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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 13 | Issue 2
Page Nos. 55-108

Online since Thursday, May 28, 2020

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EDITORIAL  

Staring down the barrel of COVID-19 Highly accessed article p. 55
Milind Prasannakumar Suryawanshi, Rashid Al Saidi
DOI:10.4103/ojo.OJO_87_2020  
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ORIGINAL ARTICLES Top

Scoop and chop - A modified phaco-chop technique for pseudoexfoliation and cataract Highly accessed article p. 57
Aparna Rao, Priti Sahay, Gopinath Das, Sarada Sarangi, Debananda Padhy
DOI:10.4103/ojo.OJO_114_2017  
PURPOSE: The purpose is to evaluate the results of the modified direct phaco-chop technique of cataract surgery in eyes with pseudoexfoliation. METHODS: All patients with pseudoexfoliation and visually significant cataract with normal intraocular pressure (IOP) and optic nerve that underwent cataract surgery by the same surgeon using Infiniti®, OZil® Torsional handpiece (Alcon Labs), were included for this retrospective hospital-based study. Direct vertical or horizontal chop technique was used in all cases with parameters set as required for quadrant removal with high vacuum after the initial cleanup of cortex under the capsulorhexis. To allow better visualization of the hardness of the nucleus core, the sides of the lens were scooped out a central well with vacuum with maximum chopping done centrally within the rhexis as the first step to enable better assessment of the depth of burying the chopper for direct chop. Intraoperative details recorded and analyzed included ultrasound time and cumulative dissipated energy. The mean visual acuity and IOP before and after surgery were recorded at 1 day, 1 week, and 1 month. Complications during or after surgery were noted. RESULTS: A total of 138 patients with a mean age of 62 ± 6.7 years underwent phachop technique of phacoemulsification for nuclear cataract grades of nuclear sclerosis 2–4 with significant improvement in visual acuity from baseline (0.26) to 3 months (0.82), P < 0.001. The mean ultrasound torsional amplitude and cumulative dissipated energy (CDE) were greater for brown cataract of grading >3, P = 0.02. A total of 8 patients had intraoperative zonular dialysis in 1 quadrant (none in >1 quadrant), which was not associated with intraoperative vitreous prolapse in 6 eyes. CONCLUSIONS: Direct modified phaco-chop technique may be a safe technique in pseudoexfoliation due to minimal zonular stress with successful outcomes and reduced complications.
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Visual and subjective outcomes following trifocal intraocular lens implantation in Iranian cataractous patients p. 63
Farhad Nejat, Shiva Pirhadi, Hossein Aghamollaei, Mostafa Naderi, Mohamadmahdi Najafi Ghodsi, Reza Gharebaghi, Khosrow Jadidi
DOI:10.4103/ojo.OJO_107_2019  
BACKGROUND: The aim of this study was to evaluate visual and refractive outcomes and quality of vision after implantation of the AT LISA tri 839MP intraocular lens (IOL). PATIENTS AND METHODS: This interventional clinical trial comprised 46 cataractous eyes of patients who underwent phacoemulsification with IOL implantation (mean age of 58.08 ± 11.01 years; range: 36–76 years old). Spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA) were measured 1, 3, and 6 months after surgery. Contrast sensitivity (CS) was measured at 6 months. Subjective quality of vision and presence of dysphotopsia by a short questionnaire were evaluated postoperatively. RESULTS: At 6 months, the mean visual acuity was 0.08 ± 0.11, 0.03 ± 0.08, 0.07 ± 0.09, 0.02 ± 0.08, 0.05 ± 0.09, and 0.02 ± 0.08 LogMAR for UDVA, CDVA, UIVA, CIVA, UNVA, and CNVA, respectively. The mean values of SE were − 0.4728 ± 0.32D. These variables improved over time, yet significant changes were detected in UDVA (P = 0.009) and SE (P = 0.0001). The mean CS value was 1.74 ± 0.08. The mean scores (0% = no symptoms; 100% = strong symptoms/unable to perform activities) for glare and halos were 7.07 ± 0.22% and 8.70 ± 0.23%, respectively. These items were reduced over time. Patients' level of satisfaction mean score for performing activities was 96.66%. CONCLUSIONS: The AT LISA tri 839MP IOL provides excellent uncorrected distance, intermediate and near vision, and CS. This IOL showed a minimal level of photic phenomena and a high level of patient satisfaction.
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Rare stromal corneal dystrophic diseases in Oman: A clinical and histopathological analysis for accurate diagnosis p. 70
Ahmed Mohamed Reda, Somaia Ahmed Saad El-Din
DOI:10.4103/ojo.OJO_283_2019  
