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   2014| May-August  | Volume 2 | Issue 2  
    Online since April 11, 2014

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Ultrasound biomicroscopy: An overview
Deepak C Bhatt
May-August 2014, 2(2):115-123
Ultrasound biomicrosopy (UBM) is a technique used to visualize the anterior segment of the eye using high frequency ultrasound. It uses 35-50 MHz probe which has a resolution of 40 microns and a depth of penetration of 4 mm. UBM is used to study the status of desment's membrane in cases of corneal edema when slit-lamp examination cannot see the desment's clearly. In open angle glaucoma, UBM does not have any significant role. In closed angle glaucoma, UBM helps to rule out occludable versus nonoccludable angles. UBM plays a major role in diagnosis of plateau iris configuration and malignant glaucoma. UBM helps to visualize the tract and bleb in cases of failed trabeculectomy and also helps in ruling out episcleal scarring or tenon's cyst. UBM is the only modality which can easily diagnose pars plannits or cyclitic membranes noninvasively. In cases of unexplained hypotony, UBM helps to diagnose ciliary body atrophy or traction on the ciliary body. In cases of trauma, it helps to rule out angle recession or cyclodialysis cleft. UBM can assess the extent of damage to the zonules in cases of trauma and also sees the integrity of posterior capsule. This article is a short overview and an introduction to the use of UBM in the evaluation of anterior segment pathologies and usefulness in treatment management.
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Improving functional vision in school for the blind students with low vision aids in Pune, India
Albert Tousif Israfil, Parikshit M Gogate, Varsha Kulkarni, Amit Shinde
May-August 2014, 2(2):99-101
Context: Many students admitted in schools for blind have some vision. Aim: To study cause of blindness (<6/60) and functional vision improvement in visually impaired students by providing optical low vision aids (LVAs). Setting and design: Prospective series among schools for blind students. Materials and Methods: Ocular evaluation of students enrolled in special schools in Pune district was done using World Health Organization's eye examination protocol. Medical records of the students were examined and ocular examination done by using torchlight, slit lamp examination, ophthalmoscopy and retinoscopy and visual acuity estimation with low vision assessment. The logMAR chart at a distance of 4 m and reduced Snellen's acuity charts and LVAs were used. Results: Four hundred and sixty students were examined; their mean age was 12.6 years (std dev 3.3 years, range 5-20 years) and 246 (53.5%) were males. Four hundred and fifteen (90%) were blind since birth. The students were blind due to microphthalmos and anophthalmos 142 (30.9%), cornea 60 (13%), lens 78 (16.9%), uvea 5%, retina 43 (9.3%) including retinopathy of prematurity (ROP) and optic nerve lesions 6%. LVA for distance was prescribed to 59 students (12.8%) who improved >1 line and for near was prescribed to 72 students (15.7%) of whom 68 attained N6-N12 acuity. Seventy-seven (16.7%) of the total students were benefited with LVA. Conclusion: LVA prescription improved visual acuity of 'blind' students and allowed them to learn and read print. ROP was a new addition in past decade as the cause of blindness.
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Duane's retraction syndrome with severe upshoot and ipsilateral superior rectus contracture: A rare presentation
Priyanka Arora, Suma Ganesh, Varshini Shanker
May-August 2014, 2(2):108-110
Type III Duane's retraction syndrome (DRS) is a rare condition and represents only 1% of all cases of Duane's syndrome. It consists of limited/absent abduction as well as adduction of the affected eye. A characteristic upshoot/downshoot/both, in adduction, and globe retraction may occur in DRS patients. Secondary muscle changes like medial rectus contracture or superior rectus contracture (SRC) may rarely be associated with DRS. SRC has been reported in patients with unilateral superior oblique palsy and dissociated vertical deviation. However, no case report of association of SRC with DRS has been reported. We report a rare case of type III DRS with severe upshoot, globe retraction and ipsilateral SRC. It is hypothesized that a long standing severe upshoot could be the reason for development of secondary SRC. The condition was treated with Y-split of lateral rectus and superior rectus recession.
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A case of subconjunctival bancroftian filariasis
Rakesh K Barot, Namrata H Manglani, Madhuri S Pattiwar, Chhaya Chande
May-August 2014, 2(2):113-114
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Comparison of phacoemulsification versus phacotrabeculectomy in the treatment of patients with chronic angle closure glaucoma and concomitant cataract
Chandrima Paul, Subhrangshu Sengupta, Ajoy Paul
May-August 2014, 2(2):93-98
Aims: Whether phacoemulsification or phacotrabeculectomy (with adjunctive mitomycin C) is the surgery of choice in eyes with chronic angle closure glaucoma (CACG) with concomitant cataract. Settings and Design: Prospective comparative case series. Materials and Methods: Patients with CACG and cataract were randomized into two groups, comparing phacoemulsification (Group A) versus combined phacotrabeculectomy with mitomycin C (Group B). Group A had 60 eyes of medically controlled CACG with cataract and 58 eyes of medically uncontrolled CACG with cataract. Group B had 53 eyes of medically controlled CACG with cataract and 61 eyes of medically uncontrolled CACG with cataract. The two groups had identical study designs. All patients were reviewed 3-monthly for 2 years after surgery. The primary outcome measure was to compare the surgical complications of phacoemulsification versus phacotrabeculectomy and the secondary outcome measures were intraocular pressure (IOP) control and disease progression in the two groups. Statistical analysis used: Fisher's exact test and chi-square test. Results: There was no statistically significant difference in IOP control, glaucomatous progression, or final visual acuity, during the 24-month follow-up, between two groups. In Group A, 5 (4.2%) of 118 eyes reported four surgical complications while in Group B, 18 (15.8%) of 114 eyes had 16 surgical complications. The difference in the proportion of eyes with one or more surgical complications between the two groups was statistically significant [P = 0.003, 95% confidence interval (CI)*]. In addition to this the risk of surgical complication with phacotrabeculectomy was significantly higher when compared to phacoemulsification [3.73 (P = 0.003, 95% CI, 1.43-9.70)]*. Conclusions: Postsurgical complications were more frequently seen after phacotrabeculectomy. However, the data did not reveal statistically significant differences in IOP control, visual acuity, or disease progression between both groups.
