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   Table of Contents - Current issue
September-December 2021
Volume 9 | Issue 3
Page Nos. 97-156

Online since Monday, September 27, 2021

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Personalized ophthalmology: Where are we? p. 97
Barun K Nayak
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Loss of visual function in diabetes mellitus p. 99
Sanaa Mohammed Konnakkodan, Valsa T Stephen, Rajeevan Palpoo
Background: Diabetes mellitus being a well-known cause for peripheral neuropathy, this study aims to detect visual pathway dysfunction in diabetics using contrast sensitivity as a subjective measure and visual-evoked potential (VEP) as an objective measure of visual pathway function. Aims: To compare contrast sensitivity and VEP in patients with type 2 diabetes mellitus as compared with control and to find the correlation with glycemic level. Materials and Methodology: This was a comparative study conducted at a tertiary eye care center. After detailed ophthalmological evaluation, contrast sensitivity and VEP of 40 patients with diabetes (20 with retinopathy and 20 without retinopathy) were compared with suitable control. Data were analyzed using the SPSS (Statistical Product and Service Solutions) version 18 using the independent sample t-test and ANOVA. Results: There was reduction of mean contrast sensitivity in diabetics as compared to nondiabetics. Contrast sensitivity was better in diabetics without retinopathy as compared to diabetics with retinopathy. There was prolongation of P100 latencies and reduction of P100 amplitudes among diabetics as compared to non-diabetics and among those with diabetic retinopathy as compared to those with normal fundus. Reduced contrast sensitivity and reduction of P100 amplitudes were seen among those with poor glycemic control. Conclusion: There was evidence of reduction of contrast sensitivity and alteration of VEP in patients with diabetes even before reduction in visual acuity giving evidence of visual pathway dysfunction in diabetes mellitus. This may also be affected by the glycemic status of the patient.
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A study of high-volume, high-quality, and low-cost cataract surgeries in a rural setup in an emerging and developing country p. 103
Shipra Singh, Neelima Mehrotra
Aim: Evaluation of visual outcome following high volume, high quality and low cost cataract surgeries in a rural setup in North India. Methods: A retrospective study was done on all patients who underwent MSICS from March 2018 to March 2020 in a tertiary care hospital. Postoperative best-corrected visual acuity (BCVA) was assessed at day 1, between 1 and 3 weeks, and after 1–2 months of surgery. Results: A total of 6514 patients were included, out of which 1952 patients had ocular comorbidities; BCVA for each patient was categorized according to the World Health Organization criteria of visual impairment. It was seen that a statistically significant number of patients had good visual outcome following surgery at 1–2 months (3017 patients) 57.6%. Among the complications following surgery, posterior capsular rent was the most common and statistically significant. Conclusion: Good visual outcome in high volume of patients can be achieved with compliance to treatment and follow-up and proper management of complications.
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Risk factors for thyroid-associated orbitopathy due to Graves' disease p. 108
Tauseef Nabi, Nadeema Rafiq, Imtiyaz Ahmad Dar
Background: Thyroid-associated orbitopathy (TAO) is the principal extrathyroidal manifestation of Graves' disease (GD). TAO is described as chronic inflammation of orbital and periorbital tissue. Environmental risk factors variably influence the development of TAO and risk factors vary with ethnicity and geographical region. Aims: To evaluate the clinical factors for TAO in patients with GD. Setting and Design: This was a hospital-based cross-sectional study done on consecutive 76 newly diagnosed patients of GD documented by thyroid 99mtechnetium-pertechnetate scan. Materials and Methods: Patients were subjected to a complete clinical workup and thyroid profile. The diagnosis of TAO was based on the criteria of Bartley and Gorman. Fifty-two TAO patients were compared with 24 non-TAO patients (controls) for risk. Statistical Analysis Used: All analyses were performed using SPSS software (version 21.0). Results: TAO was present in 52 (68%) of patients with GD. TAO was bilateral in 50 (96%) patients. Majority of the patients had mild orbitopathy (34, 65.4%) and none of the patients showed any signs of sight-threatening disease. Clinical activity score was active in 13.5% of the study group. There was significant female preponderance in TAO. Current smoking increased the risk of TAO (P = 0.023). Total triiodothyronine (T3) and mean intraocular pressure (IOP) in primary and upward gaze were significantly elevated at baseline in TAO patients. Braley's sign was seen in 30.7% of patients with TAO and in 8.3% of patients in the control group (P = 0.033). Current smoking, total T3 >4 ng/dl, and differential IOP >6 mmHg were found to be associated with the risk of TAO. Conclusion: TAO was clinically inactive and of mild severity in most cases. This study identified current smoking, total T3 >4 ng/dl, and differential IOP > 6mmHg as risk factors for TAO.