INTRODUCTION: Corneal dystrophy (CD) encirclements a heterogeneous group of genetically determined corneal diseases. Many features still remain unknown. AIM: The purpose of this study was to highlight the clinical and the histopathological aspects of rare stromal CDs and to assess the clinical and the histopathological roles in their diagnosis. PATIENTS AND METHODS: This study incorporated 10 eyes of six patients, clinically diagnosed as follows: four patients with bilateral lattice stromal CD (8 eyes) and two patients, each one eye, one with macular and the other with granular-type CD. Histopathological examination with applications of many special stains was done in four eyes (4 patients) after penetrating keratoplasty. RESULTS: The histopathological examination was in concordance with the clinical diagnosis of three examined corneas and revealed first eye with lattice dystrophy, second eye with macular dystrophy, and third eye with granular dystrophy. The fourth examined cornea was not that in concordance with the clinical diagnosis of lattice CD as it showed mixed stromal CD patterns of granular, macular, and lattice types. CONCLUSION: Histopathological assessment of corneal dystrophy cases, subjected to keratoplasty is recommended to avoid missing cases with mixed stromal corneal dystrophy. Also, using low magnification slit lamp alone in the clinical assessment of the corneal opacity appeared to be limited mode and thus, the imaging corneal methods such confocal microscopy and high-definition optical coherence tomography are recommended for future cases especially in cases with unclassic query diagnosis.
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Diabetic retinopathy among Omanis: Prevalence and clinical profile p. 76
Puspalata Agroiya, Abdul Hakeem Alrawahi, Fathimabeebi Pambinezhuth, Noor Bader Al Busaidi
DOI:10.4103/ojo.OJO_225_2019  
PURPOSE: The aim of this study is to describe the prevalence, severity and clinical profile of diabetic retinopathy (DR) among Omani diabetic patients attending a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective study involving the record review of diabetic patients attending the diabetes retina clinic of the National Diabetes and Endocrine Centre in the period between June 2015 and May 2016. Retinal evaluation of 442 native patients was conducted using direct ophthalmological examination and digital photography. DR was graded using the Early Treatment DR Study criteria. The statistical analysis was conducted using SPSS, version 20. RESULTS: The estimated total prevalence of DR was 31% (95% confidence interval: 26.6–35.3). Mild nonproliferative diabetic retinopathy (NPDR) constitutes 21.3%, while moderate-to-severe NPDR and proliferative diabetic retinopathy constitute 4.5% and 5.2%, respectively. The prevalence of vision-threatening diabetic retinopathy (VTDR) and diabetic maculopathy was 15.4% and 13.3%, respectively. Retinopathy was significantly associated with age, diabetes duration, Type 2 diabetes mellitus, coexisting comorbidities or complications, systolic blood pressure, glycated hemoglobin (HbA1c), fasting blood sugar, triglycerides, and albumin/creatinine ratio. In the regression analysis, age (P = 0.02), duration (P < 0.001), and HbA1c (P < 0.001) were independently associated with DR. CONCLUSIONS: The prevalence of DR and VTDR among Omani diabetics is high. Age, duration of diabetes, and HbA1c are the risk factors for the development of DR among Omanis. This emphasizes the importance of planning resources for different modalities of treatment of DR to face the future challenge.
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Surgical management of pediatric eye injuries p. 84
Tahra AlMahmoud, Mohamed Elhanan, Hanan N Alshamsi, Sameeha M Al Hadhrami, Rabah Almahmoud, Fikri M Abu-Zidan
DOI:10.4103/ojo.OJO_285_2019  
BACKGROUND: Eye injury is a leading cause of unilateral childhood blindness. The purpose of this research was to study the management and visual outcome of pediatric eye injuries necessitating hospitalization and surgical repair. MATERIALS AND METHODS: This is a retrospective study of children having eye injury that needed surgical repair over the period of 2012 and 2017. Demographic data, place of occurrence, activity at the time of injury, place and cause of injury, presenting signs, surgical interventions, visual acuity (VA) before and after surgery, and causes for vision limitations were studied. RESULTS: Thirty-nine eyes of children were surgically treated. The mean (range) age of the patients was 3 years (1–15 years). Nearly 61.5% were males. Almost 80% of injuries occurred at home and while playing (71.8%). Trauma with sharp objects (35.8%) was the most common cause of injury. Majority presented to the hospital in <6 h (89%), mainly with eye pain (95%). Corneal laceration (53.8%), traumatic cataract (15.3%), and foreign body (15.3%) were the most common clinical findings. Twenty-one (53.8%) eyes sustained open-globe injuries. Fifteen percent had vision of 20/200 or worse at follow-up. The VA improved significantly at follow-up (P < 0.05). The major cause of vision limitation was the cornea (33%). CONCLUSIONS: Eye injury is a major cause of vision loss in children. Despite early presentation to our hospital and prompt interventions, significant number of our pediatric patients sustained limited VA in ruptured globe injuries.
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CASE REPORTS Top

