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   2015| April-June  | Volume 22 | Issue 2  
    Online since April 1, 2015

 
 
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DIABETIC RETINOPATHY UPDATES
Imaging in diabetic retinopathy
David A Salz, Andre J Witkin
April-June 2015, 22(2):145-150
DOI:10.4103/0974-9233.151887  PMID:25949070
While the primary method for evaluating diabetic retinopathy involves direct and indirect ophthalmoscopy, various imaging modalities are of significant utility in the screening, evaluation, diagnosis, and treatment of different presentations and manifestations of this disease. This manuscript is a review of the important imaging modalities that are used in diabetic retinopathy, including color fundus photography, fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. The article will provide an overview of these different imaging techniques and how they can be most effectively used in current practice.
  4,478 331 4
Recent developments in laser treatment of diabetic retinopathy
Samuel H Yun, Ron A Adelman
April-June 2015, 22(2):157-163
DOI:10.4103/0974-9233.150633  PMID:25949072
Laser photocoagulation has been the mainstay of diabetic retinopathy treatment since its development in mid-20 th century. With the advent of antivascular endothelial growth factor therapy, the role of laser therapy appeared to be diminished, however many advances in laser technology have been developed since. This review will describe recent advances in laser treatment of diabetic retinopathy including pattern scan laser, short-pulse duration and a reduced fluence laser, and navigated laser system for proliferative diabetic retinopathy and macular edema.
  3,659 415 2
Molecular mechanisms of diabetic retinopathy: Potential therapeutic targets
Maha Coucha, Sally L Elshaer, Wael S Eldahshan, Barbara A Mysona, Azza B El-Remessy
April-June 2015, 22(2):135-144
DOI:10.4103/0974-9233.154386  PMID:25949069
Diabetic retinopathy (DR) is the leading cause of blindness in working-age adults in United States. Research indicates an association between oxidative stress and the development of diabetes complications. However, clinical trials with general antioxidants have failed to prove effective in diabetic patients. Mounting evidence from experimental studies that continue to elucidate the damaging effects of oxidative stress and inflammation in both vascular and neural retina suggest its critical role in the pathogenesis of DR. This review will outline the current management of DR as well as present potential experimental therapeutic interventions, focusing on molecules that link oxidative stress to inflammation to provide potential therapeutic targets for treatment or prevention of DR. Understanding the biochemical changes and the molecular events under diabetic conditions could provide new effective therapeutic tools to combat the disease.
  3,556 317 2
Diabetic retinopathy and systemic factors
Robert N Frank
April-June 2015, 22(2):151-156
DOI:10.4103/0974-9233.154388  PMID:25949071
Diabetic retinopathy, an oculardisease, is governed by systemic as well as local ocular factors. These include primarily chronic levels of blood glucose. Individuals with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels. The relationship of blood glucose to retinopathy is continuous, with no threshold although individuals with hemoglobin A1c levels (a measure of chronic glycemia) <6.5%, generally develop little or no retinopathy. Blood pressure levels have been claimed to influence retinopathy development and progression, but multiple controlled clinical trials of antihypertensive agents in diabetic subjects have produced only weak evidence of benefit from blood pressure lowering on the incidence and progression of diabetic retinopathy. Elevated blood lipids seem to play a role in the progression of retinopathy, and two trials of fenofibrate, a lipid-lowering agent that has not proved effective in preventing cardiovascular disease, have shown benefit in preventing retinopathy progression. The mechanism of this effect may not, however, be directly related to the reduction in blood lipids. Finally, there is strong, but only circumstantial, evidence for a genetic or epigenetic influence on the pathogenesis of diabetic retinopathy. Despite the power of large-scale epidemiologic studies and modern molecular biological and computational techniques, the gene or genes, which predispose or protect against the development and progression of diabetic retinopathy remain elusive.
