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   2017| January-April  | Volume 5 | Issue 1  
    Online since December 6, 2016

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Optical coherence tomography in glaucoma-I
Sachin Dharwadkar, Barun K Nayak
January-April 2017, 5(1):51-63
It is a well-established fact that more than 40% ganglion cells are lost before the white-on-white perimetry shows defects. Hence, the importance of modalities which can image the structures of optic nerve and surrounding retinal nerve fiber layer in the early diagnosis of glaucoma cannot be overemphasized. However, the appropriate interpretation of these imaging modalities is of paramount importance. Out of the three machines such as HRT, scanning laser polarimeter (GDx VCC), and the OCT, the OCT has made a remarkable progress and can be incorporated judiciously in the clinical practice of glaucoma management. The purpose of this article is to explain the interpretation and its clinical application in an appropriate manner in the management of patients with glaucoma.
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Prevention and correction of residual refractive errors after cataract surgery
Jeevan S Ladi
January-April 2017, 5(1):45-50
Cataract surgery today has become more of a refractive surgery with high patient expectations and demand for independence from glasses. With advances in biometry, precise intraocular lens (IOL) power calculation is the most important step in achieving desired target refraction. Noncontact optical biometry has become the gold standard worldwide with a few exceptions where contact ultrasound biometry still needs to be performed. Although there is no single formula for IOL power calculation suitable for all eyes, our understanding of which formulae to use in specific situations is much better. Despite advances in biometry and cataract surgery techniques, unsatisfactory visual and refractive outcomes occur occasionally. Enhancement after cataract surgery is required in these cases. The common methods to treat such cases are corneal-based laser refractive surgery or lens-based procedures such as piggyback IOL and lens exchange.
  11,549 1,033 3
Lid conditions affecting cataract surgery
Ramesh Murthy
January-April 2017, 5(1):65-66
Postcataract surgery endophthalmitis remains the greatest nightmare for the cataract surgeon. Most of the reported cases have found that the ocular adnexa are the major contributor of microorganisms. Conditions such as blepharitis, chalazion, stye, and entropion have a higher load of microorganisms and can be responsible for infection. It is important to manage these conditions before performing cataract surgery.
  7,299 322 1
Biologicals in uveitis
Priyanka , Jyotirmay Biswas
January-April 2017, 5(1):3-10
Most noninfectious uveitis appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. Inflammatory uveitis is a difficult condition to treat. Recently, a new class of drugs obtained by a biological process and therefore defined as "biologics" has been successfully used in the treatment of immune-mediated rheumatic diseases. These drugs target different proinflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), and IL-6 or immune effector cells including B- and T-lymphocytes. The success in rheumatology of the TNF-α inhibitors adalimumab (ADA) and infliximab (IFX) over the past several years has led to their use in uveitis, in particular in patients with Behcet's disease and for early use in patients with juvenile idiopathic arthritis who have not benefitted from methotrexate. The first experience with anti-TNF inhibitors etanercept, IFX, and ADA gave us excellent results in uveitis. Other newer biologics approved by the United States Food and Drug Administration for rheumatic diseases are emerging treatments for uveitis. These include the anti-CD20 inhibitors rituximab, the anti-TNF inhibitors certolizumab and golimumab, the IL-6 inhibitor tocilizumab, the IL-1 inhibitor anakinra, the cytotoxic T-lymphocyte antigen 4 inhibitor abatacept. Uveitis, a significant cause of ocular morbidity worldwide, is undergoing major changes as biologic therapies have entered into the field. We used PubMed and CrossRef (Google) search engine as the main source of information. In this review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging biological therapies in this context.
  4,511 845 1
Fibrin glue versus suture technique for pterygium excision: A prospective study in tertiary-based rural hospital
Surendra P Wadgaonkar, Rachana Rajpat Tiwari, Preeti A Patil, Bhimrao S Kamble
January-April 2017, 5(1):23-27
Aim: The aim of this study is to compare the results of conjunctival closure in pterygium surgery using fibrin adhesive versus vicryl sutures. Materials and Methods: This study was carried out in the premises of rural-based tertiary hospital. A comparative prospective study was performed in fifty patients (fifty eyes) with primary nasal pterygium. They were randomized to undergo pterygium surgery using either 8-0 vicryl sutures (25 eyes) or fibrin glue (25 eyes) to attach the conjunctival autograft from August 2014 to February 2015. Mean follow-up was 14 months. Outcome measures were duration of surgery, complication, postoperative discomfort, and recurrence of pterygium. Clinical assessment was performed on days at 1, 7, and 14 days, and every 2 months thereafter. Statistical Analysis: All data were evaluated by using SPSS version 19.0 (Released 2010, IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.) package program. Mann-Whitney U-test was used for the comparison of symptoms and signs of two groups. Unpaired t-test was used to compare two groups in terms of surgery time as well as recurrence rates. Results: Average operative time was 15.76 min (range 12-20 min) in the fibrin glue and 33.56 min (range 30-45 min) in the suture group (P < 0.001). The symptoms such as pain, photophobia, foreign body sensation, watering and conjunctival, and chemosis were significantly less in the subjects treated with glue than suture (for chemosis and photophobia [P = 0.001]; for pain and watering [P < 0.001]). Three cases of recurrence in the suture group and one case of pyogenic granuloma in the fibrin glue group were reported. Conclusion: The use of fibrin glue in pterygium surgery significantly reduces operative time and patient symptoms, pain, and discomfort.