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Strabismus surgery in poor binocular potential: Change in quality of life p. 112
Rolli Khurana, Siddharth Agrawal, Vinita Singh, Mohini Agrawal
Background: Previous studies prove improvement in quality of life (QOL) after strabismus surgery. Aims: The aim is to study the change in QOL and binocular functions after strabismus surgery in patients with poor binocular potential. Setting and Design: A tertiary care center-based prospective study was done over a period of 1 year to evaluate the change in scores of adult strabismus-20 (AS-20) questionnaire after successful strabismus surgery. Materials and Methods: All patients above 10 years attending the orthoptic clinic with horizontal squint were evaluated for their probability of gaining binocularity on binocular potential score and were graded into four categories. Those with poor grade of binocular potential, having a poor chance of regaining binocularity after surgery, were included in the study. They underwent surgical ocular alignment and answered the AS-20 questionnaire for QOL preoperatively and 3 months postoperatively. Statistical Analysis Used: Comparison of preoperative scores was done using unpaired t-test. The mean pre- and post-operative scores were compared using paired t-test. Two-sided significance level with P < 0.05 was considered statistically significant. Results: Out of 53 patients, surgical outcomes of 5 were outside successful limits. Of the remaining, 18 (37.5%) were esotropic and 30 (62.5%) had exotropia. Improvement in the mean psychosocial and functional scores was 13.1 ± 6.0 and 7.6 ± 6.3, respectively. Mean overall, psychosocial, and functional QOL scores were significantly higher after successful surgical ocular alignment. Conclusion: Statistically significant improvement occurs in psychosocial and functional QOL of strabismus patients (on AS-20) with poor binocular potential undergoing successful strabismus surgery. Thus, ocular alignment in such cases can be a feasible option for improving QOL rather than mere cosmetic comeback.
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Comparison of the influx of bacterial-sized particles in single plane versus multiplane femtosecond laser incisions p. 118
William May, Mohammed Al Mutlak, Waseem Aalam, Sultan Rashidi, Rajiv Khandekar
Purpose: To present ingress of dye particles that are of size of bacteria though single and multi-planar corneal incision created by femtosecond laser in donor eyes. Setting: A tertiary eye Hospital, Central Saudi Arabia. Design: Ex vivo experimental study. Methods: This ”as ex vivo experimental study. Eyes acquired from an eye-bank that ”ere deemed unsuitable for corneal transplant ”ere used to create single as ”ell as multi-planar corneal incision using LenSx femtosecond laser. Each eye received single plane (SP) and one of the multiplanes either default multi-planar (DMP) or a right-angled multi-planar (RAMP) incision. After maintaining intraocular pressure (IOP), India ink ”as placed on the ”ound. Length and ”idth of ingress dye ”ere photographed and measured for different types of ”ound. Results: A total of 10 eyes ”ere used for this experiment. At physiologic IOP, the median and 25% quartile of length”ise invasion ”as 0.29 mm for the SP group (10 eyes), 0.23 mm for the DMP group (5 eyes), and 0.22 mm for the RAMP group (5 eyes). The difference of ingress bet”een the SP and RAMP groups as ”ell as SP and DMP group ”ere statistically significant (P &#61; 0.005). The difference in length”ise and area ”ise invasion bet”een the DMP and RAMP groups ”as not statistically significant (P &#61; 0.5). Conclusion: Bacteria size particle ingress seems to be more likely through SP incision compared to multi-plane corneal incisions created ”ith a femtosecond laser.
