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   2015| May-August  | Volume 3 | Issue 2  
    Online since May 7, 2015

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Is post mydriatic test necessary in children having compound myopic astigmatism?
Mihir Kothari, Ali Hussain
May-August 2015, 3(2):77-79
Purpose: To study the need of post mydriatic test (PMT) in children with mild to moderate compound myopic astigmatism. Materials and Methods: The children having mild to moderate compound myopic astigmatism presenting to the pediatric ophthalmology department underwent subjective refraction before, immediately after cycloplegia and 3 days after cycloplegia. The refractive error was analyzed using two-tailed paired t test by dividing the refractive-errors into sphere, cylinder and axis. Spherical equivalent was analyzed separately. Result: Eighty four eyes of 42 children aged 3 to16 years (Mean 9.6, SD 3.2) were included. Mean sphere was -0.9 diopter sphere (DS) (± 1.9) without cycloplegia and -0.4 DS (± 2.0) with cycloplegia compared to -0.9 DS (± 1.8) in the PMT. Mean cylinder was -1.3 diopter cylinder (DC) (± 1.2) without cycloplegia and -1.0 DC (± 1.5) with cycloplegia compared to -1.14 DC (± 1.3) in PMT. Mean spherical equivalent was -1.5 DS (± 1.6) without cycloplegia and -0.9 DS (± 1.8) with cycloplegia compared to -1.5 DS (± 1.6) in PMT. For spherical equivalent, the correlation coefficient (r) between non-cycloplegic refraction and cycloplegic refraction; non-cycloplegic refraction and PMT; cycloplegic refraction and PMT was 0.9. However, in comparison to cycloplegic refraction, PMT was closer to non-cycloplegic refraction and differed by only 0.01 DS (± 0.9) in sphere and 0.2 D (± 0.7) in cylinder. Conclusion: PMT is not warranted in children with compound myopic astigmatism.
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An algorithmic approach in the diagnosis and management of thyroid eye disease
Akshay G Nair, Savari T Desai
May-August 2015, 3(2):113-119
Thyroid eye disease (TED) or Graves ophthalmopathy is commonly associated with thyroid dysfunction and often causes a debilitating effect on the individual. Its presentations can result in misdiagnosis and often treatment is delayed in the initial acute inflammatory stages of the disease. The pathophysiology of this disease remains a complex process. The clinical examination, the activity and severity can help us decide the stage of the disease to help us formulate a management plan. The treatment strategy for TED is multi-pronged and consists of different modalities such as medical therapy, functional and cosmetic surgery and radiotherapy. Medical therapy ranges from supportive ocular surface protection and lubrication to potent immunosuppressive agents. Surgery, too can be vision-saving in severe dysthyroid optic neuropathy or exclusively cosmetic in cases of burnt-out orbitopathy. This review, discusses the examination, investigations of TED but essentially presents a step-by-step question based approach in the staging, diagnosis and management of thyroid eye disease.
  6,691 888 1
Difficulties with self instillation of eye drops and its impact on intraocular pressure in glaucoma patients
Shalini Virani, Parveen Rewri, Murali Dhar
May-August 2015, 3(2):87-90
Aims: Prevalence of glaucoma increases with age and this potentially blinding condition requires regular instillation of eye drops. But with aging itself and accompanying co-morbidities, self instillation of eye drops gets affected. This study was designed to study the subjective difficulties associated with self instillation of eye drops in glaucoma patients and to quantitatively assess their impact on intraocular pressure (IOP). Settings and Design: Prospective interventional study at primary eye care center. Materials and Methods: A total of 69 persons diagnosed with glaucoma or ocular hypertension (OHT), who were self instilling their eye drops, were included in this study. Patients were interviewed for subjective difficulties being faced during self instillation using a formatted questionnaire. The patients were then subjected to assisted eye drop instillation for 4 weeks. The change IOP and consumption of eye drop bottles were compared between self installation and assisted instillation periods. Statistical Analysis: Paired t-test was applied at 5% significance level to compare pre and post interventional change of parameters. Results: Fifty three percent of patients reported subjective difficulties while self instilling their eye drops. Non-compliance was self-reported in 18% of the patients. The IOP dropped by 10-13% (P-value < 0.0001) and consumption of eye drop bottles was 14% (P-value < 0.0001) higher during self instillation. Conclusion: Assisted eye drop instillation may be beneficial to achieve better IOP control.
