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Δευτέρα, 18 Φεβρουαρίου 2019

Dentistry

ORIGINAL ARTICLES 

Comparative evaluation of experimental chitosan gingival retraction cords with aluminum chloride and nonimpregnated retraction cords: An In vivo studyp. 1
Aarushi Mahajan, Roopa R Nadi, Veena S Pai, SN Joshi
DOI:10.4103/jid.jid_63_18  
Aim: This study aimed to evaluate the efficacy of two chitosan gingival retraction cords with different cord thickness and to compare the effectiveness of chitosan cords against aluminum chloride gingival retraction and nonimpregnated retraction cord on different parameters. Materials and Methods: Fifty-two participants were selected and a total of 60 teeth were included which were divided randomly in the group of four. Experimental gingival retraction cords were colored yellow and black (braided, chitosan) and compared with aluminum chloride retraction cord and control nonimpregnated cord. Size for yellow chitosan cord and aluminum chloride was 00, and for black chitosan cord and control was 000. A total of four retraction cords were available for evaluation. Cords were inserted in gingival crevice with cord packer and left for 10 min. Results: There was no significant difference between the two experimental cords, but a significant difference with aluminum chloride cord showing better results with only two of the parameters, that is, the ease of packing the cord and fraying of cords. With nonimpregnated cord, there was a significant difference in hemostasis, sulcus widening, dry sulcus, and amount of bleeding at removal where all the other three cords were better than nonimpregnated cord. Conclusion: There was no statistically significant difference with respect to both the chitosan gingival retraction cords in all the criteria and with aluminum chloride cord except for fraying of cord. Both the experimental cords were superior to that of nonimpregnated cord with respect to all the criteria except for ease of packing the cord.
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Comparative evaluation of retention of zirconia copings and cast metal copings cemented onto titanium abutments: An In vitro studyp. 8
BC Deepthi, DM Mallikarjuna, Mallika S Shetty
DOI:10.4103/jid.jid_66_18  
Aim: This in vitro study was conducted to evaluate the retention of zirconia and cast metal copings luted to implant abutments using different luting agents. Subjects and Methods: Implant analogs were embedded in acrylic resin blocks, and titanium abutments were torqued at 35 N/cm onto the implant analogs. The samples were divided into two groups. Both Group A and B samples were then randomly divided into four groups each comprising specimens – Group 1, Group 2, Group 3, and Group 4. Copings were then cemented with resin modifies glass ionomer cement (GIC), GIC, zinc phosphate cement, and noneugenol zinc oxide cement, respectively. The cemented copings were subjected to tensile dislodgment forces using a crosshead speed of 5 mm/min. Results for the retention of the copings were statistically analyzed using factorial analysis of variance test. Results: Between the two copings, higher mean retention is recorded in zirconia compared to metal, and the difference between them is found to be statistically significant (P < 0.001). Among the four types of cements, higher mean retention was recorded with resin-modified GIC followed by zinc phosphate and GICs. The least retention strength was recorded with noneugenol zinc oxide cement. Conclusion: Definitive cements are recommended for luting single-unit implant-supported metal restorations. The provisional cement was found to be least retentive and may not be suitable for luting single-unit implant-supported restorations, whether for a zirconia or for a cast metal restoration.
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Awareness toward replacement of teeth, duration of use, and maintenance of dental prosthesis among adult rural population in mangalore talukp. 15
Mallika S Shetty, Ganesh Shenoy Panchmal, K Kamalakanth Shenoy
DOI:10.4103/jid.jid_74_18  
Background: Oral health is always an inseparable part of general health and awareness plays a vital role in determining the oral health of individual. The estimation of treatment need is also an important requirement in oral health care planning. Subjects and Methods: A cross-sectional survey was carried out on 1312 participants aged 18 years and above. Sixteen Gram panchayats were selected by simple random sampling a house-to-house survey was conducted to determine the awareness toward replacement of teeth among the rural population of Mangalore Taluk, Karnataka State, India. The survey pro forma was designed to collect information regarding the demographic profile, educational status, occupation, teeth missing, whether replaced with artificial substitute, and reason for not replacing the missing teeth. Data collected were analyzed using Chi-squared test. P < 0.05 was considered as statistically significant. Results: Majority of the subjects gave the reason for nonreplacement as expensive. Among males, majority of the subjects gave the reason for nonreplacement as "No time to visit the dentist." Among all the age groups, gender and education multi-unit prosthesis was needed predominantly in the upper and lower arches. Conclusion: The general public should also be made aware of the free dental treatment facilities available in the health-care centers and dental institutions and hospitals. Dental professionals should promote oral health care in rural areas by conducting health awareness programs on consequences of edentulous, importance of retaining, replacing, and maintenance of teeth.
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Force magnitude of nickel-titanium orthodontic wiresp. 19
Renata Sathler, Marcos Roberto de Freitas, Carlos Alberto Soufen, Marcelo Zanda, Thais Maria Freire Fernandes, Maria Claudia Wagner, Olga Benário Vieira Maranhão, Daniela Gamba Garib, Guilherme Janson
DOI:10.4103/jid.jid_14_18  
Objective: The purpose of this study is to evaluate the magnitude of forces released by nickel-titanium (NiTi) orthodontic wires used for leveling and alignment. Materials and Methods: Eleven groups of 0.014" NiTi orthodontic wires of six different brands were tested. A 3342 Instron universal testing machine with a 10 N load cell was used and the ISO 15.841 was followed. Kolmogorov–Smirnov tests were used to verify normality and ANOVA followed by Tukey's tests were used for intergroup comparisons. Results: Abzil conventional, GAC conventional, Morelli heat-activated (HA), Ormco CuNiTi, and Orthometric conventional released load within the optimum range of 50–100 cN. HA wires released lower forces compared to conventional wire of the same brand. Conclusions: Heat-activated Morelli and CuNiTi Ormco presented homogeneous loads within an optimal range.
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CASE REPORTSTop

