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   2016| May-August  | Volume 4 | Issue 2  
    Online since June 9, 2016

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Prevention of operative infection in ophthalmic surgery
Uday R Gajiwala, Rajesh U Patel, Rohan A Chariwala
May-August 2016, 4(2):107-115
Prevention of infection in ocular surgery is based on the science of asepsis and antisepsis not only depends on what we do pre-, intra-, and post-operatively but also depends on how we prepare our patient and personnel. Practicing no touch technique is extremely important in preventing sporadic infections, whereas breach in sterility many times is the cause of cluster infection - whether it is the presterile product purchased from the market, or items sterilized in the operation theater (OT) protocols (such as standard operating practices) play a key role in ensuring all these. There are several guidelines available to guide us. Many activities are done in the absence of the surgeon inside the OT such as cleaning and sterilization by our staff. Their understanding of the science of asepsis and antisepsis pertaining to the tasks performed by them is very important. All these needs to be monitored and continuous medical education need to be organized for our staff also. Written protocols help in achieving this. Everybody should be aware of the protocol and this should be strictly followed. No compromise at any cost should be accepted inside the OT.
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Impact of cataract on the quality of life of rural patients in India
Seema Dutt Bandhu, YG Vabale, PP Sambarey, Amol B Walke, Swati Raje
May-August 2016, 4(2):75-81
Aim: To evaluate the impact of cataract on the quality of life of rural patients in India. Materials and Methods: Cataract patients visiting a rural hospital in Maharashtra, India were surveyed preoperatively and 3 months after undergoing cataract surgery for their quality of life. Indian visual function (VF) questionnaire 33 was used for this purpose. Expectation and satisfaction from cataract surgery were evaluated separately using subjective questions. The outcomes were compared by gender, age-group and literacy and subjective visual gain (post- and pre-operative vision). Results: Of the 150 patients who participated in the study, the visual acuity of 108 (72%) was <20/200 before surgery. The data show that scores for the general, psychosocial, and VFs were 56.7 ± 18.79, 12.82 ± 4.7, and 20.24 ± 4.17, respectively, for all three before surgery. One hundred and thirty-five (90%) participants expected to be economically productive after cataract surgery. Literate patients and patients <60 years old had higher expectations for improvement of VF from surgery. Conclusions: It is concluded that though the quality of life was decreased across all the domains, the study population contributed economically toward their households before cataract surgery and expected to be able to do so after surgery. Illiterate and older patients had a lower expectation and higher satisfaction from surgery.
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Interrelation of retinopathy with peripheral neuropathy in diabetes mellitus
Virendra K Sharma, Mita V Joshi, Avijit A Vishnoi
May-August 2016, 4(2):83-87
Context: Retinopathy and neuropathy are two most important complications of diabetes mellitus. As both the complications are dealt by two different medical fraternities, a better understanding of the association between the two will help us in its early management and prevention. Aim: To study the association of various risk factors with diabetic retinopathy and diabetic peripheral neuropathy (DPN) and to find out the association of prevalence of retinopathy with neuropathy. Settings and Design: Prospective study. Materials and Methods: The cases were selected from ophthalmology outdoor, eye camps, specialty camps, and multispecialty camps. Detailed history and relevant investigations were done. Patients underwent comprehensive ocular examination by ophthalmologist and neurological examination by physiotherapist. Results: Of the 100 patients having Type 2 diabetes for more than 5 years duration, 58% were males. Twenty-seven percent cases had retinopathy and 56% cases had peripheral neuropathy. DPN was seen approximately 2 times more than retinopathy. The occurrence of retinopathy in patients with mild (glycosylated hemoglobin [HbA1c] <7%) and moderate (HbA1c between 7% and 10%) deranged blood sugar was 19.0% and 67%, respectively, and peripheral neuropathy 64% and 83%, respectively. Among the uncontrolled cases, 32% had retinopathy and 68% had peripheral neuropathy. The prevalence of retinopathy increased 2.75 times in patients with neuropathy (37%) than in patients without peripheral neuropathy (14%). Conclusion: We found a higher prevalence of retinopathy in patients with neuropathy and thus a lookout for peripheral neuropathy should be kept in diabetics presenting to us with retinopathy.
