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   Table of Contents - Current issue
Coverpage
January-April 2022
Volume 10 | Issue 1
Page Nos. 1-52

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GUEST EDITORIAL  

Why must we own everything? p. 1
Quresh Maskati
DOI:10.4103/2320-3897.337199  
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REVIEW ARTICLE Top

The oxidative and inflammatory nature of age-related macular degeneration p. 3
Rogil Jose de Almeida Torres, Rogerio Joao de Almeida Torres, Andrea Luchini, Ana Lucia Anjos Ferreira
DOI:10.4103/jcor.jcor_268_20  
The understanding of the effects of oxidation and inflammation on age-related macular degeneration (AMD) genesis has been of utmost importance for the advancement of preventive and therapeutical measures adopted in this disease. Several studies have been conducted on lifestyles, dietary antioxidants, expression of antioxidant enzymes, naturally found in the retina, as well as expression of cytokines, enzymes, and growth factors, with an ultimate goal to prevent or mitigate the visual damage induced by AMD. This article details the disruption of redox homeostasis associated with the increase of cells and inflammatory markers, major factors in triggering and/or aggravating the degenerative macular disease. The data sources used in this review study include Cochrane Database of Systematic Reviews, PubMed, MedlinePlus Health Information, and Elsevier Science.
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ORIGINAL ARTICLES Top

