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   Table of Contents - Current issue
Coverpage
September-December 2020
Volume 8 | Issue 3
Page Nos. 87-132

Online since Friday, December 4, 2020

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GUEST EDITORIAL  

Medlegal advisory – For ophthalmologists p. 87
Mahendrakumar Bajpai
DOI:10.4103/jcor.jcor_81_20  
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EDITORIAL Top

A giant leap for Journal of Clinical Ophthalmology and Research (JCOR) p. 88
Barun K Nayak
DOI:10.4103/2320-3897.302205  
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ORIGINAL ARTICLES Top

Success rate of vitrectomy in rhegmatogenous retinal detachment with choroidal detachment with perioperative oral steroids after the complete settlement of choroidal detachment: Our experience p. 91
Shilpi Harshal Narnaware, Prashant Keshao Bawankule, Dhananjay Raje, Moumita Chokraborty
DOI:10.4103/jcor.jcor_7_19  
Purpose: The purpose of this study is to study the anatomic and functional success of pars plana vitrectomy (PPV) in rhegmatogenous retinal detachments (RRD) with choroidal detachment (CD) after the complete settlement of CD following oral steroids. Materials and Methods: A prospective, observational, case series was conducted on 30 eyes of 30 patients with RRD with CD during January 2014–October 2017. Oral steroids (tablet omnacortil in dose of 1 mg/kg) were started before surgery, and the patient underwent PPV after choroidals was settled (approximately 5–7 days after starting oral steroids). Primary and final anatomical success rates and functional success rates were obtained. The exclusion criteria included previous retinal detachments surgery, combined RRD, and traumatic RRD. Results: Primary success was 53.3% (16/30) Final success was observed in 80% cases. Sixty percent of patients achieved best-corrected visual acuity of >20/200. Conclusion: The perioperative use of oral steroids help in increasing the success rate by reducing hypotony and reducing inflammatory component.
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Study of corneal endothelial morphology in primary open angle glaucoma and pseudo-exfoliatiive glaucoma patients compared with age related normal p. 95
Pooja Bhomaj, Shilpa Umarani, Janavi Kudache
DOI:10.4103/jcor.jcor_29_19  
Objectives: The corneal endothelium does not regenerate, and hence, its integrity is essential to maintain corneal clarity. In view of scarce and contradicting literature on the influence of open-angle glaucoma on endothelial cell density (ECD), and lack of direct head-to-head studies comparing the ECD in eyes with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXFG), we conducted a cross-sectional study to compare the ECD in these eyes in comparison with normal eyes without glaucoma. Materials and Methods: This was a cross-sectional study carried out at a tertiary eye care center in Western India. We enrolled 141 eyes of 141 participants in the study with 47 eyes each in the controls: POAG and PXFG groups. Group differences across the three groups in the continuous variables were analyzed using the analysis of variance or the Kruskal–Wallis test. Differences across the POAG and PXF groups were assessed using the Student t-test of the Wilcoxon rank-sum test for nonparametric variables. Group differences across categorical variables were analyzed using the Chi-square or Fischer’s exact test. Results: In multivariable linear regression analysis adjusted for age, eyes with POAG had an endothelial cell count of 185 cells/mm2 lower than normal eyes (95% confidence interval [CI] =132–238 cells lower, P < 0.001). Similarly, eyes with PXFG had an endothelial cell count of 215 cells lower than normal eyes (95% CI = 162–267 cells lower, P < 0.001). Conclusions: Eyes with POAG and PXFG have lower endothelial cell count compared to age-matched controls.
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Comparative study of secondary implantation of iris-claw lens and scleral-fixated intraocular lens in terms of visual outcome and complications p. 100
C Navya, Ajay S Hatti
DOI:10.4103/jcor.jcor_66_19  
Introduction: The modern cataract surgery is involved in implanting the posterior chamber intraocular lens (PCIOL) in the intact posterior capsule. However, the implantation of PCIOL is not possible in case of weak or no capsular support. In such situations, iris-claw lens (ICIOL) and scleral-fixated intraocular lens (SFIOL) remain as treatment options. Objective: The objective was to analyze the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications. Materials and Methods: It was a prospective study with 30 aphakia patients fulfilling inclusion criteria. These patients were divided into two groups with 15 in each group. Group I patients underwent ICIOL and other 15 patients in Group II underwent SFIOL implantation. Patients with preexisting ocular pathologies were excluded. The preoperative and postoperative evaluation was done for the follow-up period of 6 months. Results were analyzed with Chi-square test and t-test using SPSS software. Results: In ICIOL group, 86.67% of patients and 80.6% of SFIOL patients had final best-corrected visual acuity (BCVA) 6/18–6/6. The mean logMAR BCVA in both groups was comparable. The surgical time in ICIOL was significantly less than SFIOL group (P = 0.00). Suture-related complications were significantly more in the SFIOL group. Complications found in the ICIOL group were harmless. Conclusion: The visual outcome was found to be comparable in both groups. ICIOL requiring less surgical time with fewer complications was found to be a good alternative to SFIOL in correction of aphakia.
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Usefulness of optical coherence tomography angiography in choroidal neovascularization secondary to neovascular age-related macular degeneration p. 104
Mayur S Kulkarni, Mohit S Bharambe, Gauri R Kulkarni
DOI:10.4103/jcor.jcor_14_19  
Background: Optical coherence tomography angiography (OCTA) could be a valid tool to detect choroidal neovascularization (CNV) in neovascular age-related macular degeneration (nAMD), allowing the analysis of the type, the morphology, and the extension of CNV in most of the cases. Aim: The aim of the study was to highlight the role of OCTA in the nAMD. Setting and Design: This retrospective, cross-sectional study is done at tertiary eye care center. Materials and Methods: This study enrolled 24 patients (48 eyes). All patients underwent swept-source optical coherence tomography, swept-source OCTA, and fundus fluorescein angiography (FFA). OCTA was used to evaluate neovascular networks in terms of their type, location, and extent of visualization. Sensitivity and specificity of the method were assessed based on FFA diagnosis as the gold standard. Results: In our study, the sensitivity and specificity of OCTA in detecting CNV secondary to neovascular AMD seem to be high which were 85.1% and 80%, respectively. Conclusion: OCTA may be clinically useful to evaluate the CNV activity and response to treatment as well as to differentiate the various types of CNV in neovascular nAMD.
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BRIEF COMMUNICATIONS Top

