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   2015| January-March  | Volume 22 | Issue 1  
    Online since January 1, 2015

 
 
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GLAUCOMA SURGERY UPDATES
Noninvasive glaucoma procedures: Current options and future innovations
Ahmed M Abdelrahman
January-March 2015, 22(1):2-9
DOI:10.4103/0974-9233.148342  PMID:25624667
Noninvasive glaucoma procedures (NIGPs) represent a new dawn in the management of glaucoma. They try to fill the gap between the shortcoming of invasive glaucoma surgeries and antiglaucoma medications. NIGPs were introduced as an adjunct or alternative treatments for glaucoma. Some of these procedures have shown good efficacy with few serious complications. Hence, they are now used as both primary and adjunctive therapy for glaucoma. The most common NIGPS involve laser and ultrasound technologies. Currently, the portfolio of NIGPs includes argon laser trabeculoplasty, selective laser trabeculoplasty, and micropulse diode laser trabeculoplasty. More recent innovations include therapeutic ultrasound for glaucoma, ultrasonic circular cyclocoagulation, and deep wave trabeculoplasty.
  3,605 297 1
Glaucoma surgery: Taking the sub-conjunctival route
Tarek Shaarawy
January-March 2015, 22(1):53-58
DOI:10.4103/0974-9233.148349  PMID:25624674
We are currently in the midst of a surge in interest in glaucoma surgery. Novel pathways for reducing intraocular pressure (IOP) have been tried with various levels of success over the last few years. While the trabecular bypass and suprachoroidal approaches have captured much of the attention, filtering aqueous into the sub-conjunctival space remains the gold standard for lowering IOP. This review attempts to focus on current research in surgical methods to enhance filtration by potentially improving on tried and tested methods like the trabeculectomy, deep sclerectomy, and tube surgeries.
  2,949 225 1
Cataract surgery in the glaucoma patient
Jennifer S Kung, Daniel Y Choi, Anjum S Cheema, Kuldev Singh
January-March 2015, 22(1):10-17
DOI:10.4103/0974-9233.148343  PMID:25624668
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-establishing perimetric and optic nerve imaging baselines is recommended after cataract surgery. The sequence of cataract surgery relative to glaucoma surgery impacts the likelihood of complications and surgical success. There are multiple benefits to perform cataract surgery prior to glaucoma surgery while cataract surgery after trabeculectomy increases the risk of subsequent filtration failure. As "minimally invasive glaucoma surgeries" continue to improve in terms of efficacy, there is an evolving role for combined cataract and glaucoma surgery in patients with early to moderate stages of glaucoma.
  2,650 309 2
Suprachoroidal devices in glaucoma surgery
Jeffrey A Kammer, Kevin M Mundy
January-March 2015, 22(1):45-52
DOI:10.4103/0974-9233.148348  PMID:25624673
While conventional glaucoma filtration surgery provides excellent intraocular pressure (IOP) lowering effect, this comes at the expense of significant risks. As the physiology of the suprachoroidal space has become better understood, its potential as a source for aqueous drainage has generated significant interest. This has resulted in the creation of several suprachoroidal glaucoma devices with excellent IOP lowering ability and a much more favorable side effect profile.
