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   Table of Contents - Current issue
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May-August 2021
Volume 9 | Issue 2
Page Nos. 49-95

Online since Saturday, July 31, 2021

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EDITORIAL  

Rhino-cerebro-orbital mucormycosis: A new threat p. 49
Barun K Nayak
DOI:10.4103/2320-3897.302205  
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REVIEW ARTICLE Top

Intraocular lens opacification: A rare enigma Highly accessed article p. 51
Prateek Jain, Anshuman Pattnaik
DOI:10.4103/jcor.jcor_115_20  
Intraocular lens (IOL) opacification is an infrequent and often delayed complication of cataract surgery. However, correct diagnosis of the complication followed by appropriate management is crucial for effective treatment. In spite of exhaustive research, the authors were not able to find comprehensive literature comprising all facets of IOL opacification. This article hopes to address this deficiency. Detailed literature search on IOL opacification was carried out using PubMed Medline, Web of Science, and Google Scholar. The studies which adhered to the inclusion and exclusion criteria were considered for this article.
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ORIGINAL ARTICLES Top

Comparing the efficacy of 2% topical rebamipide and 0.1% topical sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease p. 55
Priyanka V Gandhi, Omkar Telang, Vrunda Morepatil
DOI:10.4103/jcor.jcor_50_19  
Background: Dry Eye Disease (DED) is a multifactorial and complex disease of the ocular surface, with a high prevalence in adults. Aims and Objectives: To compare the efficacy of 2% topical Rebamipide and 0.1% topical Sodium hyaluronate with or without 0.05% topical cyclosporine in patients with dry eye disease (DED). Materials and Methods: This prospective, randomised, comparative, interventional study was conducted at a tertiary level academic centre on 240 eyes of 120 patients having DED, with Schirmer's test (without anesthesia) value less than or equal to 10mm and tear film breakup time (TBUT) less than or equal to 10 secs. After detailed ophthalmic examination, patients were randomly allocated in 4 different groups (A B C D). Group A were given 2% topical Rebamipide, group B received 2% topical Rebamipide with 0.05% topical Cyclosporine, group C were started on 0.1% topical Sodium Hyaluronate and group D were given 0.1% topical Sodium Hyaluronate with 0.05% cyclosporine. Each of these drops was given for 4 times a day for a period of 12 weeks. All patients were followed up after 2 weeks, 4 weeks and 12 weeks. Results: Out of 120 patients, 79 (65.83%) were female and 41 (34.16%) were male. The change in the mean schirmer's score and mean TBUT score was statistically significant in all four groups from baseline to 12 weeks (p<0.05). On comparing with each other, no significance difference was noted in any group. Conclusion: According to our study, 3 months of treatment with either 2% topical Rebamipide or 0.1% sodium hyaluronate is equally effective for DED and addition of 0.05% cyclosporine have no adjunctive role.
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Comparison of photorefraction by photoscreener (PlusoptiXA12R) with autorefractometer and cycloplegic retinoscopy in children between 5 and 15 years p. 59
S. Kripa, V Rajesh Prabu, H Ranjini, Parul Priyambada, Venu Muralidhar
DOI:10.4103/jcor.jcor_63_20  
Aim: The aim of the study is to compare the photorefraction values by photoscreener (PlusoptiXA12R, PO) with those of autorefractometer (AR) (TOPCON RM800) and cycloplegic retinoscopy (CR) in children. Methods: It was an observational cross-sectional analytical study with a sample size of 1000 eyes conducted over a duration of one year in a tertiary eye care center. Children in the age group of 5–15 years with refractive error were screened using photoscreener and AR in noncycloplegic state followed by CR. Interclass correlation and agreement were assessed for measurements taken by all three modalities. Sensitivity and specificity were analyzed. P < 0.05 was taken significant for all statistical tests. Positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value were statistically analyzed. Receiver operative characteristic curve and area under the curve were plotted. Results: Refraction measurements by photoscreener had a strong positive correlation with measurements from CR and AR. Bland-Altman plots depicted the agreement for measurements taken by all three modalities. Sensitivity and specificity of values were high for photoscreener (PlusoptiXA12R) when compared with CR and AR. Conclusion: We conclude that photoscreener is a reliable alternative to AR and CR for detection of refractive error in children between 5 and 15 years of age.
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Corneal biomechanics in connective tissue disorders p. 64
Divya Kesarwani, Vaibhav Kumar Jain, Rachna Agarwal, Jaya Kaushik, Kumudini Sharma
DOI:10.4103/jcor.jcor_74_20  