  3,228 337 -
ORIGINAL ARTICLES
Enhanced depth imaging optical coherence tomography of circumscribed choroidal hemangioma in 10 consecutive cases
Duangnate Rojanaporn, Swathi Kaliki, Sandor R Ferenczy, Carol L Shields
April-June 2015, 22(2):192-197
DOI:10.4103/0974-9233.150629  PMID:25949077
Purpose: The purpose was to evaluate the features of circumscribed choroidal hemangioma using spectral-domain enhanced depth imaging optical coherence tomography (EDI-OCT). Design: Retrospective observational case series. Participants: Ten patients with newly diagnosed circumscribed choroidal hemangioma. Methods: Spectral-domain EDI-OCT was performed with a Heidelberg Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany). Main Outcome Measures: Tumor thickness and EDI-OCT features. Results: The mean tumor diameter for all eyes was 5.4 mm and mean tumor thickness was 1187 mm by EDI-OCT compared to 2400 mm by ultrasonography. EDI-OCT imaged all tumors as smooth with a gently sloping anterior contour, gradual choroidal expansion, expansion of medium and large size choroidal vessels without compression of choriocapillaris, and intact Bruch's membrane (n = 10, 100%). The height of the medium and large choroidal vessels within the tumor compared to normal medium and large vessels was comparatively increased by a mean of 265% (medium vessels) and 576% (large vessels). Outer retinal abnormalities included subretinal fluid (n = 7, 70%), lipofuscin deposition (n = 1, 10%), irregularity and thinning of retinal pigment epithelium and absence or irregularity of the ellipsoid layer (n = 4, 40%), absent external limiting membrane (n = 2, 20%), and disruption of the outer nuclear layer and outer plexiform layer (n = 3, 30%). The inner retinal abnormalities included irregularity of inner nuclear layer and structural loss or edema of inner plexiform layer (n = 3, 30%). The ganglion cell layer and nerve fiber layer were intact (n = 10, 100%). Conclusion: EDI-OCT of circumscribed choroidal hemangiomas depicts a smooth, gently sloping choroidal mass with expansion of medium and large size choroidal vessels without compression of the choriocapillaris. Structural abnormalities of outer and inner retinal layers were noted.
  3,221 162 1
Changes in corneal topography and biomechanical properties after collagen cross linking for keratoconus: 1-year results
Mohammadreza Sedaghat, Mansooreh Bagheri, Shahri Ghavami, Shahram Bamdad
April-June 2015, 22(2):212-219
DOI:10.4103/0974-9233.151877  PMID:25949080
Purpose: To evaluate changes in corneal topography and biomechanical properties after collagen cross-linking (CXL) for progressive keratoconus. Patients and Methods: Collagen cross-linking was performed on 97 eyes. We assessed uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). Corneal topography indices were evaluated using placido disc topography, scanning slit anterior topography (Orbscan II), and rotating Scheimpflug topography (Pentacam). Specular microscopy and corneal biomechanics were evaluated. Results: A 1-year-follow-up results revealed that UCVA improved from 0.31 to 0.45 and BCVA changed from 0.78 to 0.84 (P < 0.001). The mean of average keratometry value decreased from 49.62 to 47.95 D (P < 0.001). Astigmatism decreased from 4.84 to 4.24 D (P < 0.001). Apex corneal thickness decreased from 458.11 to 444.46 mm. Corneal volume decreased from 56.66 to 55.97 mm 3 (P < 0.001). Posterior best fit sphere increased from 55.50 to 46.03 mm (P = 0.025). Posterior elevation increased from 99.2 to 112.22 mm (P < 0.001). Average progressive index increased from 2.26 to 2.56 (P < 0.001). A nonsignificant decrease was observed in mean endothelial count from 2996 to 2928 cell/mm 2 (P = 0.190). Endothelial coefficient of variation (CV) increased nonsignificantly from 18.26 to 20.29 (P = 0.112). Corneal hysteresis changed from 8.18 to 8.36 (P = 0.552) and corneal resistance factor increased from 6.98 to 7.21(P = 0.202), so these changes were not significant. Conclusion: Visual acuity and K values improved after CXL. In spite of the nonsignificant increase in endothelial cell count and increase in the CV, CLX seems to be a safe treatment for keratoconus. Further studies with larger sample sizes and longer follow-up periods are recommended.