A magnetically retained cheek plumper in a maxillary single complete denture: A clinical reportp. 25
Sri Ram Venkatachalapathy, Gopi Naveen Chander, Padmashini Gnanam
DOI:10.4103/jid.jid_37_18  
Facial esthetics plays an important role in determining the psychology of patients. The loss of oral structures primarily affects the appearance in the lower half of the face. There are an increased rate of resorption of the alveolar ridges and a decrease in the muscle tonicity, both of which leads to sinking of cheeks. Rehabilitating a completely edentulous patient not only dentally but also facially will bring about an esthetic change. This leads to an increase in the patient's self-confidence and their social interactions. This clinical report introduces a simple noninvasive cost-effective technique to improve the dental and facial appearance using a detachable cheek plumper which is attached to the denture by neodymium close-field magnets.
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Bilateral pedicle flap: A novel technique for functional and esthetic management of aberrant labial frenump. 31
Isha Agrawal, Priyadarshini Nadig, Sarath Chandran
DOI:10.4103/jid.jid_44_17  
An aberrant maxillary labial frenum can lead to diastema and gingival recession creating functional and esthetic problems. Archer's classical frenectomy technique is an extensive procedure and has led to scarring and loss of interdental papilla. Conservative approaches such as Edward's frenectomy, frenum relocation by Z-plasty, and free gingival graft showed limitations in terms of esthetics. This case report describes a novel technique of bilateral pedicle flap for frenectomy which gives good esthetic results, color match, gain in attached gingiva, and no unaesthetic scar formation as healing takes place by primary intention.
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Ellis–van creveld syndrome: A rare case reportp. 35
Sandeep Katti, Pratima Oswal, Ancia Vas
DOI:10.4103/jid.jid_45_18  
Ellis-van Creveld (EVC) syndrome or chondroectodermal dysplasia is a rare autosomal recessive disease, with an incidence of 1:244,000 for the general population. The exact prevalence of this syndrome is unknown but believed to be a genetic chromosomal disorder with a higher incidence in women. EVC syndrome consists of a tetrad of principal features: chondroectodermal dysplasia, polydactyly, congenital heart defects, and hypoplastic nails and teeth. In this syndrome, many other organs can be compromised with multiple oral manifestations of hard and soft tissues, but dental literature on the subject is scarce. Hence, we report a case of a patient, visiting Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, seeking dental treatment presenting the typical features of EVC syndrome.
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A rare case report of pyogenic granuloma associated with external root resorptionp. 39
SS Suprith, Leena Patil, Srinath Thakur
DOI:10.4103/jid.jid_47_17  
This is a rare case in which external root resorption was associated with localized gingival enlargement (pyogenic granuloma) in the upper right central incisor in a 49-year-old male clinically presenting with recession and mobility in other areas. The enlargement was pedunculated measuring 1.5 cm × 2 cm reddish pink in color, soft to fibrotic in consistency, and clinically diagnosed as pyogenic granuloma with chronic generalized periodontitis and endodontic lesion. Nonsurgical periodontal therapy was performed, enlargement was excised, and histopathological report was consistent with clinical report. Since it was associated with the cervical root resorption, the patient had to immediately undergo root canal treatment. The patient was observed for 4 months. The patient did not have any complaints, and the lesion was healed satisfactorily. For the esthetic purpose, gingival veneering was planned in the anterior region as there were root resorption and discoloration. After complete treatment, the gingiva is normal and healthy, and there was no sign of recurrence of the enlargement. The patient's periodontal condition is now routinely evaluated.
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Interdisciplinary approach in the management of medically compromised patient with drug-induced gingival enlargementp. 44
Archana Devanoorkar, Nagappa Guttiganur
DOI:10.4103/jid.jid_68_17  
Drug-induced gingival overgrowth (DIGO) is one of the most common side effects of three important groups of drugs such as anticonvulsants, calcium channel blockers, and immunosuppressants. Calcium channel blockers are the important group of drugs in the management of cardiovascular diseases; however, they are associated with certain side effects such as DIGO in susceptible individuals. Nifedipine is the frequently involved drug; however, there are few cases of amlodipine-induced gingival enlargement as well. The case reported here is a 55-year-old medically compromised male patient on polypharmacy. Based on the clinical, radiographic investigations and medical history, he was diagnosed as having drug-induced gingival enlargement with chronic generalized periodontitis. The case was managed by nonsurgical periodontal therapy alone in addition to interdisciplinary approach and strict supportive periodontal therapy, which resulted in complete resolution of the gingival enlargement with restoration of normal gingival health.
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Comparative evaluation of experimental chitosan gingival retraction cords with aluminum chloride and nonimpregnated retraction cords: An In vivo study
Aarushi Mahajan, Roopa R Nadi, Veena S Pai, SN Joshi

