11 (65%) were female and 6 (35%) were male. The mean age was found to be 43.17 ± 11.04 years and the majority of the patients belonged to the age group 21—40 years (47.06%). The most common presenting symptom was found to be diminution of vision (100%), followed by headache (41.14%) and vertigo (23.52%). The most common sign was optic disc changes, namely optic atrophy (47.05%), followed by disc pallor (29.41%) and papilledema (11.76%). Meningioma (41%) was the most common tumor followed by pituitary macroadenomas (29%). At the time of presentation, two patients had the restriction of extraocular movements, seven patients had a positive relative afferent pupillary defect, and four had defective color vision. Conclusions: Ophthalmic signs and symptoms form a major part of the presentation in patients with intracranial tumors. Majority of the patients diagnosed by ophthalmologists with brain tumors presented with optic disc pallor or edema resulting in diminution of vision. By careful neuro-ophthalmic evaluation, early diagnosis of intracranial space occupying lesions can be made and prompt referral to neurosurgeon can reduce the morbidity and mortality.
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Zepto cataract surgery: The way forward
Nishanth Madhivanan, Shruti Nishanth, Nivean Madhivanan, Madhivanan Natarajan
April-June 2018, 56(2):98-101
Continuous curvilinear capsulotomy (CCC) is one of the most crucial steps of cataract surgery because of numerous surgical and anatomic advantages. The introduction of cataract surgery assisted by femtosecond laser has improved the repeatability and the accuracy of a perfectly rounded capsulotomy, as compared to the manual CCC. However, multiple surgical steps and the relatively high cost-per case have rendered this technology useful only to the affordable. This article describes a cost-effective and convenient new technique of perfecting the circular capsulotomy using a device called precision pulse capsulotomy or Zepto.
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Bilateral endogenous endophthalmitis in disseminated histoplasmosis secondary to immunosuppression: A rare case report
Surpriya Hawaibam, Dipankar Das, Ronel Soibam, Harsha Bhattacharjee, Saurabh Deshmukh, Richa Shrivastava, Krati Gupta
April-June 2018, 56(2):108-110
We report the clinical course of a 47-year-old diabetic and hypertensive male who presented to us with diminution of vision in both eyes (OU) for 4 months. He was diagnosed with granulomatosis with polyangiitis and was treated with cyclophosphamide and steroids elsewhere. Before this, he was on steroids and methotrexate for probable sarcoidosis based on cavitary lesions in the lungs. During tapering of the steroids and so in relatively immunosuppressed status, he developed fever and maculopapulo-nodular skin lesions. Skin lesion biopsy confirmed Histoplasma capsulatum and he was started on systemic antifungals. Later, he developed bilateral endogenous endophthalmitis and was managed with intravitreal medications followed by vitrectomy with lensectomy OU. The patient regained vision and is maintaining the same until 1 year of follow-up. Thus, in spite of its rare occurrence, H. capsulatum should be considered as a cause of endogenous endophthalmitis in an immunosuppressed host with systemic histoplasmosis.
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Comparison of peribulbar anesthesia with sub-tenon's in manual small incision cataract surgery
Abhinay Ashok, Srikanth Krishnagopal, Kirti Nath Jha
April-June 2018, 56(2):67-70
Aim: Comparison of peribulbar anaesthesia with sub-Tenon's anaesthesia in manual small incision cataract surgery in relation to time of onset of akinesia of extra ocular movements, pain at the time of administration, end of surgery and 1 hour after surgery and complications. Methodology: A randomized comparative study of 113 patients of which 57 patients received peribulbar anaesthesia and 56 patients received Sub-Tenon's anaesthesia. Results: The average time of onset of akinesia with sub-Tenon's anaesthesia was 2.78 ± 0.958minutes and peribulbar anaesthesia was 9.96 ± 2.141minutes. The difference was statistically significant (p = 0.00).Extraocular movements and ease of procedure between the two groups was almost the same and not statistically significant. Incidence of minor complications like chemosis and sub conjunctival haemorrhage were more in sub-Tenon's technique. Peribulbar anaesthesia ranked higher on pain score (5.12 ± 1.255) at the time of administration compared to Sub Tenon's anaesthesia (3.77 ± 1.716), the difference being statistically significant (p = 0.00). Conclusion: Sub-Tenon's anaesthesia is a safe and effective substitute for preibulbar anaesthesia in intraocular surgeries.
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Journey of the Journal
Nirmal T Fredrick, Rachula Daniel
April-June 2018, 56(2):113-128
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Toxic anteriorsegment syndrome presenting as endothelitis following uneventful phaco emulsification
Anusha Koshal Ram, Bala Subramanian
April-June 2018, 56(2):102-104
Clinical course, presentation profile, response to treatment of two patients who developed a toxic anterior segment syndrome (TASS) following uneventful phacoemulsification. Both the patients underwent slit-lamp examination and dilated fundus examination, in each follow-up and aggressive treatment with topical and systemic steroids. The white to white corneal edema and anterior chamber reaction subsided on follow-up at 1st and 2nd month, respectively, with improvement in vision. The report highlights key features such as relatively quiet eye on the first postoperative day with classical TASS picture seen on the fifth postoperative day and moderate recovery within a month necessitating a thorough examination of patients till the first week of surgery.
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From the Editor's Desk
Nirmal Fredrick
April-June 2018, 56(2):65-66
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Harold Ridley's eye-opening discovery
Tamilarasy Vasanthakumaran
April-June 2018, 56(2):111-112
This paper reviews the historical events, which led up to Harold Ridley's discovery of the intraocular lens.
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Persistent fetal vasculature
Saurabh Deshmukh, Damaris Magdalene, Krati Gupta
April-June 2018, 56(2):132-133
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Eye - The window: An interesting case report
C Usha, B Kalai Selvi, B Pramila
April-June 2018, 56(2):105-107
Chronic myeloid leukemia (CML) is a myeloproliferative disorder. It is a form of leukemia characterized by the increased and upregulated growth of predominantly myeloid cells in the bone marrow and accumulation of these cells in the blood. We hereby reporting a 37-year-old healthy male, auto driver by occupation, presented with defective vision both eyes of insidious onset for 6 months. He is not a known diabetic, hypertensive, or any other chronic illness. Two years back he was treated for pulmonary tuberculosis with category 1 anti tubercular therapy. No other ailments in the past. We did the routine assessment and suspected CML, so asked for systemic workup. Surprisingly, the result came as CML in chronic phase. He was treated with tablet imatinib 400 mg OD.
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Answers to previous issue photo quiz
Atheek Shaik, Nishanth Madhivanan
April-June 2018, 56(2):135-136
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A case report of optic nerve head tuberculosis
Mahmood Dhahir Al-Mendalawi
April-June 2018, 56(2):137-137
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Photo quiz
Malathi Nainappan
April-June 2018, 56(2):134-134
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Journal scan
Atheek Shaik, Murali Ariga, Shruti Nishanth
April-June 2018, 56(2):129-131
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