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   2011| September-December  | Volume 4 | Issue 3  
    Online since December 29, 2011

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Separate limbal-conjunctival autograft transplantation using the inferior conjunctiva for primary pterygium
Hiroki Kawano, Koji Kawano, Taiji Sakamoto
September-December 2011, 4(3):120-124
Background : Inferior limbal-conjunctival autograft transplantation has been described as a safe and effective treatment for primary pterygium. However, despite its multiple advantages, routine performance of this technique is difficult because the inferior conjunctiva is often too small to provide enough autograft material. To resolve this issue, we modified a technique, inferior separate limbal-conjunctival autograft transplantation, and evaluated its efficacy and safety Materials and Methods : A total of 50 eyes of 47 patients were retrospectively studied. Our surgery consisted of a thorough pterygium excision followed by 0.02% mitomycin C application. Next, we performed inferior conjunctival autografting, in which limbal and bulbar conjunctival autografts were independently harvested and secured to the denuded limbus and the most posterior conjunctival defect at the pterygium excision site to ensure stem-cell restoration and deep fornix reconstruction, respectively; the bare sclera between the two grafts was exposed. The outcome was assessed with a three-point grading scale at the patient's last visit. Results : The success and recurrence rates were 96.0% (48 of 50) and 0%, respectively, assessed at follow-ups occurring at a mean of 19.2 ΁ 5.6 months after surgery. Only minimal complications were encountered. Conclusion : A combination of inferior separate limbal-conjunctival autograft transplantation with intraoperative 0.02% mitomycin C application is a safe and effective technique enabling the routine use of under-sized autografts harvested from the inferior conjunctiva after thorough pterygium excision.
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Artiflex versus STAAR® implantable contact lenses for correction of high myopia
Mohammad Ghoreishi, Amin Masjedi, Kobra Nasrollahi, Aminhossein Rahgozar, Keivan Jenab, Hamid Fesharaki
September-December 2011, 4(3):116-119
Purpose : To compare two phakic intraocular lenses, Artiflex and STAAR® implantable contact lens (ICL), in high myopia. Setting : Isfahan Ophthalmology Clinic, Iran. Materials and Methods : In a randomized, prospective clinical trial study, 40 eyes of 20 patients who came to Isfahan ophthalmology clinic to correct their refractive error were examined. Artiflex was inserted in 20 eyes and ICL in the other 20 eyes. After 1 year, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), and specular microscopy of corneal endothelium were assessed in both the groups. Results : In this study, there was no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, and specular microscopy, 1 year after surgery. 40% of eyes in the Artiflex group developed anterior chamber cell and flare reaction 1 year postoperatively, but no patient in the ICL group developed the same. So, there is obvious difference in the rate of anterior chamber cell and flare reaction between these two groups. Conclusion : These two lenses have similar outcomes except in the incidence rate of anterior chamber cell and flare reaction that is greater in the Artiflex group. So, these two lenses are safe with predictable outcome in treating high myopia.
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Hemangioendothelioma of the eyelid can mimic chalazion
Yasser H Al-Faky, Salem Al Malki, Emad Raddaoui
September-December 2011, 4(3):142-143
Hemangioendothelioma is an uncommon vascular lesion that usually occurs in the liver, bone, lung, skin, and other organs with unknown etiology. A rare form of this lesion has been reported in the eyelid. We report the case of a 27-year-old female with right lower eyelid mass simulating chalazion of 3 weeks duration. The histopathologic examination of the excised nodule confirmed the diagnosis. To our knowledge, this is the fourth case of eyelid epithelioid hemangioendothelioma reported in the English literature.
  5,356 306 1
Retinoblastoma: Recent trends A mini review based on published literature
Vikas Khetan, Aditi Gupta, Lingam Gopal
September-December 2011, 4(3):108-115
Retinoblastoma (RB) is the most common intraocular malignancy in children. Recently, there have been significant advances made in the molecular pathology and the management of the disease. Last decade has witnessed better understanding of the genetics of RB, the discovery of new tumor markers expressed by the RB tumors, the identification of high-risk histopathological factors following enucleation, and newer methods of treatment including periocular chemotherapy and superselective intraarterial chemotherapy. All these advances have translated in improved survival rates for the affected children, improved rates of eye salvage, and improved visual outcomes. This article briefly reviews these advances. Method of Literature Search: Literature on the Medline database was searched using the PubMed interface. The search strategy included MeSH and natural language terms using the keywords mentioned. Reference lists in retrieved articles and textbooks were also searched for relevant references.
