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   Table of Contents - Current issue
January-April 2020
Volume 8 | Issue 1
Page Nos. 1-48

Online since Friday, March 6, 2020

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Artificial Intelligence Highly accessed article p. 1
Jatinder Bali, Shivam Nayak
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Correlation of open-angle glaucoma and ocular perfusion pressure in hypertensive individuals p. 5
Rekha Khandelwal, Rachit Khandelwal, Dhananjay Raje, Deepa Kumar, Anand Rathi
Background: Systemic hypertension has been recognized as a potential risk factor for primary open-angle glaucoma (POAG). Purpose: The purpose of this study is to study the correlation of systemic blood pressure, intraocular pressure (IOP), and ocular perfusion pressure (OPP) for the development of glaucoma in hypertensive individuals. Methods: After Institutional Ethics Committee approval, a hospital-based case–control study was conducted in a tertiary care hospital. The study group comprised of patients with systemic hypertension, and the control group had the age- and sex-matched normotensives. POAG was diagnosed if glaucomatous cupping and characteristics visual field defects were present with open angles on gonioscopy. OPP was compared between POAG and non-POAG groups. Results: In this study of 103 hypertensive and 100 normotensive patients, the mean IOP was higher among hypertensives. There were 9 (8.74%) cases of POAG in hypertensive group and 2 (2%) in the normotensive group. The mean IOP in hypertensive group was 16.5 ± 4.5 mmHg, and that of normotensive group was 13.14 ± 3.19 mmHg. The mean OPP in hypertensive patients with glaucoma was 49.38 ± 2.6 mmHg, which was significantly lower than that of patients without glaucoma, i.e., 60.16 ± 5.42 mmHg, as indicated by P < ,0.001. Conclusion: This study reveals that hypertensive patients taking anti-HT treatment with POAG have lower mean OPP as compared to those without POAG. The higher OPP could be protective against glaucomatous condition; however, interdisciplinary management of open-angle glaucoma and hypertension is the need for a better quality of life of such patients.
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A preliminary study on the treatment of amblyopia with Haidinger's brushes p. 10
Churawan Lal Sahu, R Muralidhar, D Ramamurthy
Introduction: A number of treatment options for amblyopia have been reported in the recent years. Haidinger's brushes have also been used to treat amblyopia and correct fixation abnormalities in amblyopia though there is no study that addresses visual acuity to the best of our knowledge. Type of Study: This is a nonrandomized prospective case series. Materials and Methods: Patients between the age groups of 5 and 15 years with strabismic/anisometropic/mixed/ametropic amblyopia were enrolled for the study. All patients wore their refractive correction for a month prior to the study. All patients were made to view the Haidinger's brushes through the amblyopic eye for 15 min/day for a total of 10 consecutive days. Part-time occlusion was commenced thereafter. The vision was recorded prior to the commencement of the exercise, after conclusion of the same and at 2-month review. Results: Thirty-seven eyes of 30 patients were enrolled for the study. The mean age of the patients was 8.7 ± 3.4 years. The mean number of lines of improvement was 1.2 ± 0.9 at completion of 10 days of exercise and 1.36 ± 0.9 at 2 months with patching. None of the patients had a loss of visual acuity at 2-month review. The series included patients with anisometropic, ametropic, and strabismic amblyopia though the numbers did not permit a subgroup comparison. Overall, eight eyes did not respond to exercises. Conclusions: 10 days of exercises with Haidinger brushes produces substantial visual gain in patients with strabismic, anisometropic and mixed amblyopia. The improvement is sustained at 2-month review. The results of this study need to be validated in a larger series of patients.
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Immediate sequential bilateral cataract surgery in children in a government medical university in India p. 14
Siddharth Agrawal, Vinita Singh, BM Vinod Kumar, Manisha Meena, Rajat M Srivastava, Vishal Katiyar
Aim: The aim of this study is to assess the advantages and possible risks of single sitting bilateral cataract surgery over one eye at a time approach in children with developmental cataract. Settings and Design: Children (below 12 years) with bilateral developmental cataract with consenting parents were randomized to undergo either immediate sequential bilateral cataract (ISBC) surgery (both eyes at the same time) or delayed sequential bilateral cataract (DSBC) surgery (one eye at a time) over 4 years for logistics and complications. It was a prospective, randomized control trial. Methods: Two groups of patients (below 12 years) undergoing bilateral cataract surgery were compared for number of visits, duration of hospital stay, cost of procedure, duration of operating room (OR) occupancy, and refractive outcome. The first group underwent ISBC and the second group underwent DSBC surgery. A note was also made of complications related to anesthesia and/or the surgery in both the groups. Time interval between two eye surgeries and patients not returning for second eye surgery in DSBC group were also noted. Central tendency and degree of dispersion of continuous variables were expressed as mean and standard deviation for both (ISBC and DSBC) groups. The difference between the two groups was analyzed with independent “t”-test and the level of significance taken as 95% or a P < 0.05. Results: Forty-seven patients (94 eyes) in the ISBC group and 41 (82 eyes) in the DSBC group were compared. ISBC group patients had 43.2% fewer hospital visits, 39.4% lesser duration of total hospital stay, spent 36.6% lesser, and occupied the OR for 39.0% lesser duration compared to DSBC patients. All these differences were statistically significant (P < 0.001). The refractive outcomes in both the groups were comparable (P = 0.916 for the eye operated first andP= 0.814 for the eye operated later). There were no major complications related to anesthesia or surgery in either group. The median interval between the surgeries of the two eyes in the DSBC group was 8 weeks (range: 4–73 weeks). Besides these, 11 patients (21.1%) in the DSBC group did not return for second eye surgery. Conclusions: Bilateral single sitting cataract surgery in children seems logical, patient-friendly, cost-effective, and without any significant disadvantages when performed with adequate precautions before, during, and after the procedure.
