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   2013| January-April  | Volume 6 | Issue 1  
    Online since May 15, 2013

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Small gauge vitrectomy: Recent update
Sumeet Khanduja, Ashish Kakkar, Saptrishi Majumdar, Rajpal Vohra, Satpal Garg
January-April 2013, 6(1):3-11
DOI:10.4103/0974-620X.111893  PMID:23772118
Small gauge vitrectomy, also known as minimally invasive vitreous surgery (MIVS), is a classic example of progress in biomedical engineering. Disparity in conjunctival and scleral wound location and reduction in wound diameter are its core principles. Fluidic changes include increased pressure head loss with consequent reduction in infusional flow rate and use of higher aspiration vacuum at the cutter port. Increase An increase in port open/port closed time maintains an adequate rate of vitreous removal. High Intensity Discharge (HID) lamps maintain adequate illumination in spite of a decrease in the number of fiberoptic fibers. The advantages of MIVS are, a shorter surgical time, minimal conjunctival damage, and early postoperative recovery. Most complications are centered on wound stability and risk of postoperative hypotony, endophthalmitis, and port site retinal break formation. MIVS is suited in most cases, however, it can cause dehiscence of recent cataract wounds. Retraction of the infusion cannula in the suprachoroidal space may occur in eyes with scleral thinning. As a lot has been published and discussed about sutureless vitrectomy a review of this subject is necessary. A PubMed search was performed in December 2011 with terms small gauge vitrectomy, 23-gauge vitrectomy, 25-gauge vitrectomy, and 27 gauge vitrectomy, which were revised in August 2012. There were no restrictions on the date of publication but it was restricted to articles in English or other languages, if there abstracts were available in English.
  6,137 626 -
Corneal biomechanics in iatrogenic ectasia and keratoconus: A review of the literature
Majid Moshirfar, Jason N Edmonds, Nicholas L Behunin, Steven M Christiansen
January-April 2013, 6(1):12-17
DOI:10.4103/0974-620X.111895  PMID:23772119
The Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Buffalo, NY) allows direct measurement of corneal biomechanical properties. Since its introduction, many studies have sought to elucidate the clinical applications of corneal hysteresis (CH) and corneal resistance factor (CRF). More recently, detailed corneal deformation signal waveform analysis (WA) has potentially expanded the diagnostic capabilities of the ORA. In this review, the role of CH, CRF, and WA are examined in keratoconus (KC) and iatrogenic ectasia (IE). The PubMed database was searched electronically for peer-reviewed literature in July 2012 and August 2012 without date restrictions. The search strategy included medical subject heading (MeSH) and natural language terms to retrieve references on corneal biomechanics, CH, CRF, corneal deformation signal WA, IE, and KC. The evidence suggests that while CH and CRF are poor screening tools when used alone, increased sensitivity and specificity of KC and IE screening result when these parameters are combined with tomography and topography. Recent advances in WA are promising, but little is currently understood about its biomechanical and clinical relevance. Future studies should seek to refine the screening protocols for KC and IE as well as define the clinical applicability of WA parameters.
  3,558 469 2
Persistent hyaloid artery with an aberrant peripheral retinal attachment: A unique presentation
Jay U Sheth, Ashish Sharma, Santonu Chakraborty
January-April 2013, 6(1):58-60
DOI:10.4103/0974-620X.111924  PMID:23772130
  3,795 197 -
Iris melanoma in children: Current approach to management
John P McLaughlin, Adrian T Fung, Jerry A Shields, Carol L Shields
January-April 2013, 6(1):53-55
DOI:10.4103/0974-620X.111920  PMID:23772128
Iris melanoma usually affects middle aged, Caucasian patients with light colored eyes. Pediatric iris melanoma is rare. A 15-year-old Caucasian male presented with 1-month history of a brown nodule in the inferotemporal aspect of his left eye. Iris nevus was diagnosed, and the patient was observed. Nearly 2 years later the lesion had grown in basal diameter and thickness, and the tumor was excised by partial lamellar scleral flap and sector iridectomy. Histopathology confirmed spindle cell iris melanoma. Two years post-operatively, tumor recurrence with anterior chamber angle involvement and secondary glaucoma developed. He was then treated with custom designed Iodine 125 plaque radiotherapy. This case demonstrates the recurrence of iris melanoma despite proper initial surgical management, and outlines current management options for pediatric iris melanoma.