  3,146 204 1
Risk factors and clinical outcomes of bacterial and fungal scleritis at a tertiary eye care hospital
Jagadesh C Reddy, Somasheila I Murthy, Ashok K Reddy, Prashant Garg
April-June 2015, 22(2):203-211
DOI:10.4103/0974-9233.150634  PMID:25949079
Purpose: The aim was to analyze demographics, risk factors, pathogenic organisms, and clinical outcome in cases with microbiologically proven bacterial or fungal scleritis. Materials and Methods: Retrospective review of all the medical records of patients with microbiologically proven infectious scleritis examined from March 2005 to December 2009 in the cornea services of L. V. Prasad Eye Institute, Hyderabad, India was done. Results: Forty-two eyes of 42 patients were included in this study. The mean age at presentation was 48.52 ΁ 14.10 years (range: 12-70). Surgery was the major risk factor seen in 24 eyes (58.5%). Scleral infection was noted after vitreoretinal surgery (with scleral buckle) in 15 eyes, cataract surgery in 3 eyes, pterygium surgery in 3 eyes, corneoscleral tear repair and scleral buckle surgery in 3 eyes. Sixteen eyes (39%) were on systemic or topical steroids at the time of presentation. History of injury was noted in 9 eyes (22%) and diabetes mellitus in 7 patients (17%). Associated keratitis was noted in 9 eyes (21.4%). The scleral abscess was unifocal in 33 eyes (78.5%), multifocal in 6 eyes (14.2%) and diffuse in 3 eyes (7.14%). The final follow-up ranged from 24 days to 37 months. The final visual acuity was better in 18 eyes (42.8%), stable in 13 (30.9%), and deteriorated in 7 eyes (16.6%). Recurrence was seen in 4 eyes (9.5%). Conclusions: Surgery is a major risk factor for infectious scleritis in our series. Fungus was the most common organism isolated. Thorough debridement and intensive use of medications have improved the outcome.
  3,116 187 2
DIABETIC RETINOPATHY UPDATES
Novel pharmacotherapies in diabetic retinopathy
Vaidehi S Dedania, Sophie J Bakri
April-June 2015, 22(2):164-173
DOI:10.4103/0974-9233.154389  PMID:25949073
This is a summary of current and emerging pharmacologic therapies utilized in the treatment of diabetic retinopathy (DR). Current therapies, such as ranibizumab, bevacizumab, triamcinolone acetonide, and fluocinolone acetonide, inhibit angiogenesis and inflammation and may be used alone or in combination with laser treatment. Emerging therapies aim to reduce oxidative stress or inhibit other signal transduction pathways, including the protein kinase C cascade and aldose reductase pathway. Future therapies may target other molecules crucial to the pathogenesis of DR, including hepatocyte growth factors and matrix metalloproteinase 9. Finally, the emergence of novel mechanisms of medication delivery may also be on the horizon.
  2,938 254 1
CASE REPORTS
Idiopathic peripapillary subretinal neovascular membrane in a young woman with recurrence of the lesion during pregnancy after treatment with intravitreal bevacizumab
Nasra Al-Gharbi, Omar Al Abdulsalam, Ahmed Al Habash
April-June 2015, 22(2):245-248
DOI:10.4103/0974-9233.150639  PMID:25949086
We report a 27-year-old woman who was diagnosed with idiopathic peripapillary subretinal neovascular membrane (PSRNVM) in her left eye with best-corrected visual acuity (BCVA) of 20/160. She had been treated by three monthly doses of intravitreal bevacizumab (1.25 mg/0.05 ml) at 4-week intervals, which showed a favorable response. The treatment led to regression of the choroidal neovascular membrane (CNVM) with complete resorption of subretinal fluid and improvement of BCVA to 20/25. Subsequently, recurrence of the CNVM was observed during pregnancy (28 months after treatment). To the best of our knowledge, this is the first report of recurrence of idiopathic PSRNVM during pregnancy.
