Lateral Crisscross Position for Lymphaticovenular Anastomosis: Comfortable for Both the Patient and the Surgeon

J reconstr Microsurg
DOI: 10.1055/s-0038-1676602

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EMSLIP

Obesity and Lower Extremity Reconstruction: Evaluating Body Mass Index as an Independent Risk Factor for Early Complications

J reconstr Microsurg
DOI: 10.1055/s-0038-1676538

Background The prevalence of obesity in the United States continues to grow and is estimated to affect over a quarter of the working-age population. Some studies have identified obesity as a risk factor for flap failure and complications in free flap-based breast reconstruction, but its clinical significance is less clear in nonbreast reconstruction. The role of obesity as a risk factor for failure and complications following lower extremity reconstruction has not been well described, and the limited existing literature demonstrates conflicting results. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed to identify patients undergoing local- or free-flap reconstruction of the lower extremity between 2010 and 2015. Preoperative variables and outcomes were compared between obese (body mass index ≥ 30) and nonobese patients. Chi-square analysis and Fisher's exact test were used for categorical variables and t-tests for continuous variables. Multivariate regression was performed to control for confounders. Results Univariate analysis of medical and surgical outcomes revealed that obese patients undergoing local flaps of the lower extremity required a significantly longer operative time (187.7 ± 123.2 vs. 166.2 ± 111.7 minutes; p = 0.003) and had significantly higher rates of superficial surgical site infection (SSI; 7.2% vs. 4.5%; p = 0.04). On univariate analysis, there were no significant differences in any postoperative outcomes between obese and nonobese patients undergoing microvascular free flaps of the lower extremity.On multivariate regression analysis, obesity was not an independent risk factor for superficial SSI (odds ratio = 1.01, p = 0.98) or increased operative time (β  = 16.01, p = 0.14) for local flaps of the lower extremity. Conclusions Evaluation of a large, multicenter, validated and risk-adjusted nationwide cohort demonstrated that obesity is not an independent risk factor for early complications following lower extremity reconstruction, suggesting that these procedures may be performed safely in the obese patient population.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Top‐down and Bottom‐up Control of Stress‐Coping

Abstract

In this 30^th anniversary issue review, we focus on glucocorticoid modulation of limbic‐prefrontocortical circuitry during stress‐coping. This action of the stress hormone is mediated by mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) that are co‐expressed abundantly in these higher brain regions. Via both receptor types, the glucocorticoids demonstrate, in various contexts, rapid nongenomic and slower genomic actions which coordinate consecutive stages of information processing. MR‐mediated action optimizes stress‐coping, while in complementary fashion, the memory storage of the selected coping strategy is promoted via GR. We highlight the involvement of adipose tissue in the allocation of energy resources to central regulation of stress reactions, point to still poorly‐understood neuronal ensembles in the prefrontal cortex that underlie cognitive flexibility critical for effective coping, and evaluate the role of cortisol as a pleiotropic regulator in vulnerability to, and treatment of, trauma‐related psychiatric disorders.

This article is protected by copyright. All rights reserved.

http://bit.ly/2PX8k1i

Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience

Abstract

Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment^1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity

This article is protected by copyright. All rights reserved.

http://bit.ly/2EJXtqr

Isotretinoin′s paradoxical effects in immortalized sebocytes

Abstract

in their recently published Research Letter, Burney et al.¹ reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)

This article is protected by copyright. All rights reserved.

http://bit.ly/2EIDp7j

Establishment of prize for AAOMFR best article

http://bit.ly/2CtAxtn

Oral Radiology accepted by Medline

http://bit.ly/2T5X70y

Promoting TERT Promoter Mutations for Prognostication in Cutaneous Oncology

Publication date: Available online 22 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Warren R. Heymann

http://bit.ly/2R8RBwZ

A simple and swift radiofrequency based epilation technique for gray and blonde hair

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Sanjeev Gupta, Ravi Shankar Jangra, Somesh Gupta

http://bit.ly/2GB5FLC

Histological subtype of treatment failures after noninvasive therapy for superficial basal-cell carcinoma: an observational study

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Lieke C.J. van Delft, Patty J. Nelemans, Maud H.E. Jansen, Aimee H.M.M. Arits, Marieke H. Roozeboom, Myrurgia A. Hamid, Klara Mosterd, Nicole W.J. Kelleners-Smeets

Abstract

Background

There have been concerns that recurrences after noninvasive therapy for basal-cell carcinoma (BCC) transform into a 'more aggressive' histological subtype.

Objective

To evaluate the proportion of patients with a non-superficial treatment failure after noninvasive therapy for superficial BCC.

Methods

An observational study was performed using data from a single blind, non-inferiority, randomized controlled trial (March 2008-August 2010) with five year follow-up in patients with primary superficial BCC treated with methylaminolevulinate-photodynamic therapy (MAL-PDT), 5-fluorouracil or imiquimod. Data were used from 166 adults with a histologically confirmed treatment failure.

Results

A non-superficial subtype was found in 64 of 166 treatment failures (38.6%). Proportions with a 'more aggressive' subtype than the primary tumor were 51.3% (38/74) for early and 28.3% (26/92) for later treatment failures (p=0.003). The proportion of 'more aggressive' early failures was significantly lower following imiquimod (26.3%) compared to MAL-PDT (54.8%, p=0.086) and 5-fluorouracil (66.7%, p=0.011).

Limitations

There was limited information on the exact time of occurrence of treatment failures.

Conclusion

'More aggressive' treatment failures after noninvasive therapy for superficial BCC occur most often within the first three months post-treatment probably indicating underdiagnosis of 'more aggressive' components in the primary tumor rather than transformation.

http://bit.ly/2RbwGt7

The Diagnostic Accuracy of Dermoscopy for Basal Cell Carcinoma: A Systematic Review and Meta-Analysis

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Ofer Reiter, Ilit Mimouni, Michael Gdalevich, Ashfaq Marghoob, Assi Levi, Emmilia Hodak, Yael Anne Leshem

Abstract

Background

Dermoscopy is a noninvasive technique for the diagnosis of skin lesions. Its accuracy for basal cell carcinoma (BCC) has not been systematically studied.

Objective

To systematically investigate the accuracy of dermoscopy for the diagnosis of basal cell carcinoma with comparison to naked eye examination.

Methods

A systematic review of studies reporting the accuracy of naked eye examination and dermoscopy for the diagnosis of BCC was conducted. A meta-analysis for sensitivity and specificity was performed using a bivariate mixed-effects logistic regression modeling framework.

Results

Seventeen studies were identified. The pooled sensitivity and specificity of dermoscopy for the diagnosis of basal cell carcinoma were 91.2% and 95%, respectively. In studies comparing test performance, adding dermoscopy to naked eye examination improved sensitivity from 66.9% to 85% (p=0.0001), and specificity, from 97.2% to 98.2% (p=0.006). The sensitivity and specificity of dermoscopy were higher for pigmented than non-pigmented BCC. Sensitivity increased when dermoscopy was performed by experts and when the diagnosis was based on in-person dermoscopy as opposed to dermoscopic photographs.