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Diabetic papillopathy with macular edema treated with intravitreal bevacizumab
Ahmed S Al-Hinai, Mohammed S Al-Abri, Rayah H Al-Hajri
September-December 2011, 4(3):135-138
A 46-year-old diabetic male presented with acute painless visual loss in his left eye (OS). Visual acuity was 6/36 OS with an unremarkable anterior segment examination (OU). Posterior segment showed a swollen left optic disc with large diffuse macular edema and moderate nonproliferative diabetic retinopathy (NPDR). The right eye fundus showed only mild NPDR. Optical coherence tomography and fundus fluorescein angiography were performed which revealed left macular edema and a hyperfluorescent left optic disc. Computerized tomography scan orbit and brain was normal. The patient received an intravitreal bevacizumab injection OS followed by focal laser photocoagulation 1 month later. His optic disc swelling and the macular edema subsided rapidly after the injection and his visual acuity improved to 6/6 with disc pallor.
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Recent trends in ocular oncology
Swathi Kaliki, Carol L Shields
September-December 2011, 4(3):103-104
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Orbital solitary fibrous tumor: A clinicopathologic correlation and review of literature
Mohammad Javed Ali, Santosh G Honavar, Milind N Naik, Geeta K Vemuganti
September-December 2011, 4(3):147-149
Orbital solitary fibrous tumor (SFT) is a rare tumor originating from the mesenchyme. Initially described in the pleura and subsequently in other mesenchymal structures, orbit continues to be one of the uncommon extrapleural sites. The diagnosis of orbital SFT cannot be made with certainty on clinical or radiological evaluation and requires histologic studies with immunohistochemical confirmation for which CD 34 is the most specific diagnostic test. We describe clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT along with a review of literature.
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Adalimumab in the treatment of recurrent idiopathic bilateral nodular scleritis
Ahmed M Bawazeer, Lina H Raffa
September-December 2011, 4(3):139-141
Our objective is to report a case of bilateral nodular scleritis in a 34-year-old patient, resistant to steroids and traditional disease modifying anti-rheumatic drugs, who was successfully treated with subcutaneous injections of 40 mg adalimumab. Adalimumab resulted in rapid control of scleritis in both eyes within 3 months with no recurrence over 5 years of follow-up. No side effects were reported during treatment. Although a large prospective study and a longer follow-up are required to reach a conclusive result, adalimumab has a potential role in the treatment of the above condition with the control of inflammation.
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Prevalence and causes of avoidable blindness and severe visual impairment in a tribal district of Maharashtra, India
Praful V Dhake, Kuldeep Dole, Rajiv Khandekar, Madan Deshpande
September-December 2011, 4(3):129-134
Background : We present the outcomes of a survey conducted in Nandurbar, a tribal district of Maharashtra, India. It was based on "Rapid Assessment for Avoidable Blindness" methodology and conducted in 2009 in Nandurbar, a tribal district of Maharashtra, India. Materials and Methods : We examined persons of 50 years and older ages. Ophthalmic assistants noted the distant vision [best corrected vision (BCV) and as presented]. Ophthalmologist examined eyes of persons with vision less than 6/18. The principal cause of impairment in each eye and the most "preventable" or "treatable" cause were assigned. We calculated the prevalence rates of bilateral blindness, severe visual impairment (SVI), and moderate visual impairment (MVI). Result : We examined 2,005/2,300 persons (response rate 87.2%). The prevalence of blindness, SVI, and MVI for the BCV was 1.63% (95% CI 1.11-2.15), 5.93% (95% CI 4.96-6.90), and 14.6% (95% CI 13.2-16.1), respectively. The prevalence of blindness, SVI, and MVI for the presented vision was 1.87% (1.32-2.42), 6.72% (95% CI 5.70-7.74), and 19% (95% CI 17.4-20.6), respectively. Unoperated cataract was responsible for 77% of different visual disabilities. The coverage of existing cataract surgery service was 9.4%. Lack of knowledge about cataract surgery was the main cause of unoperated cataract among 41% of interviewed participants with cataract and SVI. Conclusion : Unoperated cataract was the main curable cause of visual disabilities in tribal population of India. Increasing awareness and offering cataract surgeries at affordable cost in the district would reduce visual disabilities.
