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   Table of Contents - Current issue
Coverpage
September-December 2014
Volume 7 | Issue 3
Page Nos. 109-164

Online since Saturday, October 11, 2014

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EDITORIAL  

An eye for an eye  Highly accessed article p. 109
Santosh G Honavar, Raju Kumar
DOI:10.4103/0974-620X.142590  
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REVIEW ARTICLES Top

Vascular endothelial growth factor trap-eye and trap technology: Aflibercept from bench to bedside Highly accessed article p. 112
Ali M Al-Halafi
DOI:10.4103/0974-620X.142591  
Anti-vascular endothelial growth factor (VEGF) currently used to treat eye diseases have included monoclonal antibodies, antibody fragments, and an aptamer. A different method of achieving VEGF blockade in retinal diseases includes the concept of a cytokine trap. Cytokine traps technology are being evaluated for the treatment of various diseases that are driven by excessive cytokine levels. Traps consist of two extracellular cytokine receptor domains fused together to form a human immunoglobulin G (IgG). Aflibercept/VEGF trap-eye (VTE) is a soluble fusion protein, which combines ligand-binding elements taken from the extracellular components of VEGF receptors 1 and 2 fused to the Fc portion of IgG. This protein contains all human amino acid sequences, which minimizes the potential for immunogenicity in human patients. This review presents the latest data on VTE in regard to the pharmacokinetics, dosage and safety, preclinical and clinical experiences. Method of the literature search: A systematic search of the literature was conducted on PubMed, Scopus, and Google Scholar with no limitation on language or year of publication databases. It was oriented to articles published for VTE in preclinical and clinical studies and was focused on the pharmacokinetics, dosage and safety of VTE.
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ORIGINAL ARTICLES Top

Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity p. 116
Parag K Shah, Minu Ramakrishnan, Bani Sadat, Sandeep Bachu, V Narendran, N Kalpana
DOI:10.4103/0974-620X.142592  
Aim: To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). Materials and Methods: A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, nystagmus, detailed anterior segment and posterior segment examination, and refractive status including best corrected visual acuity. Results: Forty-eight eyes of 25 infants were included in the study. Average follow-up was 6.91 years (range, 3.8-9.5years) after laser treatment. Astigmatism was noted in 43 out of 48 eyes (89.6%). Two eyes had simple myopia whereas three eyes had no refractive error. Conclusion: After successful laser treatment for zone 1 retinopathy of prematurity (ROP), 94% of our cases developed refractive error. Although most had a favorable anatomical and visual outcome, long-term follow-up even after a successful laser treatment in ROP was necessary.
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Influence of visual angle on pattern reversal visual evoked potentials p. 120
Ruchi Kothari, Smita Singh, Ramji Singh, AK Shukla, Pradeep Bokariya
DOI:10.4103/0974-620X.142593  
Purpose: The aim of this study was to find whether the visual evoked potential (VEP) latencies and amplitude are altered with different visual angles in healthy adult volunteers or not and to determine the visual angle which is the optimum and most appropriate among a wide range of check sizes for the reliable interpretation of pattern reversal VEPs (PRVEPs). Materials and Methods: The present study was conducted on 40 healthy volunteers. The subjects were divided into two groups. One group consisted of 20 individuals (nine males and 11 females) in the age range of 25-57 years and they were exposed to checks subtending a visual angle of 90, 120, and 180 minutes of arc. Another group comprised of 20 individuals (10 males and 10 females) in the age range of 36-60 years and they were subjected to checks subtending a visual angle of 15, 30, and 120 minutes of arc. The stimulus configuration comprised of the transient pattern reversal method in which a black and white checker board is generated (full field) on a VEP Monitor by an Evoked Potential Recorder (RMS EMG. EPMARK II). The statistical analysis was done by One Way Analysis of Variance (ANOVA) using EPI INFO 6. Results: In Group I, the maximum (max.) P100 latency of 98.8 ± 4.7 and the max. P100 amplitude of 10.05 ± 3.1 μV was obtained with checks of 90 minutes. In Group II, the max. P100 latency of 105.19 ± 4.75 msec as well as the max. P100 amplitude of 8.23 ± 3.30 μV was obtained with 15 minutes. The min. P100 latency in both the groups was obtained with checks of 120 minutes while the min. P100 amplitude was obtained with 180 minutes. A statistically significant difference was derived between means of P100 latency for 15 and 30 minutes with reference to its value for 120 minutes and between the mean value of P100 amplitude for 120 minutes and that of 90 and 180 minutes. Conclusion: Altering the size of stimulus (visual angle) has an effect on the PRVEP parameters. Our study found that the 120 is the appropriate (and optimal) check size that can be used for accurate interpretation of PRVEPs. This will help in better assessment of the optic nerve function and integrity of anterior visual pathways.
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Spectral domain optical coherence tomography characteristics in diabetic retinopathy p. 126
Laxmi Gella, Rajiv Raman, Padmaja Kumari Rani, Tarun Sharma
DOI:10.4103/0974-620X.142594  
Purpose: To report the appearance of diabetic retinopathy lesions using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 287 eyes of 199 subjects were included. All the subjects underwent complete ophthalmic examination including SD-OCT. Results: The appearance of various lesions of diabetic retinopathy and the retinal layers involved were reported. In subjects with macular edema the prevalence of incomplete PVD was 55.6%. Conclusion: SD-OCT brings new insights into the morphological changes of the retina in diabetic retinopathy.
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Outcome of rhegmatogenous retinal detachment repair by scleral buckling: The experience of a tertiary referral center in Scotland p. 130
Vikas Shankar, Lik Thai Lim, Elliott Yann Ah-Kee, Harold Hammer
DOI:10.4103/0974-620X.142595  
Purpose: The primary aim of this study is to report the outcome of patients with rhegmatogenous retinal detachment (RRD) who underwent scleral buckling (SB) surgery. Methods: This is a retrospective noncomparative case series study of all patients who underwent RRD repair by primary SB between March 2008 and February 2009. Patient demographics, visual outcome, complications, and failure rates were identified and recorded. Results: A total of 65 patients underwent RRD repair by SB, with a mean age of 44.44 years. Results showed that the primary outcome (primary anatomical success following index surgery) was 90.77%, while the secondary outcome (anatomical success following repeat surgery) was 98.46%. Conclusion: The study showed a high-success rate of SB in phakic eyes both in terms of postoperative best-corrected visual acuity and complication rates. We recommend the continued use of this technique in selected cases of RRD.
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CASE REPORTS Top

