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  Citation statistics : Table of Contents
   2014| July-September  | Volume 21 | Issue 3  
    Online since June 19, 2014

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Dramatic regression of presumed acquired retinal astrocytoma with photodynamic therapy
Samuray Tuncer, Zafer Cebeci
July-September 2014, 21(3):283-286
DOI:10.4103/0974-9233.134699  PMID:25100919
Photodynamic therapy (PDT) has been used for treatment of various intraocular tumors including choroidal hemangioma, vasoproliferative tumor, amelanotic choroidal melanoma and choroidal neovascular membrane due to choroidal osteoma. This case report documents the effect of PDT for a presumed acquired retinal astrocytoma. A 42-year-old female with a juxtapapillary acquired astrocytoma was treated with a single session of PDT using standard parameters. The tumor showed dramatic regression over 6 months into a fibrotic scar. It remained regressed and stable with 20/20 vision after 51 months of follow-up. We believe that PDT can be used as a primary treatment for acquired retinal astrocytoma.
  2 2,417 126
Cosmetic soft contact lens associated ulcerative keratitis in Southern Saudi Arabia
Almamoun Abdelkader
July-September 2014, 21(3):232-235
DOI:10.4103/0974-9233.134677  PMID:25100907
Purpose: To review the microbiologic profile, clinical course, treatment, and outcome of patients with cosmetic contact lens (CL)-associated ulcerative keratitis. Materials and Methods: Observational noncomparative case series selected from an ongoing prospective series. Forty-six subjects examined at a corneal specialty practice in Abha, southern Saudi Arabia between April 2012 and June 2013, who presented with corneal stromal infiltrate on slit-lamp examination, were included in the study. Results: All patients were emmetropic, and lenses were worn solely for cosmetic purposes. Nine (19.5%) of 46 CL-wearing patients presented with laboratory-proven infectious keratitis. Pseudomonas was the most common organism (6/9; 66.6%). Staphylococcus species were the second most common, occurring in two (22.2%) of the nine cases. Streptococcus viridans in one case (11%). Laboratory-based medical therapy led to the healing of ulcers in all cases. Thirty-seven (80.4%) patients had sterile infiltrates. Conclusions: Over-the-counter use of cosmetic lenses is rapidly increasing. The easy availability of these lenses is resulting in severe sight-threatening complications in some young emmetropic individuals. Prompt treatment of microbial keratitis is important to prevent vision loss.
  2 2,666 216
A systematic approach to emergencies in uveitis
Hassan A. Al-Dhibi, Ammar M. Al-Mahmood, J. Fernando Arevalo
July-September 2014, 21(3):251-258
DOI:10.4103/0974-9233.134687  PMID:25100911
Uveitis is a common cause of preventable blindness although it is consider a sight-threatening condition particularly in cases with posterior segment inflammation. To deal with emergency conditions in uveitis, we must aware of the essential signs and symptoms that reflect a true uveitic emergency. Failure to recognize these essential signs and symptoms of a true uveitic emergency may result in a devastating visual outcome. This review provides general ophthalmologists and residents, clinical guidelines for the main uveitic entities that require immediate recognition and urgent intervention in the emergency room to prevent severe permanent visual loss.
  2 4,143 451
Bilateral choroidal osteoma with choroidal neovascular membrane treated with bevacizumab in a child
Manisha Agarwal, Meha Kantha, Rahul Mayor, Ramesh Venkatesh, Cyrus M. Shroff
July-September 2014, 21(3):265-267
DOI:10.4103/0974-9233.134692  PMID:25100914
Choroidal osteoma is a rare benign tumor. We report a male child diagnosed with bilateral choroidal osteoma, high myopia and secondary choroidal neovascularization (CNV) membrane in one eye. Co-existence of posterior staphyloma made the clinical diagnosis of choroidal osteoma difficult due to the osteoma filling the depression of the posterior staphyloma. Typical findings on fundus fluorescein angiography, optical coherence tomography, B-scan and indocyanine green angiography confirmed the diagnosis. A review of literature was performed. CNV secondary to choroidal osteoma was treated with intravitreal bevacizumab and it responded well. Regular follow-up is essential for recurrence of CNV and decalcification of the osteoma.