  3,693 281 -
A novel navigated laser system brings new efficacy to the treatment of retinovascular disorders
Jay Chhablani, Igor Kozak, Giulio Barteselli, Sharif El-Emam
January-April 2013, 6(1):18-22
DOI:10.4103/0974-620X.111898  PMID:23772120
The laser photocoagulation is now treatment of choice for various retinovascular disorders. Conventional slit-lamp based laser delivery systems have many limitations including, questionable accuracy, need of contact lens with local anesthesia, and inadvertent damage to fovea. Navigated laser system, a fundus camera based laser delivery system with computer based laser planning and laser treatment without contact lens achieves improved patient compliance, improved accuracy, and treatment ease for the physician, efficient panretinal photocoagulation pattern laser, excellent documentation, and advanced laser training. This article compares navigated laser systems with available conventional and PASCAL laser systems based on the literature and personal experience of the authors.
  3,488 302 2
Isolated retinal cotton wool spot after coronary angiography
Nikolaos Kopsachilis, Manpreet Brar, Anca I. C. Marinescu, Sobha Sivaprasad
January-April 2013, 6(1):51-52
DOI:10.4103/0974-620X.111918  PMID:23772127
Visual symptoms after coronary angiography are rarely encountered and mostly related to contrast induced transient cortical blindness or retinal artery occlusions. We report an intriguing case of a 50-year-old woman, who presented with vision deterioration in her right eye 12 h after coronary angiography for cardiac palpitation. Fundoscopy and optical coherence tomography scan revealed an isolated parafoveal cotton wool spot in her right eye that has totally resolved 6 weeks after initial presentation. This is the first case report of this rare post coronary angiography complication.
  3,547 186 -
Psychometric properties of the national eye institute refractive error correction quality-of-life questionnaire among Iranian patients
Amir H Pakpour, Isa Mohammadi Zeidi, Mohsen Saffari, Georgios Labiris, Bengt Fridlund
January-April 2013, 6(1):37-43
DOI:10.4103/0974-620X.111911  PMID:23772124
Background and Aim: To evaluate the psychometric properties of the national Eye Institute refractive error correction quality of life questionnaire (NEI-RQL-42) among Iranian patients with refractive errors. Materials and Methods: Two samples of patients (n1 = 296, n2 = 95) were consecutively selected from the eye clinic of the Boo-Ali Hospital, Qazvin. A forward-backward procedure was conducted to translate and cross-culturally adapt the Iranian version of the NEI-RQL-42. A homogeneity, stability, and reliability test was conducted for the first sample after a two-week interval. Convergent validity was computed using the correlation between the NEI-RQL-42 subscale scores, National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ-25), and the Short Form-36 (SF-36). Furthermore, Known-group analysis was performed, to determine the discriminant validity between the subgroups of patients with hyperopia, emmetropia, and myopia. Responsiveness to clinical change was tested by administering NEI-RQL-42 on the second sample that was scheduled for surgery. Results: Homogeneity was satisfactory with the Cronbach's alpha coefficients ranging between 0.70 and 0.92. The 13 subscales of the NEI-RQL-42 showed a considerable stability in intra-class-correlation (ICC) ranging between 0.70 and 0.89. Positive correlation coefficients were found among all subscales of the NEI-RQL-42 and the other quality-of-life instruments (NEI-VFQ-25 and SF-36). The NEI-VFQ-25 displayed excellent discriminant validity to differentiate the subgroups of patients, and was found to be responsive to change after the surgical correction at three months. Conclusions: The Iranian version of the NEI-RQL-42 is a valid and reliable instrument to assess refractive error correction quality-of-life in Iranian patients. Moreover this questionnaire can be used to evaluate the effectiveness of interventions in patients with refractive errors.
