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   2013| September-December  | Volume 1 | Issue 3  
    Online since August 23, 2013

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Special considerations for prescription of glasses in children
Ashwin Sainani
September-December 2013, 1(3):169-173
The most common cause of visual impairment in children is refractive error. All general ophthalmologists and most specialists come across children in their practice and treating a refractive error is the basic moral responsibility of any ophthalmic caregiver. Limited cooperation, low reliability, and risk of amblyopia make prescribing glasses for children more challenging than for adults. The basic rules of prescribing glasses take into account the visual needs according to age, strong accommodative elements, risk of amblyopia, age-related emmetropization, and associated conditions like strabismus, prior to prescribing glasses for children. This article focuses on the standard protocols of assessment and prescription of glasses for simple refractive errors as well as some special refractive situations in children.
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Retro-pupillary iris fixated intraocular lens in pediatric subluxated lens
Vipul Bhandari, Jagdeesh K Reddy, Smita Karandikar, Indeevar Mishra
September-December 2013, 1(3):151-154
Aims: The aim of this study was to evaluate the post-operative visual acuity and complications in pediatric patients with ectopia lentis who underwent lens removal and retro-pupillary iris fixated intraocular lens (IOL) implantation. Settings and Design: Retrospective, single center, 5-year clinical audit. Materials and Methods: A retrospective analysis of all pediatric cases who presented with lens subluxation and who underwent lens extraction with posterior iris claw implantation was performed over a period of 5 years from March 2008 to February 2013. A detail record of visual acuity, slit lamp examination and fundus examination was carried out. The iris claw IOL used in this case series had a 5.5/4.5 mm optic and 8/9 mm overall length. After lens removal iris claw, IOL was enclaved to the posterior surface of the iris. The main indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measure was pre-operative and post-operative best corrected visual acuity (BCVA) and secondarily post-operative complications. Results: The study involved 36 eyes of 20 patients who underwent iris claw implantation showed improvement in mean BCVA from 2/60 pre-operatively to 6/18 post-operative. The mean age of the presentation was 12 years. Post-operative outcome in all patients was good. Only one patient developed traumatic dis-enclavation with subluxation of the iris claw IOL at 6 months in which re-enclavation was performed with success. The mean follow-up period was 7 months. No eye had serious complication such as cystoid macula edema, infection, glaucoma and dislocation of IOL. Conclusions: Retro-pupillary iris fixation of IOL is a simple, safe and viable option for correction of ectopia lentis in pediatric group.
  2 4,192 417
Corneal keratin horn in a case of ocular cicatricial pemphigoid: A relentless disease
Nandini Ramchandran, Neelam Puthran, Deepa Muzumdar
September-December 2013, 1(3):157-159
We report a rare case of progressive corneal blindness in a 65-year-old female, who was diagnosed as cicatricial pemphigoid, after almost three decades of suffering recurrent oral ulcerations. The left eye was affected earlier, and to a greater extent and severity. Subsequently, the disease progressed to complete corneal keratinization in the left eye. This case highlights the natural course of the disease, wherein the patient finally sought ophthalmic consultation for the recurrent appearance of a horn like growth in the left eye along with vision impairment due to cataractous change in the less affected right eye. At this time, patient had obvious features of ocular cicatricial pemphigoid (OCP) such as formation of multiple symblephara in the right eye and a hard dry growth in an immobile, blind left eye. To the best of our knowledge, corneal keratin horn formation has not been reported as a feature of OCP so far.
  1 2,866 205
Common avoidable mistakes in the management of glaucoma
Barun K Nayak, Dhwani Shahanand
September-December 2013, 1(3):163-168
Glaucoma is managed by most of the general ophthalmologists as well as by the glaucoma specialists. Two types of mistakes by the general ophthalmologists have been noticed quite frequently while managing glaucoma. The first one is the misdiagnosis of neuro ophthalmological cases as glaucoma or failure to recognize the coexistence of neuro- ophthalmological cases and glaucoma. The second error occurs is in prescription writing which is of paramount importance. The purpose of the present write up is to discuss these commonly occurring two mistakes while managing glaucoma patients. The knowledge of which can improve the patient care with a better outcome.
