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   Table of Contents - Current issue
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May-August 2019
Volume 7 | Issue 2
Page Nos. 35-83

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EDITORIAL  

How to assess quality of journals and researches (Part I) Highly accessed article p. 35
Barun K Nayak
DOI:10.4103/jcor.jcor_59_19  
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ORIGINAL ARTICLES Top

Characteristics of open-globe injuries in a tertiary hospital of Southern India p. 37
Ankita Kothari, Mary Joseph, Anupama Janardhanan
DOI:10.4103/jcor.jcor_54_18  
Aim: This study aims to describe the epidemiology of open-globe injuries at a tertiary care hospital of South India over a period of 5 years. Materials and Methods: Review of records of 40 eyes with open-globe injuries from January 2012 to December 2016 was done for demographics, time, nature and cause of injury, visual acuity, and ocular findings. Results: The prevalence of open-globe injuries was 2%. Majority of patients underwent primary repair with 5% having undergone evisceration. Visual acuity at time of presentation was >0.74 log of minimal angle of resolution in 10% with 17.5% having no perception of light. The most common type of injury as per the Birmingham Eye Trauma Terminology System was penetration type, Zone-I. Occupational injury was the most common mode of injury. Increasing number of injuries with a mean of 8 injuries/year was noted. Vitreous loss and associated facial trauma can be taken as an added variable for predicting postoperative visual outcome. Conclusion: Our study shows a male preponderance with men between age group of 20 and 40 years being at risk of open-globe injury. Immediate recognition of eye injury by the general practitioner and quick referral of the patient to an appropriate tertiary hospital with eye care facilities, within 24 h is advisable. Occupational injury was the etiology for the majority of the patients and hence there is a need to introduce stringent worker safety protocols. Ocular trauma score is also a good indicator of the prognosis for vision.
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Clinical profile and visual outcome of ocular injuries presenting at a tertiary care hospital in Goa p. 41
Tanvi A Poy Raiturcar, Pradeep G Naik, Jagadish A Cacodcar
DOI:10.4103/jcor.jcor_12_18  
Context: The study was undertaken to describe the clinical profile and visual outcome of ocular injuries in Goa, as there were no prior systematic data describing the same. Aims and Objectives: The aim is to study the clinical profile of ocular injuries at a tertiary care hospital, to describe pattern of ocular injuries, and identify at-risk groups and to study visual outcomes among such patients. Settings and Design: This was a prospective case series tertiary hospital-based study. Materials and Methods: Five hundred consecutive patients presenting with ocular injuries to the tertiary hospital between September 2014 and August 2015 were studied. Details of history, examination, investigations, and plan of action were noted. Statistical Analysis Used: Proportions and percentages were used for statistical analysis. Results: The most common victims were in the age group of 21–40 years (45%). Injuries among males were more common (88.8%) than females (11.2%). It was noted that 26.8% patients were under the influence of alcohol at the time of injury. The most common etiology was motor vehicle accidents (62.4%), followed by domestic accidents, occupational accidents, assault, and sports injuries. Most patients (77%) presented within 6 h of injury. Isolated anterior segment injuries were seen in 96.4%, 1.4% involved the posterior segment, whereas 2.2% involved both the segments. The final visual acuity of 87.4% patients was better than 6/12.