  6,239 509 3
To study awareness and willingness of eye donation among paramedical workers
Renu Magdum, Spriha Arun, Iqra Mushtaq, Neha Sharma
May-August 2015, 3(2):95-97
Context: Current corneal procurement rates are inadequate to meet transplantation needs in India. Thus proper health care education and awareness regarding eye donation is essential. Aims: To study awareness and willingness of eye donation among paramedical workers. Settings and Design: Cross-sectional study design. Materials and Methods: Sixty paramedical workers were asked to answer a pretested semi-structured questionnaire in their own language. Questions were asked pertaining to demographic profile and assessment of awareness about eye donation. Statistical Analysis Used: SPSS (Statistical Package for Social Sciences) version 15.0. Results: The majority (45/60) of the paramedical staff were aware that eyes can be donated after death and 48/60 respondents knew that the ideal time for eye donation was within 6 hours of death. Perceived reasons for not pledging eyes by the paramedical staff included the unacceptable idea of separating the eye from the body causing disfigurement of face (16/60), lack of awareness about the concept of an eye bank where eyes can be preserved (18/60) and religious restrictions (9/60). Conclusion: The paramedical staffs of any hospital are the backbone of the health care system and can play a major role in motivating patients and their next of kin towards eye donation. Our study concluded that even though 83.33% (50/60) of paramedics had some knowledge of eye donation, 15% (9/60) believed it to be against their religious beliefs and 26.66 %( 16/60) respondents believed that it caused disfigurement of face. These beliefs are a major hurdle towards patient motivation for eye donation.Key words: Heidelberg retinal tomography, Optical coherence tomography, optic disc area, optic disc cup area, optic disc rim area, optic cup-disc ratio
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Limbal stem cell deficiency: A review
Harpal Singh Jhagta, Prachi Jain
May-August 2015, 3(2):71-75
Limbal stem cell deficiency is commonly encountered entity in routine practice. Most of the cases go unidentified at the first visit and progress to the severe disease when the problem is actually realized. In limbal stem cell deficiency, corneal limbal stem cells fail to maintain and renew corneal epithelial surface and the corneal surface is encroached by conjunctival epithelium, compromising the transparency and visual acuity. First step in the management of limbal stem cell deficiency is early control of the ocular surface inflammation and elimination of the causative factor. Surgical intervention in terms of limbal stem cell transplantation is the definitive treatment for most of the cases. Successful limbal stem cell transplantation can achieve rapid surface healing, stable ocular surface without recurrent erosions or persistent epithelial defects, regression of corneal vascularization, and restoration of a smooth and optically improved ocular surface, resulting in improved visual acuity and probably increased success for subsequent keratoplasty. Here is a brief review covering etiology, clinical presentation, and management options for the cases of limbal stem cell deficiency.
  3,447 507 3
Idiopathic hypertrophic pachymeningitis: An unusual masquerader of multiple cranial nerve palsies
Kaustubh B Harshey, Padmavathy Maharajan, Seemee Khilji, Ramakrishnan Rengappa
May-August 2015, 3(2):105-107
Idiopathic hypertrophic pachymeningtis is a rare inflammatory disorder affecting the dura mater. A 39-year-old diabetic male presented with left sixth nerve paresis along with ophthalmic and hypoglossal nerve involvement. Neuroimaging is an important tool for the neuroophthalmologist in such cases where it can point to a diagnosis as well as exclude common conditions like ischemic neuropathy in the absence of more invasive diagnostic tests. Magnetic resonance imaging (MRI) in our case revealed features suggestive of hypertrophic pachymeningitis. Secondary causes were ruled out with extensive investigations and the patient improved completely with systemic corticosteroids.