Bilateral familial vertical Duane Syndrome with synergistic convergence, aberrant trigeminal innervation, and facial hypoplasia p. 135
Malvika Gupta, Om Prakash Gupta, Vishal Vohra
DOI:10.4103/0974-620X.142596  
A 5-year-old girl presented with bilateral familial vertical  Duane retraction syndrome with alternating esotropia, elevation deficit, Marcus gunn phenomenon, and facial hypoplasia. Abnormal adducting downshoots on attempting abduction suggestive of a synergistic convergence were noted. Hypothesis suggests aberrant innervations or peripheral anatomic connections between inferior and medial recti.
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Resistant retinoblastoma in a 23-year-old patient p. 138
Yacoub A Yousef, Jihad Istetieh, Ibrahim Nawaiseh, Maysa Al-Hussaini, Khalil Alrawashdeh, Imad Jaradat, Iyad Sultan, Mustafa Mehyar
DOI:10.4103/0974-620X.142597  
Retinoblastoma is a very rare disease in adults. We are reporting a rare case of resistant retinoblastoma in 23-year-old patient. A 23-year-old male patient presented with loss of vision in the right eye over one-month duration. Examination showed an epiretinal membrane in the right macula in addition to a white mass located inferiorly and associated with vitreous seeds. The diagnosis of retinoblastoma was established. In order to save the patient's life and to preserve the eye and vision, he was treated with chemotherapy, focal therapy, and radioactive Iodine 125 plaque therapy. The tumor was resistant for treatment and recurred two years after plaque therapy, and enucleation showed well-differentiated retinoblastoma. Retinoblastoma may present in adults, and it was resistant to both chemotherapy and plaque radiation therapy in our case.
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Paediatric choroidal neovascular membrane secondary to toxoplasmosis treated successfully with anti-vascular endothelial growth factor p. 141
Gaurav Mathur, Amala Elizabeth George, Parveen Sen
DOI:10.4103/0974-620X.142598  
The purpose of this report was to evaluate the role anti-VEGF in management of CNVM secondary to ocular toxoplasmosis. Young female diagnosed as a case of bilateral ocular toxoplasmosis presented with complaints of diminution of vision in the right eye. Fundus examination showed an active CNVM adjacent to toxoplasmosis scar. In view of active CNVM, patient was administered intravitreal ranibizumab. A total of 2 injections of intravitreal ranibizumab were given. Fundus showed a scarred CNVM adjacent to the toxoplasma scar with no clinical signs of activity. Anti-VEGF therapy has been successfully used to improve visual and anatomical outcome in juxtafoveal (deleted subfoveal)CNVM secondary to toxoplasmosis.
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A case of submacular cysticercosis treated by pars plana vitrectomy in Kuwait p. 144
Vivek B Wani, Niranjan Kumar, Anil K Uboweja, Mahmood A Kazem
DOI:10.4103/0974-620X.142599  
We report a case of submacular cysticercosis in the left eye of an Indian patient living in Kuwait. Though he was systemically asymptomatic, his magnetic resonance imaging showed multiple cysts in the brain. The patient underwent pars plana vitrectomy (PPV), and the cyst was removed in total through a retinotomy over the cyst. He had another small cyst in the periphery that was also removed. He was treated with oral albendazole and systemic steroids after the surgery to treat his neurocysticercosis. He developed rhegmatogenous retinal detachment after the surgery, and the retina was successfully reattached with scleral buckling and PPV procedure. His final best corrected visual acuity improved from counting fingers at 1/2 m at presentation to 20/400. This case report shows that the ocular cysticercosis may be seen among expatriates working in the Middle East. It is important to rule out the presence of neurocysticercosis in such patients as well as multiple cysts in the affected eye. However, the functional outcome of surgical treatment of submacular cysticercosis can be disappointing.
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Vitreous occlusion of tube implant in a phakic patient with traumatic glaucoma p. 147
Suneeta Dubey, Julie Pegu, Manisha Agarwal, Anugya Agrawal
DOI:10.4103/0974-620X.142600  
Tube implants or glaucoma drainage devices have become an important method of intraocular pressure reduction when treating complex cases of traumatic glaucoma. However, it is not uncommon to have complications associated with tube implants. The optimal treatment of patients who have undergone glaucoma implant surgery complicated by vitreous incarceration is uncertain. If vitreous is present or is able to prolapse into anterior chamber, as in aphakic or pseudophakic patient without an intact posterior capsule, a concurrent anterior vitrectomy is usually performed. In such cases, pars plana vitrectomy has been found to be more effective in several studies. However, there are no set guidelines for management of such a case in a phakic eye and the management can be more challenging especially when there is no obvious deficiency in posterior capsule, zonular dialysis, or loose vitreous gel in the anterior chamber prior to or during tube implantation. We describe a case of 14-year-old phakic patient with traumatic glaucoma without vitreous gel in anterior chamber whose tube implant became occluded by vitreous resulting in increased intra ocular pressure. This is the first documented report of vitreous incarceration in a phakic patient and its successful management.
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Functional spasm of accommodation: Changes on scheimpflug imaging p. 150
Jaspreet Sukhija, Mangat R Dogra, Thara Zadeng, Jagat Ram
DOI:10.4103/0974-620X.142601  
Spasm of accommodation is a rare condition characterized by a sudden increase in myopia. It can occur in emmetropes, hypermetropes and myopes. All the physiological changes that occur in normal accommodation are exaggerated. Mostly the cause is functional disorder and the condition gradually improves. We hereby present the changes occurring in spasm of accommodation as seen on Scheimpflug imaging.
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CLINICAL IMAGE Top