  2,775 158 -
Trabecular micro-bypass Shunt (iStent® : Basic science, clinical, and future)
E Randy Craven
January-March 2015, 22(1):30-37
DOI:10.4103/0974-9233.148346  PMID:25624671
The trabecular bypass stent offers an alternative to filtration surgery. Patients who may be ideal candidates for considering this procedure are those with prior conjunctival surgery; for example, those who had a 360° peritomy from a scleral buckle might not do well with a trabeculectomy and there is no space for a tube. Highly myopic patients do not tolerate hypotony well, and the iSTB may be an option for some of these patients. I have used the iSTB in patients on anticoagulants who could not stop them, and they needed something beyond medications and laser to lower the IOP in subjects with open-angle glaucoma. Young patients, especially those with one eye, who need rapid visual recovery (for instance to return to work) may be good candidates to consider the iSTB as well. Because of the position used for clear corneal cataract surgery, the temporal approach is best for doing these. Therefore, if you are doing cataract surgery on someone who needs a lower IOP, you already are in the correct position to implant the devices. Patients may need some medications after the procedure to lower the IOP to the level desired. The results from Armenia are encouraging, given an IOP of 11.8 mmHg after 2 iSTB stents and taking daily travoprost. These results are difficult to reach even with a trabeculectomy. When selecting your fist patients, avoid those with the congested episcleral veins, look for patients with wide open angles, and if you can see aqueous veins at the slit-lamp it may indicate a viable outflow system. Probably avoid patients with IOPs over 35 mmHg. The micro-invasive trabecular bypass stents offer an alternative surgical intervention for select patients with open-angle glaucoma. Recent studies show that combining these micro-stents with medications can lead to as low of an intraocular pressure (IOP) as is achieved by many more invasive incisional surgeries. The technique is quite precise and learning the procedure is similar to clear corneal phacoemulsification followed by a goniotomy. Long-term data are starting to come in and the safety is favorable. The IOP success appears to be based on the patency of the outflow system for a given patient. Key factors in determining the success involve the placement of trabecular bypass devices into the canal of Schlemm and require a down-stream patency of the collector channel system and a low episcleral venous pressure. Because accessing the collector system may require placement by a patent channel, the placement of two stents, a longer stent with scaffolding or somehow imaging the outflow system may lead to the best control of the IOP.
  2,466 193 -
Ab interno trabeculectomy in the adult patient
Jeffrey R SooHoo, Leonard K Seibold, Malik Y Kahook
January-March 2015, 22(1):25-29
DOI:10.4103/0974-9233.148345  PMID:25624670
Glaucoma is a potentially blinding disease that affects millions of people worldwide. The mainstay of treatment is lowering of intraocular pressure (IOP) through the use of medications, laser and/or incisional surgery. The trabecular meshwork (TM) is thought to be the site of significant resistance to aqueous outflow in open angle glaucoma. Theoretically, an incision through TM or TM removal should decrease this resistance and lead to a significant reduction in IOP. This approach, commonly referred to as goniotomy or trabeculotomy, has been validated in the pediatric population and has been associated with long-term IOP control. In adults, however, removal of TM tissue has been historically associated with more limited and short-lived success. More recent evidence, reveals that even adult patients may benefit significantly from removal of diseased TM tissue and can lead to a significant reduction in IOP that is long-lasting and safe. In this review, we discuss current evidence and techniques for ab interno trabeculectomy using various devices in the adult patient.
  2,472 146 -
Endoscopic cyclophotocoagulation
Leonard K Seibold, Jeffrey R SooHoo, Malik Y Kahook
January-March 2015, 22(1):18-24
DOI:10.4103/0974-9233.148344  PMID:25624669
In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure.
  2,390 171 1
ORIGINAL ARTICLES
Prevalence of amblyopia in primary school children in Qassim province, Kingdom of Saudi Arabia
Yousef Homood Aldebasi
January-March 2015, 22(1):86-91
DOI:10.4103/0974-9233.148355  PMID:25624680
Purpose: To determine the prevalence and causes of amblyopia in primary school children in Qassim province, Kingdom of Saudi Arabia (KSA). Materials and Methods: In this cross sectional study, 5176 children, aged 6 to 13 years (mean - 9.53 ± 1.88 years) were evaluated. There were 2573 (49.71%) males and 2603 (50.29%) females. Distance visual acuity (V/A) was tested monocularly using a logMAR chart with and without correction. Cycloplegic refraction was performed in children with reduced vision. To determine the etiology of amblyopia, children were enrolled if there was a difference in V/A of two or more lines between eyes or an absolute reduction in acuity <20/30 in either eye, that could not be corrected by refraction. P ≤ 0.05 was considered statistically significant. Results: There 202 out of 5176 (3.90%) with ambylopia. There are 98 (1.88%) amblyopic females. There was no statistical difference in gender for amblyopes (P > 0.05). The prevalence of amblyopia was statistically significant higher in the older age group (10-13 year) compared to younger age group (6 to 9 years) (P < 0.05). Unilateral amblyopia (3.24%) was more frequent than bilateral amblyopia (0.66%). The most frequent causes of amblyopia were refractive error (94.56%), of which anisometropic amblyopia was present in 77.72%, isoametropic amblyopia in 16.84% and strabismus in 5.44%. Conclusion: The prevalence of amblyopia in Qassim province, KSA, is 3.9% which is similar or higher than other published studies on amblyopia. Anisometropic refractive errors are the most common underlying cause for this population. We recommend implementation of visual screening programs for children with appropriate clinical and social settings for early detection and proper management of amblyopia.
