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   Table of Contents - Current issue
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September-December 2019
Volume 7 | Issue 3
Page Nos. 85-134

Online since Wednesday, December 11, 2019

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EDITORIAL  

How to assess quality of journals and researches (Part II) Highly accessed article p. 85
Barun K Nayak
DOI:10.4103/jcor.jcor_98_19  
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ORIGINAL ARTICLES Top

Management of postoperative fungal endophthalmitis with section infiltrates: Our experience p. 87
P Veena, Ajay Sharma, Gayatri Peri
DOI:10.4103/jcor.jcor_29_17  
Aim: The aim of the study is to report the management of postoperative fungal endophthalmitis (POFE with corneoscleral infiltrates) after the cataract surgery. Settings and Design: The study was conducted at a tertiary care referral center in North Andhra. This was a retrospective, single-institution, interventional case series. Materials and Methods: Ten cases were microbiologically proven POFE, out of which eight cases having sclera-corneal infiltrates and two cases having corneal infiltrates, refractory to conventional management, were included in this study. Four cases were managed with intraocular lens (IOL) explantation, pars plana vitrectomy (PPV), intravitreal vancomycin, ceftazidime, and voriconazole, followed by the excision of corneoscleral infiltrate and therapeutic patch graft/therapeutic penetrating keratoplasty (TPK) as a secondary procedure. Six cases were managed with IOL explantation, excision of infected corneoscleral tissue, therapeutic corneoscleral patch graft/TPK, and anterior vitrectomy with intravitreal voriconazole. “Anatomical success” was defined as preserved anatomy of the globe and absence of signs of inflammation. “Functional success” was defined as an attached retina and a best-corrected visual acuity of better than 20/400. Results: Of the ten cases, the duration between cataract surgery and the diagnosis of endophthalmitis was 2–10 weeks in nine cases and 3 days in one case. Five cases were culture and potassium hydroxide (KOH) positive for fungus (Aspergillus fumigatus – 3, Aspergillus flavus – 1, and Aspergillus niger – 1), and five cases were KOH positive for fungus. No recurrences were observed after corneal patch graft/TPK with PPV and IOL explantation (Median follow-up – 12 months). Prestudy defined the criteria for successful “anatomical” and “functional” outcomes were achieved in 90% and 50%, respectively. Conclusion: This report highlights the effective role of combined IOL explantation, excision of infected tissue, therapeutic patch graft with PPV, and intravitreal voriconazole in managing POFE with corneoscleral infiltrates.
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A study of occurrence and risk factors of age-related macular degeneration in a region of Central India p. 97
Archana Sunil Nikose, Arpita Sthapak, Mayuri Patil
DOI:10.4103/jcor.jcor_87_17  
Purpose: The purpose of the study is to determine the occurrence of age-related macular degeneration (AMD) in patients aged >50 years and to study risk factors associated with it. Materials and Methods: It was a cross-sectional prospective study, in which 907 patients aged 50 years and above of both sexes were studied who visited eye outpatient department of our tertiary hospital between October 2014 and September 2016. Visual acuity, slit-lamp examination, and disc and macular evaluation with 90D lens and 20D using indirect ophthalmoscope were performed. AMD was confirmed by doing fundus fluorescein angiography. Association of AMD with hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and body mass index were studied. Results: Out of 907 patients, 21 had AMD, i.e., the occurrence was 2.3%. Of 21 patients, 15 had early AMD (1.6%) and 6 had late AMD (0.7%). The highest occurrence of 9.75% was seen in age group of 80 years and above, whereas other risk factors of AMD, i.e., smoking showed P = 0.1261, cardiovascular disease P = 0.0251, and prior cataract surgery with P = 0.0001. Conclusion: Age was found to be strong and consistent risk factor of AMD. Smoking, cardiovascular disease, and prior cataract surgery were significantly associated with AMD.
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Face turns in Type 1 Duane's retraction syndrome – Right? Left? or none? p. 101
Snehal Rhishikesh Thakre, Jyotika Prasanna Mishrikotkar, Pradnya Ashish Deshmukh
DOI:10.4103/jcor.jcor_49_18  
Purpose: The purpose of this study is to create awareness about the face turns in Type 1 Duane's retraction syndrome (DRS). Subjects and Methods: This was a retrospective analysis of 27 cases of Type 1 DRS seen in a teaching hospital. A complete strabismus workup with emphasis on deviation in primary gaze and presence and direction of anomalous head posture was done. Results: Of 27 patients, 9 patients (33.33%) had esotropia, 8 (29.63%) had exotropia, whereas 10 (37.03%) were orthotropic in primary gaze; 17 (62.96%) had a face turn, 9 (33.33%) patients had a face turn toward the affected side, 8 (29.63%) toward the sound side, while 10 (37.03%) did not have a face turn. Conclusions: It is important to be aware that patients with Type 1 DRS may have an associated face turn; the direction of which is variable depending on the deviation present in the primary position. Awareness of this interesting observation of the variations in face turn prevents a misdiagnosis of sixth nerve palsy which has more serious clinical implications.
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Surgical results of transcaruncular dacryocystorhinostomy p. 105
Mukesh Garg, Yashi Bansal, Gaganpreet Singh
DOI:10.4103/jcor.jcor_61_18  