  2,559 100 -
ORIGINAL ARTICLES
Eyelid tumors at the University Eye Clinic of Ioannina, Greece: A 30-year retrospective study
Ioannis Asproudis, Georgios Sotiropoulos, Christos Gartzios, Vassilios Raggos, Alexandra Papoudou-Bai, Ioannis Ntountas, Andreas Katsanos, Athina Tatsioni
April-June 2015, 22(2):230-232
DOI:10.4103/0974-9233.151881  PMID:25949083
Aims: The aim was to describe the epidemiology of primary eyelid tumors over a 30-year period at the Ioannina University Eye Clinic, Greece. Materials and Methods: This retrospective case series examined the histopathology of eyelid tumor specimens of patients treated between 1983 and 2012. Data were collected on patient age, gender, location of the lesion, extent of tumor excision and recurrence. Descriptive and inferential statistics were used to describe the study subgroups. Results: A total of 851 eyelid tumors comprised the study sample. There were 351 (41.2%) malignant cases and 500 (58.8%) benign cases. For malignant tumors, there were 86% basal cell carcinomas, 7% squamous cell carcinomas, and 7% basosquamous cell carcinomas. The benign eyelid lesions were comprised of 20% cysts, 18% seborrheic keratosis, 13% nevi, and 13% papillomas. Benign eyelid lesions occurred with equal frequency in the upper and lower lids. Malignant lesions were more frequently located in the lower lid. The mean age at diagnosis was 49 ± 1.45 years for patients with benign lesions and 67 ± 1.6 years for patients with malignant lesions. Conclusions: In this Greek cohort, benign eyelid lesions affected mostly young individuals, and malignant lesions occurred predominantly in elderly patients. Males and females were equally affected by malignant lesions, and recurrence after surgical excision was rare.
  2,511 133 1
Comparison of the corneal power measurements with the tms4-topographer, pentacam hr, iol master, and javal keratometer
Zahra Dehnavi, Mehdi Khabazkhoob, Ali Mirzajani, Mahmood Jabbarvand, Abbasali Yekta, Ebrahim Jafarzadehpur
April-June 2015, 22(2):233-237
DOI:10.4103/0974-9233.151884  PMID:25949084
Purpose: The aim was to compare the corneal curvature and power measured with a corneal topographer, Scheimpflug camera, optical biometer, and Javal keratometer. Materials and Methods: A total of 76 myopic individuals who were candidates for photorefractive keratectomy were selected in a cross-sectional study. Manual keratometry (Javal Schiotz type; Haag-Streit AG, Koeniz, Switzerland), automated keratometry (IOL Master version 3.02, Carl Zeiss Meditec, Jena, Germany), topography (TMS4, Tomey, Erlangen, Germany), and Pentacam HR (Oculus, Wetzlar, Germany) were performed for all participants. The 95% limits of agreement (LOAs) were reported to evaluate the agreement between devices. Results: The mean corneal power measurements were 44.3 ± 1.59, 44.25 ± 1.59, 43.68 ± 1.44, and 44.31 ± 1.61 D with a Javal keratometer, TMS4-topographer, the Pentacam and IOL Master respectively. Only the IOL Master showed no significant difference with Javal keratometer in measuring the corneal power (P = 0.965). The correlations of the Javal keratometer with TMS4-topography, Pentacam, and IOL Master was 0.991. 0.982, and 0.993 respectively. The 95% LOAs of the Javal keratometer with TMS4-topography, Pentacam, and IOL Master were − 0.361 to 0.49, −0.01 to 1.14, and − 0.36 to 0.36 D, respectively. Conclusion: Although the correlation of Pentacam, TMS4-topography, IOL Master, and Javal keratometer in measuring keratometry was high, only the IOL Master showed no significant difference with the Javal keratometer. The IOL Master had the best agreement with Javal keratometry.