Limitations

Significant heterogeneity among studies with a medium-to-high risk of bias.

Conclusion

Dermoscopy is a sensitive and specific add-on tool for the diagnosis of basal cell carcinoma. It is especially valuable for pigmented BCC.

http://bit.ly/2GJZaX0

Letter Response

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Sally Tan, Elizabeth Buzney, Arash Mostaghimi

http://bit.ly/2RbwGcB

The Uses of Naltrexone in Dermatological Conditions

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Brigette Lee, Dirk Elston

Abstract

Background

Naltrexone in standard and reduced doses is efficacious in many inflammatory and acantholytic disorders.

Objective

We summarized current data of naltrexone relevant to dermatological practice.

Methods

An English language PubMed literature search was performed using the terms naltrexone, low-dose naltrexone, Hailey-Hailey, psoriasis, lichen planopilaris, alopecia, opioid, opioid receptor, treatment, dermatology, monitoring, side effect, skin, pruritus, cutaneous, acantholytic, and Darier.

Results

Opioid receptors are found throughout the skin and affect cell proliferation, migration and adhesion. Mu opioid receptors have been found in all layers of the epidermis while delta receptors are concentrated at cell junctions and can reduce desmoglein expression. Typical doses of naltrexone result in continuous binding to receptors. Low doses result in intermittent blockade with increased ligand and receptor expression, potentiating their effect.

Limitations

Our review was restricted to the English language literature.

Conclusion

Naltrexone affects inflammation, cell adhesion, and keratinocyte proliferation and migration. While low-dose naltrexone has demonstrated efficacy in treating Hailey-Hailey disease, further dose-ranging studies are needed. Data suggest naltrexone could be helpful in the treatment of pruritus and a variety of inflammatory and acantholytic skin diseases refractory to other treatments. At higher doses, liver function tests should be monitored on a periodic basis.

http://bit.ly/2GA11gJ

Comment on “Skin stripping technique: A diagnostic clue for fiberglass dermatitis”

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Ali Rajabi-Estarabadi, Natalie M. Williams, Antonella Tosti

http://bit.ly/2RbFcYV

REPLY to “Comment on “skin stripping technique: A diagnostic clue for fiberglass dermatitis”

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): J. Company-Quiroga, S. Alique-García, Martínez-Morán, S. Córdoba, J. Borbujo

http://bit.ly/2GDf59k

Evaluating results of an interferon gamma release assay in patients with autoimmune disease on hydroxychloroquine

Publication date: Available online 21 December 2018

Source: Journal of the American Academy of Dermatology

Author(s): Rebecca Gaffney, Victoria P. Werth

http://bit.ly/2Reer6d

Visuospatial short-term memory and dorsal visual gray matter volume

Publication date: Available online 21 December 2018

Source: Cortex

Author(s): Dennis Dimond, Rebecca Perry, Giuseppe Iaria, Signe Bray

Abstract

Visual short-term memory (VSTM) is an important cognitive capacity that varies across the healthy adult population and is affected in several neurodevelopmental disorders. It has been suggested that neuroanatomy places limits on this capacity through a map architecture that creates competition for cortical space. This suggestion has been supported by the finding that primary visual (V1) gray matter volume (GMV) is positively associated with VSTM capacity. However, evidence from neurodevelopmental disorders suggests that the dorsal visual stream more broadly is vulnerable and atypical volumes of other map-containing regions may therefore play a role. For example, Turner syndrome is associated with concomitantly reduced volume of the right intraparietal sulcus (IPS) and deficits in VSTM. As posterior IPS regions (IPS0-2) contains topographic maps, together this suggests that posterior IPS volumes may also associate with VSTM. In this study, we assessed VSTM using two tasks, as well as a composite score, and used voxel-based morphometry of T1-weighted magnetic resonance images to assess GMV in V1 and right IPS0-2 in 32 healthy young adults (16 female). For comparison with previous work, we also assessed associations between VSTM and voxel-wise GMV on a whole-brain basis. We found that total brain volume (TBV) significantly correlated with VSTM, and that correlations between VSTM and regional GMV were substantially reduced in strength when controlling for TBV. In our whole-brain analysis, we found that VSTM was associated with GMV of clusters centered around the right putamen and left Rolandic operculum, though only when TBV was not controlled for. Our results suggest that VSTM ability is unlikely to be accounted for by the volume of an individual cortical region, and may instead rely on distributed structural properties.

http://bit.ly/2QP7ZDh

Atypical neural processing of rise time by adults with dyslexia

Publication date: Available online 21 December 2018

Source: Cortex

Author(s): Tilde Van Hirtum, Pol Ghesquière, Jan Wouters

Abstract

In recent studies phonological deficits in dyslexia are related to a deficit in the synchronization of neural oscillations to the dynamics of the speech envelope. The temporal features of both amplitude modulations and rise times characterize the speech envelope. Previous studies uncovered the inefficiency of the dyslexic brain to follow different amplitude modulations in speech. However, it remains to be investigated how the envelope's rise time mediates this neural processing. In this study we examined neural synchronization in students with and without dyslexia using auditory steady-state responses at theta, alpha, beta and low-gamma range oscillations (i.e. 4, 10, 20 and 40 Hz) to stimuli with different envelope rise times. Our results revealed reduced neural synchronization in the alpha, beta and low-gamma frequency ranges in dyslexia. Moreover, atypical neural synchronization was modulated by rise time for alpha and beta oscillations, showing that deficits found at 10 and 20 Hz were only evident when the envelope's rise time was significantly shortened. This impaired tracking of rise time cues may very well lead to the speech and phonological processing difficulties observed in dyslexia.

http://bit.ly/2BykDMB

Dopamine guides competition for cognitive control: Common effects of haloperidol on working memory and response conflict

Publication date: Available online 21 December 2018

Source: Cortex

Author(s): Sean James Fallon, Kinan Muhammed, Daniel S. Drew, Yuen-Siang Ang, Sanjay G. Manohar, Masud Husain

Abstract

Several lines of evidence suggest that dopamine modulates working memory (the ability to faithfully maintain and efficiently manipulate information over time) but its specific role has not been fully defined. Nor is it clear whether any effects of dopamine are specific to memory processes or whether they reflect more general cognitive mechanisms that extend beyond the working memory domain. Here, we examine the effect of haloperidol, principally a dopamine D₂ receptor antagonist, on the ability of humans to ignore distracting information or update working memory contents. We compare these effects to performance on an independent measure of cognitive control (response conflict) which has minimal memory requirements. Haloperidol did not selectively affect the ability to ignore or update, but instead reduced the overall quality of recall. In addition, it impaired the ability to overcome response conflict. The deleterious effect of haloperidol on response conflict was selectively associated with the negative effect of the drug on ignoring – but not updating – suggesting that dopamine affects protection of working memory contents and inhibition in response conflict through a common mechanism. These findings provide new insights into the role of dopamine D₂ receptors on human cognition. They suggest that D₂ receptor effects on protecting the memory contents from distraction might be related to a more general process that supports inhibitory control in contexts that do not require working memory.