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Occlusion therapy in older children with amblyopia
V Kavitha, S Chaitra, Mallikarjun M Heralgi
May-August 2016, 4(2):71-74
Background: Occlusion therapy is effective in older children with amblyopia. Objective: To evaluate and compare visual outcomes in older children aged between 9 and 18 years with unilateral refractive amblyopia after treatment with patching and/or optical correction. Settings and Design: Prospective randomized controlled study. Materials and Methods: Sixty children (9-18 years) with unilateral refractive amblyopia (anisometropic/meridional) with best-corrected visual acuity (BCVA) ≤6/12 (0.3 logMAR) in the worse eye were 1:1 randomized into nonocclusion and occlusion group. Both treatment groups underwent 4 weeks refractive adaptation period (RAP) and three follow-up visits at 6 weeks interval. After RAP, the better eye in the occlusion group was patched for 6 h daily, while the nonocclusion group children continued to wear spectacles for 18 weeks. BCVA (logMAR) at each visit was compared with the baseline reading. Statistical Analysis Used: Descriptive and inferential statistical analyses were used. Student's t-test and Chi-square/Fisher exact test was used to calculate the P value. Results: There was a significant improvement in BCVA from baseline to 18 weeks after RAP within both treatment groups (P < 0.001) and significant higher proportion of children in occlusion group showed three lines of improvement compared with nonocclusion group (P = 0.011). Improvement in BCVA from baseline to 18 weeks was noted irrespective of the severity of amblyopia and age of the participants more so in occlusion group. Conclusion: Occlusion therapy is an effective and better treatment than only spectacle correction in children aged between 9 and18 years, with unilateral refractive amblyopia.
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Ocular trauma has fallen on our blind spot
Kirti Nath Jha
May-August 2016, 4(2):65-69
Trauma-related visual impairment is an unrecognized public health problem. Insufficient epidemiological data on eye injuries underlies the prevailing apathy. We conducted PubMed search for articles on prevalence/incidence, and epidemiology of eye injuries/ocular trauma in India published from year 2000 to 2014 and included for analysis the studies with sufficient statistical power. We also retrieved data from National Sample Survey Organization (NSSO) and Census of India. Book chapters were also searched for relevant references. Available data throw light on the magnitude and dimensions of trauma-related visual impairment. Andhra Pradesh eye diseases study recorded history of eye injuries in 7.5% of a South Indian population, resulting in unilateral blindness in 0.6% of eye-injured. NSSO 1991 too has recorded high prevalence (35/1000 in rural areas, and 32/1000 in urban areas) of injury-related visual impairment. Results reveal the majority of injuries occur at work in an unorganized sector where Occupational Safety and Health (OSH) cover are almost nonexistent. Data on eye injuries at home, at sports, and combat-related injuries are incomplete. Due to their cataract-centric design, rapid assessment of avoidable blindness surveys fails to reveal injury-related visual impairment. To estimate injury-related visual impairment, we recommend the establishment of a National Ocular Trauma Registry. Comprehensive population-based surveys shall provide additional sources of data. Compliance with OSH measures, education of workforce, provision of eye protective device for hazardous occupations, mandatory reporting, and monitoring and audit of eye injuries should go hand-in-hand.
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Presumed Vogt-Koyanagi-Harada (VKH) disease in Nepalese population: A rare entity
Ranju Kharel (Sitaula), Dev Narayan Shah, Meenu Chaudhary
May-August 2016, 4(2):97-100
Vogt-Koyanagi-Harada (VKH) disease is a granulomatous inflammatory disorder affecting the eyes, auditory system, meninges, and skin. It typically affects those of more pigmented groups, such as Hispanics, Asians, Native Americans, Middle Easterners, and Asian Indians and is rare among Nepalese population. Hereby, we report a series of eight VKH cases with bilateral ocular involvement, of which six were females. The mean age of the patients was 38.13 ± 11.53 years. The acute uveitic stage was the commonest stage of presentation (4/8). Posterior segment involvement was in the form of disc edema (9/16), serous retinal detachment (5/16), and multifocal choroiditis (5/16). The extraocular manifestations were present in seven cases; neurological manifestations being the commonest.