Immune recovery uveitis associated with active cytomegalovirus retinitis: A rare presentation p. 109
Mandabi Sengupta, Dipankar Das, Susmita Paul, Puneet Misra, Prakhar Chaudhary, Kunal Shinde
DOI:10.4103/jcor.jcor_72_19  
Immune recovery uveitis (IRU) is the ocular manifestation of immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV)-infected patients with cytomegalovirus (CMV) retinitis receiving highly active antiretroviral therapy (HAART). Here, we report the case of a 48-year-old HIV-infected patient, with poor adherence to HAART, who presented with gradual diminution of vision and pain in the left eye for 2 months. HAART was restarted along with anti-tubercular treatment for central nervous system tuberculosis 6 months ago. Clinical examination revealed the features of uveitis and active CMV retinitis. Laboratory investigations showed increased CD4+ T-lymphocyte count. We diagnosed the case as IRU associated with active CMV retinitis. The patient recovered with topical steroid and oral anti-CMV therapy. Although IRU is commonly seen in patients with inactive CMV retinitis, rarely this may be seen in association with active CMV retinitis, particularly when HAART therapy is initiated without treating CMV retinitis.
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Successful repair of severed medial rectus following trauma p. 111
Vipin Singh, Alka Sharma, Anupriya Chaubey, Pramod Kumar, Siddharth Agrawal, Apjit Kaur
DOI:10.4103/jcor.jcor_90_19  
Direct injury to the extraocular muscles following penetrating orbital trauma is often challenging for the clinicians. The decision whether to attempt primary repair or to have a staged approach is difficult to make, with each having its merits and demerits. We report here a case of direct injury to the medial rectus resulting in its complete transection. The patient was successfully managed by imaging followed by exploration and reattachment of the transected muscle in a single surgery.
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Aponeurotic ptosis due to playful lid eversion: Case report and literature review p. 114
Rajat M Srivastava, Vinita Singh, Rolli Khurana, Siddharth Agrawal
DOI:10.4103/jcor.jcor_85_19  
Aponeurotic ptosis is known to occur due to a wide variety of causes that lead to dehiscence of levator aponeurosis from the tarsal plate. We report here two cases with an unusual mechanism, resulting in this type of ptosis. Both the cases presented with spontaneous progressive drooping of upper lids, more on the right side, and gave a history of repeated playful eversion of upper lids. The first case underwent successful levator palpebrae superioris aponeurosis reattachment. Peroperatively, disinsertion and thinning of aponeurosis confirmed the diagnosis. Repeated habitual eversion of lids had probably caused stretching and mild chronic inflammation of the tarsus and lid retractors, leading to progressive thinning with disinsertion of the levator aponeurosis.
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Unilateral acute conjunctivitis caused by Oestrus ovis larva: A rare case report from Western India p. 117
Aruna Kumari R. Gupta, Akash P Patel, Yashvi P Nathwani, Geera C Kyada, Kunjan Kikani
DOI:10.4103/jcor.jcor_100_19  
External ophthalmomyiasis is a relatively rare condition caused by infestation of ocular tissue by the larva of Oestrus ovis (sheep botfly) which is a parasite of sheep and goats. We present a case of ophthalmomyiasis caused by O. ovis, from Western India. The patient presented with left eye acute conjunctivitis associated with conjunctival chemosis and watering. The larvae of O. ovis were seen in the bulbar and palpebral conjunctiva. Prompt removal of the larvae was done from the conjunctiva which helped in relieving the symptoms. It is important for ophthalmologists to be aware of ophthalmomyiasis, as this is often misdiagnosed as acute conjunctivitis.
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Adie’s pupil – Case series p. 119