http://bit.ly/2QMgVJJ

Increased Inhibition Following Negative Cues: A Possible Role for Enhanced Processing

Publication date: Available online 21 December 2018

Source: Cortex

Author(s): Hadas Okon-Singer, Avishai Henik, Shai Gabay

Abstract

Based on findings showing that attention is captured by aversive stimuli, previous studies have hypothesized that inhibition of return (IOR) is reduced at spatial locations previously occupied by threat cues. Yet evidence for this view is limited: Only a few studies have demonstrated a reduced degree of IOR following threat cues, while most have not found differences in IOR between aversive and neutral cues. In contrast to previous studies that used the spatial cuing paradigm and for the most part employed mild negative stimuli as cues, we examined the influence of highly aversive, colored and complex pictures of real life situations. As opposed to the stimuli used in previous studies, these pictures are thought to result in enhanced processing as well as in specific enhancement for threat pictures in comparison to neutral ones. Based on evidence indicating that enhanced processing of spatial cues results in increased IOR, we hypothesized that the negative picture cues employed in the present study would yield increased IOR. This hypothesis was confirmed in two experiments. We suggest that the enhancement of IOR following highly threatening cues may be related to efficient spatial orienting of attention in response to stimuli that are important from an evolutionary point of view. The results are discussed in the context of neurocognitive mechanisms that may underlie the modulation of IOR by emotional information.

http://bit.ly/2BBz0zF

Simple cell culture media expansion of primary mouse keratinocytes

Publication date: Available online 22 December 2018

Source: Journal of Dermatological Science

Author(s): Sooah Kim, Byung Woo Kim, Vicky P. Prizmic, Eugene Oh, Victoria Yu, Dongwon Kim, Luis A. Garza

http://bit.ly/2EMXnOW

Water mobility spectral imaging of the spinal cord: parametrization of model-free Laplace MRI

Publication date: Available online 22 December 2018

Source: Magnetic Resonance Imaging

Author(s): Dan Benjamini, Peter J. Basser

Abstract

Diffusion magnetic resonance imaging (dMRI) of biological systems most often results in non-monoexponential signal, due to their complexity and heterogeneity. One approach to interpreting dMRI data without imposing tissue microstructural models is to fit the signal to a multiexponential function, which is sometimes referred to as an inverse Laplace transformation, and to display the coefficients as a distribution of the diffusivities, or water mobility spectra. Until recently, this method has not been used in a voxelwise manner, mainly because of heavy data requirements. With recent advancements in processing and experimental design, voxelwise Laplace MRI approaches are becoming feasible and attractive. The rich spectral information, combined with a three-dimensional image, presents a challenge because it tremendously increases the dimensionality of the data and requires a robust method for interpretation and analysis. In this work, we suggest parameterizing the empirically measured water mobility spectra using a bimodal lognormal function. This approach allows for a compact representation of the spectrum, and it also resolves overlapping spectral peaks, which allows for a robust extraction of their signal fraction. We apply the method on a fixed spinal cord sample and use it to generate robust intensity images of slow- and fast-diffusion components. Using the parametric variables, we create novel image contrasts, among them the information entropy of the water mobility spectrum, which pack unique features of the individual diffusion regimes in the investigated system.

http://bit.ly/2LxqwxY

Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females

Summary

Objective

Research findings on the relationship between serum androgens and adipose tissue in older females are inconsistent. We aimed to clarify the relationship using state‐of‐the art techniques to evaluate associations between body fat distribution and plasma testosterone (T) levels in older postmenopausal women.

Design

Observational, cross‐sectional study of healthy, community dwelling postmenopausal women.

Patients and Measurements

Postmenopausal women, (60‐80 years old) were included in this study. Overall body composition was evaluated by dual‐energy x‐ray absorptiometry. Abdominal and thigh fat depots were measured by magnetic resonance imaging. Circulating T concentrations by liquid chromatography‐tandem mass spectrometry.

Results

Thirty‐five women (66.6 ± 0.8 years) participated in this study. T levels were positively associated with clinical proxy measure of adiposity including weight (ρ=0.39), BMI (ρ=0.43) and waist circumference (ρ=0.39) (all p<0.05). Fat mass and percent body fat were correlated with T levels (ρ=0.42 and 0.38 respectively, both p<0.05). T correlated with overall and superficial abdominal fat (ρ=0.34 and 0.37 respectively, both p<0.05) but not with visceral adipose tissue. T increased with greater thigh fat (ρ=0.49, p<0.05) in both superficial and deep depots (ρ=0.50 and 0.35 respectively, both p<0.05).

Conclusion

Our results suggest that postmenopausal women with higher circulating T levels have both higher regional and overall body adiposity. These findings underscore the sexual dimorphism in the relationship between serum androgen levels and adiposity.

This article is protected by copyright. All rights reserved.

http://bit.ly/2LtJwxD

Rates of Abnormal Aldosterone/ Renin ratio in African‐origin compared to European‐origin patients; a retrospective study

Abstract

Introduction

The aldosterone/ renin ratio is the initial screening test for primary hyperaldosteronism (PHA), but little data exists regarding ethnic variations in this.

Methods

Following clinical observation of a high prevalence of abnormal ARR in patients of African origin, we retrospectively reviewed all ARR measurements in a single centre over 10 years. Rates of hypokalaemia, intraventricular septal thickness (IVS, by echocardiography) and adrenal imaging were recorded when available.

Results

ARR was available in 1473 patients, and abnormal in 374 (25.4%). Abnormal ARR was observed in 305/ 1349 (22.6%) of European‐origin and 69/ 124 (55.6%) of African‐origin patients (p<0.001). Among those with abnormal ARR, hypokalaemia (<3.5 mmol/l) was documented on at least one occasion in 171/ 305 (56.1%) European‐origin and 43/ 69 (62.3%) African‐origin patients (p=0.35). Median (range) IVS was 1.57 (0.78 ‐ 2.80) cm in African‐origin and 1.20 (0.69 ‐ 2.18) cm in European‐origin patients (p<0.002); IVS did not correlate with aldosterone or ARR however. Adrenal adenoma was identified in 41/170 (24.1%) of European‐origin and 4/29 (13.7%) African‐origin patients (p=0.15), while hyperplasia was identified in 35/170 (20.5%) of European and 8/29 (27.5%) African patients (p=0.39).

Conclusion

In summary, ARR was abnormal in 55.6% of African‐origin patients screened at an Irish hospital. Rates of hypokalaemia were similar between European‐origin and African‐origin patients. These findings have implications for the use of current screening guidelines for ARR in African‐origin patients and also for the mechanistic role of aldosterone in hypertensive complications in African‐origin patients.