Purpose: The purpose of this study is to determine the corneal biomechanical properties in patients with connective tissue disorders (CTDs) and compare them with age-matched healthy control. Materials and Methods: In this cross-sectional study, 62 patients (study group) with CTDs and 44 healthy patients (control) were analyzed by Ocular Response Analyzer (Reichert Inc., Depew, N. Y., USA) and Corneal Pachymetry (SP-2000, Tomey, Nagoya, Japan). The right eye of all patients was assessed for corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPc), and Goldmann-correlated intraocular pressure (IOPg), and central corneal thickness (CCT). Results: Mean CH (9.54 ± 1.66 mm Hg [study group] and 10.62 ± 1.21 mm Hg [control]; P = 0.013) and mean CRF (9.95 ± 1.47 mm Hg [study group] and 10.76 ± 1.25 mm Hg [control]; P = 0.040) were significantly different between groups. Mean IOPc, IOPg, and CCT were not significantly different between groups. In the subgroup analysis of study cases (oral steroid versus nonsteroid therapy) of CTDs, CRF which was significantly lower in steroid (9.25 mm Hg) compared nonsteroid therapy (10.20 mm Hg) (P = 0.045), whereas, other parameters such as CCT, CH, IOPc, and IOPg were comparable between the two groups (P ≥ 0.05). Conclusion: CH is altered in CTDs which may be an independent risk factor for glaucoma and might underestimate intraocular pressure so CH is an important consideration in patients with CTDs.s
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Epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases of refractive error in pediatric population visiting a tertiary eye care center p. 67
Vimal Krishna Rajput, Naren Shetty, Pritish Raut
DOI:10.4103/jcor.jcor_9_20  
Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases in children visiting a tertiary care eye center in southern India. Materials and Methods: This prospective study was conducted on 367 children, ≤15 years of age, with significant refractive error who visited our tertiary eye care hospital over a period of 1 year. Every child underwent detailed ocular examination. Significant refractive error was defined as myopia of ≥−0.75 diopter (D), hypermetropia of more than +2 D, and astigmatism of more than 0.75 D. Descriptive statistics were computed for better and the worse eye. Statistical tests were applied between the worse and better eyes using Chi-square test. Results: A total of 367 children (38.8%) were diagnosed for the first time of having refractive error. Only 146 (39.8%) children presented with visual complaints. With respect to the vision in the worse eye, 65.9% (n = 240) had moderately subnormal vision. There was no statistically significant difference (P = 0.057) between age distribution and visual acuity in the worse eye. Two hundred and thirty-eight children (64.9%) had significant astigmatism as compared to 161 myopic (43.9%) children. There was a statistically significant difference between reasons of visit and different age groups. Conclusions: Astigmatism was the most prevalent refractive error and uncorrected astigmatism the most significant amblyogenic factor. Since majority of children, especially in the younger age group, present with nonvisual complaints, involvement of pediatricians and parents will help us to reduce morbidity due to uncorrected refractive error and amblyopia.
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Study of prevalence of preventable keratitis, seasonal variation, and microbiological etiology along with quack practice in a Tertiary Eye Care Center in Maharashtra - Central India p. 71
Namrata Kabra, Sakina Mussaji, Supriya Govind Hande
DOI:10.4103/jcor.jcor_31_19  
Purpose: The purpose of the study is to evaluate the prevalence of preventable keratitis, seasonal variations, and microbiological etiology along with quack practices presented at a Tertiary Eye Care Center in Maharashtra (Central India), over a period of 1 year. Materials and Methods: A retrospective study of microbiology of corneal scraping reports in infectious keratitis cases from July 17, 2017 to June 17 2018. Incidence of bacterial and fungal keratitis and culture growth were analyzed for seasonal pattern. Type and frequency of quack practice in the patients were analyzed as well. Results: Among the 795 infectious keratitis cases, culture growth was positive in 322 (40.5%) samples; 258 (80.1%) and 64 (19.9%) were of fungal and bacterial etiology, respectively. The predominant fungal organism was Fusarium Spp. (61.2%) and the predominant bacteria organisms were Streptococcus spp. and Nocardia with (28.1/%) each. Seasonal statistics showed peak in infectious keratitis in rainy seasons with higher incidence of fungal keratitis. It was seen that in 50% of the participants, trauma was the predisposing factor. Six percent of the patients had a history of quack practice from which 53% removed the foreign body with the tip of the tongue. Conclusions: Infectious keratitis is a common problem in central India, with fungal being the most common etiology with surge in rainy season. A significant number of patients still prefer traditional ways of treatment hence awareness and basic knowledge can prevent blindness caused by preventable infectious keratitis.
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BRIEF COMMUNICATIONS Top