  3,400 268 -
Effects of Artisan aphakic intraocular lens on central corneal thickness and intra ocular pressure in pediatric eyes with crystalline subluxated lenses
Saemah Nuzhat Zafar, Sorath Noorani Siddiqui, Ayesha Khan
January-April 2013, 6(1):44-47
DOI:10.4103/0974-620X.111914  PMID:23772125
Purpose: To study effects of Artisan iris fixated intraocular lens (IOL) on central corneal thickness (CCT) and intraocular pressure (IOP) in pediatric eyes with crystalline subluxated lenses. Materials and Methods: The study included 17 eyes undergoing Artisan aphakic IOL implantation after lensectomy for subluxated crystalline lenses. CCT and IOP measurements were recorded pre-operatively and post-operatively taking the mean of 4 post-operative visits. Patients were divided into Group A (n = 8) including patients with lensectomy and iris fixation of Artisan IOL as a primary procedure and Group B (n = 9) including patients in which lensectomy was carried out as a primary surgery and Artisan IOL fixation as a secondary procedure. Results: Children ranged in age from 08 years to 16 years, mean 11.59 ± 2.96 years. Follow-up period ranged from 7 months to 16 months, mean 11.24 months ± 4.27. Mean pre-operative and post-operative IOP in Group A was 14.88 ± 2.80 and 14.16 ± 0.59 respectively (P = 0.528). In Group B it was 12.44 ± 2.79 and 14.44 ± 1.15 respectively (P = 0.080). Mean pre-operative and post-operative CCT in Group A was 529.13 ± 24.23 and 529.87 ± 17.46 respectively (P = 0.674). In Group B it was 567.33 ± 29.13 and 568.83 ± 25.69 respectively (P = 0.859). Conclusions: Primary and secondary Artisan aphakic IOL implantation did not cause any significant changes in corneal thickness or IOP during the follow-up period.
  3,369 204 -
Short term outcome of Ahmed glaucoma valve implantation in management of refractory glaucoma in a tertiary hospital in Oman
Manali R Shah, Rajiv B Khandekar, Rajiv Zutshi, Rahima Mahrooqi
January-April 2013, 6(1):27-32
DOI:10.4103/0974-620X.111905  PMID:23772122
Background: We present outcomes of Ahmed Glaucoma Valve (AGV) implantation in treating refractory glaucoma in a tertiary hospital in Oman. Refractory glaucoma was defined as previously failed conventional glaucoma surgery and an uncontrolled intraocular pressure (IOP) of more than 21 mm Hg despite treatment with three topical and/or oral therapy. Materials and Methods: This historical cohort study was conducted in 2010. Details of medical and surgical treatment were recorded. Ophthalmologists examined eyes and performed glaucoma surgeries using AGV. The best corrected distant vision, IOP, and glaucoma medications were prospectively reviewed on 1 st day, 1 st , 6 th , 12 th week postoperatively, and at the last follow up. Result: Glaucoma specialists examined and treated 40 eyes with refractory glaucoma of 39 patients (20 males + 19 females). Neo-vascular glaucoma was present in 23 eyes. Vision before surgery was <3/60 in 21 eyes. At 12 weeks, one eye had vision better than 6/12, seven eyes had vision 6/18 to 6/60, and eight eyes had vision 6/60 to 3/60. Mean IOP was reduced from 42.9 (SD 16) to 14.2 (SD 8) and 19.1 (SD 7.8) mmHg at one and 12 weeks after surgery, respectively. At 12 weeks, five (12.5%) eyes had IOP controlled without medication. In 33 (77.5%) eyes, pressure was controlled by using one or two eye drops. The mean number of preoperative anti-glaucoma medications (2.38; SD 1.1) was reduced compared to the mean number of postoperative medications (1.92; SD 0.9) at 12 weeks. Conclusion: We succeeded in reducing visual disabilities and the number of anti-glaucoma medications used to treat refractory glaucoma by AGV surgery.
  3,179 222 -
Screening for subclinical keratoconus
Maria Clara Arbelaez, Maria Bernardita Sekito
January-April 2013, 6(1):1-2
DOI:10.4103/0974-620X.111891  PMID:23772117
  2,836 368 -
Comparison of central corneal thickness of primary open angle glaucoma patients with normal controls in South India
Maya Natarajan, Krishna Das, Jayakumar Jeganathan
January-April 2013, 6(1):33-36
DOI:10.4103/0974-620X.111907  PMID:23772123
Background: Studies mainly in the western population have compared central corneal thickness in primary open angle glaucoma and normal individuals have found variable results. We did this study to compare the central corneal thickness of primary open angle glaucoma patients with normal controls in a south Indian population. Materials and Methods: This was a masked, cross-sectional study undertaken in a tertiary care center in South India. A total of 50 controls and 50 primary open angle glaucoma patients were studied. Central corneal thickness between the two groups was compared using Wilcoxon two sample test and the signed rank test. Results: The mean central corneal thickness in the control group was 536 μm (462-608 μm) and in the primary open angle glaucoma group was 531 μm (476-609 μm). Conclusion: There was no significant difference in the central corneal thickness between primary open angle glaucoma patients and the normal controls.
