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   Table of Contents - Current issue
Coverpage
September-December 2018
Volume 6 | Issue 3
Page Nos. 83-120

Online since Tuesday, October 23, 2018

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EDITORIAL  

Author's obligations: Often neglected p. 83
Barun K Nayak
DOI:10.4103/jcor.jcor_80_18  
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ORIGINAL ARTICLES Top

Repeatability of manual and portable handheld automated keratometric measurements in pediatric population p. 85
Kunal Kaushik, Amit Maitreya, Anuradha Raj
DOI:10.4103/jcor.jcor_54_17  
Background: The cornea is not only responsible for the majority of the refraction of the eye, but is also readily accessible for measurement and modification. The refractive power of the anterior corneal curvature can be measured by an instrument known as keratometer and various manual and automated keteratometers are available for this purpose. Objective: To study the comparison between keratometric measurements by Bausch and Lomb manual keratometer (MK) and Nidek KM-500 portable handheld automated keratometer (PAK) in pediatric age group. Methods: 404 eyes of 202 children of age between 5-16 years were examined. Three sets of readings of vertical, horizontal meridia and axis measurements were taken for each eye using both instruments. Results: The mean of average vertical, horizontal keratometry and axis readings using MK were 43.24 ± 1.52 D, 42.86 ± 1.47 D and 10.33 ± 36.47 degrees respectively. The mean of average vertical, horizontal keratometry and axis readings using PAK were 43.29 ± 1.41 D, 42.99 ± 1.34 D and 20.78 ± 12.39 degrees respectively. The mean of average keratometric astigmatism (KA) for MK and PAK were 0.661 ± 0.796 D and 0.663 ± 0.590 D respectively. The reliability coefficients of MK and PAK were 0.888 and 0.994 respectively for vertical meridia, 0.993 and 0.989 respectively for horizontal meridia, 0.973 and 0.963 respectively for axis measurements. Conclusion: Both the instruments had good comparability and repeatability. Keratometric measurements using MK and PAK were significantly similar. However, there was statistically significant difference in the axis measurements using both the instruments.
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Retropupillary fixated iris-claw lens: An effective alternative for aphakia Highly accessed article p. 91
Kishore Kumar Proddatoori, Sai Divya Jajapuram, Sasi Pyda, Shahin Zamrudh
DOI:10.4103/jcor.jcor_75_17  
Context: Visual rehabilitation in aphakia has been a challenge with a wide variety of surgical options available for the ophthalmologist. We report the visual outcome with retropupillary fixated iris-claw lens secondary to intraoperative complications and secondary implantation in aphakia. Aims: This study aims to evaluate the postoperative visual acuity and complications of retropupillary fixated iris-claw intraocular lens (IOL) implantation in the management of aphakia. Settings and Design: This was a prospective interventional case series. Subjects and Methods: An interventional study on 50 eyes of 50 patients fulfilling the inclusion criteria was conducted. Preoperative visual acuity, slit-lamp examination, and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris-claw lens were done. The primary outcome measure was postoperative best-corrected visual acuity (BCVA) and the secondary postoperative complications were recorded at various intervals following surgery for 6 months. Results: The final BCVA in 80% of the patients at 6 months ranged from 6/12 to 6/6. The common complications noted were pupillary distortion (34%), pigment clumping over the IOL (20%), iris chaffing at the enclaved site (28%), and secondary glaucoma (12%). Retinal detachment was noted in one patient secondary to trauma after the surgery. No patient had complications such as corneal decompensation, IOL dislocation, cystoid macular edema, and endophthalmitis. Conclusions: Our study suggests that retropupillary fixated iris-claw IOL is an effective, safe, and simple procedure with minimal surgical time for visual rehabilitation in aphakia with less incidence of visually threatening complications. Its posterior location decreases the incidence of corneal decompensation. It is an effective procedure for primary implantation with intraoperative posterior capsular rent and severe zonular dialysis.
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Detecting ocular surface changes associated with soft contact lens wear using conjunctival impression cytology p. 95
Swathi Nagarajan, MP Narmada, N Kavitha
DOI:10.4103/jcor.jcor_13_17  