  1 2,019 131
Fabrication of a custom ocular prosthesis
Tania Sethi, Mohit Kheur, Colin Haylock, Husain Harianawala
July-September 2014, 21(3):271-274
DOI:10.4103/0974-9233.134694  PMID:25100916
Defects of the eye may follow removal of a part of or the entire orbit. This results in the patient becoming visually, esthetically and psychologically handicapped. Restoring the defect with a silicone- or acrylic-based prosthesis not only restores esthetics but also gives back the lost confidence to the patient. This is a case report of a patient with a `pthisical eye` and details the steps in fabrication of an ocular prosthesis. Particular attention has been given to the laboratory process in this technique to minimize the residual monomer content in the artificial eye.
  1 2,147 227
Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi
Roshni Ranjit, Lynette Menezes, Mitchell Drucker, Gerald Msukwa, Nkume Batumba
July-September 2014, 21(3):240-243
DOI:10.4103/0974-9233.134684  PMID:25100909
Context: Neonatal conjunctivitis is associated with poor prenatal care worldwide. Purpose: Data on neonatal conjunctivitis is scarce in Malawi. This study describes risk factors associated with conjunctivitis in neonates born in a large tertiary care hospital in Blantyre, Malawi. Materials and Methods: Medical records of a retrospective cohort of 231 neonates diagnosed with conjunctivitis from January 2006 to December 2009 at a large tertiary hospital in Malawi were reviewed. All subjects were clinically diagnosed with ophthalmia neonatorum. Data were collected on patient demographics and clinical features. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers as well as the treatments administered. Results: Mean age of the mother was 23.45 years (range, 15-40 years), and the mean number of previous deliveries was 2.3 (range, 1-7) children. Nearly, 80% of mothers delivered preterm infants via spontaneous vaginal delivery. The mean birth weight of neonates was 2869.6 grams (1100-5000 grams). Among mothers, premature rupture of membranes was the leading risk factor (24%) followed by sepsis during labor (9%), and history of sexually transmitted infections (STI) (7%). Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. Tetracycline with a saline eyewash was used frequently (34%) compared with combinations of benzyl penicillin and gentamicin. Conclusions: Improving prenatal care to reduce sepsis, traumatic deliveries, and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population.
  1 2,597 200
Quality of life in non-infectious uveitis patients on immunosuppressive therapy
Sheik Kaleemunnisha, S. Sudharshan, Jyotirmay Biswas
July-September 2014, 21(3):225-231
DOI:10.4103/0974-9233.134675  PMID:25100906
Purpose: To assess visual function and vision related quality of life in patients with non-infectious posterior or panuveitis treated with immunosuppressives. Materials and Methods: Forty-three patients with non-inflammatory posterior or panuveitis were enrolled in this prospective study. All subjects underwent a detailed interview, complete ophthalmic examination, quality of life assessment using National Eye Institute Visual Function Questionnaire (VFQ-25), visual function evaluation (visual acuity and visual field) at baseline and at a sixth month follow up visit. Results: The mean NEI-VFQ 25 composite score of the subjects with posterior or panuveitis was 58.0 (±24.1). There was a statistically significant improvement (P = 0.004) in the composite score following treatment from 58.0 (±24.1) to 74.3 (±22.0) with effect size of 1.03. The psychological well-being and general health subscales showed significant improvement in the mean score following immunosuppressive therapy. While considering the visual function tests, there was a three-line improvement in the visual acuity score and changeover in the visual field severity from moderate to early defect with corresponding improvement in the visual field pattern. Though most of the patients complained of side effects such as tiredness, gastrointestinal upset and weight gain, there was improvement in the general health subscale. Conclusion: The significant improvement in the general health subscale despite side-effects shows that the benefit of immunosuppressive outweighs the risks of the therapy and this may also reflect the relatively low impact of these side-effects on the quality of life. This study shows that the use of immunosuppressives improves the quality of life of the individual.
  1 2,174 142
Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response
Albert S Khouri, James Lin, Tamara L Berezina, Barry Maltzman, Robert D Fechtner
July-September 2014, 21(3):205-209
DOI:10.4103/0974-9233.134668  PMID:25100902
Purpose: To evaluate the effectiveness of repeat selective laser trabeculoplasty (SLT) in eyes exhibiting only a modest response upon initial treatment. Materials and Methods: Retrospective chart review was conducted of 51 eyes that received initial 360 degree SLT (SLT1) and subsequent SLT (SLT2) from 2003-2011 at a large academic ophthalmology practice. Successful response (S) was a post-treatment 12 month mean IOP reduction ≥20% from baseline, while modest response (M) was <20% reduction over the same time. Chi-squared and log rank analyses were used to determine if success after SLT2 depended on having successful (S1) or modest (M1) response after SLT1. Results: IOP was significantly reduced from baseline in both SLT1 and SLT2. The proportion of eyes with S2 was not significantly different between those with initial M1 or S1 (36.67% vs. 52.38%, respectively; P = 0.26). Log rank analysis revealed no differences between M1 and S1 in determining SLT2 success (P = 0.41). This outcome was similar when the analyses were performed for the right and left eye independently. Conclusion: The proportion of eyes that successfully responded to repeat SLT did not differ based upon whether the response to initial SLT was successful or modest. This raises the possibility that repeat SLT should not be excluded as an option for those eyes that have only a modest initial response.