  2,130 288 -
The effectiveness of home-based pencil push-up therapy versus office-based therapy for the treatment of symptomatic convergence insufficiency in young adults
Hamed Momeni-Moghaddam, James Kundart, Abbas Azimi, Farzaneh Hassanyani
January-March 2015, 22(1):97-102
DOI:10.4103/0974-9233.148357  PMID:25624682
Purpose: To compare the effectiveness of pencil push-up therapy (PPT) versus office-based vision therapy in patients with convergence insufficiency. Materials and Methods: In this study, 60 students from Zahedan University of Medical Sciences with convergence insufficiency were selected. After determining their refractive error (with a retinoscope), near point of convergence (by millimeter ruler), near heterophoria (by alternate prism cover test), and positive fusional vergence at near (by prism bar), subjects were divided into two groups to receive PPT (at least three times a day for 5 minutes each time) or office-based therapy (two times each week for 60 minutes each visit) without home reinforcement. Subjects were re-examined 4 and 8 weeks after initiation of treatment. Statistical analysis was performed with the independent samples t-test and the analysis of variance (ANOVA). Statistical significance was indicated by P < 0.05. Results: The near point of convergence, phoria, and positive fusional vergence were not statistically different between the two groups before treatment (P > 0.05). After 4 and 8 weeks of therapy, only the positive fusional vergence was statistically significantly different between groups (P = 0.001). Results from ANOVA indicated a considerable difference between the two groups in general but the observed difference was related only to positive fusional vergence. Conclusion: PPT and office-based vision therapy are comparable for treatment of convergence insufficiency. While we do not deny the more efficacious nature of office-based therapy, it is not always practical, may be too expensive, and may not be locally available. A home-based therapy offers a cost-effective reasonable alternative.
  2,122 175 -
GLAUCOMA SURGERY UPDATES
Update on Schlemm's canal based procedures
Kaweh Mansouri, Tarek Shaarawy
January-March 2015, 22(1):38-44
DOI:10.4103/0974-9233.148347  PMID:25624672
Surgical options for glaucoma have expanded in recent years. This article provides an evidence-based update on the novel or emerging surgical techniques for the treatment of open-angle glaucoma that are based on the Schlemm's canal (SC). Canaloplasty is an ab externo approach and was developed as an alternative to traditional filtering surgeries. The Hydrus microstent (Ivantis Inc., Irvine, CA) is a so-called SC scaffold that directly bypasses the trabecular meshwork to drain aqueous humor into the SC, which it keeps dilated over approximately one quadrant. Canaloplasty has also been shown to lower intraocular pressure (IOP) by up to 40% and combined with cataract surgery. IOP was lowered 44% at 24 months while maintaining a favorable safety profile. The Hydrus device has been proposed as an adjunct to cataract extraction surgery. To date, no published evidence from clinical trials is available on its in vivo safety and efficacy. Schlemm's canal based glaucoma procedures show promise as alternative treatments to traditional glaucoma surgery. Surgeons must be comfortable with angle anatomy. A prerequisite for functionality of these techniques is the integrity of the distal outflow system. At present, however, it is not possible to conclude whether these novel procedures will be viable alternatives to standard filtering surgery over the long-term.
