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   Table of Contents - Current issue
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January-April 2021
Volume 9 | Issue 1
Page Nos. 1-47

Online since Saturday, April 10, 2021

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EDITORIAL  

The conundrum of COVID-19 vaccine p. 1
Barun K Nayak
DOI:10.4103/2320-3897.302205  
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ORIGINAL ARTICLES Top

Quality of life in patients affected by age-related macular degeneration Highly accessed article p. 3
Aratee C Palsule, Aditi A Kulkarni, Ketan V Jathar
DOI:10.4103/jcor.jcor_99_19  
Context: Age-related macular degeneration (ARMD) is an eye condition which results in loss of vision because of damage to the retina. ARMD affects central vision, and it shows association with psychological distress and depression. Aims: Our study aimed to evaluate the quality of life (QoL) in patients with ARMD and its association with best-corrected visual acuity (BCVA) and treatment. Subjects and Methods: A cross-sectional study including patients clinically diagnosed as neovascular ARMD (wet ARMD) and geographic atrophy (dry ARMD). Patients were classified into Group 1: Patients with dry ARMD, Group 2: Patients with wet ARMD not treated with anti-vascular endothelial growth factor (VEGF) injections, and Group 3: Patients with wet ARMD who had received at least 3 anti-VEGF injections. To assess the vision-related QoL, National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used. Results: We included 60 patients, 20 in each group. There were 23 women and 37 men; with mean age of 78.2 ± 7.9 years. We observed significant difference in near activities (P = 0.03), distance activities (P = 0.002), and vision-specific social functioning (P = 0.001), when comparing VFQ-25 subdomain scores with patients with better eye BCVA. We found Group 3 had significantly more vision-specific role difficulties than Group 1 (41.87 ± 21.94 vs. 26.87 ± 25.73). We found Group 2 had significantly better vision-specific mental health (49.37 ± 19.8 vs. 35.31 ± 19.9) and lesser vision-specific dependency than Group 3 (57.08 ± 26.6 vs. 40.00 ± 26.7). Conclusions: Vision-specific mental health is better in untreated wet ARMD patients than those who have taken anti-VEGF injections in our study population.
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Study of peripapillary retinal nerve fiber layer thickness in patients of type 2 diabetes mellitus and its correlation with glycemic control Highly accessed article p. 9
Valerie Menezes, Ugam P S. Usgaonkar, Akshaya Nagvenkar
DOI:10.4103/jcor.jcor_78_19  
Context: The retina of diabetic patients undergoes neurodegenerative changes, in addition to the vascular changes. Aims: The aim of this study is to evaluate the peripapillary retinal nerve fiber layer (RNFL) thickness in type 2 diabetes mellitus (DM) patients compared to healthy controls, using optical coherence tomography (OCT) and to correlate it with glycemic control. Settings and Design: Prospective study. Subjects and Methods: A total of 90 patients were enrolled in the study. The study group included 120 eyes of 60 type 2 DM patients. Sixty eyes of 30 healthy participants served as the control group. All patients underwent an OCT scan for peripapillary RNFL thickness measurement. Metabolic control of DM was assessed using glycosylated hemoglobin (HbA1c). Statistical Analysis Used: Independent sample t-test was used for normally distributed variables. Pearson's correlation analysis was used to assess the correlation between HbA1c and RNFL thickness. Results: Right eye RNFL thickness was thinner in diabetic patients than controls, with a statistically significant P value (P = 0.002) in the superior quadrant and inferior quadrant (P = 0.019). The average, superior, and inferior RNFL thickness in the left eye was significantly thinner in diabetic patients as compared to controls (P < 0.001, P = 0.001, and P < 0.001 respectively). No significant correlation was found between HbA1c and RNFL thickness. Conclusions: The peripapillary RNFL is thinner in diabetic patients as compared to controls. This is the first study of its kind, among diabetic patients in Goa, which makes this study unique.
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Effect of high myopia on macular thickness: An optical coherence tomography study in a tertiary care hospital, Karnataka, India p. 14
Arathi Choudhary, Raksha Halmuthur Venkatesh, MP Jayashree, Hamsa Dyamenahalli Surendrappa, R Divya, LM Darshini
DOI:10.4103/jcor.jcor_80_20  
Aim: The aim is to study the correlation of high myopia with macular thickness by optical coherence tomography (OCT). Design: Case control study. Subjects and Methods: Sixty patients visiting outpatient department, Department of Ophthalmology of a tertiary care hospital, were enrolled in the study. The macular thickness of 30 high myopes and 30 emmetropes was measured using OCT. All high myopes had a spherical equivalent of ≥-6.0 Diopters (D) and intraocular pressure <21 mmHg. All the participants were chosen after excluding other ophthalmic diseases or any history of ocular or refractive surgery. Statistical Analysis: Variables are expressed as mean ± standard deviation. Data analysis was performed using SPSS version 20. Unpaired and Paired t-test were used. P ≤ 0.05 was considered statistically significant. Results: The para and perifoveal retinal thickness were significantly thin in high myopic eyes as compared to emmetropic eyes. The central foveal thickness was 298.93 ± 38.813 μm in high myopes and 224.63 ± 16.439 μm in emmetropes, which was statistically significant P < 0.001. Conclusion: The macular thickness was significantly decreased in myopic eyes compared to emmetropic eyes. However, the central foveal thickness was significantly high in high myopes. Therefore, the analysis of macular thickness in the evaluation of macular diseases or glaucoma should be considered based on refractive errors and the location of measurement.
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CURRENT OPHTHALMOLOGY Top