Pattern of uveitis in general Ophthalmology practice p. 9
Charushila V Gajapati, Akash Belenje Shetty, KV Pooja
DOI:10.4103/jcor.jcor_5_21  
Aim: The aim of this study is to describe the pattern of uveitis in a General Ophthalmology Clinic in North Karnataka. Materials and Methods: Case records of uveitis seen from June 2015 to December 2019 were reviewed retrospectively. Data regarding the patients' age, sex, anatomical location of the disease, and etiology were analyzed. Results: A total of 119 records were reviewed. The mean age at the presentation was 40.4 years with a male preponderance. The majority of unilateral cases had anterior uveitis. We could establish a specific diagnosis in 63.9% of cases. The most common noninfectious etiology was spondyloarthropathy causing anterior uveitis (19.3%) and tuberculosis causing posterior uveitis is the most common form of infective etiology (12.9%). Conclusion: Our study revealed that anterior uveitis of noninfectious etiology is more frequently encountered by general/comprehensive ophthalmologists. In our region, the most common cause of anterior uveitis was spondyloarthropathy, whereas infectious etiology must be considered in posterior uveitis, and the most common etiology in our region was tuberculosis.
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Chemical injury with “packet of chunna” (lime) in children: A major ocular health concern in central rural India p. 15
Pradhnya Sen, Prerana Tripathi, Amit Mohan, Khushboo Agarwal, Chintan Shah, Gautam Singh Parmar, Alok Sen
DOI:10.4103/jcor.jcor_54_21  
Purpose: The purpose of the study is to report the hazardous effect of chunna packet (lime) on ocular surface in terms of pattern of presentation and visual outcome in children. Materials and Methods: Children of age <16 years with definitive history of chemical injury with chunna packet were analyzed. Ocular chemical injury was graded according to Modified Roper Hall grading system. Best corrected visual acuity (BCVA) and anterior segment examination evaluation were compared at time of presentation and at 3 months and categorized on the basis of WHO visual disability classification. Likelihood ratio of BCVA with time of presentation and grade of injuries were calculated using Pearson's correlation coefficient. Results: Eighty eyes of 74 children with a history of ocular burns resulting from lime were included in the study. Of these, 6 patients had bilateral burns. Mean age at the time of injury was 8.44 ± 4.29 years. Many children presented late after 3 weeks of injury (n = 24, 32.4%). The most common grade of injury was Grade 4 (n = 31, 38.8%). Clinical presentations were corneal haze (55%), limbal ischemia (65%), lime particle in fornix (36.2%), corneal scar (33.7%), and symblepharon (22.5%). Surgical intervention was advised in 54 eyes (67.5%) in the form of amniotic membrane grafting, symblepharon release, limbal stem cell transplantation, and tectonic keratoplasty. Mean BCVA at presentation was 1.65 ± 0.99 and at 3 months was 1.39 ± 1.03. Conclusion: Grade of injury and time of presentation were strongly associated with visual outcome in cases of chemical injury with chunna packet.
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Factors associated with nonregression of retinopathy of prematurity after laser treatment in western India p. 19
Sucheta R Kulkarni, Ananya Sudhir Nibandhe, Nilesh A Kakade, Anuprita Gandhi Bhatt, Madan D Deshpande
DOI:10.4103/jcor.jcor_65_21  
Background: To report the characteristics of preterm infants treated for retinopathy of prematurity (ROP) and to establish the factors associated with nonregression of ROP. Methods: This cross-sectional study where data were collected retrospectively was carried out at a tertiary eye care center in Pune, India, from December 1, 2017, to November 30, 2019. All infants who were treated for severe ROP (either laser therapy or combination of anti-vascular endothelial growth factor and laser) and had completed 3-month follow-up were included in the study. Nonregression was defined as a persistent plus disease/active new vessels, progression to tractional disease after 3 weeks of completion of treatment, or poor structural outcome (tractional retinal detachment) within 3 months of treatment. Data were assessed at 3 months to look for treatment outcome and reasons for nonregression. Association between risk factors and nonregression of ROP was analyzed using statistical tests. Results: Of the 210 eyes (105 infants) which were treated, 95 eyes (45.23%) had aggressive posterior ROP (APROP). Nonregression was documented in 12/210 (5.7%) eyes. At 3 months, ten eyes developed tractional retinal detachment whereas two eyes developed vitreous hemorrhage. Eleven of the 12 eyes had APROP (P = 0.0014). Ocular risk factors, systemic risk factors, and delayed institution of treatment were associated with nonregression in about a third of eyes (33.3%) each. Conclusion: Most nonregressing ROP cases are APROP in western India.
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Evaluation of reasons of glaucoma treatment dropouts in a health-care center p. 23
Surohi Shah, Khushi Shah, Aarti Popat, Hemaxi Desai, Disha Jariwala, Naina Chaturvedi
DOI:10.4103/jcor.jcor_81_21  
Aims: The aim of this study is to evaluate the reasons of dropout in glaucoma patients in a health-care center. Materials and Methods: A cross-sectional study was carried out among 135 glaucoma patients assessed from January 2013 to January 2016 and lost to follow-up for more than 1 year; who were inquired about their reason of dropout through telephonic talk. Statistical Analysis Used: Z-test (SPSS-Statistical Package for the Social Sciences; version 21). Results: Out of 135 patients, 11 were untraceable due to wrong numbers. Of the remaining 124 patients, 33.1% cited lack of communication as their reason of dropout, followed by 29.8% of patients citing distance from the hospital and 19.3% citing no immediate visual improvement/symptoms. Among the dropouts, 49.2% of patients were on medical treatment, 26.4% of patients underwent laser peripheral iridotomy (LPI) only, 12.1% were on medical treatment post-LPI, 9.7% of patients underwent trabeculectomy, and 1.6% of patients were on medical treatment postsurgery. Conclusions: The most common factors of glaucoma treatment dropout found in our study were lack of communication followed by far distance from hospitals and no immediate visual improvement on treatment. Strategies to improve follow-up may include provision of appropriate education, motivation, and adequate counseling as well as accessible health care to prevent blinding eye disease.
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Profile of orthoptic clinic patients at a tertiary care Government Medical University in North India: A 6-year review p. 27
Vikas Chahal, Vinita Singh, Jyotsana Singh, Gurkiran Kaur, Rajat M Srivastava, Siddharth Agrawal
DOI:10.4103/jcor.jcor_123_21  
Aim: This study aims to study clinicodemographic profile of patients presenting to orthoptic clinic over the previous 6 years. Methods: Records of all new patients registered at the orthoptic clinic over 6 years' (January 1, 2014, to December 31 2019) were retrieved. Details of patient demographics, clinical presentation and management were studied in this hospital-based descriptive observational study after obtaining institutional ethical clearance. Records that were incomplete and those of patients with a history of strabismus surgery at presentation were excluded from analysis. Exact binomial confidence intervals (CIs) were calculated for the estimates of proportion. The results were reported as percentage (95% CIs). Descriptive statistics were used for subtypes of strabismus and amblyopia. Results: Out of 1548 patients, 896 were male (57.88%) and 652 (42.12%) were female. Mean age at presentation was 18.53 ± 10.41 years. Comitant strabismus was seen in 1083 (69.96%) and incomitant in 203 (13.11%). Among comitant deviations exotropia (XT) was commonest (n = 511, 47.18%), 6th nerve palsy (34%) was the most common cause among incomitant deviations, Duane retraction syndrome (DRS) constituted 24% of restrictive strabismus and amblyopia was present in 16.71% (n = 331) of patients. The left eye (LE) was more frequently involved in unilateral amblyopia (P < 0.0001). Conclusions: In our study, male to female ratio was 1.37. XT, 6th Nerve palsy, and DRS were the commonest types of comitant, paralytic and restrictive deviations respectively. Prevalence and severity of different types of amblyopia have also been described.
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BRIEF COMMUNICATIONS Top