Journal of Interdisciplinary Dentistry 2019 9(1):1-7

Aim: This study aimed to evaluate the efficacy of two chitosan gingival retraction cords with different cord thickness and to compare the effectiveness of chitosan cords against aluminum chloride gingival retraction and nonimpregnated retraction cord on different parameters. Materials and Methods: Fifty-two participants were selected and a total of 60 teeth were included which were divided randomly in the group of four. Experimental gingival retraction cords were colored yellow and black (braided, chitosan) and compared with aluminum chloride retraction cord and control nonimpregnated cord. Size for yellow chitosan cord and aluminum chloride was 00, and for black chitosan cord and control was 000. A total of four retraction cords were available for evaluation. Cords were inserted in gingival crevice with cord packer and left for 10 min. Results: There was no significant difference between the two experimental cords, but a significant difference with aluminum chloride cord showing better results with only two of the parameters, that is, the ease of packing the cord and fraying of cords. With nonimpregnated cord, there was a significant difference in hemostasis, sulcus widening, dry sulcus, and amount of bleeding at removal where all the other three cords were better than nonimpregnated cord. Conclusion: There was no statistically significant difference with respect to both the chitosan gingival retraction cords in all the criteria and with aluminum chloride cord except for fraying of cord. Both the experimental cords were superior to that of nonimpregnated cord with respect to all the criteria except for ease of packing the cord. 


Comparative evaluation of retention of zirconia copings and cast metal copings cemented onto titanium abutments: An In vitro study
BC Deepthi, DM Mallikarjuna, Mallika S Shetty

Journal of Interdisciplinary Dentistry 2019 9(1):8-14

Aim: This in vitro study was conducted to evaluate the retention of zirconia and cast metal copings luted to implant abutments using different luting agents. Subjects and Methods: Implant analogs were embedded in acrylic resin blocks, and titanium abutments were torqued at 35 N/cm onto the implant analogs. The samples were divided into two groups. Both Group A and B samples were then randomly divided into four groups each comprising specimens &#8211; Group 1, Group 2, Group 3, and Group 4. Copings were then cemented with resin modifies glass ionomer cement (GIC), GIC, zinc phosphate cement, and noneugenol zinc oxide cement, respectively. The cemented copings were subjected to tensile dislodgment forces using a crosshead speed of 5 mm/min. Results for the retention of the copings were statistically analyzed using factorial analysis of variance test. Results: Between the two copings, higher mean retention is recorded in zirconia compared to metal, and the difference between them is found to be statistically significant (P &#60; 0.001). Among the four types of cements, higher mean retention was recorded with resin-modified GIC followed by zinc phosphate and GICs. The least retention strength was recorded with noneugenol zinc oxide cement. Conclusion: Definitive cements are recommended for luting single-unit implant-supported metal restorations. The provisional cement was found to be least retentive and may not be suitable for luting single-unit implant-supported restorations, whether for a zirconia or for a cast metal restoration. 