Context: Contact lenses (CLs) offer middle ground for those not wishing to wear glasses nor undergo refractive surgeries. These lenses may cause ocular surface changes which cause discomfort on using CLs. Aims: This study aims to evaluate conjunctival cytological changes induced by regular CL use among college students and to determine correlation, if any, between the cytological alteration and symptoms and pattern of CL wear. Settings and Design: This was cross-sectional, observational study. Materials and Methods: Thirty-three students wearing CL and an equal number of age-matched controls were evaluated. Data regarding pattern of CL use were collected. Conjunctival impression cytology (CIC) was performed, appropriately stained, and assessed for cytological changes using the Nelson grading system. Statistical Analysis Used: Odds ratio and Chi-square test to determine the prevalence of conjunctival changes in CL users and those with discomfort. Logistic regression analysis is to determine statistically significant association with alteration in conjunctival cytology. P < 0.05 was considered to be statistically significant. Results: Conjunctival cytological changes were seen exclusively in CL users. The duration of use produced a statistically significant effect on conjunctival cytological changes (P < 0.001). Abnormal conjunctival cytological changes were seen in a majority of symptomatic users (odds ratio: 16.9; P < 0.001). Conclusion: The prevalence of conjunctival cytological alterations is more in symptomatic CL wearers and increases with duration of CL use.
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Anatomical and visual outcomes of phacoemulsification and 23-gauge pars plana vitrectomy assisted with perfluorocarbon and 27-gauge twin-chandelier endoillumination for primary rhegmatogenous retinal detachment p. 99
Soon Wai Ch'ng, Patel Gordon-Bennett, Guzaliya Safiullina, Partha Ray Chaudhuri
DOI:10.4103/jcor.jcor_99_17  
Context: Anatomical and visual outcomes of phacoemulsification and 23-gauge (23G) pars plana vitrectomy (PPV) assisted with perfluorocarbon liquid (PFCL) and 27-gauge twin-chandelier endoillumination for primary rhegmatogenous retinal detachment (RRD). Aims: This study aims to determine the anatomical and visual outcomes of phacoemulsification and 23G PPV for primary RRD assisted with 27-gauge (27G) transconjunctival twin-chandelier endoillumination and bimanual vitreous base shaving under PFCL. Settings and Design: A prospective single tertiary center cohort study of 65 consecutive eyes by a single surgeon between August 2013 and June 2014. Subjects and Methods: The primary outcome measure was the primary retinal reattachment rate. The secondary outcome measure was best-corrected visual acuity (BCVA). All patients were reviewed postoperatively up to 4 months. Statistical Analysis Used: Chi-squared, Student's t-test, and one-way ANOVA test were used in this study. Results: At 4 months, overall retinal reattachment was 83.1% with a single operation and 87.7% with a second surgery. After exclusion of the proliferative vitreoretinopathy (PVR) cases, the primary retinal reattachment rate improved to 93.9% and secondary retinal reattachment rate was 98.0%. The mean BCVA improved from logMAR 1.06–0.83 (P = 0.002). PVR (P = 0.0001), silicone oil tamponade (P = 0.002), macula-off RD (P = 0.12), location of RRD (P = 0.09), and delay of more than 7 days for surgery (P = 0.09) were associated with a higher redetachment rate. The main postoperative complications were small bubbles of PFCL in the posterior segment (18.5%) and subretinal PFCL (3.1%). Conclusions: Chandelier endoillumination and PFCL-assisted 23G PPV with phacoemulsification has reattachment rates and visual outcomes similar to the current standard of RRD repair of different complexities. This surgical technique can be considered an alternative method of repairing RRD, with some advantages.
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An investigative study on the impact of smoking on visual evoked response of healthy volunteers p. 105
Ruchi Kothari, Vidit Panchal, Pradeep Bokariya
DOI:10.4103/jcor.jcor_123_17  
Background: Cigarette smoking not only has numerous deleterious effects on respiratory and cardiovascular systems of the body but also poses a threat to damage the visual system and may lead to poor eyesight. Visual evoked potentials (VEPs) reflect electrical phenomena occurring during the visual processing so are widely used both in research and in clinical practice to elucidate the function of the visual system. Aim of Study: To explore the effect of smoking on the VEP response of healthy volunteers. Materials and Methods: VEP recordings were taken using an Evoked Potential Recorder (RMS EMG. EP MARK II) where the stimulus configuration consisted of transient pattern-reversal method, in which a black-and-white checkerboard was generated (full field) on a VEP monitor. Results: The mean age of thirty smokers was 46.70 ± 17.33 years compared to 47.25 ± 15.62 years in 60 controls (range 19–76 years). Predominant P100 latency delays in 60% of cases, of which 55.56% had markedly prolonged latencies. Both latency delay and amplitude reduction were seen in remaining 40% of cases, i.e., 12 of 30 smokers. Marked prolongation of latency with marked amplitude reduction was observed in 9 (75%) of these 12 cases and all belonging to the most chronic smokers. Conclusion: To the best of our knowledge, ours is one of the first studies to comment on implications of smoking on VEP. As VEP abnormalities obtained in cases of smokers having extreme chronicity were severe, substantial, and explicit, we propose that VEP could be a useful neurophysiologic tool to demonstrate the visual deficits due to smoking.
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BRIEF COMMUNICATIONS Top