  1 2,118 155
Effect of yellow-tinted intraocular lens on standard automated perimetry and short wavelength automated perimetry in patients with glaucoma
Naveed Nilforushan, Mohammad Parsamanesh, Fei Yu, Nariman Nassiri, Arezoo Miraftabi, Anne L. Coleman
July-September 2014, 21(3):216-219
DOI:10.4103/0974-9233.134671  PMID:25100904
Purpose: To investigate the effect of cataract surgery and yellow-tinted intraocular lens (IOLs) implantation on perimetry indices of short-wavelength automated perimetry (SWAP) and standard automated perimetry (SAP) testing in patients with coexisting cataract and glaucoma. Materials and Methods: In this prospective comparative case series, phacoemulsification with implantation of yellow-tinted Acrysof Natural IOL was performed in 16 eyes of 16 patients with visually significant cataract (best-corrected visual acuity (VA) better than 20/120) and mild to moderate glaucoma. Pre- and postoperative values for VA and for perimetry indices including mean deviation (MD), pattern standard deviation (PSD), and foveal threshold (FT) from both SAP and SWAP testing were compared. Results: Postoperative VA improved significantly after cataract surgery and yellow-tinted IOL implantation (P < 0.001). After cataract extraction and IOL implantation, MD and FT on SWAP testing improved significantly (P = 0.001); however, there was no statistically significant change with SAP testing between the pre- and postoperative perimetry indices. There was no statistically significant change in PSD with either SAP or SWAP testing postoperatively. The differences between pre- and postoperative values for all perimetry indices under study were not significant when comparing SAP with SWAP tests, except for MD which had improved statistically significantly in SWAP testing (P = 0.03). Conclusions: In mild to moderate glaucoma patients with cataracts, the perimetry indices of SWAP testing improved after phacoemulsification and yellow-tinted IOL implantation. This suggests that the yellow-tinted IOLs have less effect on SWAP testing than visually significant cataracts.
  1 1,843 105
Ophthalmia due to spitting cobra venom in an urban setting - A report of three cases
Leslie Jonathan Ang, Srinivasan Sanjay, Tiakumzuk Sangtam
July-September 2014, 21(3):259-261
DOI:10.4103/0974-9233.134689  PMID:25100912
To describe three presentations of spitting cobra venom induced ophthalmia in urban Singapore. Case notes and photographs of three patients with venom ophthalmia who presented to our clinic between 2007 and 2012 were reviewed. Two patients encountered the spitting cobra while working at a job site while the third patient had caught the snake and caged it. The venom entered the eyes in all 3 cases. Immediate irrigation with tap water was carried out before presenting to the Accident and Emergency department. All patients were treated medically with topical antibiotic prophylaxis and copious lubricants. The use of anti-venom was not required in any case. All eyes recovered with no long-term sequelae. If irrigation is initiated early, eyes can recover with no significant complications or sequelae.
  - 5,372 151
Bilateral optic nerve aplasia: A rare isolated central nervous system anomaly
Tejaswini P. Khandgave, Varsha N. Kulkarni, Deepa V. Muzumdar, Neelam Puthran
July-September 2014, 21(3):262-264
DOI:10.4103/0974-9233.134690  PMID:25100913
Optic nerve (ON) aplasia is a rare developmental anomaly comprising of absence of the ON, ganglion cells and the central retinal vessels. It is usually accompanied by a variety of central nervous system (CNS) malformations. We report an extremely rare case of bilateral true ON aplasia occurring as an isolated CNS anomaly. A 10-month-old female child was detected with bilateral absence of fixation, associated with multiple ocular findings of microcornea, anterior embryotoxon, pupillary corectopia, partial aniridia and lens coloboma. The optic disc locations were visible as avascular whitish areas. There were no retinal vessels seen in the disc area or elsewhere. There were bilateral multiple chorioretinal atrophic patches present. B-scan ultrasonography showed bilateral absence of ONs. Magnetic resonance imaging showed thinned out bilateral ONs with a hypoplastic optic chiasma and optic tract. There were no other CNS anomalies. Flash visually evoked potential was unrecordable.