Optical coherence tomography angiography: Unveiling the new entity in glaucoma diagnostics p. 18
Jigyasa Sahu
DOI:10.4103/jcor.jcor_43_20  
Optical coherence tomography angiography (OCT-A) is an emerging technology in the field of glaucoma, probably due to its role in potentiating early diagnosis as well as evaluating subtle positive effects after therapy. Being a noninvasive modality, it is gaining wide popularity in ophthalmic diagnostics. Recent studies have shown a decrease of different blood flow indices like peripapillary and macular vessel and perfusion density in glaucoma patients when compared to the normal population. It has been shown to have acceptable repeatability and reproducibility. This article aims to discuss the pros and cons of imbibing OCT-A in the armamentarium of glaucoma diagnostics. Furthermore, limitations and fears of such a step have been discussed along with the scope for further research areas. Its relative newness, cost inefficiency, and lack of normative data pose diagnostic dilemmas to glaucoma specialists. On the other hand, the never extinguished inquisitiveness of studying blood flow in glaucoma has been sustained by growing research in this field.
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BRIEF COMMUNICATIONS Top

Delleman–Oorthuys syndrome: A case report of an atypical variant p. 24
Rakesh Shetty, Jaya Kaushik, Ankita Singh, Poninder Kumar
DOI:10.4103/jcor.jcor_3_20  
A 4-year-old male child, born to nonconsanguineous parents, was brought with a history of a fleshy red mass in both eyes and abnormally shaped eyelids since birth. Evaluation revealed delayed developmental milestones and temporoparietal alopecia over the right side along with focal areas of hyperpigmented skin over the face, chest, back, and both upper limbs. Ocular evaluation revealed skin tags over the upper eyelids, epibulbar dermoid along with upper lid coloboma, and microcornea in both eyes. He had deformed temporoparietal bones on both sides. Magnetic resonance imaging brain revealed generalized cerebral atrophy with prominent Virchow–Robin spaces and enlarged ventricular system but atypically normal corpus callosum. He was diagnosed as an atypical variant of Delleman syndrome (a rare congenital disorder involving eyes, skin, and brain and comprising orbital cyst, eyelid colobomas, skin appendages, polymicrogyria as well as characteristic mid-hindbrain abnormalities). Multidisciplinary treatment approach and long-term neurological follow-up are recommended in these patients.
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An unusual presentation of Vogt-Koyanagi-Harada disease p. 27
RS Keerthhi Dhevi, G Geetha, M Prabhu Shanker, V Anusha
DOI:10.4103/jcor.jcor_84_19  
We report a rare case of bilateral Vogt-Koyanagi-Harada (VKH) disease coexisting with sub hyaloid hemorrhage in one eye, in a 59-year-old female who presented with diminution of vision in both eyes, right more than left. The anterior segment examination was within normal limits. Fundus examination and imaging revealed features typical of VKH in one eye and these features masked by subhyaloid hemorrhage in the other eye. Varied differential diagnoses appropriately ruled out, subjective and clinical improvement with systemic steroids hits the bull's eye diagnosis of probable VKH with early disease manifestation coexisting with subhyaloid hemorrhage secondary to valsalva maneuver.
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Onodi cell abscess causing optic neuritis and orbital apex syndrome during pregnancy: A case report p. 30
Harikrishnan Vannadil, Sanjana Jaiswal, Srinivas Kishore Sistla, Shruthi Bathula
DOI:10.4103/jcor.jcor_7_20  
Onodi cells are an anatomic variation in the pneumatization of the ethmoidal air cells. Onodi cells can be affected by various pathologies causing optic nerve manifestations. Being a physiologically immunocompromised state, the clinical course of these etiologies varies greatly during pregnancy. When such conditions are manifested during pregnancy, the armamentarium of the clinician is severely restricted both in terms of investigations and treatment. The first suspicion of such a sight-threatening condition relies majorly on clinical examination. Here, we describe the first documented case of Onodi cell abscess-induced optic neuritis in pregnancy managed with methylprednisolone and transsphenoidal surgery.