  2,106 173 2
ORIGINAL ARTICLES
Impact of cataract surgery in reducing visual impairment: A review
Rajiv Khandekar, Anand Sudhan, BK Jain, Madan Deshpande, Kuldeep Dole, Mahul Shah, Shreya Shah
January-March 2015, 22(1):80-85
DOI:10.4103/0974-9233.148354  PMID:25624679
Purpose: The aim was to assess the impact of cataract surgeries in reducing visual disabilities and factors influencing it at three institutes of India. Materials and Methods: A retrospective chart review was performed in 2013. Data of 4 years were collected on gender, age, residence, presenting a vision in each eye, eye that underwent surgery, type of surgery and the amount the patient paid out of pocket for surgery. Visual impairment was categorized as; absolute blindness (no perception of light); blind (<3/60); severe visual impairment (SVI) (<6/60-3/60); moderate visual impairment (6/18-6/60) and; normal vision (≥6/12). Statistically analysis was performed to evaluate the association between visual disabilities and demographics or other possible barriers. The trend of visual impairment over time was also evaluated. We compared the data of 2011 to data available about cataract cases from institutions between 2002 and 2009. Results: There were 108,238 cataract cases (50.6% were female) that underwent cataract surgery at the three institutions. In 2011, 71,615 (66.2%) cases underwent surgery. There were 45,336 (41.9%) with presenting vision < 3/60 and 75,393 (69.7%) had SVI in the fellow eye. Blindness at presentation for cataract surgery was associated to, male patients, Institution 3 (Dristi Netralaya, Dahod) surgeries after 2009, cataract surgeries without Intra ocular lens implant implantation, and patients paying <25 US $ for surgery. Predictors of SVI at time of cataract surgery were, male, Institution 3 (OM), phaco surgeries, those opting to pay 250 US $ for cataract surgeries. Conclusion: Patients with cataract seek eye care in late stages of visual disability. The goal of improving vision related quality of life for cataract patients during the early stages of visual impairment that is common in industrialized countries seems to be non-attainable in the rural India.
  1,971 225 -
Pediatric cataract surgery in national eye centre Kaduna, Nigeria: Outcome and challenges
Murtala M Umar, Ahmed Abubakar, Ibrahim Achi, Mahmoud B Alhassan, Amina Hassan
January-March 2015, 22(1):92-96
DOI:10.4103/0974-9233.148356  PMID:25624681
Purpose: To assess the outcomes of congenital/developmental cataract from a tertiary eye care hospital in Northwest Nigeria. Materials and Methods: A retrospective chart review was performed of all patients diagnosed with congenital or developmental cataract who underwent surgery from January 2008 to December 2009. Data were collected on patient demographics, preoperative characteristics, intraoperative complications, and postoperative outcomes as well as complications. Results: A total of 181 eyes of 102 patients underwent surgery. There were 95 (52.5%) right eyes. There were 64 (62.7%) males. The mean age of the patients was 6.88 ± 7.97 years. Fifty-four (51.3%) patients were below 3 years old. Most (62%) patients had congenital cataract with a history of onset within the first year of life [39 (62.9%) patients]. Amblyopia, nystagmus, and strabismus were the most frequent ocular comorbidities accounting for 50.3%, 36.5%, and 35.4% of eyes respectively. The majority (84.3%) of the patients had surgery within 6 months of presentation. All patients underwent manual small incision cataract surgery (MSICS). Seventy-nine (77.5%) patients underwent simultaneous bilateral surgery. Intraocular lens implantation was performed in 83.4% eyes. The most common early and late postoperative complication was, posterior capsular opacity which occurred in 65 eyes of 43 children. In these cases, moderate visual acuity was predominant visual outcome. Conclusion: Treatment of pediatric cataract in our setting is complicated by demographic factors which results in late presentation and consequently, late treatment of children. Short-term visual outcome is fair. Data on long term postoperative outcomes could not be acquired due to poor follow-up.