  3,256 271 1
An unsuspected case of lens-induced uveitis: A case report
Sudha M Rao, Srinivasa V Murthy, K Geethamala
May-August 2015, 3(2):100-102
We report here a case of unsuspected lens-induced uveitis occurring after small incision cataract surgery (SICS) in a 47-year-old man as a result of retained lens fragment, resulting in a painful blind eye over a period of 1 year. This was not recognized post-operatively on account of a hyphema that developed in the post-operative period. The true nature of the condition became apparent only on histopathological examination of the enucleated eye ball. The gross examination showed that a part of the cataractous lens along with some of its capsule was retained. The intra-ocular lens (IOL) was displaced and an exudate filled the cavity. Microscopy revealed the retained lens fragment, an acute-on-chronic inflammatory reaction with fibrosis in the interior of the eyeball.
  2,571 233 1
Determinants of effectiveness of scleral buckling as a primary care surgery in rhegmatogenous retinal detachment among underprivileged cases unable to afford vitrectomy
Padma B Prabhu, Raju Kuzhupally Vallon
May-August 2015, 3(2):81-86
Background: The purpose of this study was to determine the role of scleral buckling in the present era of pars plana vitrectomy and to evaluate the factors determining the outcome of buckling in terms of anatomical attachment of retina, visual recovery, and complication rate. Aims: To analyze the surgical outcome of uncomplicated rhegmatogenous retinal detachment (RRD) after scleral buckling and to assess the factors predictive of good outcome in the study group. Design: Retrospective chart review. Materials and Methods: Patients who underwent scleral buckling for primary RRD during the period of 2 years from June 2010 were included. The details regarding age, gender, laterality, presenting complaints, duration of the disease, coexisting systemic disease, and ocular risk factors were noted. Details of ocular examination, best corrected visual acuity (BCVA), intraocular pressure (IOP), and B scan ultrasonography findings were recorded. Follow up data of these patients for a period of four months after buckling procedure was collected. Statistical analysis was performed. Results: The type of RRD whether fresh or old, subclinical, subtotal or total, macular detachment, or the duration of onset did not affect the final outcome. Cataract surgery with vitreous disturbance was associated with poor anatomical and visual recovery. Milder cases of trauma had good prognosis. Lower pre-operative IOP and poorer pre-operative visual acuity were predictors of poor functional recovery. The technique of surgery did not influence the results. Conclusion: This surgical technique remains a choice for the underprivileged cases that are unable to afford high cost retinal procedures.
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A study of morphology of cataract in western India
Seema Dutt Bandhu, Yogendra Ganpat Vabale, Prajakta Pradeep Sambarey, Swati Sanjeev Raje
May-August 2015, 3(2):91-93
Background: Population-based studies of lens opacity have suggested that the distribution of lens opacity types may differ between races. We report the prevalence of the different types of age-related cataract based on the LOCS III (Lens opacification classification system III) grading cataract among adults in the western Indian state of Maharashtra. Materials and Methods: Cataract was classified on examination of eyes with dilated pupils. Demographic data included age, sex, occupation, dietary habits (vegetarian or non-vegetarian), and tobacco use. Results: A total of 198 patients were included in the present study. The highest prevalence was that of nuclear sclerosis (NS), in its pure form (45.5%) or as mixed occurrence [3% NS+CC (cortical cataract) and 11.1% NS+PSCC (posterior sub-capsular cataract)]. The prevalence of NS was significantly higher (57.4%) in higher age group as compared to that in lower age group (33.7%). On the other hand, prevalence of NS+PSCC cases was more than double (26.5%) in lower (< 65 years) age group as compared to that in higher (>65 years) age group (11.1%). The type of occupation was significantly associated with type of cataract (χ2 = 11.64, P = 0.003); majority (50%) of the CC type and NS+PSCC type (41.2%) were farmers, whereas 50.8% of NS type were housewives. Majority of the diabetic patients (71.1%) belonged to NS type. Among the tobacco users 56.8% had the nuclear sclerosis type of cataract. Conclusions: Nuclear sclerosis was the most prevalent morphology of cataract in the study group.
