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   2022| May-August  | Volume 10 | Issue 2  
    Online since July 18, 2022

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An insight into competency-based undergraduate curriculum and its application in Ophthalmology
Nitin Nema, Romi Srivastava, Sukhwant Bose
May-August 2022, 10(2):91-97
The revised undergraduate (UG) medical curriculum envisages the Indian Medical Graduate (IMG) to assist the nation in achieving its goal of “health for all.” It adopts learner-centered and outcome-oriented approach to train an IMG who can effectively cater to the needs of the society. It emphasizes on the development of competencies and prepares the learner to work in real life situations. Hence, there is the shift in focus from “must know” to “must do.” Apart from being a competent clinician, the graduate has to function in the roles of effective communicator, leader, life-long learner, and professional. For acquisition of the competencies, some key components have been added in competency-based medical education. Each subject expert has to make sure to teach and assess the subject-wise skills as well as these competencies. This enables the UG students to acquire knowledge, skills, ethics, values, and attitude to work as competent and skillful health-care professionals.
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Role of B-scan ultrasonography in preoperative evaluation of posterior segment in dense cataract: An observational study in a tertiary eye care hospital
Rajarathna Hegde, Vidya Hegde, Anupama Bappal
May-August 2022, 10(2):67-69
Context: B-scan ultrasonography is a diagnostic tool available for use in dense cataracts that gives vital information on vitreous, retina, choroid, and sclera. Aims: This study was planned to determine the abnormalities of the posterior segment in the presence of dense cataracts using B-scan ultrasonography and to determine the sensitivity and specificity of it. Settings and Design: Observational study design. Subjects and Methods: This observational study was done in patients with dense cataracts of any age. All the study participants underwent anterior segment evaluation, vision assessment, and posterior segment evaluation using B-scan ultrasonography. After cataract surgery, fundus evaluation of these patients was done. Pearson Chi-square test was used for assessing sensitivity and specificity of B-scan ultrasonography. Results: A total of 184 eyes of 161 patients were analyzed. The mean age of the study group was 59.17 ± 10.65 years. Majority of the participants (76.4%) were from rural areas. Out of 161 participants, 23 had bilateral dense cataracts. Preoperative B-scan ultrasonography assessment in 184 eyes showed posterior vitreous detachment (n = 40), retinal detachment (n = 2), vitreous hemorrhage, posterior staphyloma, and asteroid hyalosis (n = 1 each). Sensitivity and specificity of B-scan were analyzed in 173 eyes. Pearson Chi-square test showed the sensitivity of B-scan ultrasonography to be 64.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 81.5%. Conclusions: The study showed that B-scan is a good tool for diagnosing posterior segment pathologies in patients with dense cataracts.
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Ocular surface disease in glaucoma patients on topical medications and its relation to duration of treatment and number of medications
Samruddhi N Chanekar, Ugam P S. Usgaonkar, Shekhar O Akarkar
May-August 2022, 10(2):55-58
Background: Topical antiglaucoma medications can alter the tear film and lead to ocular surface disease (OSD). Aim: This study was done to check for the presence of OSD in patients of glaucoma on topical antiglaucoma medications and to analyze the severity of OSD with duration of treatment and number of topical antiglaucoma medications. Setting and Design: This is a prospective observational study in a tertiary care hospital. Materials and Methods: The study was undertaken in 54 eyes of 54 glaucoma patients taking antiglaucoma medications for at least 6 months and control group of 54 subjects. All the participants were assessed for OSD by ocular surface disease index (OSDI) questionnaire, Schirmer's 1 test, and tear break up time test (TBUT). Statistical Analysis: Mean and percentage were used to analyze the variables. Comparison analysis was done with analysis of variance test. P < 0.05 was considered significant. Results: The prevalence of OSD in patients of glaucoma on topical antiglaucoma medications was found to be 74%, 69%, and 83% based on OSDI questionnaire, Schirmer's test, and TBUT test, respectively. There was increase in severity of OSD with increased duration of treatment and increase in number of topical antiglaucoma medications. Conclusion: Most patients of glaucoma on topical antiglaucoma medications were having OSD. Severity of OSD is directly proportional to duration of treatment and number of drugs used.