  - 1,891 102
Severe anisometropic myopia in identical twins
Olukorede O. Adenuga
July-September 2014, 21(3):275-278
DOI:10.4103/0974-9233.134695  PMID:25100917
High anisometropic myopia is a rare condition in twins. Genetic factors have been implicated in its development and there may be an association with vision-threatening complications. A pair of 11-year-old twins presented with poor distance vision in both eyes. Detailed ocular examination was performed including slit lamp examination, dilated funduscopy, cycloplegic refraction, keratometry and axial length measurement. The objective refraction was -6.50DS -2.00DC × 180 (right eye), -1.00DS (left eye) for the first twin; -13.75DS -2.25DC × 180 (right eye), -0.50DS -0.75DC × 04 (left eye) for the second twin. This case suggests an underlying genetic defect in the development of myopia.
  - 1,952 118
Nine years of retained perfluoro-n-octane in the anterior chamber after retinal detachment repair with no signs of ocular toxicity
Emad B. Abboud, M. Al-Falah
July-September 2014, 21(3):279-282
DOI:10.4103/0974-9233.134697  PMID:25100918
Perfluoro-n-octane (PFO) is commonly used in vitreoretinal surgery. In this case report, we present a 35-year-old patient with retained PFO up to 9 years after par plana vitrectomy. Post-operatively, PFO bubbles occupied 15% of the anterior chamber (AC). Follow-up over 9 years, consistently showed a quiet AC, normal intraocular pressure and endothelial cell counts remained stable. Until date, the patient has been under observation and there have been no ocular symptoms or side-effects. Residual PFO that inadvertently remains in the AC can be well- tolerated, without side-effects for up to 9 years.
  - 2,072 92
Rare association of familial aniridia, microcornea with myopia and aphakia
Jaya Biswas, Asim Chakrabarti, Debabrata Das
July-September 2014, 21(3):268-270
DOI:10.4103/0974-9233.134693  PMID:25100915
Aniridia is a rare congenital malformation that may be associated with various ocular and systemic manifestations. We describe two cases of familial total aniridia associated with microcornea, high myopia and dislocated lens. No systemic abnormality was noted in any of the cases.
  - 2,054 110
Eyelid angiokeratoma
Ramadan S. Hussein, Hala Kfoury, Yasser H. Al-Faky
July-September 2014, 21(3):287-288
DOI:10.4103/0974-9233.134702  PMID:25100920
Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is excoriated or traumatized. We report an exceedingly rare solitary eyelid angiokeratoma in an otherwise normal middle aged male. Our case represents the second case in the English peer reviewed literature since 1966, when the first case of eyelid angiokeratoma was reported.
  - 1,865 96
Ophthalmia neonatorum prophylaxis and the 21 st century antimicrobial resistance challenge
David Meyer
July-September 2014, 21(3):203-204
DOI:10.4103/0974-9233.134667  PMID:25100901
  - 2,224 224
Orbito-oculoplastic diseases in Lagos: A 4-year prospective study
Bolanle G. Balogun, Bola J. Adekoya, Modupe M. Balogun, Olufunke A. Ehikhamen
July-September 2014, 21(3):236-239
DOI:10.4103/0974-9233.134678  PMID:25100908
Aims: To determine the prevalence of orbito-oculoplastic diseases and thereby contributing a data base to the emerging orbito-oculoplastics subspecialty in the sub-Saharan region. Settings and Design: A tertiary eye care centre. Materials and Methods: A descriptive prospective study was done in a tertiary eye care center. Demographic and clinico-pathological diagnoses of 269 patients presenting to the oculoplastics clinic over a 4-year period (January 2008 -December 2011) were collected at entry and during follow-up visits. These were patients referred from the general ophthalmology clinics of the study center, secondary eye care centers within and from neighboring states. Patients were categorized based on the primary diagnosis after examination by the oculoplastics surgeon. Ethical issues were considered though data collection did not involve direct patient participation. Statistical Analysis Used: Microsoft Excel 2007 software. Results: Two hundred and sixty-nine patients were seen with 141 (52.4%) females. Leading etiological factors were trauma; 81 (30.0%), congenital anomalies 55 (21.0%) and tumors 44 (16.0%). Eyelid diseases were the most frequent 115 (42.8%), with ectropion 36 (31.0%) and ptosis 33 (29.0%) being the most common. Orbital and peri-orbital lesions 44 (16.4%) were mainly dermoids 12 (27.3%) and capillary heamangioma 4 (9.1%) in the pediatric age while thyroid orbitopathy 11 (25.0%) was predominant in adults. Ocular and degenerative diseases were retinoblastoma in 4 (16.7%) and phthisis bulbi in 10 (33.3%). Contracted socket was 22 (84.0%) of socket pathologies. Primary conjunctival diseases occurred less often, rather Stevens-Johnson syndrome in 9 (30.0%) and its ocular complications were more frequent. Conclusions: It is expected that this survey will provide a database for oculoplastics surgeons and ophthalmologists in an emerging subspecialty and thus enhance training focus and equipment acquisition.