  2,399 162 -
CASE REPORTS
Postcataract Surgery Endophthalmitis Caused by Acinetobacter Lwoffii
Rupak Roy, Debmalya Das, Saurabh Kumar, Anjan Mukherjee
April-June 2015, 22(2):253-254
DOI:10.4103/0974-9233.151974  PMID:25949088
Acinetobacter lwoffii is a rare cause of endophthalmitis. We report a case of acute postoperative endophthalmitis in a female, who was treated successfully with pars plana vitrectomy and intravitreal antibiotics.
  2,450 80 1
ORIGINAL ARTICLES
Prevalence and histopathological characteristics of corneal stromal dystrophies in Saudi Arabia
Sultan Alzuhairy, Hind M Alkatan, Ali A Al-Rajhi
April-June 2015, 22(2):179-185
DOI:10.4103/0974-9233.151975  PMID:25949075
Purpose: The aim was to determine the frequency and describe the main histopathologic features of corneal stromal dystrophy in Saudi Arabia. Methods: A single-center, retrospective analysis of 193 corneal specimens diagnosed with stromal dystrophy. All samples were retrieved from the Histopathology Department at King Khaled Eye Specialist Hospital over a 10-year period (2002 to December 31, 2011). Cases of stromal dystrophy undergoing keratoplasty were included in the study. Routine histopathologic stains and specific stains were used to determine a diagnosis. The corresponding demographic data and basic clinical/surgical information were collected via chart review. Results: The study sample was comprised of 193 eyes. The final diagnoses were macular corneal dystrophy (MCD) in 180 (93.26%) eyes, granular corneal dystrophy (GCD) in 9 (4.66%) and lattice corneal dystrophy (LCD) in 4 (2.07%) eyes. The mean age at presentation was 27.03 years for MCD, 26.33 years for GCD and 53.75 years for LCD. The interval between diagnosis and surgical intervention was not statistically different between the macular and granular groups (P = 0.141). There was a positive family history for the MCD (37.22%) and GCD (44.44%) groups. All eyes underwent penetrating keratoplasty (PKP) except 10 MCD cases that underwent lamellar keratoplasty. Diffuse stromal deposits were present in 87.2% of MCD corneas and 66.67% of GCD corneas. Seventeen eyes with MCD were misdiagnosed as GCD. None of the LCD cases were clinically identified since all of these cases were diagnosed as corneal scarring. In eyes with MCD that underwent PKP, there was diffuse stromal involvement (in 87.22% eyes) and changes in Descemet's membrane (in 53.5% eyes). Conclusion: This pathological study suggested that MCD was the most common corneal stromal dystrophy that required keratoplasty in Saudi Arabia. Patient with MCD and GCD presented at a significantly younger age than LCD. The clinical diagnosis of MCD is not achieved in all cases likely due to a more severe phenotype in the Saudi population or the presence of corneal scarring that is associated with previous trachoma, which obscures the classical appearance of LCD. We believe that PKP is first-line surgical treatment, especially for MCD because it involves all corneal layers. However, deep stromal involvement and changes in Descemet's membrane in MCD should be considered when selecting the surgical procedure.
  2,391 123 -
DIABETIC RETINOPATHY UPDATES
Telemedicine in diabetic retinopathy: Current status and future directions
Taraprasad Das, Rajiv Raman, Kim Ramasamy, Padmaja Kumari Rani
April-June 2015, 22(2):174-178
DOI:10.4103/0974-9233.154391  PMID:25949074
Telemedicine is exchange of medical data by electronic telecommunications technology that allows a patient's medical problems evaluated and monitored by a remotely located physician. Over the years, telemedicine and telescreening have become important components in health care, in both disease detection and treatment. Highly visual and image intensive ophthalmology is uniquely suited for telemedicine. Because of rising disease burden coupled with high opportunity cost in detection, diabetic retinopathy is an ideal ophthalmic disease for telescreening and decision-making. It fits to Wilson and Jungner's all 10 criteria of screening for chronic diseases and the American Telehealth Association's 4 screening categories.