Spectral-domain optical coherence tomography in choroidal rupture following firecracker injury p. 109
Vimal Krishna Rajput, Shweta Asaram Bhalsing
DOI:10.4103/jcor.jcor_50_16  
In India, firecrackers are an integral and essential part of the celebrations. Injuries from firecrackers can lead to serious and irreparable visual damage. We report a case of choroidal rupture following injury caused by firecracker and correlate its optical coherence tomography findings. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.
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Open globe injury secondary to a dog bite presenting to a tertiary care hospital p. 111
Marushka Aguiar, Ugam P S. Usgaonkar
DOI:10.4103/jcor.jcor_78_17  
We are presenting a rare case of an open globe injury in a 75-year-old female secondary to a bite from a stray dog involving her face and right eye which had a large lid laceration and a full-thickness corneoscleral tear. The visual acuity was reduced to the perception of light. There was circumcorneal as well as ciliary congestion. The cornea showed a 5 mm × 2 mm × 0.5 mm tear with surrounding corneal haze. The anterior chamber was shallow with a hyphema. There was no view of the iris, pupil, and lens. The patient was given anti-rabies immunoglobulin infiltration as well as anti-rabies vaccine as per schedule. Stay sutures were placed for the scalp avulsion, and lid laceration and patient was taken to operation theater for corneoscleral suturing. The patient has been followed up 6 weeks after suturing. Visual prognosis remains poor.
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Infective scleral abscess by Proteus mirabilis in an immunocompetent patient p. 113
Nibedita Das, Joyeeta Das
DOI:10.4103/jcor.jcor_88_17  
A 48-year-old Indian gentleman presented with severe pain, redness, swelling, and dimness of vision in his right eye. On slit-lamp examination, a temporal scleral nodule with overlying conjunctival defect was found. Microbiological investigations of the nodule revealed Proteus sp. Systemic and topical antimicrobial therapy successfully healed the lesion after 2nd week of treatment with complete resolution in the 5th weeks. Isolated infectious scleritis is very unusual pathology found in medical literature, and among the organism reported till date, Proteus sp. is the rarest to found. To the best of our knowledge, this may be the first reported case of spontaneous scleral abscess due to Proteus sp.
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COMMISSIONED ARTICLE Top

Ophthalmology in ancient time – the Sushruta Samhita p. 117
Sangeeta Shah
DOI:10.4103/jcor.jcor_15_17  
Sushruta, who lived during 600 BC, had vast knowledge of medicine and surgery mainly based on Ayurveda. His works have been recorded in Sushruta's compendium which is said to be one of the oldest treatizes available on medicine/surgery. Based on the compendium, we can assume that some form of medical knowledge must have existed in India much ahead of Sushruta's time. Diseases, their pathogenesis, signs and symptoms, treatment, and complications are described in such a depth that it leaves us wondering as to how Sushruta could have developed precise clinical skills simultaneously in all parts of medical science including medicine, surgery, plastic surgery, anesthesia, ophthalmology, midwifery, genetics, anatomy, and diabetes.
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