  2,983 219 1
Multicavitary ciliary body melanoma presenting as a cyst
Jennifer Jang, Swathi Kaliki, Ralph C Eagle, Jerry A Shields, Carol L Shields
January-April 2013, 6(1):48-50
DOI:10.4103/0974-620X.111916  PMID:23772126
Cyst-like cavities in uveal melanoma occur rarely and can simulate a benign intraocular cystic lesion resulting in delayed diagnosis and inappropriate management. Herein, we describe a 66-year-old Caucasian female who presented with a "cystic" ciliary body mass in the right eye oculus dexter (OD). Slit lamp examination OD showed anterior bulging of the iris temporally from an underlying pigmented ciliary body mass and transillumination disclosed slight shadow from the tumor. Ultrasound biomicroscopy (UBM) revealed multiple cyst-like cavities within a tumor, lined by "thick walls" of at least 200 μm and occupying 80% of the tumor volume. A clinical diagnosis of multi-cavitary ciliary body melanoma was suspected and partial lamellar sclero iridocyclectomy was performed. Histopathology confirmed the diagnosis of low-grade spindle melanoma of the ciliary body with multiple empty and fluid filled cyst-like cavities without epithelial lining. UBM is an important diagnostic tool in the differentiation of "thick walled" cavitary melanoma from "thin walled" benign pigment epithelial cyst.
  2,870 227 -
Visual outcome following extracapsular cataract extraction in mature cataracts with pseudoexfoliation syndrome: A retrospective study
Abdullah Al-Mujaini, Upender K Wali
January-April 2013, 6(1):23-26
DOI:10.4103/0974-620X.111902  PMID:23772121
Purpose/Objective: To report the best corrected visual acuity, at the end of one year, in 33 patients (35 eyes), who underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation (PC-IOL) for mature and hypermature cataracts, with pseudoexfoliation (PEX). Design: Retrospective, non-comparative, single-institutional (Sultan Qaboos University Hospital) study. Participants: Thirty-three patients with mature and hypermature cataracts, with PEX operated upon between January 2007 and December 2008, by one surgeon (AM). Materials and Methods: Retrospective study of thirty-three patients (35 eyes) with mature and hypermature cataracts, with ocular PEX, evaluating the visual outcome at the end of 12 months following ECCE with PC-IOL. Results: Thirty eyes (85.71%) showed improvement in the best corrected visual acuity (BCVA) ranging from 0.2 to 1.0 Snellen lines. Four eyes (11.43%) had unchanged BCVA from the baseline. There were no intraoperative complications in any patient. One eye (2.86%) that did not improve developed retinal detachment at three months follow-up, and was referred to the Vireoretinal Unit and follow-up has been lost. Conclusion: Extracapsular cataract extraction is a safe and effective technique in eyes with mature and hypermature cataracts with PEX.
  2,607 297 -
Nodular episcleritis after laser in situ keratomileusis in patient with systemic lupus erythematosus
Mohammad Al-Amry
January-April 2013, 6(1):65-66
DOI:10.4103/0974-620X.111938  PMID:23772134
  2,555 166 -
Simultaneous surgical correction of dissociated vertical deviation, superior oblique overaction and A-pattern with associated horizontal strabismus: A case series
Suma Ganesh, Nidhi Khurana, Sumita Sethi, Priyanka Arora
January-April 2013, 6(1):66-68
DOI:10.4103/0974-620X.111941  PMID:23772135
  2,375 224 -
Spontaneous epiretinal membrane separation
Anton M Kolomeyer, Daniel M Schwartz
January-April 2013, 6(1):56-57
DOI:10.4103/0974-620X.111921  PMID:23772129
  2,267 246 1
Anterior ischemic optic neuropathy and dialysis: Effect of hypotension
Buthaina I Sabt
January-April 2013, 6(1):64-65
DOI:10.4103/0974-620X.111934  PMID:23772133
  2,246 192 1
Head trauma with contralateral traumatic optic neuropathy
Brijesh Takkar, Digvijay Singh, Rohit Saxena, Vimla Menon
January-April 2013, 6(1):61-62
DOI:10.4103/0974-620X.111925  PMID:23772131
  2,127 220 -
It is not chalazion
Abdullah Al-Mujaini, Buthaina Sabt, Ibrahim Al-Hadabi
January-April 2013, 6(1):63-63
DOI:10.4103/0974-620X.111933  PMID:23772132
  1,951 211 -