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Prevalence of refractive errors in school-going female children of a rural area of Madhya Pradesh, India p. 45
Ankur Saxena, Nitin Nema, Ajit Deshpande
DOI:10.4103/jcor.jcor_126_17  
Background and Aim: Uncorrected refractive errors are the second most common cause of blindness after cataract. In previous studies from India, it is reported that majority of the children with blindness were female. Therefore, an obvious need was felt to screen school-going female children from a rural area for the prevalence of refractive error and associated ocular morbidity. Materials and Methods: A cross-sectional study was carried out in 1322 female students of rural schools. The permission required for screening of the children was obtained from the principal of the school. Students were examined by an ophthalmologist in their respective school premises. A brief history pertaining to eye problem and family history of ocular ailment were recorded. Clinical examination of the eye and refraction under cycloplegia, when needed, were done. Difficult and unmanageable cases were referred to the base hospital for further evaluation. Results: Refractive error was the most common ocular morbidity (38.7%). Myopia was the most common refractive error with a prevalence of 67.1%, followed by hypermetropia (18.8%) and astigmatism (14.1%). There was a decrease in the prevalence rate of visually impaired students to 0.4% (from the initial rate of 10%) after prescribing the spectacles. Other ocular morbidities encountered were strabismus (2.79%) and amblyopia (2.11%). Conclusion: Refractive error was the most prevalent ocular morbidity in the rural school-going girls, followed by strabismus and amblyopia. If properly treated and timely managed, a dramatic decline in the rate of refractive error-related visual disability can be achieved.
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Prospective clinical study to find out epidemiology of presbyopia in a prepresbyopic population (age group 34–40 years) p. 51
Deepak Mishra, Prashant Bhushan, MK Singh, Bhavesh Makkar, BP Sinha, Gyan Bhaskar
DOI:10.4103/jcor.jcor_53_18  
Background: Several studies have been carried out regarding the epidemiology of presbyopia at or after 40 years of age. Now a day we find the need of presbyopic glasses before the age of 40 years, so we plan this study in pre-presbyopic age group. Aim: To find out epidemiology of presbyopia in a pre-presbyopic age group (age 34-40 years). Settings and Design: A prospective clinical study was done on two thousand two hundred and ninety-six patients at two tertiary care centres in India. Duration of study was three years and eight months. Materials and Methods: The degree of presbyopia was determined as minimum amount of plus lens needed to achieve maximum improvement in lines read to the end point (N8). Patients were divided in 3 groups, group 1 (age 34-36), group 2 (age 36-38) and in group 3 (age 38-<40). A detailed epidemiological profile and systemic history were noted in the prescribed Performa. Statistical Analysis Used: Data was analyzed by SPSS software 16. Results: Maximum (43.7%) number of patients was in group 3.In the study females predominated over males and maximum (51.9%) patients were from middle socioeconomic status. We found that 53.6 % were from urban area. 39.6 % patients had accepted that near vision problem affected their daily work efficiency and quality of life. Conclusion: This study shows occurrence of presbyopia in pre-presbyopic age group. So we recommend patients should be screened and treated before the age of 40 years for presbyopia to reduce burden of avoidable visual impairments and for improvement in quality of life.
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Clinical profile and burden of primary glaucoma in rural camp patients attending a tertiary care center in India p. 55
Rekha R Khandelwal, Dhananjay Raje, Rachit R Khandelwal
DOI:10.4103/jcor.jcor_79_18  
Purpose: To study clinical profile and burden of primary glaucoma in rural camp patients attending a tertiary care center. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital of a single academic institute after ethical approval. Primary glaucoma patients aged ≥40 years, referred from the outreach camps, were included for a period of 12 months (2016–2017). A detailed history was recorded. Ocular examination included visual acuity, slit-lamp examination, disc evaluation, gonioscopy, intraocular pressure (IOP), and visual fields. Glaucoma was defined according to the International Society Geographical and Epidemiological Ophthalmology. Results: Out of 4204 referred cases from community program, 115 cases had primary glaucoma. Open-angle group had 63 (54.78%) cases whereas narrow-angle group had 52 (45.22%). The hospital-based prevalence for open-angle glaucoma was 1.11% (95% confidence interval [CI]: 0.8, 1.44) and for narrow-angle glaucoma was 1.07% (95% CI: 0.76, 1.38). The mean IOP was higher in narrow-angle group (P < 0.0001). The proportion of unilateral blindness was significantly high in narrow-angle category (P = 0.0203). Conclusions: The ratio of open-angle glaucoma to narrow-angle glaucoma was 1.2:1. Associated risk factors were age, gender, high IOP, refractive errors, and systemic illness. Narrow-angle glaucoma was more blinding as compared to open-angle glaucoma. Majority of the primary glaucoma found in camp patients was undiagnosed.