  1 4,867 470
Nuggets in clinical approach to diagnosis of glaucoma
Sayyed Mazhar
September-December 2013, 1(3):175-181
Having a high index of suspicion and comprehensive examination are key to success in early diagnosis of glaucoma. The diagnosis of glaucoma is many a time straight forward in mid or late stages, but becomes elusive in early stages. Once a diagnosis of glaucoma is made then the patient is to be treated ether by medical line of treatment or with surgical intervention or with lasers and the follow-up remains to be life-long. So, one has to be very astute in making a diagnosis of glaucoma. Glaucoma not only affects the quality of vision, but also the quality-of-life. We all know the glaucoma is an irreversible blindness so early diagnosis is of prime importance. Opportunistic screening at our clinics with comprehensive eye examination is very important. This article deals with importance history taking and diagnostics in case of glaucoma. Perfecting our basics makes our life easier for further management.
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Retinitis pigmentosa with unilateral choroidal coloboma: A rare association
Pallavi Agrawal, Priyanka Suresh Karande, Leena Vadhel, Abidi Naheed
September-December 2013, 1(3):187-187
  1 1,904 209
To study the incidence of endophthalmitis after manual small incision cataract surgery in a tertiary eye care center
Prabhushanker Mahalingam, Kumar Sambhav
September-December 2013, 1(3):147-150
Purpose: We studied the incidence and outcome of endophthalmitis after manual small incision cataract surgery in a high volume tertiary eye care center. Materials and Method: It was a retrospective study and the data were retrieved from the hospital records of the patients who underwent manual small incision cataract surgery in a tertiary eye care center from April 2010 to October 2012. The preoperative visual acuity, cataract grading, preoperative risk factors, surgical complications, postoperative visual acuity, time interval between surgery and endopthalmitis, microbiological profile, treatment given, and final visual acuity were recorded. Results: A total of 64,926 patients were operated between April 2010 and October 2012. All the patients were followed up at Day 1, Day 7, and 6 weeks postoperatively. Of these, 31 cases were diagnosed as endophthalmitis and were treated accordingly. Conclusion: The incidence of endophthamitis in this study is 0.048%, which is comparable to all modern studies.
  1 2,423 361
Giant subperiosteal orbital Schwannoma with luxated globe
Vijay D Khetan
September-December 2013, 1(3):159-162
A middle-aged Indian female patient presented with unilateral chronic painless progressive giant orbital tumor of 15 years duration causing complete anterior globe luxation. Roentgenograms revealed enlarged orbital cavity with soft-tissue mass shadow. Computed tomography showed a giant orbital cyst filling the entire orbit displacing the orbital contents outside with intact, but thinned orbital walls. The lesion was solitary and well-encapsulated. Surgical excision using combined anterior and lateral orbitotomy approach completely removed the subperiosteal cyst and associated cosmetic blemish with recovery of extra-ocular movements. Histology confirmed the diagnosis of Schwannoma with massive cystic degeneration and areas of calcification.
  - 2,229 208
Statin sensitive lipid-retinopathy in familial hypercholesterolemia
Aysha Salam, Prasad Palimar, Alison Davis
September-December 2013, 1(3):155-156
An asymptomatic 9-year-old boy was referred for extensive lipid exudation into the retina. He was known to have familial hypercholesterolemia. The lipids resorbed rapidly and spontaneously merely by lowering the cholesterol levels with statins. The possible mechanism of action and the potential role of expanding this therapy are briefly discussed.