Purpose: The objective of the study is to evaluate the effectiveness of the transcaruncular approach of dacryocystorhinostomy (DCR) in the management of the cases of chronic dacryocystitis. Materials and Methods: A prospective study was conducted on 30 patients presenting in the outpatient department with chronic dacryocystitis at a tertiary eye care center. Intraoperative parameters were observed and noted at the time of surgery. Patients were followed up for a minimum period of 6 weeks and interviewed for subjective improvement of symptoms. Outcome measures were anatomical patency, epiphora, esthetic outcome, and presence of any complications. Results: Thirty patients of chronic dacryocystitis with nasolacrimal duct obstruction comprising 22 females and 8 males with a mean age of 43.8 years were operated by transcaruncular modification of external DCR. The surgical success rate of 90% was achieved after a follow-up period of 6 weeks. Postoperative complications included periorbital edema, mild nasal bleeding, and section leak which resolved by day 7 postoperatively. The procedure was associated with minimal intraoperative complications. One patient (3%) had significant intraoperative bleeding, and two patients (7%) had canalicular injury and both the patients were managed with canalicular intubation. Conclusions: Transcaruncular DCR is a cost-effective and esthetic approach not requiring the use of any endoscope or lasers and provides the benefits of external approach without a skin incision. It is associated with minimal intraoperative and postoperative complications. The surgical success rate of the procedure is comparable to the other conventional methods of DCR.
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Comparative evaluation of keratometric changes after pterygium excision surgery p. 110
Deepti Shukla, Indra Dandaliya, Preeti Mittal, Madhu Mathur
DOI:10.4103/jcor.jcor_65_18  
Aim: The aim of this study was to evaluate and compare keratometric changes after pterygium excision surgery. Settings and Design: The study was carried out at a tertiary eye care center in central Rajasthan, India. Materials and Methods: Total 50 patients of primary pterygium without any other corneal pathology were undergone to pterygium excision surgery with conjunctival autograft and selected for study after complete preoperative assessment. Keratometric values were measured using Bausch-Lomb keratometer preoperatively and postoperatively on day 1, day 7, and 1 month serially. Mean difference in keratometric values or mean keratometric astigmatic changes preoperatively and postoperatively were compared. Results: The mean age of the patients was 32.58 ± 9.67 years and male-to-female ratio was 2.12:1. The mean preoperative keratometric values were significantly decreased postoperatively in all grades of pterygium. Moreover, the amount of keratometric astigmatism varies with the grades of pterygium. In patients with pterygium Grade I, mean keratometric (K) value was reduced to 0.66 ± 0.30 diopter (D) at 1 month postoperatively. Similarly, in patients with pterygium Grade II, it was reduced to 0.71 ± 0.32D, and in pterygium Grade III and IV, it was reduced to 1.82 ± 0.27D and 2.72 ± 0.53 D, respectively at 1-month follow-up visit. Conclusion: The pterygium excision surgery significantly causes reduction in pterygium-induced keratometric astigmatism. Moreover, the differences in the K-reading are proportional to the grades of pterygium.
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A comparative study between topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients attending a tertiary care center in West Bengal p. 113
Prasanna Uday Patil, Supriya Sudhir Pendke, Mousumi Bandyopadhyay, Purban Ganguly
DOI:10.4103/jcor.jcor_62_18  
Background: Ocular inflammation, which is common after cataract surgery, may cause patients to have postoperative pain and photophobia. Topical nonsteroidal anti-inflammatory drugs have been shown to be clinically effective in controlling inflammation after cataract surgery. Aim: The present study aims to compare topical ophthalmic nepafenac (0.1%) and ketorolac (0.5%) for their analgesic and anti-inflammatory effects in postoperative senile cataract patients. Materials and Methods: A total of 212 patients were included in the study and randomly allocated in two equal groups to receive either nepafenac (0.1%) or ketorolac (0.5%). Patients underwent cataract extraction on the scheduled date by manual small incision cataract extraction. The drug application was started on the day of operation. For both the groups, the drug was applied thrice daily. The ocular parameters were observed and noted down according to group assigned successively on day 1, day 3, day 7, day 14, and day 28. Results: There was no significant difference between the two drugs as far as visual acuity, and intraocular pressure outcome was concerned. The effect of nepafenac (0.1%) on anterior chamber cells and flare was more than ketorolac (0.5%) during 1st week (up to day 7), but at the end of the observation period (28 days), the effect was similar with both drugs. In nepafenac (0.1%) group, higher percentage of patients was free from pain and ocular discomfort than that of ketorolac (0.5%) group throughout the observation period. Conclusion: Nepafenac (0.1%) was found superior than ketorolac (0.5%) in dealing with ocular discomfort and pain and with respect to early recovery from anterior chamber inflammation.
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Retrospective analysis of clinical profile of pediatric proptosis in a tertiary care hospital of Eastern India p. 117
Chandana Chakraborti, Nabanita Barua, Rosy Kahakashan Chisthi, Subhadri Manna
DOI:10.4103/jcor.jcor_73_18  
Background: Pediatric proptosis can often present with puzzling clinical features and needs a systematic approach to avoid diagnostic dilemma. Aims and Objectives: To study the clinical and etiological profile, management, and outcome of pediatric proptosis. Materials and Methods: This retrospective noncomparative study involved the analysis of record files of 41 cases of childhood proptosis, who presented in the eye outpatient department and oculoplastic clinic between January 2013 and December 2016. Results: There were a total of 41 children, age varied from 6 months to 15 years. The maximum number of cases 25 (61%) were in the age group of 0–5 years. Male:female ratio was 1.77:1. Unilateral cases were found to be 31 (76%) and bilateral cases be 10 (24%). Neoplastic lesions constituted 22 (54%) of which benign lesions were 3 (14%) and malignant were 19 (86%). Among malignant, primary were 11 (58%) and secondary were 8 (42%). Inflammatory/infective lesions were 8 (20%). Conservative/medical management was given to 11 cases (27%). Surgery with pre- or post-operative chemo- or radio-therapy was the treatment of choice. Conclusion: Neoplastic lesions were found to the most common cause of proptosis in this study. Apart from detail ocular and systemic examination, final etiological diagnosis is possible in certain cases only after investigations such as peripheral smear, bone marrow examination, histopathological examinations, ultrasonography B-scan, computed tomography scan, and magnetic resonance imaging. Timely diagnosis and management can save the vision and many a times lives.
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BRIEF COMMUNICATIONS Top