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Ophthalmic manifestations in children with delayed milestones p. 18
Chandrakishor Hemraj Pardhi, Sujata Sanjay Chahande
Aim: The aim of the study is to identify ophthalmic manifestations in children with delayed milestones. Materials and Methods: This was a prospective, observational, and interventional study carried out at tertiary care hospital during July 2016–June 2018 where preschool children with a history of delayed milestones were included. Results: A total of 50 preschool children were included. Male patients (33 [66%]) showed higher incidence than females (17 [34%]). Age group 0–1 year had maximum 17 (34%) cases, followed by 13 (26%) in 1.1–2 years, 6 (12%) in 2.1–3 years, and 7 (14%) each in 3.1–4 years and in 4.1–5 years. Most common ocular manifestations found were congenital cataract 10 (20%), followed by refractive error 8 (16%), 5 (10%) each for optic atrophy and retinal detachment, 4 (8%) strabismus, 3 (6%) nystagmus, 2 (4%) glaucoma, and 1 (2%) each for proptosis, disc hypoplasia, microcornea, Persistent Hyperplastic Primary Vitreous (PHPV), iridocorneal endothelial syndrome, and cone dystrophy. Twenty (40%) patients needed no intervention, while glasses were given to 14 (28%) patients, 10 (20%) underwent cataract surgery and 3 (6%) retinal detachment surgery, 2 (4%) patients started on topical medication, and 1 (2%) underwent trabeculectomy surgery. Refractive error found in 8 (16%) children. Twenty-one (42%) patients were associated with various systemic diseases. Along with their primary ocular diseases, five (10%) patients had association with other ocular findings. Conclusion: Children showed improvement in their behavior posttreatment. Parents noticed attentiveness and environmental awareness of children in the surroundings. Children became more responsive in parent–child playful games using colorful objects.
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Efficacy of autologous fibrin glue versus sutures for conjunctival autograft in pterygium surgery: A 1-year randomized controlled study p. 24
BK Rekha, Sheetal V Girimallanavar
Background and Aim: In recent times, the use of fibrin glue has reduced operating time and postoperative complications associated with sutures. Since it is a plasma-derived product, it has few drawbacks. The objective was to compare the efficacy, postoperative complications, and operating time of autologous fibrin glue and sutures for attaching conjunctival autografts in pterygium surgery. Materials and Methods: A total of 44 patients with primary pterygia were selected and divided in two groups: Group 1 (n = 22) underwent conjunctival autograft placement with autologous fibrin glue, whereas Group 2 (n = 22) patients underwent conjunctival autograft placement with sutures after pterygium excision. Patient demographics, history, and ocular examinations were noted; they were followed-up and examined after surgery until 3 months. Primary outcomes were postoperative pain, foreign body sensation, lacrimation, discomfort, graft retraction, graft displacement, subgraft hemorrhage, and recurrence rate. Secondary outcomes included intra- and post-operative complications. SPSS 16 was used to analyze the data. Results: The mean operative time was significantly less in Group 1 compared to Group 2 (22.1 ± 5.43 vs. 25.2 ± 2.61 min;P= 0.004). The intensity of postoperative pain was significantly lower in the group 1 than in the group 2 on postoperative day 1 and after 1st week (P < 0.05). However, foreign body sensation, lacrimation, and discomfort were significantly lower in Group 1 than in Group 2 after 1st week of surgery. No recurrence was observed in both groups during the 3-month follow-up period. In addition, no serious intra- and post-operative complications were encountered. Conclusion: Autologous fibrin adhesive was effective in conjunctival autografting among the patients undergoing pterygium excision. It significantly reduced operative time, postoperative outcomes, and complications.
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Type 1 early treatment of retinopathy of prematurity with corneal haze? Cause p. 30
Shilpi Harshal Narnaware, Prashant Keshao Bawankule
This is a case report which highlights the challenges faced in treating Type 1 early treatment of retinopathy of prematurity (ETROP) with corneal haze. We report a case of a preterm boy born at 28 weeks with birth weight of 1000 g who presented with corneal haze along with Type 1 ETROP. Because of inability to complete LASER and increase in posterior plus disease , intravitreal ranibizumab was given as a rescue therapy to buy time. Finally, we could succeed in treating the disease with complete regression and clear cornea on the last follow-up.