  2,438 222 -
Bilateral disciform keratitis: A rare feature of Reiter's syndrome
Tejaswini P Khandgave, Neelam Puthran, Varsha N Kulkarni
May-August 2015, 3(2):102-104
Reiter's syndrome is a relatively rare seronegative spondyloarthropathy characterized by a triad of urethritis, arthritis, and conjunctivitis. Human leukocyte antigen B27 (HLA B27) is positive in over two-thirds of the patients. Involvement of the cornea in the form of a bilateral disciform keratitis in a first episode of Reiter's is an extremely rare feature, with only one previous report. Other report indicates the occurrence of disciform keratitis in patients with chronic recurring episodes of Reiter's syndrome. We report acase of a young girl who developed bilateral disciform keratitis against a clinical background of arthritis of the left knee. There was preceding history of acute infective diarrhea, 1 month earlier. Initially, the keratitis was thought to be viral, but response to antiviral treatment was poor. A clinical suspicion of Reiter's syndrome was confirmed by a positive HLA B27 test. Definitive treatment with steroids and sulfasalazine resulted in resolution of the keratitis.
  1,892 223 -
Guidance for publication in peer reviewed journal
Barun K Nayak
May-August 2015, 3(2):69-70
  1,583 245 -
Post-traumatic chronic discharging orbital sinus: An interesting case report
Vidya Hegde, Rashmi Jain, Anupama Bappal
May-August 2015, 3(2):108-110
We report a rare case of a chronic discharging orbital sinus with retained multiple pieces of wooden stem. A 50-year-old male presented with swelling and discharge of 8 months duration on the medial aspect of right upper lid following a fall. Magnetic resonance imaging (MRI) showed presence of a foreign body granuloma. Orbital exploration revealed presence of multiple fragments of plant stems. Removal of these stem pieces along with granulation tissue resulted in resolution of his symptoms. The patient, on retrospective enquiry, gave the history of presence of Parthenium plants in the area where he fell. This case report highlights the need to suspect a retained foreign body in the presence of a non-healing wound.
  1,609 161 -
Posterior reversible encephalopathy syndrome in oncology
Akhil Kapoor, Sitaram Maharia, Daleep Singh, Harvindra Singh Kumar
May-August 2015, 3(2):111-111
  1,256 128 -
Angiographic guided sclerotherapy as a treatment modality of an orbital mass
Saurabh Shrivastava, Reshma Ramakrishnan, Aarti Shyam Agrawal, Abhinav Loomba, Chaitali Patel
May-August 2015, 3(2):98-100
We report a case of a 6-year-old child who presented with an orbital mass, in which invasive and non-invasive radiological investigations were used for diagnosis and its subsequent management with angiographic guided intralesional sclerotherapy using 3% sodium tetradeclysulphate. Angiographic guided sclerotherapy prevents accidental injection into major vessel and its extravasation into surrounding tissue. The use of sclerosing agents in the treatment of lymhangiomas of the orbit and other parts of body is known but angiographic guided sclerotherapy in the treatment of a vascular orbital mass is still not well-known.
  1,184 178 -
Corneal topography and tomography: Erratum

May-August 2015, 3(2):119-119
  1,165 180 -
Postgraduate training program in ophthalmology in India: What's lacking?
Javed Hussain Farooqui
May-August 2015, 3(2):111-112
  1,141 164 2