This article is protected by copyright. All rights reserved.

http://bit.ly/2rOp8OH

Aquagenic pruritus and the JAK2 V617F mutation

http://bit.ly/2Sn2vfC

Microbial keratitis: Significant increase in Gram-positive bacterial infection

Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18  
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y

Giant cell arteritis related arteritic anterior ischemic optic neuropathy

http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_1_142_248176_f1.jpg

: Clinico-pathological correlation

Mohit Dogra, Ramandeep Singh, Mangat R Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:

Dr. Mohit Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012 
India

DOI: 10.4103/ijo.IJO_881_18

A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.^[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.^[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.^[4],[5]

Figure 1: (a) showing pale disc edema (blue arrows) with an inferotemporal branch retinal artery occlusion, (b and c) showing "wedge shaped" equatorial choroidal infarcts on fluorescein angiogram, and (d) right side temporal artery biopsy at 200× magnification showing intimal proliferation with breaks in the internal elastic lamina (yellow arrows) with extravasation of red blood cells in the tunica media (black arrow) with minimal inflammatory cells, suggestive of vasculitis Click here to view

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Hayreh SS, Podhasky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.
2.	Wayand CM, Bartley GB. Giant cell arteritis: New concepts inpathogenesis and implications of management. Am J Ophthalmol1997;123:392-5.
3.	Guevara M, Kollipara CS. Recent advances ingiant cell arteritis. CurrRheumatol Rep 2018;20:25.
4.	HayrehSS. Management of ischaemic optic neuropathy. Indian J Ophthalmol 2011;59:123-36.
5.	Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D. Anterior ischemic optic neuropathydue tobiopsy-provengiant cell arteritisin Thai patients. ClinOphthalmol 2015;9:1071-5.

Ophthalmology

http://www.ijo.in/currentissue.asp?sabs=y

Indian Journal of Ophthalmology – On the right path Santosh G Honavar Indian Journal of Ophthalmology 2019 67(1):1-2

Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required? Jatinder Bali, Rohit Garg, Renu T Bali Indian Journal of Ophthalmology 2019 67(1):3-6

Hypopigmented fundus in a young male Nawazish Fatma Shaikh, Vinod Kumar Indian Journal of Ophthalmology 2019 67(1):7-7

Current concepts in crosslinking thin corneas Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev Indian Journal of Ophthalmology 2019 67(1):8-15 Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.

Management of Duane retraction syndrome: A simplified approach Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):16-22 Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well.

Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement Manca Tekavcic Pompe, Alki Liasis, Richard Hertle Indian Journal of Ophthalmology 2019 67(1):23-30 Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording.

Commentary: "Current" consensus: Electrodiagnostics in eye Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):30-31

Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu Indian Journal of Ophthalmology 2019 67(1):32-36 Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns.

Commentary: Assessment of limbal ischemia in ocular burns Naveen Radhakrishnan, N Venkatesh Prajna Indian Journal of Ophthalmology 2019 67(1):37-37