  1,982 194 -
Adherence to topical glaucoma medications in Ethiopian patients
Lemlem Tamrat, Girum W Gessesse, Yeshigeta Gelaw
January-March 2015, 22(1):59-63
DOI:10.4103/0974-9233.148350  PMID:25624675
Purpose: Successful outcomes of medical treatment for glaucoma require proper and daily use of medication to prevent disease progression. The aim of this study was to determine the adherence to anti-glaucoma medications and factors associated with non-adherence among patients with ocular hypertension (OHT) or glaucoma at Jimma University Specialized Hospital, Ethiopia. Materials and Methods: A hospital based cross sectional study was conducted on 200 consecutive patients from July to November 2010 at Jimma University Hospital in Southwest Ethiopia. Patients with OHT or glaucoma who were taking topical anti-glaucoma medications for more than six months were included. The study subjects were interviewed and their medical records were reviewed. Non-adherence to glaucoma therapy (NAGT) was defined as self-reported on missed medications or missed appointments, or a physician noting poor adherence. A P < 0.05 was statistically significant. Result: Overall, 135 (67.5%) patients were non adherent to glaucoma therapy. Non adherence was associated with older age (P = 0.04), advanced stage of glaucoma (P = 0.01), longer frequency of follow up (P = 0.00) and financial problem (P = 0.000). Sex (P = 0.53), level of education (P = 0.09), and marital status (P = 0.77) were not statistically significantly associated with non-adherence to anti-glaucoma drug treatment. Conclusion: A relatively high proportion of patients were not adhering to the medications regimen for glaucoma. Older age, advanced glaucoma, lengthier frequency of follow-up and financial hardship were associated with non-adherence. Eye care providers should be aware of the problem of non-adherence to topical medications.
  1,739 184 -
Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism
Mahfouth A Bamashmus, Khammash Hubaish, Mohammed Alawad, Hisham Alakhlee
January-March 2015, 22(1):108-114
DOI:10.4103/0974-9233.148359  PMID:25624684
Purpose: The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism. Patients and Methods: A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the quality of vision were formulated including; global satisfaction; quality of uncorrected and corrected vision; quality of night vision; glare; daytime driving and; night driving. Main outcome measures were responses to individual questions and scale scores and correlations with clinical parameters. The scoring scale ranged from 1 (dissatisfied) to 3 (very satisfied) and was stratified in the following manner: 1-1.65 = dissatisfied; 1.66-2.33 = satisfied and; 2.33-3 = very satisfied. Data at 6 months postoperatively are reported. Results: This study sample was comprised of 200 patients (122 females: 78 males) ranging in age from 18 to 46 years old. The preoperative myopic sphere was − 3.50 ± 1.70 D and myopic astigmatism was 0.90 ± 0.82 D. There were 96% of eyes within ± 1.00 D of the targeted correction. Postoperatively, the uncorrected visual acuity was 20/40 or better in 99% of eyes. The mean score for the overall satisfaction was 2.64 ± 0.8. A total of 98.5% of patients was satisfied or very satisfied with their surgery, 98.5% considered their main goal for surgery was achieved. Satisfaction with uncorrected vision was 2.5 ± 0.50. The main score for glare was 1.98 ± 0.7 at night. Night driving was rated more difficult preoperatively by 6.2%, whereas 79% had less difficulty driving at night. Conclusion: Patient satisfaction with uncorrected vision after LASIK for myopia and myopic astigmatism appears to be excellent and is related to the residual refractive error postoperatively.