  2,195 180 -
ORIGINAL ARTICLES
Bacterial keratitis in a tertiary eye centre in Iran: A retrospective study
Firoozeh Rahimi, Mohammad Nasser Hashemian, Amir Khosravi, Golnaz Moradi, Shahram Bamdad
April-June 2015, 22(2):238-244
DOI:10.4103/0974-9233.151870  PMID:25949085
Purpose: To report the characteristics and laboratory findings of 182 patients with bacterial keratitis diagnosed at Farabi Eye Hospital in Tehran, Iran. Materials and Methods: In this retrospective study, data were collected on demographics, risk factors, location, size and depth of the ulcer, height of the hypopyon, uncorrected visual acuity, results of smear and culture tests, and antibiotic sensitivity of cultured bacteria. Results: There were 110 (60.4%) males and 72 (39.6%) females with an average age of 56.0 ± 2.3 years. Ocular trauma (17.6%) and positive history of corneal surgery (14.3%) were major risk factors. The mean age of contact lens users was 22.5 ± 7.7 years. Sixty patients (33%) used topical antibiotics, 21 (11.5%) patients utilized topical steroid, and 26 (14.3%) cases used both topical antibiotic and steroid at presentation. Culture results were, 81 (44.5%) cases were Gram-positive, 63 (34.6%) were Gram-negative, 10 (5.5%) were mixed bacteria and in 28 (15.4%) cases had detected growth. The isolated bacterial species from the corneal ulcers were less resistant to ceftazidime (6%) and amikacin (6%). The majority of patients were treated with medical therapy; however, 81 cases (44.5%) received at least one surgical procedure. Conclusion: Among the patients with bacterial corneal ulcers, trauma was the most common risk factor. Over-the-counter antibiotic and steroid were commonly used in the majority of patients. The most common bacteria isolated were Gram-positives, and they were less resistant to ceftazidime and amikacin. Penetrating keratoplasty was the most common surgical procedure in patient who required surgery.
  2,180 187 -
Four petals evisceration for atrophia bulbi
Molham A Elbakary
April-June 2015, 22(2):226-229
DOI:10.4103/0974-9233.150645  PMID:25949082
Purpose: To study the use of four petals evisceration in atrophia bulbi to allow insertion of large orbital implant. Materials and Methods: An interventional case series. All cases were atrophia bulbi. The axial lengths (AL) of atrophic and contralateral normal eye were measured. It was planned to use implant 3 mm smaller than AL of the contralateral normal eye. Four petals evisceration was used in all cases. Results: Twenty cases were included. The mean age was 27.08 ΁ 16.07 years. The mean axial length (AL) of atrophic eyes was 16.97 ΁ 1.42 mm. In 75% of cases, the planned implant was inserted. In all cases, the implant diameter was larger than AL of atrophic eye by a mean of 2.57 ΁ 0.64 mm. The AL of atrophic eye did not affect the implant size. The mean follow-up period was 22.4 ΁ 10.1 months. Implant exposure was not recorded in any case. Volume deficiency was recorded in 2 cases (10%). Conclusions: Four petals evisceration facilitated the use of suitable sized implant in atrophia bulbi with minimal complications.