  2,780 379 2
Posterior reversible encephalopathy syndrome
Sumana J Kamath, Priyansha Multani, Madhurima A Nayak
May-August 2014, 2(2):111-112
Posterior reversible encephalopathy is a relatively newly recognized disorder, which presents as a complication of pregnancy induced hypertension. Its usual presentation is blurred vision, headache, seizures and disturbance of consciousness. A 20-year-old primigravida presented with seizures, headache and loss of vision in both eyes. She was drowsy and blood pressure was 120/100 mm Hg. Ocular examination was fairly normal, except that her vision was a perception of light and fundus showed early papilledema. She was started on antihypertensives and anticonvulsants. The pregnancy was terminated. A magnetic resonance imaging revealed hyperintense areas in bilateral posterior occipitoparietal regions in T2 weighted images suggestive of posterior reversible encephalopathy syndrome (PRES). She had an improvement of vision starting from the very next day of the presentation. Treatment of this condition involves recognition of the offending factor and its removal. PRES is clinico-neuroradiological diagnosis and its knowledge can help prompt reversal and relief of anxiety to the patient.
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Orbitocranial wooden foreign body
Milind Suryawanshi, Wilson Desai, Ajit Joshi, Rohini Suryawanshi
May-August 2014, 2(2):105-108
We report a case of orbitocranial wooden foreign body, piercing through roof of orbit, frontal sinus and frontal lobe and reaching up to corpus callosum. It was, missed at the time of injury by treating surgeon and removed by us after five months. Meticulous exploration of wound and radiological imaging study of orbital injuries is mandatory at the time of injury as they complement each other in the diagnosis. Unlike metal foreign bodies that are easily diagnosed on radiological imaging, intraorbital wooden foreign bodies are often missed on cursory clinical evaluation and radiodiagnosis. This may result into significant ocular morbidity at a later date.
  2,284 245 1
Clinico-biochemical correlation of ocular manifestations and visual prognosis in victims of hooch tragedy
Suma Unnikrishnan, Kuzhuppally Vallon Raju
May-August 2014, 2(2):87-92
Background: Hooch tragedies are very common in India, especially in the low socioeconomic group resulting in varying mortality and morbidity. Various biochemical changes occur following methanol poisoning. An attempt is made to follow up such patients to correlate these biochemical changes and clinical presentations to the final visual outcome. Aim: To study the visual problems in the victims of acute methanol poisoning and its correlation with biochemical changes. We also studied the visual prognosis and sequel of acute methanol poisoning in correlation with the initial presentation, biochemical changes and treatment modalities. Study Design: Observational study. Materials and Methods: Twenty-nine patients attended in ophthalmology casualty of a tertiary center with history of blurring of vision after consuming illicit liquor were included in the study. Four patients presented with no perception of light, 15 patients were having poor vision (<6/18). On follow up, the two patients remained with no perception of light. Even though four patients showed initial improvement, they later deteriorated. Patients who permanently lost vision were having severe metabolic acidosis at presentation. Statistical Analysis: Was done by chi square test using SPSS 16 version software for studying the significance. Results and Conclusion: Acute methanol poisoning can badly affect the visual functions. Blood pH and serum bicarbonate level has got direct correlation with visual deficit. The presence of metabolic acidosis, if not corrected early will result in permanent visual impairment. Early intervention with hemodialysis and systemic steroids can improve the visual outcome.
  2,076 267 1
Neurothekoma of orbit
Nitin V Trivedi, Girish P Nehete, Poorti G Nehete
May-August 2014, 2(2):103-105
Myxoid neurothekeoma, also known as "dermal nerve sheath myxoma", is a rare tumor of presumed nerve sheath origin, which affects adolescents and young adults. A middle-aged woman came with the complaint of inferior displacement of left eyeball for 4 years. She was diagnosed previously as pseudotumor and treated with systemic steroids twice before, following which symptoms were relieved for short duration. There is a history of ptosis surgery done in childhood. Orbit examination showed firm, nonmovable, nonreducible mass below superior orbital margin. Computed tomography scan of orbit showed a round well-circumscribed, isodense mass located in the suprabulbar extraconal space. Surgical excision of mass through anterior orbitotomy was performed. One large size nodule with rest small daughter nodules was removed. Histopathological examination revealed myxoid lobules and fascicles of spindle cells with no atypia, suggestive of nerve sheath myxoma. It is so far rarest tumor in the orbit.
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Saluting the unsung heroes: The reviewer
Barun Kumar Nayak
May-August 2014, 2(2):85-85
  1,518 190 -