  1,743 162 2
Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma
Paaraj Dave, Sirisha Senthil, Nikhil Choudhari, Garudadri Chandra Sekhar
January-March 2015, 22(1):64-68
DOI:10.4103/0974-9233.148351  PMID:25624676
Purpose: The aim was to report the outcome of Ahmed glaucoma valve (AGV) (New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation as a surgical intervention following an initial failed combined trabeculotomy + trabeculectomy (trab + trab) in refractory primary congenital glaucoma (RPCG). Materials and Methods: Retrospective chart review of 11 eyes of 8 patients who underwent implantation of AGV (model FP8) for RPCG between 2009 and 2011. Prior trab + trab had failed in all the eyes. Success was defined as an intraocular pressure (IOP) >5 and ≤ 18 mmHg during examination under anesthesia with or without medications and without serious complications or additional glaucoma surgery. Results: The mean age at AGV implantation was 15.4 ± 4.9 months. The mean preoperative IOP was 28 ± 5.7 mmHg which reduced to 13.6 ± 3.4 mmHg postoperatively at the last follow-up (P < 0.0001). The number of topical antiglaucoma medications reduced from a mean of 2.6 ± 0.5 to 1.6 ± 0.9 postoperatively (P = 0.009). The definition of qualified success was met in 10 (90%) eyes. One eye developed a shallow anterior chamber with choroidal detachment at 1-week, which resolved spontaneously with medications. None of the eyes developed a hypertensive phase. One eye had a long tube resulting in tube corneal touch that required trimming of the tube. One eye developed tube retraction, which was treated with a tube extender. The mean follow-up was 17.9 ± 9.3 (6.2-35.4) months. Conclusion: Managing RPCG remains a challenge. AGV implant was successful in a significant proportion of cases.
  1,680 170 -
CASE REPORTS
Rare case of optic pathway glioma with extensive intra-ocular involvement in a child with neurofibromatosis type 1
Vasudha Gupta, Kourosh Sabri, Kaitlyn F Whelan, Virginia Viscardi
January-March 2015, 22(1):117-118
DOI:10.4103/0974-9233.148361  PMID:25624686
We present a case of a 3-year-old girl with a positive family history of neurofibromatosis type-1 (NF1) presented with best corrected visual acuity of 20/40 in the right eye and <20/400 in the left eye. External ocular examination revealed left eye proptosis of 3 mm, grade II left relative afferent pupillary defect and full range of ocular motility with no strabismus. Slit lamp examination revealed iris lisch nodules bilaterally. Dilated fundus examination of the right eye was normal. Left eye disclosed a large mass extending from the optic nerve head, with associated subretinal fluid. There was neovascularization at the optic disc as well as a superior retinal hemorrhage. Computed tomography of brain/orbits showed an enlarged left optic nerve with a large mass at the optic nerve head, with no evidence of calcification. In addition, a large left optic pathway glioma (OPG), multiple hamartomas within the brain and a smaller low-grade right OPG was also reported. The remarkable feature of our case is the rare intraocular optic nerve involvement of the OPG. Early and regular ophthalmological assessment of all NF1 suspect/confirmed cases is of paramount importance in order to detect OPG early, resulting in timely intervention and salvage of vision.
  1,662 91 -
Conjunctival necrosis following a subconjunctival injection of triamcinolone acetonide in a child
Chong Ying Jiun, Wong Chee Kuen, Ismail Shatriah
January-March 2015, 22(1):125-128
DOI:10.4103/0974-9233.148364  PMID:25624689
Conjunctival necrosis is a rare complication following periocular/intraocular triamcinolone acetonide injection and has been reported extensively in adults. We describe a child who developed conjunctival necrosis following subconjunctival injection of triamcinolone acetonide for severe chronic anterior uveitis. Prompt diagnosis and management of this uncommon condition is vital.
