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   Table of Contents - Current issue
Coverpage
January-April 2014
Volume 7 | Issue 1
Page Nos. 1-50

Online since Saturday, March 01, 2014

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EDITORIAL COMMENTARY  

Problem-based learning in ophthalmology: A brief review p. 1
Fahad al Wadani, Ataur Rahman Khan
DOI:10.4103/0974-620X.127908  
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ORIGINAL ARTICLES Top

Optical coherence tomographic assessment of retinal nerve fiber layer thickness changes before and after glaucoma filtration surgery p. 3
Kumaresh Chandra Sarkar, Palash Das, Ranabir Pal, Chattaranjan Shaw
DOI:10.4103/0974-620X.127910  
Background: Glaucomatous Optic Neuropathy (GON) is very common in the glaucoma patients, and impaired effect of glaucoma is measured by the Retinal Nerve Fiber Layer (RNFL) thickness. Objective: The study was conducted to find out the mean RNFL thickness, RNFL thickness in different quadrants, Intra-Ocular Pressure (IOP) changes, and visual field changes after filtration surgery in different ages and genders using Optical Coherence Tomography (OCT). Materials and Methods: The study was an interventional case-series conducted at the Glaucoma Clinic at the Regional Institute of Ophthalmology at Kolkata from March 2009 to August 2010. Fifty-one eyes of 43 open angle glaucoma patients had been selected for clinical and ophthalmologic evaluation. All the eyes of glaucoma patients who fulfilled the inclusion criteria were registered in the study population. The glaucoma filtration surgery was done in these patients. The RNFL thickness, IOP, visual field changes were measured before and after intervention of filtration surgery. Pre-operative OCT images of RNFL were obtained 0 to 120 days before surgery, and post-operative images were obtained from 60 to 120 days after surgery. Data collected in a standard data collection form included schedule. Results: Paired t-test was used. RNFL thickness was (pre-operative: 52.56 ± 17.40, post-operative: 58.48 ± 20.20, P < 0.0001) significantly increased after filtration surgery measured by OCT with significant reduction of IOP (r = - 0.38, P = 0.005) irrespective of age and gender. Conclusions: An increase in RNFL thickness was observed after glaucoma filtration surgery that correlated with IOP reduction.
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Comparison of relation between visual function index and retinal nerve fiber layer structure by optical coherence tomography among primary open angle glaucoma and primary angle closure glaucoma eyes p. 9
Aparna Rao
DOI:10.4103/0974-620X.127911  
Purpose: To compare the visual field index (VFI) in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) eyes, and to study the correlation with disc variables on optical coherence tomography (OCT) in all stages of severity. Materials and Methods: Thirty POAG and PACG underwent Humphrey visual field 24-2 along with detailed examination. They also underwent stratus OCT imaging of the optic nerve and retinal nerve fiber layer (RNFL). The correlation of VFI with RNFL thickness was compared in POAG and PACG. Results: The VFI significantly differed between POAG and PACG, with POAG eyes apparently having a better VFI at all severities of glaucoma. There were statistically significant differences in the superior max (Smax) and inferior max (Imax) in early and moderate POAG and PACG eyes. In early and moderate glaucoma, multivariate regression showed that maximum correlation of the VFI was seen with the mean deviation (b = 1.7, P < 0.001), average and superior RNFL thickness (b = 2.1, P < 0.001 and b = 1.8, P = 0.03, respectively), and age (b = 0.7, P = 0.04); while no correlation was seen with intraocular pressure (IOP), axial length, sex, or other clinical variables. VFI did not correlate well with RNFL thickness or other disc variables on OCT in severe glaucoma. Conclusion: VFI may not serve as a useful indicator of visual function in severe glaucoma. More useful indicators are required to monitor glaucoma patients with severe damage.
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CASE REPORTS Top