  2,018 81 -
CASE REPORTS
Enhanced depth imaging optical coherence tomography of precursor cell leukemic choroidopathy before and after chemotherapy
Murtaza K Adam, John D Pitcher, Carol L Shields, Joseph I Maguire
April-June 2015, 22(2):249-252
DOI:10.4103/0974-9233.150630  PMID:25949087
Serous retinal detachment (SRD) can be the initial manifestation of leukemia. Herein, we explore the retinal and choroidal features on enhanced depth imaging optical coherence tomography (EDI-OCT) of SRD in a patient with undiagnosed leukemia. A 23-year-old male developed blurred visual acuity of 20/200 in the right eye oculus dexter (OD) and 20/200 in the left eye oculus sinister (OS). Funduscopically, he manifested serous macular detachment in both eyes oculi uterque (OU) without hemorrhagic retinal abnormalities. EDI-OCT disclosed macular detachment OU and homogeneous, marked choroidal opacification with thickening to 724 ΅m OD and estimated >600 ΅m OS and with loss of choroidal detail OU. Peripheral blood smears revealed severe thrombocytopenia and normal leukocyte count. Peripheral cytochemisty, immunophenotyping, and bone marrow aspirate confirmed the presence of atypical lymphoblasts, fulfilling criteria for precursor cell leukemia. Following systemic chemotherapy, the visual acuity improved to 20/25 OD and 20/20 OS. On EDI-OCT, the choroidal thickening resolved to 431 um OD and 443 um OS, leaving a normal choroidal appearance. Massive choroidal infiltration with leukemic cells could be the cause of serous macular detachment found in patients with newly diagnosed leukemia.
  1,981 89 -
ORIGINAL ARTICLES
Quantitative analysis of segmented fluorescein angiography images for the follow-up of choroidal neovascular membrane
Sambuddha Ghosh, Pampa Haldar, Prashanth Ravindran, Jyotirmoy Chatterjee, Sandeep V Paranjape, Gautam Bhaduri
April-June 2015, 22(2):186-191
DOI:10.4103/0974-9233.151869  PMID:25949076
Purpose: The aim of this study was to evaluate choroidal neovascular (CNV) lesions with fluorescein angiography (FA) and to identify quantitative parameters and correlate these parameters to treatment outcomes. Subjects and Methods: This institution based cross-sectional study evaluated 30 eyes with active sub-foveal predominantly classic CNV treated with bevacizumab. Pre- and post-injection segmented FA images were analyzed. Lesion area and CNV lesion were manually delineated. Outcome measure was the change 1-month after each injection in different intensity values (0-255 divided in eight regions A [lowest intensity] to H [highest intensity] on a linear scale) in lesion area, perimeter, greatest linear dimension (GLD), area, visual acuity (VA) and central macular thickness (CMT). Results: At month 3, statistically significant changes from baseline occurred in VA, CMT, lesion area, GLD and perimeter (P < 0.05 all comparisons). Change in CMT from baseline to 3 months postinjection was correlated with change in VA (P = 0.009, r = 0.469) and intensity regions B (P = 0.001, r = −0.565), D (P = 0.001, r = 0.560), E (P = 0.035, r = 0.386). At month 3, change in intensity values 0-63 (A + B) was negatively correlated with CMT (P = 0.001, r = −0.575) and lesion area (P = 0.019, r = −0.427); change in intensity values 64-223 (C-G) was positively correlated with CMT (P = 0.000, r = 0.636) and lesion area (P = 0.002, r = 0.551). Conclusions: Decrease in area, GLD, perimeter and area with intensity ≥ 64 on segmented FA were associated with a favorable outcome of treatment. These parameters may be useful adjuncts to existing evaluation techniques during follow-up of CNV.
  1,956 98 -
Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa
Oluwatosin O O Haastrup, John C Buchan, Andy Cassels-Brown, Colin Cook
April-June 2015, 22(2):220-225
DOI:10.4103/0974-9233.151878  PMID:25949081
Purpose: To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. Methodology: A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. Results: Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. Conclusion: The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.
  1,875 103 -
CASE REPORTS
Patch graft for corneal perforation following trivial trauma in bilateral terrien's marginal degeneration
Merle Fernandes, Divya Vira
April-June 2015, 22(2):255-257
DOI:10.4103/0974-9233.151873  PMID:25949089
A young female presented with blurred vision in the left eye after she rubbed her eye. On examination of both eyes, she had 360° thinning adjacent to the limbus, lipid deposition and superficial vascularization with a perforation in the left eye. The patient was diagnosed with bilateral Terrien's marginal degeneration (TMD) with perforation. Corneal topography of the right eye revealed high oblique astigmatism confirming the diagnosis. A peripheral patch graft was performed for the left eye. At 18 months postoperatively, the best-corrected visual acuity was 20/20 in both eyes. The graft was clear. Topography of right eye was stable, and the left eye had oblique astigmatism. Bilateral advanced TMD in a young patient presenting with corneal perforation following trivial trauma is extremely uncommon. Patch graft may be an option for restoring the globe integrity in such cases. Regular follow-up is necessary as the condition progresses slowly.