Sowmya Raveendra Murthy
DOI:10.4103/jcor.jcor_1_20  
Adie’s pupil, also called as Adie’s tonic pupil is the common cause of anisocoria or unequal pupils in clinics. It is used to denote the parasympathetic denervation of the pupil with absent light responses and retained near reflex. We describe a case series of patients diagnosed with Adie’s pupil. We retrospectively reviewed the case records of patients diagnosed with Adie’s pupil between January 2016 and December 2017. The diagnosis was made based on light-near dissociation of pupils, vermiform movements of the iris, and supersensitivity to dilute pilocarpine. Routine blood investigations, venereal disease research laboratory test was ordered in all patients. Out of the forty patients included, there were 23 male and 17 female. It was bilateral in 6 and unilateral in 34 cases. Most cases were between 20 and 50 years. There were 3 cases <20 years and 4 cases >50 years. Hypothyroidism and diabetes were noted in 2 cases each. Interestingly, the erythrocyte sedimentation rate (ESR) was raised in 9 cases. Our series points toward the common occurrence of Adie’s pupil and needs to be looked for during the examination. Although the etiology seems not clear in our review, it gives a clue to investigate further in view of raised ESR suggesting inflammation.
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Wolfram syndrome with childhood glaucoma: A rare case report with review of literature p. 122
Divya Kesarwani, Gunjan Jain, Sarswati , Rachna Agarwal, Kumudini Sharma, Vaibhav Kumar Jain
DOI:10.4103/jcor.jcor_26_20  
Wolfram syndrome (WFS) is a rare neurodegenerative disorder characterized by young-onset diabetes mellitus, central diabetes insipidus, optic nerve atrophy, and hearing loss. The ophthalmic association of this order has been limited to optic nerve atrophy. We report here a case of WFS and its disease course with childhood glaucoma as a rare ophthalmic manifestation which has been reported just once earlier. The patient had young-onset diabetes mellitus (insulin dependent), diabetes insipidus, and optic-disc pallor suggestive of partial optic atrophy. However, hearing assessment was normal at the time of presentation and in due course of disease. Glaucoma is one of the rare possible ocular manifestations of WFS which should be highly considered while evaluating patient with this disorder.
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POSTGRADUATE SECTION Top

Spectrum of Calotropis procera latex-induced ocular toxicity p. 125
Fayiqa Ahamed Bahkir
DOI:10.4103/jcor.jcor_11_20  
Exposure to Calotropis procera latex is a common occurrence in certain parts of South East Asia, especially during festivals in India, where exposure can occur due to inadvertent rubbing of the eyes after touching the flowers, or an accidental fall of latex into the eyes while handling the plant itself. Management depends on the symptomatology and time of presentation of the patient after ocular injury with the latex. This article deals with pathophysiology, signs, symptoms, management options, and possible complications of C. procera latex toxicity.
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LETTERS TO THE EDITOR Top

Tuberous sclerosis and foramen of Monro p. 128
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/jcor.jcor_108_19  
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The clinical relevance of Hyper Immunoglobulin E Syndrome in Ophthalmology p. 129
Rajalakshmi Selvaraj, Renuka Srinivasan
DOI:10.4103/jcor.jcor_23_20  
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Immediate sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery p. 130
Ali Adel Ne'ma Abdullah
DOI:10.4103/jcor.jcor_31_20  
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A lifetime experience of an ophthalmologist!! p. 131
Tanvi Jain, Nisheeta Agarwala
DOI:10.4103/2320-3897.302206  
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