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Sporadic form of isolated orbital Burkitt lymphoma presenting with fulminant proptosis and dystopia p. 32
Mansour Al-Mohaimeed
This is a rare case report of fulminant proptosis with dystopia caused by isolated orbital involvement of nonendemic Burkitt lymphoma. We present the case of a 6-year-old Egyptian child who suffered from progressive, painful proptosis and dystopia in his left eye for 10 days. We discovered a noncompressible, soft-tissue mass at the superotemporal part of the orbit. The presence of an orbital inflammatory pseudotumor was suspected when the patient was administered with systemic corticosteroids and antibiotics. Histopathological examination of the obtained specimen revealed the “starry-sky” appearance of histiocytes, which is characteristic of Burkitt lymphoma. The patient underwent chemotherapy with remarkable improvement of his dystopia and proptosis. Although orbital Burkitt lymphoma is a rare tumor, ophthalmologists should be aware of its differential diagnosis of rapidly progressive proptosis with dystopia in children, which may initially masquerade as orbital cellulitis or a pseudotumor.
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Sutureless scleral fixated three-piece intraocular lens in the management of dislocated capsular bag–capsular tension ring–intraocular lens complex p. 35
Naresh Babu Kannan, Olukorede O Adenuga, Rajan P Renu, Kim Ramasamy
A number of techniques have been described in the management of capsular bag (CB)–capsular tension ring (CTR)-intraocular lens (IOL) dislocation, including pars plana vitrectomy (PPV) with explantation of the CTR and IOL through a corneal section and exchange with a scleral suture-fixated IOL or anterior chamber IOL, and repositioning of the CB–CTR–IOL complex with scleral suture fixation. We describe a technique of managing CB–CTR–IOL dislocation which involves PPV with CTR removal and sutureless scleral fixation of the same three-piece IOL. This was performed in two patients with good visual outcome and well-centered IOLs postoperatively.
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The Warren Hill calculator: A simplified online guide for surgically induced astigmatism calculation p. 38
Venkatesh Suganthraj, Machireddy R Sekharreddy, Shruti P Hegde
Surgically induced astigmatism (SIA) ranks as one of the principle factors resulting in compromised post- operative visual acuity. There are several factors contributing to the post -operative SIA, namely type and site of wound construction, the age of the patient and the surgical expertise of the surgeon. The first and foremost step in this process is for the surgeon to be aware of the magnitude and the vector of the SIA induced by his/her hands. The SIA online calculator software for orthogonal astigmatism has opened newer vistas in the field of cataract surgery. This software has been developed by Dr Warren Hill and can be downloaded from the online site. To simplify matters, the same data is made available in the form of a mobile APP- the SIA calculator App. This is a rapid and comfortable way to obtain the results.
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Posterior scleritis-induced optic neuropathy and exudative retinal detachment – A challenging diagnostic dilemma p. 39
Pritam Bawankar, Dipankar Das, Harsha Bhattacharjee, Ronel Soibam
We report three cases of posterior scleritis (PS) to analyze the clinical profile and ultrasonographic and fluorescein angiography features of this rare disorder. Fundus findings included serous retinal detachment (RD), disc edema, disc hyperemia, corkscrewed retinal vessel, and retinal folds. Ultrasonography revealed a variable degree of thickening of the posterior eye wall (choroid and sclera). Fluorescein angiography revealed persistent dye leakage from the disc and early pinpoint areas of hyperfluorescence with pooling of dye in late frames of an angiogram. Optical coherence tomography showed serous macular detachment in all cases at the time of presentation. The purpose of this manuscript was to describe three cases of PS associated with optic neuropathy and exudative RD previously misdiagnosed with a range of conditions. This case study also demonstrates the importance of B-scan ultrasonography and fluorescein angiography for the appropriate diagnosis of PS and also the effectiveness of systemic corticosteroid therapy.
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Acremonium keratitis in a patient with healed herpetic eye disease p. 43
Rashmeet Arora, Sarita Agrawal, Darshani Marya, Neel Shah, Santosh Kengua
We report the case of a 65-year-old male who presented with pain, diminution of vision, redness foreign-body sensation, and watering for 1 month. The patient was a known case of bronchial asthma and was on inhalational budesonide treatment for 3 years. The patient had cataract surgery 18 months back and has a history of herpetic eye disease. Corneal cultures were positive for acremonium.
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Infective scleral abscess by Proteus mirabilis in an immunocompetent patient p. 46
Mahmood Dhahir Al-Mendalawi
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Retinopathy of prematurity: Screening challenges p. 47
Kannegolla Anudeep, Krishnagopal Srikanth, Manavi D Sindal, Kirti Nath Jha
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