  4,618 462 2
Multidermatomal herpes zoster ophthalmicus in an immunocompetent male
Shobhana Dube, Pratyush Ranjan, V Rajshekhar
January-April 2017, 5(1):38-40
Herpes zoster (HZ) is caused by varicella zoster virus, which most commonly affects the thoracic (45%), cervical (23%), and trigeminal nerve (15%). Multidermatomal involvement is rare in an immunocompetent patient. We report an unusual case of HZ ophthalmicus involving all three divisions of trigeminal nerve including the superficial cervical plexus in an immunocompetent male. We recommend in such situation patient should be followed up to ensure earlier tests were not done during the window period.
  4,314 210 3
Correlation between clinical, fluorescein angiography and optical coherence tomography findings in clinically significant macular edema
Nishant Rathi, Sumana J Kamath, Madhurima K Nayak
January-April 2017, 5(1):11-16
Background: Macular edema is an important cause of visual morbidity in diabetic retinopathy. It can be assessed by both fluorescein angiography (FA) and optical coherence tomography (OCT). Aims: To study, if any, correlation exists between FA and OCT patterns in Clinically significant macular edema (CSME). Furthermore, to correlate macular thickness as determined by OCT to best-corrected visual acuity (BCVA). Materials and Methods: This was a prospective study which compared patterns in FA and OCT in patients with CSME. All the patients who were diagnosed as CSME underwent a complete ophthalmic examination and were subjected to FA and OCT. Those with a hazy media were excluded from the study. The results were analyzed by Fisher's exact test. Results: A total of 32 eyes were studied. FA revealed that most of the patients had diffuse leak (59%), followed by focal leak (31%) and combined leak (10%). On OCT, isolated sponge-like retinal swelling was seen among 66% eyes, spongy retinal swelling with cystoid macular edema/serous foveal detachment in 28% eyes, and 6% had a combined pattern. There was a statistical correlation between FA and OCT findings in our study (P = 0.038). The mean central foveal thickness in our study was 321.75 ΁ 98.30 μm, and there was a statistically significant correlation between central foveal thickness and BCVA (P = 0.043). Conclusion: There is a significant correlation between OCT and FA findings for CSME. Furthermore, the foveal thickness correlates to BCVA.
  3,267 509 1
Ocular hemodynamic alterations in patients of Type 2 diabetes mellitus
Rekha R Khandelwal, Preeti A Mundhada, Rajkumar R Khandelwal, Mohana Majumdar, Rachit R Khandelwal, Dhananjay Raje, Anand Rathi
January-April 2017, 5(1):17-22
Purpose: To study ocular blood flow velocity in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery in patients with Type 2 diabetes. Materials and Methods: The retrobulbar circulation in 46 eyes of Type 2 diabetic patients was compared with age-matched 21 nondiabetic eyes. The diabetic subjects were further divided into diabetics with no-clinical retinopathy (n = 24) and with either preproliferative or proliferative retinopathy (n = 22). Philips HD11XE machine was used for performing Color Doppler imaging. Results: The end-diastolic velocity (EDV) in OA was 3.21 cm/s in the preproliferative/proliferative group as compared to 6.0 and 8.5 cm/s in no-retinopathy and control group, respectively. The peak systemic velocities and EDVs of CRA in the diabetic group were significantly lower than those of normal subjects regardless of the retinopathy. The resistivity index (RI) of CRA was 0.81 in diabetic group and 0.70 in control group, which was statistically significant. Conclusion: The study showed reduced blood flow velocity and increased RI in Type 2 diabetic patients as compared to normal healthy individuals. There are significant changes noted in retrobulbar flow in patients with diabetic retinopathy as compared to patients without retinopathy.