Tubulointerstitial nephritis and uveitis syndrome: Our experience p. 89
Rachna Agarwal, Vikas Kanaujia, Priyadarshini Mishra, Kumudini Sharma
DOI:10.4103/ojo.OJO_56_2016  
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a distinct oculorenal disorder of immune origin and accounts for some cases of unexplained recurrent uveitis. We report three cases of TINU syndrome, one of which had primarily come to us with uveitis. It is the occurrence of tubulointerstitial nephritis and uveitis in a patient in the absence of other systemic diseases that can cause either interstitial nephritis or uveitis. TINU syndrome is a diagnosis of exclusion. Our aim in reporting these cases is to highlight the association of nephritis and uveitis, which together form a distinct clinical disorder called the TINU syndrome.
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Secondary ocular hypertension post intravitreal dexamethasone implant (OZURDEX) managed by pars plana implant removal along with trabeculectomy in a young patient p. 92
Rathini Lilian David, Parveen Sen
DOI:10.4103/ojo.OJO_40_2018  
We report a case of refractory secondary ocular hypertension after insertion of dexamethasone implant (OZURDEX) for posterior uveitis in a young patient, which necessitated removal of the implant through pars plana vitrectomy along with a trabeculectomy. A young male developed secondary ocular hypertension following dexamethasone implant (OZURDEX) injection for control of posterior uveitis. As the implant was still present in the vitreous cavity, we successfully performed a pars plana removal of the implant along with trabeculectomy with mitomycin C. Early intervention is essential to prevent glaucomatous optic neuropathy in young uveitic patients receiving OZURDEX implant.
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Management of iatrogenic globe perforation during peribulbar anesthesia with submacular hemorrhage p. 95
Abdulaziz Al-Shehri, Ayman Al-Ghamdi, Abdulmohsen Al-Shehri, Adel Alakeely
DOI:10.4103/ojo.OJO_208_2019  
A patient with an amblyopia and poor vision in the fellow eye experienced iatrogenic globe perforation during peribulbar anesthesia for cataract surgery. The injection and surgery were immediately aborted. Visual acuity was hand motion, and retinal examination revealed retinal detachment, hemorrhagic choroidal detachment, and submacular hemorrhage. These were initially managed medically until the hemorrhagic choroidal detachment resolved and afterward by combined phacoemulsification with pars plana vitrectomy, subretinal recombinant tissue plasminogen activator, and gas tamponade. Two weeks post operative, the patient achieved the best-corrected visual acuity of around 20/200, which after 1 year of follow-up improved to 20/70.
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CLINICAL IMAGES Top

Spontaneous closure of a large traumatic macular hole p. 98
Pratyusha Ganne, Nagesha C Krishnappa, Girish Velis
DOI:10.4103/ojo.OJO_99_2019  
Spontaneous closure of a large traumatic macular hole is a rare event. We report a case of a large traumatic macular hole in a 16-year-old that closed spontaneously following an epiretinal membrane formation. Centripetal contraction of the membrane resulted in hole closure and subsequent improvement in visual acuity.
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Vitelliform Vitreoretinopathy: Clinical Implications of the Vitreomacular Interface p. 100
Giancarlo A Garcia, Peter H Tang, Carolyn K Pan, Prithvi Mruthyunjaya
DOI:10.4103/ojo.OJO_214_2019  
Pathologies of the vitreomacular interface are implicated in a variety of sight-threatening clinical entities. The authors present a photo essay of a case of Terson syndrome with a striking premacular dehemoglobinized hemorrhage with ovoid morphology. This unique “vitelliform” finding highlights the distinct structure of the premacular vitreous space and its important implications in both health and disease.
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Multimodal imaging of an isolated retinal venous macroaneurysm p. 102
Syed Zohaib Maroof Hussain, MA Rehman Siddiqui
DOI:10.4103/ojo.OJO_231_2019  
We report a case of a young male with symptomatic isolated venous macro-aneurysm without any associated systemic disease. Multi modal imaging was useful in making the correct diagnosis. To the best of our knowledge, primary isolated venous macro-aneurysm has not been reported previously.
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CLINICAL QUIZ Top

Am I going blind?; Answers for clinical quiz p. 104
Ammar Hamad Al-Farsi, Sana Al-Zuhaibi, Anuradha Ganesh
DOI:10.4103/ojo.OJO_115_2019  
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LETTER TO THE EDITOR Top

Squamous papilloma of the eyelid margin: Lamellar division and cryotherapy p. 105
Gautam Lokdarshi, Neelam Pushker, Seema Kashyap, Mandeep S Bajaj, Abdul Shameer
DOI:10.4103/ojo.OJO_47_2018  
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