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Bilateral exudative retinal detachment in a case of paraganglioma
Vishal Vohra, Harshika Chawla, Praveen Malik
May-August 2016, 4(2):92-95
Bilateral exudative retinal detachment due to extra-adrenal pheochromocytomas in a pediatric age group has been rarely reported. We report a case of a 12-year-old female child with exudative retinal detachment and hypertensive retinopathy changes secondary to hypertensive emergency due to extra-adrenal pheochromocytoma. The patient presented with sudden painless diminution of vision in both eyes since 15 days. Fundus examination showed exudative retinal detachment with Grade 4 hypertensive retinochoroidopathy changes. Supine blood pressure of 190/140 mm of Hg was recorded. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a heterogeneously enhancing right para-aortic mass likely representing extra-adrenal pheochromocytoma. Hypertensive ocular damage represents target organ damage in humans with systemic arterial hypertension. Fundus examination is a rapid and low cost modality for detecting previously existing and new onset vascular damage. Prompt recognition and timely referral of such cases have prodigious implications for both ocular and general health of a person.
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How to enhance the skills of scientific writing
Barun Kumar Nayak
May-August 2016, 4(2):63-64
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Coexistent retinal vasculitis and aggressive posterior retinopathy of prematurity in a preterm infant
Sucheta R Kulkarni, Nikhil A Labshetwar, Nilesh A Kakade, Valvi T Chhaya
May-August 2016, 4(2):100-102
We report a rare case with simultaneous occurrence of retinal vasculitis and aggressive posterior retinopathy of prematurity (APROP) in a preterm infant. During ROP screening at 5 weeks of age, RetCam imaging revealed early vascular shunts in zone I and plus disease diagnostic of APROP along with bilateral retinal vasculitis. APROP regressed with laser followed by intravitreal bevacizumab (IVB) in right eye and with laser only in left eye. Antifungal treatment was started (Fluconazole 6 mg/kg/day) on clinical suspicion of fungal sepsis with eventual resolution of retinal vasculitis. Retinal vasculitis can be an ocular sign of systemic fungal infection and can predispose an infant for development of retinopathy of prematurity (ROP). Simultaneous occurrence of both entities might pose a challenge in the management.
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Postoperative fungal endophthalmitis due to Basidiobolus ranarum: Report of a rare case
Radha Annamalai, Anupma Jyoti Kindo, Muthukumar Muthayya
May-August 2016, 4(2):89-91
Postoperative fungal endophthalmitis is a significant cause of visual loss due to the rapid progress and severe inflammation. Management is dictated by the precise identification of fungus subspecies, choice of antifungal agent, and associated systemic features. We report a rare case caused by Basidiobolusranarum, never known to have caused endophthalmitis or any form of ocular infection or inflammation. A 59-year-old, Asian, immunocompetent, agriculturist presented with endophthalmitis on the 3 rd postoperative day. Smear and culture from the aqueous and vitreous samples detected a species of fungus called Basidiobolusranarum. Fungal endophthalmitis should be suspected even in patients who present in the early postoperative period and rare species considered even in immunocompetent individuals. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections.
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Deep anterior lamellar keratoplasty in dematiaceous keratomycosis
Shilpa Ajit Joshi, Neha Sandeep Sharma, Madan Deshpande
May-August 2016, 4(2):95-97
Deep anterior lamellar keratoplasty is a technique which has been used effectively to treat anterior stromal corneal opacities, with the obvious benefit of preserving host endothelium. This report documents its use in a case of dematiaceous keratomycosis resistant to conservative management. Therapeutic penetrating keratoplasty, although a gold standard, has a high risk of rejection and poor graft survival. In our patient, careful case selection and meticulous dissection ensured elimination of infection, restoration of vision, and absence of recurrence of infection.
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Content is king: So also are the distribution channels?
Jatinder Bali, Renu T Bali
May-August 2016, 4(2):103-103
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Letter to the editor in response to the article "Surgical technique to avoid deroofing in advanced vitreomacular traction"
Suresh Ramchandani, Neha Dhiware, Priyanka Patkar, Prajakta Paritekar
May-August 2016, 4(2):104-105
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