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Eyelid trichoblastoma – A case series p. 123
Gunja Chowdhury, Meghana Tanwar, Usha Kim, Shanthi R Krishnan
Purpose: This study aims to explore the clinicopathological features of a rare eyelid tumor, trichoblastoma (TBL). Methods: This is a retrospective study of patients undergoing excision biopsies of eyelid masses at a tertiary eye care center in South India, between January 2017 and December 2018. Patient demographics, clinical and differentiating histopathological features, and recurrence of TBL were studied. Results: Amongst all eyelid masses, 15 were histopathologically diagnosed with TBL. The average age at presentation was 64 years as female preponderance and average duration of mass being 786 days. Change in color was noted in three patients, change in size in 14 cases and history of bleeding from the mass in three. Lower lid was the most common site involved (eight patients). The average dimension of the lesions was 158.67 mm2. One patient had lid margin involvement with loss of lashes noted in three cases and conjunctival involvement in three patients. Morphologically, eight lesions were nodular while five were noduloulcerative. Pigmented TBL was noted in eight patients, TBL with atypia in three patients. TBL, malignant TBL, rippled variant and TBL with trichofolliculoma were noted in one patient each. Clinical and histopathological diagnoses correlated in four patients. No recurrence was noted with the maximum follow-up period being 23 months. Conclusion and Relevance: A differential diagnosis of TBL should be kept in mind while managing eyelid tumors because benign lesions can mimic commonly diagnosed malignancies and vice versa.
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Ologen collagen matrix for bleb repair in long standing sweating bleb- A case report with histopathological correlation p. 128
Aparna Rao, Rakhi P Dcruz, Nibedita Sahoo
A 68-year-old man, presented with reduced vision and hypotony 6 years after combined cataract + glaucoma (phacoemulsification + trabeculectomy + intraocular lens) surgery with Mitomycin-C, clinical evaluation depicted a sweating bleb. Surgical repair was done with the use of donor scleral patch graft and collagen matrix implant along with conjunctival advancement. Histopathology of the excised thinned-out bleb wall showed a single layer of metaplastic conjunctival epithelium with the complete absence of goblet cells. The use of adjuvant mitomycin-C in trabeculectomy is known to cause bleb leak and associated complications in the long run. However, the histopathological features of sweating blebs and their surgical management is not well defined in the literature.
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Inflamed pedunculated giant molluscum contagiosum of eyelid in an immunocompetent child p. 130
Divyalakshmi Kaiyoor Surya, Cynthia Arunachalam
Molluscum contagiosum (MC) is a skin infection caused by a member of the Poxvirus family. It typically affects young or immunocompromised individuals.[1]. Lesions are localised localized on the face, arms, legs, and anogenital region. Typically, it presents as single or multiple umbilicated papules or nodules on the skin and eyelid margin and conjunctiva.[2] There are very few reports of giant molluscum presenting as an inflammatory lesion in an immunocompetent patient. Here, we are presenting a case of solitary giant MCmolluscum contagiosum presenting like an inflamed pedunculated mass of eyelid in an immunocompetent child. A one 1½and half -year- old immunocompetent child presented with an inflamed large umbilicated lesion in upper eyelid which was excised in toto. Excision revealed a gyriform lesion and histopathologic confirmation was done.
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Fungal choroidal abscess in a case of aggressive retinopathy of prematurity p. 132
Taranpreet Kaur, Vipan Kumar Vig, Inderjit Kaur, Sunita Arora
Fungal choroidal abscesses are rarely reported entities on routine retinopathy of prematurity screenings done on neonates. With the increasing use of broad-spectrum intravenous antibiotics on preterm neonates during their stay in neonatal intensive care unit who are already immunodeficient, we hereby bring this case into notice so as to keep fungal etiologies as a close differential in comparison to bacterial choroidal abscesses, the latter being more common in the older age group. The late diagnosis of fungal choroidal abscess and the lack of systemic treatment for the same could possibly lead to acquired hydrocephalus and other systemic complications.