  1,638 93 1
ORIGINAL ARTICLES
Open globe injuries in Nigerian children: Epidemiological characteristics, etiological factors, and visual outcome
Cecilia O Ojabo, Keziah N Malu, Olasupo S Adeniyi
January-March 2015, 22(1):69-73
DOI:10.4103/0974-9233.148352  PMID:25624677
Purpose: To evaluate the epidemiological characteristics, the etiological factors, the type and severity of injury, visual outcome, and prognostic factors of open globe injuries in children. Materials and Methods: This was a retrospective non-comparative case study. A chart review was performed of patients aged 16 years or younger presented at the Eye Unit of the Federal Medical Centre Makurdi, Nigeria, between January 2001 and December 2006. Data were collected on patient demographics, geographic locale of injury, type of ocular injury and vision. Statistical significance was indicated by P < 0.05. Results: The study sample comprised 78 children. A statistically significantly greater number of males (n = 51) sustained injury compared to females (n = 27; P < 0.05). The mean age of the study sample was 9.7 ± 2.40 years (range, 1 year 2 months to 15 years 8 months). The age-group that sustained injury most commonly was 6 years to 10 years. Left eyes were more likely to be affected, accounting for 53 (68.0%) cases. There were 54% (n = 42) of patients injured at home and 51.0% (n = 40) were injured while playing. The most common injury was corneoscleral laceration, (67.9% [n = 24] eyes). Only 30.0% (n = 23) patients presented within the first 24 hours of the injury, 38.5% (n = 30) of patients were visually impaired and 25.6% (n = 20) patients were blind on presentation. Visual acuity at last follow up indicated that 39.7% (n = 31) patients were visually impaired and 39.7% (n = 31) were blind. Conclusion: More public health efforts should be geared towards preventing potential causes of ocular injury at home and at playgrounds.
  1,563 147 1
EDITORIAL
A nuanced approach to the surgical management of glaucoma
Malik Y Kahook, Leonard K Seibold, Jeffrey R SooHoo, Kaweh Mansouri, Tarek Sharaawy
January-March 2015, 22(1):1-1
DOI:10.4103/0974-9233.148341  PMID:25624666
  1,555 129 -
CASE REPORTS
Delleman Oorthuys syndrome
Syed Wajahat A Rizvi, Mohammed Azfar Siddiqui, Adeeb A Khan, Ziya Siddiqui
January-March 2015, 22(1):122-124
DOI:10.4103/0974-9233.148363  PMID:25624688
Oculocerebrocutaneous or Delleman syndrome is a rare congenital syndrome characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects, intracranial cysts and skin appendages. We here report a case of 1-year-old male child with periocular skin tags, lid colobomas, and dermal hypoplasia. The patient had delayed developmental milestones and history of tonic-clonic seizures. Magnetic resonance imaging of the head revealed a large arachnoid cyst, aplastic cerebellar vermis and polymicrographic pattern of the cerebral cortex. A complex cyst of spleen was also noted on abdominal ultrasonography. Orbital cysts depending on the size can be excised or left alone. Neuroimaging evaluation of patients with congenital orbital cysts and skin appendages is emphasized for early and appropriate management.
  1,568 114 -
Spontaneous central retinal artery occlusion in a teenager with sickle cell trait
Sivakami A Pai, Sudhira Pai Hebri, Moza A Dekhain
January-March 2015, 22(1):119-121
DOI:10.4103/0974-9233.148362  PMID:25624687
Sickle cell trait (SCT) is traditionally considered a benign condition by ophthalmologists. Several studies have reported ocular complications in SCT, but these complications have been described as a consequence of trauma, exertion, and associated systemic disorders. We here in the report a case of an Arab teen boy, who presented with a sudden loss of vision in his left eye of 1 h duration. The ocular examination revealed acute central retinal artery occlusion. He underwent a series of laboratory and radiological investigations. The blood investigations revealed SCT and abnormal partial thromboplastin time. The fundus fluorescein angiography revealed abnormal retinal vascular perfusion. Marked blood rheological impairment and activation of the coagulation pathway can occur without any contributing factors in SCT leading to severe ocular complications. This is one of the young patients with spontaneous vascular occlusion in SCT.
  1,553 124 1
Fibrin sealant-assisted revision of the exposed Ahmed tube
Nikhil S Choudhari, Aditya Neog, Supriya Latka, Bhaskar Srinivasan
January-March 2015, 22(1):115-116
DOI:10.4103/0974-9233.148360  PMID:25624685
Tube exposure is a known complication of Ahmed glaucoma valve (AGV) implantation. Repair of the exposed tube is not easy. A 42-year-old monocular aphakic male had undergone retinal detachment repair with placement of an episcleral-encircling band followed by implantation of AGV. He presented to the clinic on routine review with exposure of the shunt tube. The complication was managed by placing scleral and conjunctival grafts over the exposed tube using a fibrin adhesive (Tisseel kit; Baxter AG, Vienna, Austria). The novel use of the fibrin sealant in the repair of AGV tube exposure was for better graft-integration.