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Prevalence and distribution of ocular morbidities among primary school children in Goa p. 61
Shekhar O Akarkar, Pradeep G Naik, Jagadish A Cacodcar
DOI:10.4103/jcor.jcor_34_18  
Background: Early detection and treatment of ocular morbidity among children is important. Eye screening of school children is useful in detecting the correctable causes of decreased vision, especially refractive errors and minimizing long-term visual disability. This information is essential to plan eye care programs to reduce the burden of visual impairment among them. There is a lack of community studies on ocular morbidity on primary school children in Goa. Aim: The aim was to study the prevalence and distribution of common ocular morbidities among primary schoolchildren in Goa. Settings: This is a community-based study in government and private primary educational schools in Goa. Materials and Methods: In this cross-sectional study, 817 children aged 6–10 years from five primary schools in Goa were screened for detecting ophthalmic problems. Statistical Analysis Used: Proportions and percentages were used. Results: The prevalence of ocular morbidities was 13.22%, and they included refractive errors (9.55%) (predominantly myopia [62.82%]), strabismus (1.1%), conjunctivitis (1.1%), lid swelling (0.74%), and color blindness (0.15%). Conclusion: A high prevalence of ocular morbidity was observed among primary school children. Refractive errors were the most common ocular disorders.
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Visual outcome and major surgical complications of extracapsular cataract extraction versus manual small-incision cataract surgery performed by resident doctors at tertiary care institute as part of learning curve p. 65
Shekhar Akarkar, Ugam P. S Usgaonkar
DOI:10.4103/jcor.jcor_8_18  
Background: Cataract surgery has its own learning curve to the resident doctors. Our resident doctors are trained in extracapsular cataract extraction (ECCE) and manual small-incision cataract surgery (MSICS). In ECCE and initial cases of MSICS, they are trained to do can-opener capsulotomy (COC) and then they are trained in continuous curvilinear capsulorrhexis (CCC). Aim: We designed a study to compare the visual outcome and major surgical complications of resident doctor performed ECCE versus MSICS at our institute. Setting and Design: This was a hospital-based study in ophthalmology department (retrospective study). Materials and Methods: A total of 239 patients with visually significant cataract presenting to our outpatient department were enrolled in the study. Data of consecutive cataract surgeries done by 10 junior residents (JRs) from March to August 2017 were analyzed. First-year residents were trained for ECCE (JR1 group) for 6 months. During the same time period, 2nd-year residents were trained for MSICS (with COC) for first 3 months (JR2 group). Then, as a part of learning curve, 2nd-year residents were then trained for MSICS (with CCC) for next 3 months (JR3 group). Data were analyzed using the Chi-square test, percentages. Results: Out of 239 cataract surgeries performed by residents over a 6-month period, ECCE were 52 (21.8%) and MSICS were 187 (78.2%) cases. Both the surgeries in MSICS (2nd-year residents) and ECCE (1st-year residents) had good visual outcome (94.6% vs. 84.6%). The overall major surgical complication rate for MSICS was 7.0% while that for ECCE was 11.5%. Conclusion: We conclude that both surgeries can be taught to beginner surgeons with good visual outcome. Both surgeries have safe learning curve with good visual results when done under supervision as evidenced by a low rate of major surgical complications.
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BRIEF COMMUNICATIONS Top

An unusual case of penetrating trauma with a copper wire causing a traumatic subluxated cataract p. 71
Tanvi A Poy Raiturcar, Marushka Aguiar
DOI:10.4103/jcor.jcor_13_18  
A 22-year-old male presented with injury with a copper wire to left eye at the workplace. Visual acuity was reduced to finger counting with severe ocular pain. Slit lamp examination showed that the intraocular foreign body entered the anterior chamber through a 0.5 mm scleral wound and pierced through iris and lens causing a traumatic cataract. The patient was taken to operatingtheater with a removal of the copper wire and primary closure of the scleral wound. Two weeks' postoperatively, the patient was taken up for a cataract surgery but left aphakic. He is to be posted for a scleral-fixated intraocular lens at a later date.