  - 1,872 130
Limitations in imaging common conjunctival and corneal pathologies with Fourier-domain optical coherence tomography
Hakan Demirci, Daniel W. Steen
July-September 2014, 21(3):220-224
DOI:10.4103/0974-9233.134673  PMID:25100905
Purpose: To describe the limitations of Fourier-domain optical coherence tomography (OCT) in imaging common conjunctival and corneal pathology. Materials and Methods: Retrospective, single-center case series of 40 patients with conjunctival and cornea pathology. Results: Fourier-domain OCT imaged laser in situ keratomileusis (LASIK) flaps in detail, including its relation to other corneal structures and abnormalities. Similarly, in infectious or degenerative corneal disorders, Fourier-domain OCT successfully showed the extent of infiltration or material deposition, which appeared as hyper-reflective areas. In cases with pterygium, the underlying cornea could not be imaged. All cases of common conjunctival pathologies, such as nevus or pinguecula, were successfully imaged in detail. Nevi, scleritis, pterygium, pinguecula, and subconjunctival hemorrhage were hyper-reflective lesions, while cysts and lymphangiectasia were hyporeflective. The details of the underlying sclera were not uniformly imaged in conjunctival pathologies. Fourier-domain OCT imaged the trabeculectomy bleb in detail, whereas the details of structures of the anterior chamber angle were not routinely visualized in all cases. Conclusions: Light scatter through vascularized, densely inflamed, or thick lesions limits the imaging capabilities of Fourier-domain anterior segment OCT.
  - 2,144 123
Proparacaine hydrochloride topical drop and intracameral 0.5% lignocaine for phacotrabeculectomy in patients with primary open angle glaucoma
Rajesh Subhash Joshi
July-September 2014, 21(3):210-215
DOI:10.4103/0974-9233.134669  PMID:25100903
Aim: To compare the efficacy and safety of 0.5% intracameral lignocaine to 1% intracameral lignocaine prior to phacotrabeculectomy. Study Design: Prospective, comparative, observational, and interventional study. Setting: Tertiary eye care center in central India. Materials and Methods: This study was comprised of 79 patients (79 eyes) with primary open angle glaucoma scheduled for phacotrabeculectomy. Patients were assigned to 1 of 2 Groups receiving proparacaine 0.5% eye drops and 1% intracameral lignocaine just prior to phacotrabeculectomy (Group 1, n = 39) and 0.5% intracameral lignocaine after completion of phacoemulsification just prior to trabeculectomy (Group 2, n = 40). The visual analogue scale was used to record intraoperative and postoperative pain. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. An anesthetist also noted the vital parameters and the requirement for intravenous medications. Results: There was no significant difference in the intraoperative pain score (P = 0.0733) or supplemental anesthesia (P = 0.372) between Groups. Postoperative pain score was statistically significant in Group 2 (P < 0.0001). The overall operating conditions in both Groups were comparable (P = 0.7389). A greater number of patients in Group 2 (88.57%) preferred the same anesthetic technique for combined surgery in the fellow eye. There was no difference in inadvertent eye movements and lid squeezing between Groups and they did not interfere with surgery. Conclusion: Topical anesthetic drops supplemented with 0.5% intracameral lignocaine before performing trabeculectomy is as effective as 1% intracameral lignocaine given at the beginning of phacotrabeculectomy for primary open angle glaucoma.
  - 2,782 182
Review of choroidal osteomas
Ramzi M. Alameddine, Ahmad M. Mansour, Eman Kahtani
July-September 2014, 21(3):244-250
DOI:10.4103/0974-9233.134686  PMID:25100910
Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization.
  - 3,908 279