Dopamine levels in human tear fluid Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu Indian Journal of Ophthalmology 2019 67(1):38-41 Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer&#39;s strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 &#177; 11.80 pg/ml (mean &#177; SEM), 279 &#177; 14.8 pg/ml (mean &#177; SEM), and 470.4 &#177; 37.64 pg/ml (mean &#177; SEM) in the plasma and in the tears collected using Schirmer&#39;s strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels.  EDITORIAL   Indian Journal of Ophthalmology – On the right path  p. 1 Santosh G Honavar DOI:10.4103/ijo.IJO_2074_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta GUEST EDITORIAL Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required?  p. 3 Jatinder Bali, Rohit Garg, Renu T Bali DOI:10.4103/ijo.IJO_1292_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ONE MINUTE OPHTHALMOLOGY Hypopigmented fundus in a young male  p. 7 Nawazish Fatma Shaikh, Vinod Kumar DOI:10.4103/ijo.IJO_1834_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta REVIEW ARTICLES Current concepts in crosslinking thin corneas  p. 8 Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev DOI:10.4103/ijo.IJO_1403_18   Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Management of Duane retraction syndrome: A simplified approach p. 16 Nripen Gaur, Pradeep Sharma DOI:10.4103/ijo.IJO_967_18   Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CONCENSUS CRITERIA Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement p. 23 Manca Tekavcic Pompe, Alki Liasis, Richard Hertle DOI:10.4103/ijo.IJO_1103_18   Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: "Current" consensus: Electrodiagnostics in eye p. 30 Nripen Gaur, Pradeep Sharma DOI:10.4103/ijo.IJO_1590_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLE Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns  p. 32 Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu DOI:10.4103/ijo.IJO_945_18   Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Assessment of limbal ischemia in ocular burns p. 37 Naveen Radhakrishnan, N Venkatesh Prajna DOI:10.4103/ijo.IJO_1432_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Dopamine levels in human tear fluid p. 38 Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu DOI:10.4103/ijo.IJO_568_18   Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer's strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 ± 11.80 pg/ml (mean ± SEM), 279 ± 14.8 pg/ml (mean ± SEM), and 470.4 ± 37.64 pg/ml (mean ± SEM) in the plasma and in the tears collected using Schirmer's strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Pythium keratitis in South India: Incidence, clinical profile, management, and treatment recommendation p. 42 Ravula Hasika, Prajna Lalitha, Naveen Radhakrishnan, Gunasekaran Rameshkumar, N Venkatesh Prajna, Muthiah Srinivasan DOI:10.4103/ijo.IJO_445_18   Purpose: To study the demographic profile, clinical features, treatment outcome, and ocular morbidity of microbiologically proven Pythium keratitis in South India. Methods: A retrospective analysis of clinical records of microbiologically proven Pythium keratitis at a tertiary eye care referral center in South India from January 2016 to November 2017 was performed. Demographic details, predisposing risk factors, microbiological investigations, clinical course, and visual outcome were analyzed. Results: Seventy-one patients with microbiologically proven Pythium keratitis were identified. The mean age was 44(±18.2) years with an increase in male preponderance and 50% were farmers. Duration of delay at time of presentation to the hospital was a mean of 14(±7.2) days. The visual acuity at baseline ranged from 6/6 to no light perception (median 2.1 logMAR). A combination of 5% natamycin and 1% voriconazole was given to 42% patients, and natamycin alone was given to 39.4% patients. 1% itraconazole eye drops alone was initiated in 7 (10%) patients and 3 among this group responded. Therapeutic keratoplasty (TPK) was performed in 48 (67.6%) patients. None of the primary grafts remained clear after a period of 1 month. Twenty-six eyes (54.2%) had graft reinfection and all these eyes either developed anterior staphyloma (4) or were eviscerated (3) and 13 eyes became phthisical. The remaining 22 patients who had TPK resulted in failed graft. Among these, re-grafts were performed in 6 patients, of which 5 were doing well at the last follow-up. Conclusion: We report a large series of patients with Pythium keratitis. Promoting early and differential diagnosis, awareness of clinicians and specific treatment options are needed for this devastating corneal disease. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Pythium insidiosum keratitis p. 47 Prashant Garg DOI:10.4103/ijo.IJO_1491_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49 Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma DOI:10.4103/ijo.IJO_500_18   Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonasspp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The novel model: Experimental optical coherence tomography–guided anterior segment imaging chick embryo model p. 54 Resat Duman, Tolga Ertekin, Rahmi Duman, Esra Aslan, Mehmet Cem Sabaner, Ersan Çetinkaya DOI:10.4103/ijo.IJO_263_18   Purpose: The aim of this study was to present an experimental optical coherence tomography (OCT)–guided anterior segment (AS) imaging chick embryo model. Through this model, we aimed to reveal similarities and differences between human cornea, AS tissues, and chick embryo tissues by quantitative image analysis. Methods: Ex vivo, the chick embryos' globes were determined by detailed AS camera of spectral-domain (SD)-OCT in 10 fertilized specific pathogen-free eggs on the 20th day. Quantitative image analysis of anterior chamber tissues was performed with SD-OCT in detail. After imaging, cross sections of the chick embryo globes containing cornea with anterior chamber were histologically examined and compared with human tissues. The similarities of our model with data in the human cornea and AS studies in the literature were compared. Results: SD-OCT imaging was able to successfully delineate the AS tissues of chick embryos such as the cornea, iris, lens, pupil, conjunctiva, ciliary body, anterior chamber, and lens. Quantitative semi-automated measurements showed the following: mean central corneal thickness: 213.4 ± 7.05 μm (197–223 μm), mean anterior chamber depth: 878.9 ± 41.74 (804–919 μm), mean anterior chamber area: 2.43 ± 0.16 mm2 (2.17–2.73 mm2), mean corneoscleral junction (limbal) thickness: 322.8 ± 20.05 μm (289–360 μm), and mean iris thickness: 230.4 ± 13.27 μm (203–245 μm). In addition, detailed histological comparisons of the AS tissues with human tissues were evaluated to be very similar. Conclusion: In conclusion, this chick embryo model mimics human tissues and it can be considered as a platform for the study of teratogen-induced malformations and AS dysgenesis during gestation of AS tissues. In addition, this study demonstrates the feasibility of SD-OCT in the quantitative assessment of AS structures in chick embryo model. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparative analysis of retropupillary iris claw versus scleral-fixated intraocular lens in the management of post-cataract aphakia p. 59 Nivean Madhivanan, Sabyasachi Sengupta, Manavi Sindal, Pratheeba Devi Nivean, Maitri Arun Kumar, Murali Ariga DOI:10.4103/ijo.IJO_326_18   Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL) p. 64 Shweta Walia, Santosh Kashyap, V Bhaisare, P Rawat, N Kori DOI:10.4103/ijo.IJO_447_18   Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant. Results: Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis p. 69 Jitender Jinagal, Gaurav Gupta, Aniruddha Agarwal, Kanika Aggarwal, Madhuri Akella, Vishali Gupta, Deepti Suri, Anju Gupta, Surjit Singh, Jagat Ram DOI:10.4103/ijo.IJO_713_18   Purpose: To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. Methods:Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. Results: 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. Conclusion: Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Linear discriminant score for differentiating early primary open angle glaucoma from glaucoma suspects p. 75 Gunjan A Deshpande, Prashant K Bawankule, Dhananjay V Raje, Moumita Chakraborty DOI:10.4103/ijo.IJO_678_18   Purpose: To determine the diagnostic accuracy of a linear discriminant function (LDF) based on macular ganglion cell complex (GCC), optic nerve head (ONH) and retinal nerve fibre layer (RNFL) for differentiating early primary open-angle glaucoma (POAG) from glaucoma suspects. Methods: In this cross-sectional study, data from consecutive 127 glaucoma suspects and 74 early POAG eyes were analysed. Each patient underwent detailed ocular examination, standard automated perimetry, GCC and ONH and RNFL analysis. After adjusting for age, gender and signal strength using the analysis of covariance; Benjamin–Hochberg multiple testing correction was performed to detect truly significant parameters to calculate the LDF. Subsequently, diagnostic accuracy of GCC and ONH and RNFL were determined. The obtained LDF score was evaluated for diagnostic accuracy in another test set of 32 suspect and 19 glaucomatous eyes. Data were analysed with the R-3.2.1 (R Core Team 2015), analysis of variance, t-test, Chi-square test and receiver operating curve. Results: Among all GCC parameters, infero temporal had the best discriminating power and average RNFL thickness and vertical CDR among ONH and RNFL parameters. LDF scores for GCC had AUROC of 0.809 for a cut-off value 0.07, while scores for ONH and RNFL had AUROC of 0.903 for a cut-off value − 0.24. Analysis on combined parametric space resulted in avg RNFL thickness, vertical CDR, min GCC + IPL and superior GCC + IPL as key parameters. LDF scores obtained had AUROC of 0.924 for a cut-off value 0.1. The LDF was applied to a test set with an accuracy of 84.31%. Conclusion: The LDF had a better accuracy than individual GCC and ONH and RNFL parameters and can be used for diagnosis of glaucoma. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Linear discriminant score for differentiating early primary open angle glaucoma from suspects p. 81 Sushmita Kaushik DOI:10.4103/ijo.IJO_1506_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES The impact of primary open-angle glaucoma: Comparison of vision-specific (National Eye Institute Visual Function Questionnaire-25) and disease-specific (Glaucoma Quality of Life-15 and Viswanathan 10) patient-reported outcome (PRO) instruments p. 83 Suresh Kumar, Sahil Thakur, Parul Ichhpujani DOI:10.4103/ijo.IJO_798_18   Purpose: To compare a general vision-specific patient-reported outcomes (PRO) instrument, National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) with two disease-specific PRO instruments, Glaucoma Quality of Life-15 (GQL-15), and Viswanathan 10 in patients with varying severity of primary open angle glaucoma (POAG). Methods: This hospital-based, prospective study enrolled 140 glaucoma patients. The patients were classified into mild, moderate, and severe glaucoma based on visual field defects. All these patients were administered the three PRO instruments and the results were statistically analyzed. Results: All the three instruments showed high internal consistency (Cronbach's alpha for GQL-15, NEIVFQ-25, and Viswanathan 10 were 0.918, 0.937, and 0.929, respectively) There was a statistically significant difference between patients with mild, moderate, and severe POAG with all instruments (P ≤ 0.001). The instruments correlated well across several parameters especially the peripheral vision and glare/dark adaptation. The disease-specific scales however are simpler and faster to administer. Conclusion: All three instruments were reliable in assessment of mild, moderate, and severe glaucoma. They correlated strongly with each other in most of the related subscales, domains, and questions. NEIVFQ-25 additionally gave information regarding the general, psychological, and social effects of the disease. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The evaluation of intraocular pressure fluctuation in glaucoma subjects during submaximal exercise using an ocular telemetry sensor p. 89 Banu Bozkurt, Nilsel Okudan, Muaz Belviranli, Ayse Bozkurt Oflaz DOI:10.4103/ijo.IJO_585_18   Purpose: To evaluate the effect of acute submaximal exercise on intraocular pressure (IOP) fluctuations in open-angle glaucoma (OAG) subjects using an ocular telemetry sensor (OTS, Sensimed TriggerFish®). Methods: Twelve OAG subjects aged 45–65 years with no medical limitation for exercise were included in this prospective study. A submaximal exercise test was performed using a cycle ergometer for 20 min during which OTS voltages and metabolic parameters were recorded continuously. IOP voltages taken before, during, and after exercise were compared using the Friedman test and correlations with the metabolic parameters were evaluated using the Spearman analysis. Results: In two subjects, the OTS stopped functioning after a few hours. Median OTS measurements were 37.60 mVeq 10 min before exercise [interquartile range (IQR) 137.27], 51.75 (IQR 121.2), 62.35 (IQR 123.72), 54.6 (IQR 141.3), and 59.7 mVeq (IQR 196.7) during exercise (4 time points, 5 min apart), and 50.7 (IQR 147.35) and 64.2 mVeq (IQR 103.25) 10 and 30 min after exercise and the change was statistically non-significant (P = 0.66). No correlations were found between OTS and metabolic parameters measured at the same time points (P > 0.05). Nocturnal acrophase pattern was detected in five subjects (50%), diurnal acrophase in two patients, and double-hump in two patients. Median IOP voltages in the morning, afternoon/evening, and night were 335.84, 149.15, and 341.38 mVeq, respectively (P < 0.001). Conclusion: Continuous IOP monitoring did not reveal a remarkable voltage change in OAG patients during or immediately after exercise, but nocturnal IOP peaks in half of the patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Surgical outcomes of repeat trabeculectomy augmented with high dose mitomycin C p. 95 Sharmila Rajendrababu, Sujani Shroff, Sangeeta Vivek Patil, Mohammed Sithiq Uduman, Ashok Vardhan, SR Krishnadas DOI:10.4103/ijo.IJO_682_18   Purpose: To evaluate the surgical outcomes of repeat trabeculectomy augmented with risk factor adjusted mitomycin C (MMC) exposure in eyes with previous failed trabeculectomy. Methods: Case records of 38 eyes of 37 patients with previous failed filter who underwent repeat trabeculectomy with MMC were reviewed retrospectively. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP) reduction, requirement of anti-glaucoma medications, postoperative complications, and surgical success (defined as IOP of ≤21 mmHg and >5 mmHg along with 20% reduction from preoperative IOP with or without adjuvant medications) at 1-year postoperatively. Statistical analysis was done using the STATA 14.1 (Texas, USA). Results: Patient's mean age was 46.41 (±20.43) years and the mean preoperative IOP was 32.73 (±9.26) mmHg which reduced to 16.22 (±7.08) mmHg postoperatively at 12 months (P < 0.001). Mean number of anti-glaucoma medications reduced from 2.76 (±0.83) preoperatively to 1.89 (±0.95) postoperatively (P < 0.001). Surgical success was observed in 81.1% at 1 year (n = 30). Eyes that received MMC >3 min had a postoperative mean IOP of 12.50 (±3.23) mmHg compared to 23.08 (±7.19) mmHg with MMC <3 min (P < 0.001). Seven eyes (18.4%) developed postoperative complications, and all were seen in eyes that received MMC >3 min (P = 0.033). Conclusion: Repeat trabeculectomy with MMC, used in higher concentration and exposure time altered according to individual risk factor plays a crucial role in the success and hence it could be considered as a viable option before planning a tube surgery. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Visual rehabilitation of patients with low vision in uveitis p. 101 Sarika Gopalakrishnan, Sridharan Sudharshan, Rajiv Raman, Velu Saranya, Parthopratim Dutta Majumder, Jyotirmay Biswas DOI:10.4103/ijo.IJO_875_18   Purpose: To elucidate the clinical profile of visual impairment (VI) and rehabilitation of the uveitic patients with irreversible low vision. Methods: Retrospective analysis of visual rehabilitation of patients with uveitis suffering from poor vision with low vision devices (LVD). Results: Most common cause of uveitis was choroiditis (46.29%), followed by retinitis (25.92%), retinochoroiditis (18.51%), and chronic panuveitis sequelae (9.25%). Of these 54 cases, 35.18% had moderate VI, 25.92% had severe VI, 20.37% had mild VI, and 18.51% had profound VI or blindness. Statistically significant improvement (P < 0.05) in near vision was seen in choroiditis (52%) and retinitis (72%), whereas clinically significant improvement in distance vision was found in patients with choroiditis. Most commonly prescribed LVD was half-eye prismatic spectacle magnifier (22.2%). Conclusion: Rehabilitation of the uveitic patients with low vision is challenging. LVD may be a beneficial tool in these patients to help them perform their day-to-day activities independently. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to anti-vascular endothelial growth factor of abnormal retinal vascular net in para foveal telangiectasia group II images on optical coherence tomography-angiography p. 105 Ketan Saoji, Avinash Pathengay, Jay Chhablani, Bhavik Panchal, Shreyansh Doshi, Merlin Saldanha DOI:10.4103/ijo.IJO_374_18   Purpose: To identify optical coherence tomography-angiography (OCT-A) findings to predict treatment response during anti-vascular endothelial growth factor (VEGF) therapy in eyes with para foveal telangiectasia (PFT) group II. Methods: In this retrospective series, Twelve eyes of seven patients diagnosed with PFT group II without evidence of sub-retinal neovascular membrane (SRNVM) clinically or on spectral domain-OCT (SD-OCT) were included. All patients underwent OCT-A on the Topcon DRI OCT Triton® with 4.5 mm macula scans. The patients with abnormal vascular nets were further classified into type A and B nets and administered intravitreal anti-VEGF therapy. Visual acuity and size of type A and B nets were evaluated pre- and post-injection. Paired t- test and intraclass correlation were used to analyse data. Results: Patients with type A net showed significant improvement in visual acuity (logMAR 0.38, P = 0.0047). The size of type A net showed statistically significant decrease (P = 0.0008) on 6 month follow up. Type B net did not show statistically significant difference in visual acuity or size following anti-VEGF therapy. Conclusion: OCT-A plays an important role in early detection of possible neovascular nets (type A), in the absence of obvious SRNVM. Treatment decisions based on OCT-A may be helpful to achieve better visual outcome. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical and electrophysiological results of eye muscle surgery in 17 patients with downbeat nystagmus p. 109 Richard W Hertle, Ashraf Ahmad DOI:10.4103/ijo.IJO_703_18   Purpose: To test the hypothesis that eye muscle surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function. Methods: This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye muscle surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software. Results: Patients' age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1–10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV. Conclusion: This study supports the hypothesis that eye muscle surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PHOTO ESSAY Simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts p. 116 Rama Rajagopal, Pratik V Kataria, Sudharshan Sridharan, Krishna Kumar, Kuzhanthai Lily Therese, Poongulali Selvamuthu DOI:10.4103/ijo.IJO_902_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Atypical presentation of macular corneal dystrophy managed by Descemet stripping endothelial keratoplasty p. 118 Sunita Chaurasia, Dilip K Mishra DOI:10.4103/ijo.IJO_602_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Peripheral ulcerative keratitis: An extremely rare case presentation after Paederus (beetle) injury p. 120 Nitin N Tiwari, Shreesha K Kodavoor, Dandapani Ramamurthy, Shreyas Ramamurthy, Jayamani Ravi, Mohamed Faizal DOI:10.4103/ijo.IJO_605_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ultrasound biomicroscopic appearance of accessory iris membrane p. 122 Natasha Gautam Seth, Himanshu Kashyap, Ajay Jurangal, Surinder Singh Pandav DOI:10.4103/ijo.IJO_927_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Posterior lenticonus masquerading as posterior capsular rupture following blunt trauma p. 123 Pooja Jain, Jawahar Lal Goyal DOI:10.4103/ijo.IJO_879_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Double rosette cataract: A striking image! p. 124 Aditya Sethi, Srikanth Ramasubramanian DOI:10.4103/ijo.IJO_941_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Transcorneal tube extrusion: Anterior segment optical coherence tomography–aided management p. 126 Shikha Gupta, Gunjan Saluja, Abadh Kishore Chaurasia, Aswini Kumar Behera, Viney Gupta DOI:10.4103/ijo.IJO_416_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Multimodal imaging characteristics of refractile drusen p. 128 Samarth Mishra, Sugandha Goel, Subham Sinha Roy, Barun Garg, Marina Parvin, Kumar Saurabh, Rupak Roy DOI:10.4103/ijo.IJO_867_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A case report of anterior visual pathway aplasia p. 129 Jakkidi Prathibha Reddy, Prabhu M Shanker, Geetha Ganesan, Rajesh Prabu DOI:10.4103/ijo.IJO_256_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Eccrine intraepidermal poroma of the eyelid p. 131 Sukriti Ahuja, Apjit Kaur, Madhumati Goel, Shivanjali Raghuvanshi, Ajay Arya DOI:10.4103/ijo.IJO_547_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta OPHTHALMIC IMAGES Bilateral acute depigmentation of iris p. 133 Sonam Yangzes, Simar Rajan Singh, Jagat Ram DOI:10.4103/ijo.IJO_847_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARIES Commentary: Bilateral acute depigmentation of iris p. 134 S Bala Murugan DOI:10.4103/ijo.IJO_1512_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta OPHTHALMIC IMAGES When color matters: Waardenburg syndrome p. 135 Tarjani V Dave, Rajeev R Pappuru, Vivek P Dave DOI:10.4103/ijo.IJO_889_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Subluxated spherophakic lens: Zonules still not relinquished p. 136 Vanita Pathak-Ray DOI:10.4103/ijo.IJO_1154_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta "Triangle sign" in Morgagnian cataract p. 137 Saurabh Deshmukh, Harsha Bhattacharjee, Krati Gupta DOI:10.4103/ijo.IJO_940_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Sunflower cataract in chalcosis bulbi p. 137 Richa Agarwal, Yashpal Goel, Kamlesh Anand DOI:10.4103/ijo.IJO_1035_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Optical coherence tomography of intraocular lens glistening p. 138 Koushik Tripathy, Uma Sridhar DOI:10.4103/ijo.IJO_1031_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An eye within an eye p. 139 Kowsigan Magesan, Parthopratim Dutta Majumder, Vikas Khetan DOI:10.4103/ijo.IJO_1135_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Free floating pigmented vitreous cyst p. 140 Vinod Kumar, Shreyans Jain, Amber Amar Bhayana, B Shilky Singh DOI:10.4103/ijo.IJO_855_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Choroidal vasculature without angiography p. 141 Raja Narayanan, Kyoko Ohno-Matsui DOI:10.4103/ijo.IJO_780_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Giant cell arteritis related arteritic anterior ischemic optic neuropathy: Clinico-pathological correlation p. 142 Mohit Dogra, Ramandeep Singh, Mangat R Dogra DOI:10.4103/ijo.IJO_881_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Ligneous conjunctivitis in a Dandy–Walker syndrome: A rare case report p. 143 Arjun Srirampur, Muralidhar Ramappa, Sunita Chaurasia, Geeta Vemuganti DOI:10.4103/ijo.IJO_772_18   Ligneous conjunctivitis (LC) is a rare form of pseudomembranous conjunctivitis seen in children, perhaps due to plasminogen deficiency, which manifest as a chronic refractory pseudomembranous conjunctivitis. LC cases are incapable in maintaining their fibrinolytic activity due to plasminogen deficiency; consequently, transudates of plasma assume as a thick, gelatinous, woody membranes over the mucosal surfaces. This is a short case report on a child with a LC, who presented with recurrent pseudomembranous conjunctivitis in conjunction with progressive congenital hydrocephalus due to aqueductal stenosis (Dandy–Walker syndrome). This rare association was clinically confirmed and prompt corrective surgical measures were instituted. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Treatment of corneal neovascularization with topical aflibercept in a case of exposure keratopathy following cerebellar astrocytoma surgery p. 145 Sibel Aksoy DOI:10.4103/ijo.IJO_418_18   In this report, we report the case of a 7-year-old boy with corneal neovascularization due to exposure keratopathy following cerebellar astrocytoma surgery. Corneal surface healing was achieved with topical treatment and therapeutic contact lens, after which topical steroid was administered for stromal haze and corneal neovascularization. After 2 months of steroid therapy failed, corneal neovascularization responded well to topical aflibercept administration, showing complete regression. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Shewanella algae keratitis p. 148 Chelsey A Bravenec, Rahul T Pandit, Hilary A Beaver DOI:10.4103/ijo.IJO_617_18   A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial keratoplasty followed by penetrating keratoplasty (PKP) presented with a 2.7 × 4.2 mm corneal ulcer, culture positive for Shewanella algae and Klebsiella oxytoca. A topical antibiotic regimen of gentamicin 14 mg/mL and vancomycin 50 mg/mL was administered according to culture sensitivities. There was concurrent use of loteprednol 0.5% (Lotemax Gel, Bausch and Lomb, Rochester, NY, USA) and later addition of erythromycin 0.5% ointment. The corneal ulcer improved with antibiotic therapy but was complicated by poor patient follow-up. Descemetocele formation prompted PKP in the right eye. The graft was successful and visual acuity improved from a low of light perception to maximum of 20/200 Snellen. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Emerging corneal pathogens: First report of Pseudopestalotiopsis theae keratitis p. 150 Sayali Sane, Savitri Sharma, Ranjith Konduri, Merle Fernandes DOI:10.4103/ijo.IJO_791_18   A 55-year-old lady developed a corneal ring infiltrate following trauma with a wooden stick. 10% KOH mount of corneal scrapings revealed septate hyaline fungal filaments. White feathery colonies with shiny black dots grew on potato dextrose agar. Characteristic features of Pestalotiopsis spores were seen on Lactophenol cotton blue mount. DNA sequencing showed 99% similarity with Pseudopestalotiopsis theae. Complete resolution was noted with topical and oral antifungals. To the best of our knowledge, this is the first report of Pseudopestalotiopsis keratitis following trauma with vegetative matter highlighting the role of DNA sequencing in identification of rare fungi. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta In vivo confocal microscopy and anterior segment optical coherence tomography follow-up of cysteamine treatment in corneal cystinosis p. 153 Huseyin Baran Ozdemir, Mehmet Cüneyt Özmen, Zeynep Aktas, Murat Hasanreisoglu DOI:10.4103/ijo.IJO_736_18   A 36-year-old female presented initially with photophobia and visual deterioration. After examination and laboratory tests, patient was diagnosed with cystinosis. Cysteamine drops 4 × 1 drops/day was given as treatment for 1 year. During follow-up, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) was performed. Photophobia was relieved and IVCM obtained the decrease in size and density of corneal crystals 1 year after. Depth of corneal crystals did not change but crystal density score reduced with cysteamine treatment. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Femtosecond laser-assisted successful management of subluxated cataractous lens with vitreous in anterior chamber p. 155 Jeewan S Titiyal, Manpreet Kaur, Anubha Rathi, Ruchita Falera DOI:10.4103/ijo.IJO_764_18   Femtosecond laser-assisted cataract surgery was performed in a case of posttraumatic cataract with six clock hours subluxation and vitreous in the anterior chamber (AC). Femtosecond laser pretreatment allowed a closed-chamber creation of corneal incisions, capsulotomy, and lens fragmentation with minimal sudden lens-diaphragm movements and zonular stress. Integrated imaging systems allowed customization of the size and position of capsulotomy and nuclear fragmentation, based on the extent and site of subluxation. Presence of vitreous in AC did not hamper femtosecond laser application. Triamcinolone-assisted vitrectomy was performed before phacoemulsification and after implanting the intraocular lens (IOL). Postoperative uncorrected visual acuity was 20/20 with a stable IOL. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Angiostrongylus cantonensis in anterior chamber p. 158 Uma Sharan Tiwari, Ankita Aishwarya, Shashi Gandhi, Priya Sisodia DOI:10.4103/ijo.IJO_843_18   Live worm in anterior chamber is a rare finding. We hereby report a case of ocular Angiostrongylus cantonensis, which, to the best of our knowledge, is the third case report from India. A 70-year-old female presented with the complaints of watering and foreign body sensations in right eye since 2 months. On examination, a translucent worm of approximately 15 mm length was found freely moving in anterior chamber. Patient underwent surgical removal of live worm, which was identified as A. cantonensis. Educating people regarding importance of hygiene is important for prevention of worm infestation. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Angiostrongylus cantonensis in anterior chamber p. 161 S Bala Murugan DOI:10.4103/ijo.IJO_1511_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Acute hypertensive uveitis as the first presentation of multiple sclerosis p. 163 Melissa Kate Shields, Sumu Simon, WengOnn Chan, Jagjit S Gilhotra DOI:10.4103/ijo.IJO_345_18   Ophthalmic manifestations of multiple sclerosis are frequent including acute optic neuritis, ocular motor disturbances and intermediate uveitis. We report an unusual case of multiple sclerosis presenting as acute hypertensive uveitis. A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. Intraocular pressure was 55mmHg and 14 mmHg on the right and left respectively. He had a right relative pupillary defect and a left internuclear ophthalmoplegia. Vitreous cells were present in the right eye and there was peripheral sclerosis and periphlebitis superior temporally. MRI Brain and Spine revealed multiple T2 hyperintense lesions consistent with multiple sclerosis. Multiple sclerosis may present initially with an acute elevation of intraocular pressure and intermediate uveitis. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Familial Blau syndrome:First molecularly confirmed report from India p. 165 Mahesh Janarthanan, Chanchal Poddar, S Sudharshan, Luis Seabra, Yanick J Crow DOI:10.4103/ijo.IJO_671_18   Blau syndrome (BS) is a rare autoinflammatory disorder characterized by the clinical triad of arthritis, uveitis, and dermatitis due to heterozygous gain-of-function mutations in the NOD2 gene. BS can mimic juvenile idiopathic arthritis (JIA)-associated uveitis, rheumatoid arthritis, and ocular tuberculosis. We report a family comprising a mother and her two children, all presenting with uveitis and arthritis. A NOD2 mutation was confirmed in all the three patients – the first such molecularly proven case report of familial BS from India. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An unusual case of multifocal central serous chorioretinopathy with low serum cortisol managed using eplerenone p. 167 Kanika Aggarwal, Aniruddha Agarwal, Vishali Gupta DOI:10.4103/ijo.IJO_651_18   In this report, we describe a rare case of a 44-year-old Asian male with acute central serous chorioretinopathy (CSC) with bullous exudative retinal detachment. Endocrinology evaluation revealed hypothalamic–pituitary–adrenal axis suppression with low serum cortisol. Furthermore, neuroimaging revealed the presence of a pituitary microadenoma. He was treated with systemic eplerenone and hydrocortisone. After 12 weeks, bullous detachment completely resolved. Our case is a unique description of acute CSC with underlying low serum cortisol levels that responded to treatment with mineralocorticoid antagonist. This case highlights the various endocrine abnormalities other than the raised serum cortisol that can occur in patients with CSC. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTERS TO THE EDITOR Commentary: Double-layer sign" on spectral domain optical coherence tomography in pachychoroid spectrum disease p. 171 Jay Chhablani, Spoorti K R Mandadi DOI:10.4103/ijo.IJO_1456_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary: Multiple small branch retinal arteriolar occlusions following coil embolization of internal carotid artery aneurysm p. 172 Swarna Biseria Gupta DOI:10.4103/ijo.IJO_683_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Comparative analysis of non-absorbable 10-0 nylon sutures with absorbable 10-0 vicryl sutures in pediatric cataract surgery p. 173 Amit Mohan, Pradhnya Sen, Elesh Jain DOI:10.4103/ijo.IJO_877_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries p. 174 Arjun Srirampur, Anupama Kalwad, Pasyanthi Balijepalli, Kavya Reddy Katta DOI:10.4103/ijo.IJO_723_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries p. 175 Thomas Kuriakose, Smitha Jasper, Sherina Thomas DOI:10.4103/ijo.IJO_1769_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema p. 176 Sohan Singh Hayreh DOI:10.4103/ijo.IJO_1308_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema p. 177 Uppal Gandhi, Jay Chhablani, Preeti P Chhablani DOI:10.4103/ijo.IJO_1771_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 178 Ramanuj Samanta DOI:10.4103/ijo.IJO_1642_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy p. 179 Srikant Padhi, Vinod Kumar DOI:10.4103/ijo.IJO_1739_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 180 Koushik Tripathy, Arpan Chaudhuri DOI:10.4103/ijo.IJO_1654_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 181 Srikant Padhi, Vinod Kumar DOI:10.4103/ijo.IJO_1740_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting p. 181 Devesh Kumawat, Pranita Sahay, Dheepak Sundar, Rohan Chawla DOI:10.4103/ijo.IJO_1384_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting p. 182 Gloria P Trujillo-Sanchez, Alejandro Gonzalez-De la Rosa, Jose Navarro-Partida, Luis Haro-Morlett, Juan C Altamirano-Vallejo, Arturo Santos DOI:10.4103/ijo.IJO_1516_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Association of obesity and age-related macular degeneration in Indian population p. 183 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