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Adult presentation of Haab's striae p. 73
Harikrishnan Vannadil, Archana Dharmdeo Singh, Sunandan Bhatta
DOI:10.4103/jcor.jcor_78_18  
In adults, Haab's striae are often an accidental finding during routine examination. The presence of Haab's striae points to an underlying event involving the eye during the developmental stage. Even though in most cases, the event might have been resolved, an attempt should be made to ascertain the cause for such a finding. Here, we report a case of a young adult with Haab's striae in one eye and a posttraumatic phthisical fellow eye. In the absence of any concrete history, we have to consider the possibility of glaucoma as well as trauma. Necessary investigations and follow-up are warranted in such cases.
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Scleral fixation of brown diaphragm intraocular lens in cases of posttraumatic aniridia with aphakia p. 76
Ronel Soibam, Pritam Bawankar, Harsha Bhattacharjee, Krati Gupta
DOI:10.4103/jcor.jcor_21_18  
Traumatic aniridia is a devastating complication of penetrating ocular injuries. Aniridia associated with aphakia can be treated with standard intraocular lens (IOL) implantation with or without scleral fixation; however, the problem of photophobia and glare remains still a concern. Although postoperative inflammation and secondary glaucoma are the main concerns, the scleral fixation of brown diaphragm IOL seems to be a good option for the management of traumatic aniridia and aphakia. Herein, we evaluated the clinical outcomes of three patients with posttraumatic aniridia who were treated with pars plana vitrectomy and scleral fixation of a brown-colored diaphragm IOL.
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Inadvertent descemetorhexis and Descemet's membrane detachment after cataract surgery – Reendothelialization after C3F8 descemetopexy: A case report and review of literature p. 78
Abraham Kurian, Iodine Reghunadhan, Swapna Nair, Asha George
DOI:10.4103/jcor.jcor_29_18  
We report a case of extracapsular cataract surgery, wherein inadvertent large central descemetorhexis and loss of Descemetís membrane (DM) were noted intraoperatively. Postoperatively, near total detachment of the remaining DM was noted. C3F8 descemetopexy at 2 weeks resulted in successful reattachment of the detached DM and reendothelialization in the area of lost DM. The corneal edema resolved with eventual good visual outcome and no complications. Although spontaneous reattachment of Descemetís detachment is described, early descemetopexy results in better visual outcome even in cases with extensive DM loss probably due to early resumption of the physiologic function following earlier anatomic reattachment.
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Retinitis sclopetaria in blast injury p. 81
Maithili Mishra, Sheela P Kerkar, Samruddhi Dani, Priyarthi Pradhan, Bhooshan Gandhi, Sonal S Desai
DOI:10.4103/jcor.jcor_64_18  
A 52-year-old male presented with decreased vision in his left eye for 1.5 years after he suffered from a blast injury at his workplace in a chemical factory. Clinical examination revealed no systemic abnormality; however, ocular evaluation of the left eye showed traumatic mydriasis of the pupil and fundus examination showed multiple choroidal ruptures with extensive scar formation and widespread pigmentary alteration, causing a distinctive pattern of retinitis sclopetaria. Closed globe injury, especially blast injury, which has a high velocity causes a typical pattern of retinal findings. Our patient did not develop retinal detachment even after 1.5 years of trauma; however, macular involvement caused poor vision and prognosis. Spectral-domain optical coherence tomography did not reveal any abnormal choroidal neovascularization. Retinitis sclopetaria is an uncommon entity, and long-term clinical outcomes are not well reported. In this report, we would like to discuss the clinical features seen after a long-standing trauma, injury mechanism, suggested treatment, and prognosis.
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