  1,892 75 -
EDITORIAL
Diabetic retinopathy: A global epidemic
Arup Das
April-June 2015, 22(2):133-134
DOI:10.4103/0974-9233.154385  PMID:25949068
  1,707 177 -
CASE REPORTS
Amiodarone-induced multiorgan toxicity with ocular findings on confocal microscopy
Ugur Turk, Bengu Gerceker Turk, Suzan Guven Yilmaz, Esref Tuncer, Emin Alioglu, Tugrul Dereli
April-June 2015, 22(2):258-260
DOI:10.4103/0974-9233.154411  PMID:25949090
Amiodarone is an antiarrhythmic medication that can adversely effect various organs including lungs, thyroid gland, liver, eyes, skin, and nerves. The risk of adverse effects increases with high doses and prolonged use. We report a 54-year-old female who presented with multiorgan toxicity after 8 months of low dose (200 mg/day) amiodarone treatment. The findings of confocal microscopy due to amiodarone-induced keratopathy are described. Amiodarone may cause multiorgan toxicity even at lower doses and for shorter treatment periods.
  1,773 109 2
ORIGINAL ARTICLES
Incidence and determinants of endophthalmitis within 6 months of surgeries over a 2-year period at King Khaled Eye Specialist Hospital, Saudi Arabia: A review
Rajiv Khandekar, Saeed Al-Motowa, Hind M Alkatan, Mohammed Karaoui, Anne Ortiz
April-June 2015, 22(2):198-202
DOI:10.4103/0974-9233.154397  PMID:25949078
Background: We present the incidence and determinants of endophthalmitis between July 2010 and June 2012 at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. On its basis, we recommended recommendations to strengthen the infection prevention and control strategies. Methods: This is a retrospective review of health records type of study. The details of cases reported having endophthalmitis among those operated in 2 years of study period were studied. The incidence of endophthalmitis was calculated for different eye surgeries and epidemiological variables. The causative organisms in vitreous tap were reviewed. The visual outcomes 6 weeks following intervention/treatment of endophthalmmitis were also studied. Results: Of the 22,554 cases operated, 17 developed endophthalmitis. The incidence was 0.08% (95% confidence interval [CI] 0.04-0.11). The incidence of endophthlamitis among cataract surgeries was 0.12% (95% CI 0.04-0.21). Five specimens did not show any bacteria or fungus. Staphylococcus epidermis (3 cases) was the main pathogen identified. In 8 (47%) eyes, vision deteriorated in spite of treatment. In 5 (29%) eyes, it became stable and in 4 (23.5%) eyes, it improved following treatment. Signs of infection were noted in 1 st week, 3 weeks and 12 weeks in 4, 6 and 5 eyes respectively. Late presentation of infection (6 months postoperatively) was reported in two eyes. Conclusions: A vigilant infection control unit in a large eye hospital helps in monitoring endophthalmitis related catastrophes and suggests timely preventive measures to reduce the occurrence and appropriate measures to limit visual disabilities following eye surgery related endophthalmitis.
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LETTERS TO THE EDITOR
Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi
Mahmood Dhahir Al-Mendalawi
April-June 2015, 22(2):261-261
DOI:10.4103/0974-9233.154412  PMID:25949091
  1,023 75 -
Response to maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi
Roshni Ranjit
April-June 2015, 22(2):262-262
DOI:10.4103/0974-9233.154422  PMID:25949092
  1,016 64 -
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