Huge congenital teratoma containing tooth in a three-day-old neonate p. 13
Krishna Pada Baidya, Sambuddha Ghosh, Abhijit Datta, Subhalakshmi Mukhopadhyay, Goutam Bhaduri
DOI:10.4103/0974-620X.127912  
Congenital teratoma is a rare cause of congenital proptosis. A full term three-day-old male child was presented with massive unilateral swelling in the left orbit, which was noted since birth. Diagnosis of orbital teratoma without intracranial extension was made based on clinical examination and imaging. Lid-sparing exenteration of the left orbit was done. Histopathological examination confirmed the diagnosis of cystic teratoma. Congenital orbital teratoma with a tooth and mature elements of all the three germ cell layers is reported due to its extreme rarity.
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Primary conjunctival amyloidosis p. 16
Chandana Chakraborti, Krittika P Chaudhury, Ranu Roy Biswas
DOI:10.4103/0974-620X.127914  
A 19-year-old previously healthy male presented with a 4 year history of painless drooping of right upper eyelid.On eversion of the right upper eyelid, a yellowish pink mass was seen in the tarsal region. Rest of the ocular examination was normal in both the eyes. Initial biopsy showed chronic inflammation. Subsequently, the entire mass was excised and histopathological examination showed the presence of amyloid in the subconjunctival stroma. At 3 months follow-up, similar lesion was detected in the right lower, left upper, and lower lid, which were treated with cryotherapy, with partial resolution. Patient has been followed up for more than 2 years without any complaints. To our knowledge, this is the first case report of an isolated primary conjunctival amyloidosis with involvement of both the upper and lower palpebral conjunctiva of either eye. It was treated successfully by excision and cryotherapy.
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Choroidal metastasis from leiomyosarcoma in two cases p. 19
Eric Feinstein, Swathi Kaliki, Carol L Shields, Hormoz Ehya, Jerry A Shields
DOI:10.4103/0974-620X.127917  
Leiomyosarcoma is a malignant tumor of mesenchymal cells and is the most common soft-tissue sarcoma. Leiomyosarcoma is a notably rare tumor in the ophthalmic region and can be of primary, secondary or metastatic origin. To the best of our knowledge, there has only been one published case of leiomyosarcoma metastasis to the choroid. In this case study, we report two cases of primary leiomyosarcoma with metastasis to the choroid of the eye. Both cases displayed systemic metastasis and showed response to high dose plaque radiotherapy. Despite its prevalence as the leading form of sarcoma, leiomyosarcoma rarely metastasizes to the ocular region.
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Intra-bleb hematoma and hyphema following digital ocular compression p. 22
Sagar Bhargava, Nikhil S Choudhari, Lingam Vijaya
DOI:10.4103/0974-620X.127918  
We report successful outcome of a huge post- trabeculectomy intra-bleb hematoma and hyphema that occurred following digital ocular compression. The patient was a 64-year-old lady suffering from bilateral primary angle closure glaucoma and cataract. She was on anti-platelet therapy. She underwent single-site phacoemulsification, intra-ocular lens implantation and trabeculectomy with mitomycin C in the right eye. The trabeculectomy was under-filtering. She was asked to perform digital ocular compression thrice daily. On 15 th post-operative day, she presented with a huge intra-bleb hematoma and hyphema. The hematoma did not respond to conservative measures and was drained to prevent bleb failure. We recommend caution in the consideration of digital ocular compression in patients on prophylactic anti-coagulation.
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Late post-traumatic flap dislocation and macrostriae after laser in situ keratomileusis p. 25
Rajesh Sinha, Himanshu Shekhar, Sana Tinwala, Anita Gangar, Jeewan S Titiyal
DOI:10.4103/0974-620X.127919  
We report an unusual flap-related complication that occurred 4 years after uneventful laser in situ keratomileusis (LASIK) performed in the eye of a 20-year-old woman. She developed dislocation with partial infolding of the LASIK flap with macrostriae and epithelial ingrowth in her left eye after trauma by a wooden chip. The flap was refloated, stretched, smoothened, and hydrated on both under and outer surfaces after epithelial debridement. At 1 week, the uncorrected visual acuity was 20/20 with absence of flap striae. The present case highlights that flap adhesions are not very strong even months and years after LASIK. Flap refloatation and stretching with hydration on both sides of the flap are effective in removing flap striae.
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Manual intrastromal corneal keratotomy: An alternate encouraging approach for refractive error correction Highly accessed article p. 28
Saravana Kodandapani, Sukanya Saravana
DOI:10.4103/0974-620X.127921  
Results of femtosecond based intrastromal astigmatic keratotomy have been reported to be encouraging for correction of Astigmatism. We report a new surgical technique-manual intrastromal corneal keratotomy (MICK) for correction of simple refractive astigmatism (−1.5 DC against the rule). The technique involves the creation of a 100 μm thickness corneal flap creation using Moria M2 evolution LSK MicroKeratome and 300 μm depth, 4 mm long manual transverse astigmatic keratotomy on both sides of the steep axis 3 mm from the pupillary center along with four incision peripheral radial keratotomy outside the optic zone (based on the mesopic pupil). The flap was repositioned and routine post-operative regimen was followed. Patient achieved 20/20 vision in both eyes post-operatively on the first day, which was maintained even at the 1 month follow-up. This simple technique could be useful as an alternative method for correction of refractive errors in patients not suitable for excimer and/or femtosecond laser treatment.
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CLINICAL IMAGES Top