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Posterior-segment intraocular foreign body removal preserving intraocular lens – A novel technique p. 136
Chahveer Singh Bindra, Parminder Singh Bindra, Preeti Bindra
We report a case presenting with corneal tear with vitreous incarceration with intraocular foreign body (IOFB) impacted in the retina following hammer chisel injury. Following anterior-segment repair and anterior vitrectomy, standard 23G pars plana vitrectomy was performed, and impacted foreign body was released. Metallic IOFB was retrieved with the help of 23G magnet just behind the intraocular lens (IOL) following which serrated forceps was used for grasping. 23G magnet was now used via limbal incision to retrieve the foreign body in the anterior chamber through the preexisting posterior capsular rent. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction was done with the help of serrated forceps by extending the side port. This surgical technique appears to be safe and effective for retrieving fragile, slippery, large IOFB without explanting the IOL and extension of scleral incision with prompt recovery.
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Leukemic retinopathy with rare presentation in B-cell acute lymphoblastic leukemia p. 138
Paurnima U Bodhankar, Divya Balakrishnan, Nadhna Basheer, Mahesh Gopalakrishnan, Giridhar Anantharaman
A 14-year-old male presented with blurring of vision, headache, and bilateral serous macular detachment (SMD) with thick choroid without any significant leak on fluorescein angiogram. As the imaging was inconclusive, we advised him thorough systemic evaluation. His platelet count was significantly reduced with a higher percentage of blast cells on peripheral smear. The diagnosis of B-cell acute lymphoblastic leukemia was confirmed by an oncologist on flow cytometry and was immediately started on chemotherapy. After a month, SMD resolved completely with the restoration of visual acuity. This case highlights the role of early diagnosis and urgent treatment before systemic manifestations reducing disease mortality.
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Mucormycosis: An epidemic within a pandemic p. 142
Manav Deep Singh, Shreya Gujral, Munish Guleria, Shalini Malhotra, Taru Dewan, Anwara Mammel, Mohandeep Kaur
There has been a steep rise in the incidence of mucormycosis in India during the second wave of COVID-19 infection. This outbreak has principally been attributed to uncontrolled diabetes mellitus and injudicious use of corticosteroids. However, many nondiabetics and those never on steroids have also suffered from this deadly disease recently. Thus, research is under the way to look for other offending factors. Mucormycosis is an opportunistic, potentially fatal, fungal infection caused by a group of saprophytic fungi belonging to family Mucoraceae. Rhino-orbito-cerebral mucormycosis is the most common reported type. The fungi are angioinvasive in nature, leading to thrombosis and rapid tissue necrosis. It also shows neurotropism. We have conducted current literature review using the electronic database of PubMed and recent mycology books, to analyze the possible risk factors, pathogenesis, clinical features, and management protocol of mucormycosis, giving special emphasis on the Indian data. Medline search was supplemented by the personal communication with some researchers, since the problem is of recent origin and publications are still in progress. Our personal experience and current data declared by, or orders issued by union health ministry or state ministries have also been referred to. A high index of suspicion is essential for the early detection as the initial signs and symptoms might go unnoticed as they are nonspecific. The diagnosis requires the sample collection by nasal and sinus endoscopy, direct microscopic examination under potassium hydroxide (KOH), culture, imaging, and molecular tools. Histopathology and KOH mount are the cornerstones for the confirmation of diagnosis. A combination of aggressive medical therapy and surgical debridement can improve the survival. Amphotericin B continues to be the drug of choice.
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Comment on “Study of peripapillary retinal nerve fiber layer thickness in patients of type 2 diabetes mellitus and its correlation with glycaemic control” p. 150
Bharat Gurnani, Kirandeep Kaur
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Comment on “Effect of high myopia on macular thickness: An optical coherence tomography study in a tertiary care hospital, Karnataka, India” p. 151
Bharat Gurnani, Kirandeep Kaur
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Prisms in ophthalmology p. 152
Smita Kapoor
Prisms are used commonly in ophthalmic practice. In strabismus, they have a diagnostic and therapeutic role. Various types of prisms used in ophthalmology have been explained in the article. Positions and placement of a prism lens have also been dealt with. The clinical applications have been explained in detail.
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