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Prevalence of ocular morbidity in preschool children in Pune, Maharashtra
Sagar Kalamkar, Parikshit Madhav Gogate, Hardeep Kaur, Supriya Pramod Phadke, Amit Shinde
May-August 2022, 10(2):63-66
Purpose: The purpose of this study was to determine the prevalence of ocular morbidity in preschool children in Anganwadis of Pune. Methods: All preschool children from Anganwadi in the area of Vishrantwadi and Yerawada in Pune city, western India, in the age group 36 to <72 months, underwent comprehensive eye examination in October 2019–February 2020: visual acuity estimation of each eye separately, slit-lamp examination, cycloplegic refraction, orthoptic evaluation, and fundoscopy. Prior to screening, an informed written consent form was taken from their parents and class teacher. All children needing optical or medical care were provided the same. Results: We examined 1341 children (aged 3 to <6 years, mean: 3.85 ± 1.0) in 36 Anganwadis, and 693 (51.7%) were girls; 81 (6%) children were detected to have ocular morbidities. There were refractive error in 42 (3.1%), strabismus 8 (0.6%), disorder of lid and adnexa 11 (0.8%), allergic conjunctivitis 2 (0.15%), bacterial conjunctivitis 3 (0.2%), viral conjunctivitis 2 (0.15%), corneal opacity 3 (0.2%), nystagmus 4 (0.3%), convergence insufficiency 3 (0.2%), and cataract 2 (0.15%). There was no gender difference for any morbidity, but older children were more likely to have one (P < 0.001). Out of 42 having refractive error, 5/42 (12%) had myopia, 1/42 (2%) hypermetropia, 11/42 (26%) myopic astigmatism, 3/42 (7%) compound myopic astigmatism, and 22/42 (52%) had mixed astigmatism. Conclusion: Refractive error in preschool children was not an insignificant problem. Most of the morbidities were treatable, and visual impairment was preventable.
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A dream come true for Maharashtra Ophthalmological Society: Dreamcon AIOC 2022
Barun K Nayak
May-August 2022, 10(2):53-54
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Clinically significant changes in the spherical equivalent hyperopia in patients with refractive accommodative esotropia
Kanwar Mohan, Suresh Kumar Sharma
May-August 2022, 10(2):59-62
Aims: To determine the frequency and factors affecting clinically significant (≥1.0 diopters, D) changes in the spherical equivalent (SE) hyperopia in patients with refractive accommodative esotropia (RAET). Materials and Methods: The medical records of consecutive patients 3–12 years of age with RAET who had cycloplegic autorefraction initially and at follow-ups, initial hyperopia ≥2.0 diopters, and a minimum follow-up of 5 years were reviewed. A difference of ≥1.0D in SE hyperopia between the initial and follow-up/final visits was considered clinically significant. Results: This study included 161 patients (median age, 5 years). The mean follow-up period was 8.7 ± 2.4 years (range, 5.0–17.5 years). Overall, 88 patients (55%) had no clinically significant (<1.0D) change; 65 (40%), ≥1.0D decrease; and 8 (5%), ≥1.0D increase in SE hyperopia between the initial and final visits. Twenty-seven patients (17%) had ≥2.0D decrease and 11 (7%) ≥3.0D. There was no clinically significant change in SE hyperopia in 83% at age ≤7 years, and a ≥1.0D decrease in about 45% after age 12 years and in 3% after age 16 years. A ≥2.0D decrease was more common with initial hyperopia ≥4.0D than with <4.0D (P = 0.001). There was no significant difference between amblyopic and nonamblyopic eyes (P = 0.276). Conclusions: A clinically significant (≥1.0D) decrease in SE hyperopia occurred in 40% and ≥3.0D in 7% of the patients with RAET. Most patients did not have a clinically significant decrease up to age 7 years and after age 16 years. Patients with initial hyperopia ≥4.0D had a more decrease. Amblyopia had no effect.
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Pesticide exposure presenting as acute conjunctival necrosis
RH Deepthi, GP Thanuja
May-August 2022, 10(2):82-84
Acute direct ocular exposure to insecticides is rare and can present as a chemical injury. We present a case of a 21-year-old male patient who had an accidental exposure to chlorpyrifos and propoxur while spraying it as an insecticide. He presented with severe conjunctival ischemia and necrosis involving the inferior fornix. He underwent amniotic membrane transplantation to preserve the ocular surface. The case report highlights the chemical effects of organophosphorus compounds on the ocular surface.
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Double macular hole with gyrate atrophy: A long-term postoperative follow-up
Paurnima Ulhas Bodhankar, Ajit Kamalakar Joshi, Abhinandan N Patil
May-August 2022, 10(2):72-75
A 55-year-old female presented with diminution of vision, night blindness, and gyrate atrophy with “double macular hole” in the left eye. Spectral-domain optical coherence tomography of the left eye showed coexisting full thickness and lamellar macular hole with both eyes intraretinal schisis and thin epiretinal membrane. After electroretinography and biochemical confirmation of gyrate atrophy, along with arginine-restricted diet, left eye surgery was advised. Postoperatively complete closure of double hole with the resolution of schisis was achieved. However, at subsequent follow-up visits, significant recurrence of intraretinal schisis was noted due to the continued toxic effect of hyperornithinemia on inner retinal layers and retinal pigment epithelium, highlighting the need for effective future treatment options.