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Central retinal vein occlusion caused by anomalous prepapillary venous loop p. 32
Pradeep Gajanan Tekade, HN Ravishankar, Pradeep Sagar
DOI:10.4103/jcor.jcor_28_20  
We present a case of prepapillary venous loop complicated by central retinal vein occlusion (CRVO). A 56-year-old female reported to us with blurring of vision in the right eye, noticed 8 days ago. Fundus examination in the right eye showed multiple superficial retinal hemorrhages in all the four quadrants with dilated veins and cystoid macular edema, suggestive of CRVO. Prepapillary venous loops were seen in both the eyes. In our case, both the eyes had an abnormal venous anatomy at the disc. On fundus fluorescein angiography, only the looped segment showed laminar flow in late phase in both the eyes. Hence, patients with an abnormal retinal venous anatomy should be treated with caution as they are considered to be at a high risk of retinal vein occlusion.
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Rare foreign bodies encountered in ophthalmic practice p. 34
Sudha Menon, Praveena S Kumar, H Vijaya Pai
DOI:10.4103/jcor.jcor_14_20  
Ocular trauma and retained foreign bodies in the eye form a common occurrence in ophthalmic practice. Mild trauma may often be overlooked and patients, quite often, present late with serious complications. The clinical presentations and management of three patients who presented with a FB in the anterior chamber, within the lens, and within the orbit, respectively, are discussed. The diagnostic and management issues are highlighted along with a brief review of relevant literature.
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Radiological, histopathological, and immunohistochemical characterization of solitary fibrous tumor of the lacrimal sac: A rare case report p. 38
Prakash Kumar, Sanjeev Kumar, Rashmi Chandra, Rajendra Kumar
DOI:10.4103/jcor.jcor_38_20  
Solitary fibrous tumor (SFT) is a benign spindle cell neoplasm of mesenchymal fibroblast cells. It can appear in various locations, but SFT of the lacrimal sac is rare. Due to their variable clinical, histological, and radiological presentation, it can be easily misdiagnosed. We report a rare case of SFT of the lacrimal sac with its radiological, histological, and immunochemical characterization.
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Chronic postoperative endophthalmitis with an unusual organism: Unconventional approach p. 41
Rakesh Maggon, Kapil Gopal Shahare
DOI:10.4103/jcor.jcor_26_19  
Chronic postoperative endophthalmitis (CPE) following cataract surgery with the appearance of distinct plaques is most commonly caused by Propionibacterium acnes and the standard treatment is intraocular lens (IOL) explant and complete capsulectomy. We report a case of CPE who presented with an indolent recurrent course, manifested numerous typical plaques in the capsular bag, and was treated with an IOL explant, re-implant, and two-port 23G pars plana vitrectomy under direct vision with good results. The organism grown was Bacillus species which is the most common known cause of posttraumatic endophthalmitis and typically has a rapidly devastating course. It is very rare to detect Bacillus species as an incriminating organism in CPE.
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LETTERS TO THE EDITOR Top

Managing retinopathy of prematurity amidst hazy cornea p. 44
Siddharth Madan
DOI:10.4103/jcor.jcor_78_20  
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Chronic relapsing inflammatory optic neuropathy: A rare entity p. 45
Abhishek Juneja, Kuljeet Singh Anand
DOI:10.4103/jcor.jcor_106_20  
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POSTGRADUATE SECTION Top

Scheimpflug imaging system: Opening up the black box of iris bombe p. 46
Shruthy Vaishali Ramesh, Prasanna Venkatesh Ramesh, Meena Kumari Ramesh, Ramesh Rajasekaran
DOI:10.4103/jcor.jcor_195_20  
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