Kimura's disease involving the conjunctiva p. 33
Sonal P Yadav, Swapnil Patil, Anirudha Puntambekar, Rahul Deshpande
DOI:10.4103/jcor.jcor_104_20  
A 50-year-old female presented with gradually increasing, pink nodular lesion on the temporal bulbar conjunctiva of the left eye, noticed in the past 15 days. She denied any history of trauma or similar episodes in the past or concurrent systemic illness. The lesion did not change after a 2-weeks long topical steroid course. It was then surgically excised. Histopathological analysis revealed lymphoid follicles with proliferating blood vessels lined up by plump endothelial cells with mixed infiltrate containing numerous eosinophils. Based on these findings, diagnosis of Kimura's disease (KD) was established. KD is a rare, chronic inflammatory disorder of possible allergic or autoimmune etiology which has been rarely described in conjunctiva.
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Importance of careful clinical examination and multimodal imaging before injecting intravitreal steroid p. 35
Naresh Babu, Piyush Kohli, Vedang Shah, Kim Ramasamy
DOI:10.4103/jcor.jcor_102_19  
Intravitreal injections have now become the most preferred treatment for retinal vascular diseases. Intravitreal steroids are associated with complications such as cataracts, glaucoma, and central serous chorioretinopathy (CSCR). We report a case who developed CSCR after a single injection of intravitreal triamcinolone, given for the treatment of cystoid macular edema (CME) secondary to branch retinal venous occlusion (BRVO). On careful retrospective examination, we found that pachychoroid and a pigment epithelial detachment was present even before the injection was given. Four months postinjection, there was a recurrence of CME due to BRVO while there was no sign of CSCR. We emphasize on the importance of a careful clinical examination and appropriate interpretation of multimodal imaging before injecting intravitreal steroids.
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Sympathetic ophthalmia in a phthisical eye with B-cell proliferation p. 37
Dipankar Das, Saurabh Desmukh, Bhavya Gokani, K Vanitha, Apurba Deka, Jyotirmay Biswas
DOI:10.4103/jcor.jcor_216_20  
Sympathetic ophthalmia is a dreaded ocular condition resulting in bilateral panuveitis following penetrating injury in one eye or associated with surgeries and laser procedures. We describe a case of a 13-year-old girl who presented with blurring of vision in the right eye for the past 2 years following penetrating trauma in the left eye 9 years back. Histopathology of left enucleated phthisical eye showed diffuse stromal choroiditis with B-cell proliferation on immunohistochemistry, thus confirming chronicity of the disease.
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Journey of choroidal tubercle to choroidal granuloma p. 40
Rajwinder Kaur, Harijot Singh, Balbir Khan, Akriti Sehgal, Anupriya Aggarwal
DOI:10.4103/jcor.jcor_23_21  
Choroidal tubercles may be unilateral or bilateral and appear as a polymorphic yellowish lesion with discrete borders. Tubercles can arise early in the stages of progression of tuberculosis (TB) and are indicative of hematogenous dissemination seen in acute military TB. Choroidal granuloma is seen in chronic TB in response to antitubercular treatment. We report a case of a 14-year old girl who presented with fever, altered sensorium, and irritability for 1 week. Fundus examination revealed bilateral multiple choroidal tubercles. Antitubercular treatment was started after magnetic resonance imaging head and cerebral spinal fluid cytology confirmed the diagnosis of disseminated TB. Enhanced depth imaging optical coherence tomography was done on follow-up visits to see the stages of progression or regression of choroidal tubercle after the treatment. This is a rare case, reporting the transition of choroidal tubercle into choroidal granuloma, which is demonstrated with serial imaging using various modalities.
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Fungal seeding of bandage contact lens with no underlying corneal invasion of boston keratoprosthesis p. 43
KS Siddharthan, Anushri Agrawal, Jagdeesh Kumar Reddy
DOI:10.4103/jcor.jcor_125_20  
Infectious keratitis develops in 13.6% of eyes after keratoprosthesis (Kpro) implantation, with a similar rate of culture-positive bacterial and fungal keratitis. We report a case of 73-year old man who underwent Boston Kpro implantation in the left eye 2 years back. He presented with conjunctival discharge and a whitish growth over the bandage contact lens (BCL) for the past 2 weeks. Slit-lamp examination showed a whitish elevated growth with surrounding diffuse brownish feathery seeding all over the BCL. The BCL which was sent for culture grew fungus. The underlying Kpro was clear with no evidence of any active infiltrate. The patient was started on topical antifungal eye drops and was followed up for 12 months with no recurrence of infection. Educating the patient to be sensitive and to report immediately if they note any abnormality is as important as cleaning or replacing the BCL on a regular basis.
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Different management strategies of scleral necrosis p. 46
Ruchi Shukla, Anjum Mazhari, Ashutosh Kumar Mishra
DOI:10.4103/jcor.jcor_46_21  
Surgically induced necrotizing scleritis is a rare complication of ocular surgeries. Mitomycin C (MMC) when used intraoperatively may be related to serious postoperative complications. We report management of two cases in which patients underwent pterygium excision with adjunctive use of MMC and they both developed scleral necrosis. In the first case, scleral patch grafting was performed, while the other case underwent advanced Tenon's flap with a sliding conjunctival flap. Tectonic coverage can be done by various methods such as scleral patch grafting and advanced Tenon's flap and both provide structural and functional stability to eyes with scleral defects.
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LETTER TO EDITOR Top