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Central serous chorioretinopathy in coronavirus disease-19 patient
Shipra Singh, JL Goyal, Divya Singh
May-August 2022, 10(2):85-87
A 46-year-old male with mild coronavirus disease 2019 (COVID-19) symptoms presented to the emergency department complaining of decreased vision in the right eye (RE). Funduscopic examination revealed serous macular detachment at the posterior pole with loss of foveal reflex in the RE. Fundus fluorescein angiography revealed pinpoint leakage in the early phase, which was enlarged in the late phase to appear like inkblot suggestive of central serous chorioretinopathy (CSCR), which was confirmed on optical coherence tomography as hyporeflective space due to the collection of serous fluid between the neurosensory retina and retinal pigment epithelium. He received COVID-19 directed therapy. The patient became systemically alright and his vision in the RE improved. Severe acute respiratory syndrome coronavirus 2 is associated with thromboembolic events and retinal ischemia may create hyperpermeability of choroid leading to the formation of CSCR.
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A rare case report of branch retinal vein occlusion in a COVID-19-positive patient
Pradeep Kumar Panigrahi
May-August 2022, 10(2):70-71
This case report is about a rare case of branch retinal vein occlusion in a healthy 53-year-old male with active COVID-19 infection. All laboratory tests for hypercoagulable state were normal. The patient responded well to multiple injections of intravitreal ranibizumab with complete resolution of macular edema and improvement of vision.
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Case of a diagnostic challenge: Retinal astrocytic hamartoma or retinoblastoma?
Ankita Kothari, Geoffrey Lam
May-August 2022, 10(2):75-77
Retinal manifestations of tuberous sclerosis (TS) include retinal astrocytomas and retinal granulomas. The retinal astrocytomas and retinal granulomas are benign tumors which clinically appear indistinguishable from retinoblastoma (Rb) lesions in their early stages. We report a case of TS with features of retinal hamartomas which closely resemble Rb lesions. We emphasize the important role of ocular coherence tomography in combination with frequent examinations under anesthesia to differentiate the two entities. TS and Rb can present as the most dangerous combination, and it's best not to assume a malignant condition as a benign one at the cost of a child's life.
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Comments on: Comparative study of secondary implantation of iris–claw lens and scleral-fixated intraocular lens in terms of visual outcome and complications
Mithun Thulasidas
May-August 2022, 10(2):88-88
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Intravitreal ranibizumab for postlaser anterior segment ischemia in retinopathy of prematurity
Vasumathy Vedantham
May-August 2022, 10(2):77-79
This case report documents the successful management of anterior segment ischemia, a very rare complication following laser in retinopathy of prematurity (ROP), by intravitreal injection of Ranibizumab, an anti-vascular endothelial growth factor agent. This is the first report as per MEDLINE search on the use and efficacy of bilateral intravitreal injection of Ranibizumab in anterior segment ischemia postlaser in ROP.
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Bug alert! A case report and review of literature on bilateral phthiriasis palpebrarum
Shivani H Patel, Ankit V Shah, Shwetambari Singh, Dipali Purohit, Rutul Patel, Shivani Hindocha
May-August 2022, 10(2):80-82
We report a case of phthiriasis palpebrarum in an immunocompetent individual along with the review of the literature. A 61-year-old woman presented with a 2-month history of itching and burning sensation in both eyes. Examination revealed lice and nits anchored to the eyelashes with a mild follicular conjunctival reaction and no evidence of discharge. The patient recovered fully within 2 weeks after manual removal of the lice and crusts along with topical antibiotic ointment and oral ivermectin, with no evidence of lice or nits on follow-up. This study suggests that patients presenting with itching of the eyelids and other asthenopic symptoms should be carefully examined by slit-lamp examination, to not miss out on unusual diagnoses such as found in this case.
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Comment on An unusual presentation of Vogt-Koyanagi-Harada disease-9
Pradeep Kumar Panigrahi
May-August 2022, 10(2):89-89
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Study of peripapillary retinal nerve fiber layer thickness in patients of type 2 diabetes mellitus and its correlation with glycemic control
Valerie Menezes, Ugam P Sinai Usgaonkar, Akshaya Nagvenkar
May-August 2022, 10(2):89-90
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