Bilateral conjunctival melanocytosis and retinitis pigmentosa p. 122
Rajesh Subhash Joshi, Iqbal Zarir Hussain Bombaywala
DOI:10.4103/jcor.jcor_11_18  
Conjunctival pigmented lesions have varied appearances. It arises from the melanocytic or nonmelanocytes. It is rare to find conjunctival melanocytosis associated with retinal pigmentary dystrophy. We report a case of a 69-year-old male with bilateral typical retinitis pigmentosa with conjunctival melanocytosis. The excessive pigmentation of conjunctiva was recognized when the patient came for cataract surgery. The conjunctival pigment was identified during slit lamp examination. Histopathological section of superior conjunctiva revealed stromal mononuclear infiltrate with melanin pigment in the basal cells. To the best of our knowledge, such an association has not previously been described. Such an association needs to be studied in a large case series. The present of conjunctival pigments may alert the eye surgeon to look for pigmentary disorder of the retina.
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Successful management of central retinal artery occlusion and optic nerve injury postendoscopic sinus surgery with combined hyperbaric oxygen and intravenous steroids p. 124
Ramesh Murthy, Nikhil Beke, Aratee Palsule, Manisha Deshmukh
DOI:10.4103/jcor.jcor_55_18  
Functional endoscopic sinus surgery, especially ethmoidal surgery, carries a risk of orbital injury because of the close relation between the orbit and the sinuses. For central retinal artery occlusion (CRAO), hyperbaric oxygen therapy has shown good outcome. Intravenous steroids are prescribed for cases of optic nerve injury. We describe a case of combined optic nerve injury and CRAO following endoscopic sinus surgery which was managed successfully with good recovery of vision with multimodal therapy with a combination of intravenous methylprednisolone and hyperbaric oxygen
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LETTERS TO THE EDITOR Top

Can you identify this conjunctival pigmentation? p. 127
Amol Ganvir, Shruti Shirwadkar, Nayana Potdar, Chhaya A Shinde
DOI:10.4103/jcor.jcor_36_18  
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A typical case of optic nerve head avulsion p. 128
Shachi Rohan Desai, Tejas Desai
DOI:10.4103/jcor.jcor_63_18  
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POSTGRADUATE SECTION Top

Ophthalmic manifestations of tuberous sclerosis: A diagnostic clue p. 130
Richa Dhiman, Aditi Prashar, RK Sharma, Mandeep Tomar, Nishita Yadav
DOI:10.4103/jcor.jcor_81_18  
A 22-year-old female with severe headache was referred to eye outpatient department for fundus examination with a possibility of intracranial space-occupying lesion. On fundus examination, we found bilateral disc edema with creamy white elevated lesion in the left eye suggestive of retinal astrocytoma which was confirmed by spectral-domain optical coherence tomography. Hence, the patient underwent magnetic resonance imaging brain, ultrasonography abdomen, and dermatological workup which confirmed it to be the case of tuberous sclerosis. This case report exemplifies the systemic manifestations of tuberous sclerosis complex and its specific expression in the eye. Hence, in turn, to establish an appropriate diagnosis, retinal manifestations of the disorder must not be overlooked.
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