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A case series of neuroendocrine (carcinoid) tumor metastasis to the orbit
Kiran Turaka, Arman Mashayekhi, Carol l Shields, Sara E Lally, Brad Kligman, Jerry A Shields
September-December 2011, 4(3):125-128
Purpose/Background : To report the clinical and radiographic features and treatment outcome of neuroendocrine tumor (carcinoid) metastasis to the orbit. Materials and Methods : Retrospective chart review of four cases. Results : Mean patient age at the time of diagnosis of the primary neuroendocrine tumor and orbital metastasis was 58 and 66 years, respectively, with a mean duration of 8 years between diagnosis of primary tumor and orbital metastasis. Primary neuroendocrine tumor sites were gastrointestinal tract (n = 2), lung (n = 1), and testicle (n = 1). The most common presenting symptom was diplopia (three cases). Magnetic resonance imaging revealed orbital tumor in all cases. Octreotide scan was positive in one case. Treatment was tumor excision in three cases followed by external beam radiotherapy in two cases and one patient was followed without treatment. Tumor cells showed immunoreactivity to chromogranin, synaptophysin, and neuron-specific enolase in all cases. Mean follow-up after orbital tumor diagnosis was 39 months. Three patients had known systemic extraorbital metastasis before orbital involvement (mean interval of 5.9 years) and one case had immediately after development of orbital metastasis. One patient had multiple recurrences of orbital metastasis and eventually underwent exenteration. Two patients died of disseminated metastasis between 2 and 3 years after diagnosis of orbital metastasis. Conclusion : All four patients with orbital metastasis from neuroendocine tumor had evidence of systemic extraorbital metastasis. Aggressive metastatic neuroendocine tumors of orbit can lead to local recurrence even after surgical excision and radiation. Imaging tests were helpful in allowing early diagnosis and for monitoring after treatment.
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Can retinal microtrauma by internal limiting membrane peeling cause retinal angiomatosis proliferans?
Pukhraj Rishi, Maneesh Dhupper, Ekta Rishi
September-December 2011, 4(3):144-146
A 32-year-old male presented with decreased vision in right eye since 1 month following trauma with plastic ball. Best-corrected visual acuity (BCVA) was 20/160 in right eye and 20/20 in left. Right eye examination revealed angle recession, choroidal rupture, and macular hole. He underwent vitrectomy, internal limiting membrane (ILM) peeling, and 14% C3F8 gas injection. After 6 weeks, BCVA was 20/30; fundus showed macular hole closure. Six months after surgery, fundus revealed retinal vascular lesions suggestive of stage I RAP-like lesions; vision was maintained. Clinical findings were confirmed on Video ICGA, FFA, and OCT. The patient was periodically reviewed and lesions were nonprogressive until last follow-up, 13 months after surgery. It seems quite probable that ILM peeling may have caused retinal microtrauma leading to the formation of RAP-like lesions. What factors lead to such an event is as yet not clearly understood. Hence, larger studies with a longer follow-up are warranted to better understand these findings.
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A 62-year-old lady with an eyelid mass
Abdullah Al-Mujaini, Upender Wali
September-December 2011, 4(3):150-150
  2,594 211 -
Shopping for doctors: Thyroid eye disease patients are never satisfied
Haitham H Al Mahrouqi
September-December 2011, 4(3):151-152
  2,438 251 -
Genetic testing in retinal dystrophies
Anuradha Ganesh, Rosanne B Keep
September-December 2011, 4(3):105-107
  2,323 306 -
Optic nerve infiltration in relapse of acute lymphoblastic leukemia
Mohammad Javed Ali, Santosh G Honavar
September-December 2011, 4(3):152-152
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