  1,547 96 -
ORIGINAL ARTICLES
Regression rate of posterior uveal melanomas following iodine-125 plaque radiotherapy
Hakan Demirci, Fiorella Saponara, Adam Khan, Leslie M Niziol, Choonik Lee, James A Hayman, Grant Comer, David C Musch
January-March 2015, 22(1):103-107
DOI:10.4103/0974-9233.148358  PMID:25624683
Aim: To characterize the regression rate of posterior uveal melanoma following radioactive iodine-125 (I-125) plaque. Materials and Methods: We retrospectively analyzed 95 patients with posterior uveal melanoma who were treated with only radioactive I-125 plaque and had more than 3 years follow-up. All patients were treated with plaque radiotherapy using tumor dose of 85 Gy at the tumor apex, following COMS protocol. Regression rate was assessed with standardized A-scan ultrasonography. Associations with tumor regression were evaluated by means of mixed linear regression modeling. Results: Mean decrease in the tumor thickness (% original thickness) at 12, 24, and 36 months after radiotherapy for melanomas <3 mm in thickness was 29%, 38%, and 45%, for melanoma 3-8 mm in thickness was 32%, 44%, and 59%, and for melanoma more than 8 mm in thickness was 52%, 62%, and 68%, respectively. With a doubling of follow-up time (0.5-1 year, or 1-2 years of follow-up from treatment), tumors <3 mm in thickness at treatment showed a 0.5 mm decrease in tumor thickness, whereas melanomas 3-8 mm showed a 1 mm decrease, and melanomas >8 mm showed a 1.7 mm decrease. Uveal melanomas that developed systemic metastasis showed an additional 0.4 mm decrease with a doubling of follow-up time from treatment, compared with those that did not develop metastasis (P = 0.050). Conclusions: Posterior uveal melanomas with higher initial thickness show steeper and more reduction in tumor thickness following radioactive I-125 plaque. After the initial phases, the regression curve became similar for tumors with different thicknesses.
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Comparison of visual, refractive and topographic keratometry outcomes of intacs and intacs SK in mild to moderate keratoconus eyes
Abdulrahman Al Muammar
January-March 2015, 22(1):74-79
DOI:10.4103/0974-9233.148353  PMID:25624678
Purpose: The purpose was to evaluate and compare the visual and refractive outcomes, topographic keratometry (K) and complications of Intacs and Intacs SK for mild to moderate keratoconus. Methods: In this retrospective study, all mild to moderate keratoconus eyes that underwent implantation of Intacs (Intacs group) or Intacs SK (Intacs SK group) with minimum follow-up of 12 months were included. Preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, manifest cylinder, spherical equivalent (SE), minimum topographic keratometry, maximum topographic keratometry, and average topographic keratometry were compared in both groups. Results: There were 16 eyes in the Intacs group and 18 eyes in the Intacs SK group. Preoperatively, both groups were comparable for most parameters except gender and minimum K and average K. At 6 months postoperatively there were statistically significant improvements in UDVA, CDVA, manifest sphere, SE, minimum K, maximum K, and average K (P < 0.05, all comparisons). Manifest cylinder improved at 6 months, but the improvement was not statistically significant (P > 0.05). The outcomes remained stable with no statistically significant differences between the 6 and 12 months visits. There were no complications in both groups. Conclusion: Both models of Intacs significantly improved vision and refractive outcomes, and topographic keratometry in cases of mild to moderate keratoconus. Intacs SK provided better (not statistically significant) results.
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LETTER TO THE EDITOR
'Floating lens sign' in traumatic lens dislocations
Sameer Vyas, Satheesh Krishna, Ajay Kumar, Niranjan Khandelwal
January-March 2015, 22(1):129-130
DOI:10.4103/0974-9233.148365  PMID:25624690
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