Bilateral papilledema: A case of cerebral venous sinus thrombosis p. 33
Suchi Shah, Devendra Saxena
DOI:10.4103/0974-620X.127924  
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Acute myeloid leukemia presenting as bilateral proptosis and right temporal swelling p. 35
Sajid Ansari, Raj Kumar Rauniyar, Kanchan Dhungel, Panna Lal Sah, Kaleem Ahmad, Mukesh Kumar Gupta, Meenu Agrawal
DOI:10.4103/0974-620X.127927  
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Complications of retained intraorbital wooden foreign body p. 38
Bijnya B Panda, Usha R Kim
DOI:10.4103/0974-620X.127929  
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Intraocular glass foreign body-Retained amiss! p. 40
Lakshmi Kuniyal, Ekta Rishi, Pukhraj Rishi
DOI:10.4103/0974-620X.127931  
Open globe injuries with intraocular foreign bodies are important cause of visual morbidity. Timely detection of foreign body is must to improve the visual outcome and to prevent eye from developing complications. It is important to understand the need of meticulous history taking and thorough examination besides other investigations to detect foreign body. Glass foreign bodies are little difficult to visualize because of its transparent nature. The best time to detect foreign body is at the time of primary repair. Until one suspects the presence of foreign body, it is missed most of the time. We chose to report this case as it is unusual to miss big IOFB in anterior chamber impacted in lens matter at the time of primary corneal repair. It is important to remember that an ounce of vigilant vision is worth a pound of care.
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Cranio-orbital-temporal neurofibromatosis: An uncommon subtype of neurofibromatosis type-1 p. 43
Nibedita Acharya, Manjoo S Reddy, Caroline T Paulson, Deepti Prasanna
DOI:10.4103/0974-620X.127934  
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A rare presentation of bilateral Sturge-Weber syndrome p. 46
Nitin Nema, Jagriti Jain, Vinod Porwal
DOI:10.4103/0974-620X.127937  
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CLINICAL QUIZ Top

3 year old boy with squint and blurred vision in Left Eye p. 49
Mary K Jacob, Haidar F Tamimi
DOI:10.4103/0974-620X.127939  
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LETTER TO THE EDITOR Top

Tobacco-alcohol optic neuropathy. Is complete recovery possible? p. 50
Sobha Joseph, Sahar Al-Ali, Ajay Tripathi
DOI:10.4103/0974-620X.127948  
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