Ocular crystals in chronic uveitic eye Highly accessed article p. 75
Dipankar Das, Ganesh Chandra Kuri, Ronel Soibam, Harsha Bhattacharjee, Shahinur Tayab, Hemalata Deka, Bidhan Chandra Das, Shyam Sundar Das Mohapatra, Tanvi Gupta, Apurba Deka
DOI:10.4103/jcor.jcor_37_20  
Intraocular crystals are seen in chronic uveitis. We present a case of a young man with clinical presentation of refractile crystals in the anterior chamber (AC) with right painful blind eye secondary to uveitic glaucoma, which had earlier retinal detachment surgery. AC tap revealed the crystals in cytology, and further, enucleation of the eyeball showed those crystals in the anterior and posterior segments of the eye. Intraocular crystals at multiple sites were rare occurrence.
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Sinus bradycardia following single-day use of timolol eye drops in a healthy young adult - A rare case report p. 78
Sandip Sarkar, Pragathi Shankaralingappa, Amit Kumar Deb, Sangaraju Suneel, Subashini Kaliaperumal, Kaviyapriya Natarajan, Sasikumar Mahalingam
DOI:10.4103/jcor.jcor_91_20  
We report the rare case of timolol-induced sinus bradycardia in an otherwise healthy young individual following just 1 day use of timolol eye drops. A 35-year-old male presented with dispersed hyphema and raised intraocular pressure following blunt trauma in the left eye. He was prescribed timolol eye drops and topical steroids. He presented next day with giddiness, sweating, and heart rate (HR) of 30/min. Electrocardiogram confirmed sinus bradycardia injection atropine 0.5 mg intravenous was given. Timolol was substituted with brimonidine-brinzolamide drops. HR returned to normal of 72/min after 2 days of observation. Our case, therefore, represents an exaggerated response to topical timolol.
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A rare case report of hypophysitis in pituitary macroadenoma mimicking pituitary apoplexy p. 80
Akkayasamy Kowsalya, Sivagami Nachiappan, Mahesh Kumar
DOI:10.4103/jcor.jcor_123_20  
Hypophysitis, a rare inflammatory disorder of the pituitary gland is often misdiagnosed as mass lesion. Granulomatous hypophysitis presenting clinically as pituitary apoplexy is rare. A 23-year-old woman with pituitary macroadenoma presented with sudden diminution of vision in the right eye with features clinically mimicking pituitary apoplexy. Imaging revealed pituitary macroadenoma with hypophysitis. After a course of high-dose intravenous corticosteroids, her visual acuity improved to 6/6. Although apoplexy and hypophysitis have subtle clinical and radiological differences, it is essential to differentiate them to avoid unnecessary invasive procedures when conservative treatment can suffice.
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Sclerocornea - A rare manifestation of full trisomy 13 p. 83
Snehal Ganatra, Shashikant Shetty, P Vijayalakshmi
DOI:10.4103/jcor.jcor_117_20  
Patau syndrome when caused by attachment of an extra chromosome with chromosome 13 is called as full trisomy 13. It is caused by nondisjunction of chromosomes during meiosis. The extra chromosome disrupts normal development, causing multiple and complex organ defects. Children with trisomy 13 are born full term, but they rarely live more than a few days or weeks. Our patient was a 1-year-old female child who presented with various typical and atypical ocular and systemic findings of full trisomy 13. Her karyotyping showed the presence of an extra copy of chromosome 13. Anterior segment dysgenesis is known to occur with Patau's syndrome, but sclerocornea as a manifestation of full trisomy 13 has not been reported prior.