Comment on “quality of life in patients affected by age-related macular degeneration” p. 49
Bharat Gurnani, Kirandeep Kaur
DOI:10.4103/jcor.jcor_53_21  
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OPINION CATEGORY Top

Protocols involved in training allied ophthalmic personnel and setting up ocular microbiology laboratories in peripheral centers p. 50
Arpan Gandhi, Shalinder Sabharwal
DOI:10.4103/jcor.jcor_235_20  
One of the most important causes of corneal blindness in our country is infective keratitis (IK). IK blinds at least 1.5 million eyes every year in the world; and its projected that India alone will have 0.6 million people blind due to IK by 2020. From studies describing it as a 'silent epidemic', to others referring to it as an 'ophthalmic emergency', IK is a problem which can not be ignored in a world of growing antibiotic resistance. The detailed protocols involved in setting the Ocular Microbiology set up and training staff would involve the core requirement in combating IK is to have targeted treatment specific to the causative microorganisms. This is possible when corneal scraping and microbiology work up is done for all patients presenting with IK. All eye hospitals and ophthalmologists should set up protocols for integrating microbiology services in their practice.We have been following the below training method and trained over 50 people from secondary centers, ophthalmic clinics and institutes . Before we thought of going ahead with this we had the consent and the ownership of the management to do so and they felt it was the need of the hour for such training protocols to be defined and implemented.We categorized the process into Capacity building,Infrastructure and Implementation and quality monitoring. The training also included Antibiotic Sensitivity .The process and reporting both were explained in detail. Also on how it was clinically relevant was explained.
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