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Off-label use of medication: A strong case for advocacy with government
Barun K Nayak
January-April 2017, 5(1):1-2
  2,036 327 -
Dacron mesh encasement of gold weight implants in paralytic lagophthalmos
Titap Yazicioglu, Işıl Kutlutürk
January-April 2017, 5(1):29-33
Purpose: The purpose of this study is to evaluate the efficacy of Dacron mesh used as an encasement material for gold weight implantation, which is a new therapeutic technique, in patients with paralytic lagophthalmos. Materials and Methods: Fifteen eyelids of 14 patients with paralytic lagophthalmos, who underwent surgery with Dacron mesh-covered gold implants, were retrospectively reviewed. None of the patients had any eyelid surgery, and none had orbital or any other eyelid disease. All patients had various degrees of preoperative corneal pathology due to lagophthalmos. The patients were followed up for a mean of 17.5 ± 12.4 months (range: 6-36 months), and both postoperative success and complications were reported. Pre- and post-operative lagophthalmos degrees were compared between cases with successful results and cases with complications. Preoperative lagophthalmos degrees of <9 mm versus ≥9 mm were also compared between successful and complicated cases. The Wilcoxon signed test was used to measure mean differences between pre- and post-operative values. Differences were statistically significant when P < 0.05. Results: During final visits, while 13 of 15 operated eyelids had adequate lid closure with no complications, 3 of 15 patients developed inflammation and infection in the early postoperative period. During follow-up, two of complicated patients responded to treatment poorly, and implants were removed. Skin ulceration was observed in the third patient, and the implant was replaced with a new one with no Dacron coverage, achieving adequate lid closure and satisfaction. Conclusions: Dacron mesh may be a good option as a barrier for gold weight implants to prevent implant extrusions; however, the high rate of early postoperative inflammation raises concerns about its use.
  1,839 173 -
Isolated reversible toxic optic neuropathy secondary to linezolid
Liron Berkovitz, Irena Krasnitz, Itzchak Beiran, Eytan Z Blumenthal, Michael Mimouni
January-April 2017, 5(1):40-42
A 67-year-old male diagnosed with methicillin-resistant Staphylococcus aureus-induced osteomyelitis was started on second-line antibiotic therapy (linezolid). One year following initiation of treatment, he presented to the emergency room with bilateral painless acute deterioration in vision. Visual field testing suggested bilateral optic neuropathy. Following cessation of linezolid visual acuity and visual fields reverted to normal. A handful of case reports has described reversible optic neuropathy occurring shortly after initialization of linezolid treatment. This is, to the best of our knowledge, the first report of isolated delayed onset reversible optic neuropathy with concomitant use of linezolid unaccompanied by any other systemic toxic manifestations. Reversible optic neuropathy may occur in patients receiving long-term linezolid treatment. Ophthalmic follow-up including visual field testing in patients receiving long-term linezolid treatment may assist in early recognition.
  1,750 175 -
Study of surface ocular tumours and its association with human immunodeficiency virus infection
Ranjana Pande, Mehul Joshi
January-April 2017, 5(1):35-38
A retrospective analysis of 30 patients who were referred to our hospital (A tertiary referral center in Maharashtra) was done. Mass excisional biopsy for histopathology and screening for human immunodeficiency virus (HIV) of all 30 patients was done from 2010 to 2013. The data were analyzed, and the correlation between HIV status and surface ocular tumors was done. Thirty patients were enrolled. There were 17 males and 13 females giving an overall male:female ratio of 1.31:1. On the other hand, the ratio of male:female in the HIV-positive patients was 1.71:1. Their ages ranged from 22 to 74 years with a mean age of 39.7 years. Twenty-two patients were positive while eight patients were negative for the HIV. The CD4 counts of the patients varied from 58 cells/μl to 88 cells/μl with the median count of 70 cells/μl among those who were HIV-positive. Histopathological study showed ocular surface squamous neoplasia (OSSN) in 23 patients, i.e. 77% cases, sebaceous cell carcinoma in 4 cases, i.e. 13% cases, basal cell carcinoma in 2 cases, i.e. 7% cases, and nevus in 1 case, i.e. 3% cases. Among those who were HIV positive, the histopathology showed OSSN in 19 i.e. 86% cases, sebaceous cell carcinoma in 2 i.e. 9% cases, and basal cell carcinoma in 1 i.e. 4.5% cases. This study shows that OSSN is the most frequent surface ocular tumor and majority of HIV-positive patients with tumors are young and have less CD4 count.
  1,341 188 -
Intraorbital pulse dose rate brachytherapy for myoepithelial carcinoma ex pleomorphic adenoma
Anup Narendra Chandak, Saptagirish Rambhatla, Smitha K Shambhu
January-April 2017, 5(1):43-44
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Erratum: A rare case of cerebrospinal fluid rhinorrhea post external dacryocystorhinostomy surgery

January-April 2017, 5(1):67-67
  934 131 -