Ocular findings in a case of periorbital giant congenital melanocytic nevus p. 153
Usha K Raina, Anisha Seth, Anika Gupta, Supriya Batta
DOI:10.4103/0974-620X.142602  
Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus that rarely occurs in the periorbital region. Various systemic, as well as ophthalmic associations, have been reported with GCMN. However, there is only one case report describing ophthalmic findings in periorbital GCMN. We describe the ocular findings in a case of periorbital GCMN.
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EDITORIALS Top

Erratum p. 155
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CLINICAL PRACTICE Top

Interdisciplinary approach: A boon for ocular rehabilitation p. 156
Shital J Sonune, Deeksha Sharma, Narendra Nirmal, Sonal Mehta
DOI:10.4103/0974-620X.142604  
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CLINICAL QUIZ Top

A 48-year-old female with sudden onset of painless diminution of vision in left eye p. 158
Akshay J Bhandari, Surekha V Bangal, Dipti Padghan, Gogri Pratik
DOI:10.4103/0974-620X.142605  
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LETTERS TO THE EDITOR Top

Pre-macular hemorrhage in chronic malaria p. 159
Brijesh Takkar, Parijat Chandra, Anubha Rathi, Rajvardhan Azad
DOI:10.4103/0974-620X.142606  
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External ophthalmomyiasis p. 160
Ratnesh Ranjan, Arvind Jain
DOI:10.4103/0974-620X.142607  
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Recurrent microbial keratitis in eyes with keratoconjunctivitis sicca with coexisting ocular surface pathology  Highly accessed article p. 161
Mayank A Nanavaty, Anish N Shah, Rima Al-Sukkar, Damian B Lake
DOI:10.4103/0974-620X.142608  
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