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A rare case of acorea: Congenital absence of pupil p. 85
Parul Priyambada, Rajesh V Prabu, Rajlaxmi B Wasnik, H Ranjini
DOI:10.4103/jcor.jcor_22_20  
Acorea is a congenital anomaly in which there is an absence of pupillary aperture. It is known to have an autosomal dominant inheritance and is associated with microphthalmos, cataract, and iridocorneal dysgenesis. It is caused when the mesodermal tissue of the iris fails to regress during embryogenesis. The lack of pupillary aperture prevents light entering the eye, often causing stimulus deprivation amblyopia. This case describes one such patient with acorea in the right eye with dense amblyopia.
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Severe retinal pigment epitheliopathy following brilliant blue G-assisted epiretinal membrane peeling p. 87
Chahveer Bindra, Parminder Bindra, Preeti Bindra
DOI:10.4103/jcor.jcor_148_20  
To report a case of severe retinal pigment epitheliopathy following 23G pars plana vitrectomy and brilliant blue G (BBG) assisted epiretinal membrane (ERM) peeling in Stage IV primary ERM. Multimodal imaging analyses, including fundus photography, optical coherence tomography, and fundus autofluorescence, were performed to evaluate preoperative and postoperative findings. The patient underwent uneventful pars plana vitrectomy with BBG-assisted ERM peeling with the help of xenon endoilluminator and fine tipped forceps. Six weeks after surgery, the patient complained of paracentral scotomas. On evaluation with retinal imaging, pigmentary alteration was seen over the posterior pole corresponding to the peeled area. A risk of retinal pigment epitheliopathy after uneventful vitrectomy with BBG-assisted ERM peeling is present even with modern endoilluminators. The retinal phototoxicity, use of vital dyes, duration of surgery, stage of ERM preoperatively, and mechanical trauma during peeling may be associated risk factors.
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LETTERS TO EDITOR Top

Integrating ocular microbiology as part of cornea clinics in secondary center for better patient management p. 90
Sanil Shivaji Sawant, Arpan Gandhi
DOI:10.4103/jcor.jcor_158_20  
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Endophthalmitis: Has the surgeon genuinely not followed the protocols for cataract surgery - Need for contemplation before decision p. 91
Lipi Chakrabarty
DOI:10.4103/jcor.jcor_79_20  
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POSTGRADUATE SECTION Top

The abracadabra of cycloplegics in clinching the diagnosis of accommodative spasm p. 93
Shruthy Vaishali Ramesh, Prajnya Ray, Prasanna Venkatesh Ramesh, Meena Kumari Ramesh, Ramesh Rajasekaran
DOI:10.4103/jcor.jcor_242_20  
Accommodative spasm (AS) is a rare involuntary asthenopic condition occurring in children, adolescents and young adults who engage more in near work. It presents as a repetitive condition of accommodation, which shows a tendency to maintain accommodation in the absence of a stimulus. Here, we discuss in brief about AS with reference to a patient who reported to us with such a condition.
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