  - 2,968 262
Nuances of starting a new medical journal
Barun Kumar Nayak
September-December 2013, 1(3):135-136
  - 4,482 3,611
Toric intraocular lenses: A review
Rajesh Sinha, Himanshu Shekhar, Sana Tinwala, Anubha Rathi, Jeewan S Titiyal
September-December 2013, 1(3):193-196
  - 3,285 594
Retinal nerve fibre layer thickness by OCT3 provides direct assessment of axonal loss in optic neuritis and may help in the early diagnosis and progression analysis of multiple sclerosis
Subhrangshu Sengupta, Partha Biswas, Chandrima Paul, Ajoy Paul
September-December 2013, 1(3):137-142
Context: Retinal nerve fibre layer (RNFL) being unmyelinated, RNFL thickness (RNFLT) provides direct evidence of axonal loss in optic neuritis (ON) and may prove to be a valuable diagnostic and prognostic tool in the development of multiple sclerosis (MS). Aims: Assessment of RNFLT by OCT3 in patients with recent onset retrobulbar ON, comparison of obtained values based on presence or absence of the periventricular white matter lesion (PVWML) on magnetic resonance imaging (MRI), comparison with the RNFLT of a control group, and analysis of the obtained results. Settings and Design: Cross-sectional study. Materials and Methods: Eighteen patients with <=3 weeks onset clinically diagnosed retrobulbar ON between 19 and 55 years were included. RNFLT was assessed on presentation by OCT3 for both the eyes. MRI of brain and spinal cord with gadolinium enhancement was also performed in all patients, after adequate medical clearance. Patients were divided into: group A (10 patients) with no MRI-proven PVWML and group B (8 patients) with one or more PVWML, operationally deemed to have MS. RNFLT analysis was also done in 18 age-matched controls who were assigned to group C. Statistical Analysis Used: ANOVA and Student's t test. Results: ON eyes in group B had thinnest RNFLT (average temporal = 39.75 μ), followed by group A (average temporal = 44.3 μ), and finally by group C (average temporal-OU = 80.78 μ). Conclusions: Our study shows that patients with ON, irrespective of detection of PVWML on MRI, have thinner RNFL compared to age-matched controls (P < 0.001). The average RNFLT values are lowest in patients with PVWML. The aspect of RNFL thinning in non-ON eyes should be further studied as a possible subclinical indicator of MS.
  - 2,447 2,224
Incidence of rebleed following 23 gauge transconjunctival sutureless vitrectomy for vitreous hemorrhage due to vascular etiologies
Manish Nagpal, Sidharth Bhardwaj, Navneet Mehrotra
September-December 2013, 1(3):143-146
Context: There has been speculation among surgeons on whether the incidence of rebleeds is higher whilst using the small gauge surgery and the concern is probably due to the higher reported incidence of post-operative hypotony in sutureless wounds. Hence, we carried out this study to report the incidence of rebleed following 23 gauge transconjunctival sutureless vitrectomy (TSV) for vitreous hemorrhage (VH) due to vascular etiologies. Aims: The aim of our study was to study the incidence of rebleed following 23 gauge TSV for VH due to vascular etiologies. Settings and Design: Retrospective case series. Materials and Methods: One hundred and nineteen eyes underwent 23-gauge TSV for VH due to proliferative diabetic retinopathy (n = 95), retinal vein occlusion (n = 15) and vasculitis (n = 9). Patients were examined post-operatively on day 1, 30, 90, and finally at 180 days. Statistical Analysis Used: Paired t-test and Fisher test. Results: Rebleed was noted in 17 patients of whom 3 had spontaneous clearance while 14 (11.8%) had a non-clearing post-operative vitreous hemorrhage. Of these 14 eyes, re-vitrectomy was performed in 8 eyes while six patients underwent air blood exchange. Conclusions: The incidence of non-clearing VH requiring intervention following 23 gauge TSV is 11.8%. All the eyes had clear media at final follow-up.
  - 2,926 275
Pseudoexfoliative syndrome: Revisited
Purvi R Bhagat, Granthali A Pawar
September-December 2013, 1(3):183-186
Pseudo exfoliation syndrome is the most common cause of secondary open angle glaucoma wherein due to poorly understood reasons, an unknown substance, a pseudoexfoliative material, is deposited on the anterior lens capsule and other structures of the anterior segment, especially the cornea, iris, pupillary margins, angles and zonules. Fifty percent of these patients ultimately develop glaucoma. The glaucoma when developed is more aggressive, exhibits more pressure fluctuations and is more resistant to standard lines of care and management. Therefore, these cases require close follow-ups and lifelong monitoring. Cataract surgery in these cases also requires special pre-operative planning and intraoperative management because of the attendant problems like poorly dilating pupils and zonular weakness. A major concern with this condition is that the deposition of the material continues throughout the life of the patient leading to unexpected complications at any time, which warrants intensive counseling patient. After extensive internet surfing and literature search, we herein attempt to present the important features of this common, but yet under recognized and less understood disease.
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Quiz 3
Priyanka Ahuja
September-December 2013, 1(3):189-191
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