Awareness toward replacement of teeth, duration of use, and maintenance of dental prosthesis among adult rural population in mangalore taluk
Mallika S Shetty, Ganesh Shenoy Panchmal, K Kamalakanth Shenoy

Journal of Interdisciplinary Dentistry 2019 9(1):15-18

Background: Oral health is always an inseparable part of general health and awareness plays a vital role in determining the oral health of individual. The estimation of treatment need is also an important requirement in oral health care planning. Subjects and Methods: A cross-sectional survey was carried out on 1312 participants aged 18 years and above. Sixteen Gram panchayats were selected by simple random sampling a house-to-house survey was conducted to determine the awareness toward replacement of teeth among the rural population of Mangalore Taluk, Karnataka State, India. The survey pro forma was designed to collect information regarding the demographic profile, educational status, occupation, teeth missing, whether replaced with artificial substitute, and reason for not replacing the missing teeth. Data collected were analyzed using Chi-squared test. P &#60; 0.05 was considered as statistically significant. Results: Majority of the subjects gave the reason for nonreplacement as expensive. Among males, majority of the subjects gave the reason for nonreplacement as &#8220;No time to visit the dentist.&#8221; Among all the age groups, gender and education multi-unit prosthesis was needed predominantly in the upper and lower arches. Conclusion: The general public should also be made aware of the free dental treatment facilities available in the health-care centers and dental institutions and hospitals. Dental professionals should promote oral health care in rural areas by conducting health awareness programs on consequences of edentulous, importance of retaining, replacing, and maintenance of teeth. 


Force magnitude of nickel-titanium orthodontic wires
Renata Sathler, Marcos Roberto de Freitas, Carlos Alberto Soufen, Marcelo Zanda, Thais Maria Freire Fernandes, Maria Claudia Wagner, Olga Ben&#225;rio Vieira Maranh&#227;o, Daniela Gamba Garib, Guilherme Janson

Journal of Interdisciplinary Dentistry 2019 9(1):19-24

Objective: The purpose of this study is to evaluate the magnitude of forces released by nickel-titanium (NiTi) orthodontic wires used for leveling and alignment. Materials and Methods: Eleven groups of 0.014&#8221; NiTi orthodontic wires of six different brands were tested. A 3342 Instron universal testing machine with a 10 N load cell was used and the ISO 15.841 was followed. Kolmogorov&#8211;Smirnov tests were used to verify normality and ANOVA followed by Tukey&#39;s tests were used for intergroup comparisons. Results: Abzil conventional, GAC conventional, Morelli heat-activated (HA), Ormco CuNiTi, and Orthometric conventional released load within the optimum range of 50&#8211;100 cN. HA wires released lower forces compared to conventional wire of the same brand. Conclusions: Heat-activated Morelli and CuNiTi Ormco presented homogeneous loads within an optimal range. 


A magnetically retained cheek plumper in a maxillary single complete denture: A clinical report
Sri Ram Venkatachalapathy, Gopi Naveen Chander, Padmashini Gnanam

Journal of Interdisciplinary Dentistry 2019 9(1):25-30

Facial esthetics plays an important role in determining the psychology of patients. The loss of oral structures primarily affects the appearance in the lower half of the face. There are an increased rate of resorption of the alveolar ridges and a decrease in the muscle tonicity, both of which leads to sinking of cheeks. Rehabilitating a completely edentulous patient not only dentally but also facially will bring about an esthetic change. This leads to an increase in the patient&#39;s self-confidence and their social interactions. This clinical report introduces a simple noninvasive cost-effective technique to improve the dental and facial appearance using a detachable cheek plumper which is attached to the denture by neodymium close-field magnets. 


Bilateral pedicle flap: A novel technique for functional and esthetic management of aberrant labial frenum
Isha Agrawal, Priyadarshini Nadig, Sarath Chandran

Journal of Interdisciplinary Dentistry 2019 9(1):31-34

An aberrant maxillary labial frenum can lead to diastema and gingival recession creating functional and esthetic problems. Archer&#39;s classical frenectomy technique is an extensive procedure and has led to scarring and loss of interdental papilla. Conservative approaches such as Edward&#39;s frenectomy, frenum relocation by Z-plasty, and free gingival graft showed limitations in terms of esthetics. This case report describes a novel technique of bilateral pedicle flap for frenectomy which gives good esthetic results, color match, gain in attached gingiva, and no unaesthetic scar formation as healing takes place by primary intention. 


Ellis–van creveld syndrome: A rare case report
Sandeep Katti, Pratima Oswal, Ancia Vas

Journal of Interdisciplinary Dentistry 2019 9(1):35-38

Ellis-van Creveld (EVC) syndrome or chondroectodermal dysplasia is a rare autosomal recessive disease, with an incidence of 1:244,000 for the general population. The exact prevalence of this syndrome is unknown but believed to be a genetic chromosomal disorder with a higher incidence in women. EVC syndrome consists of a tetrad of principal features: chondroectodermal dysplasia, polydactyly, congenital heart defects, and hypoplastic nails and teeth. In this syndrome, many other organs can be compromised with multiple oral manifestations of hard and soft tissues, but dental literature on the subject is scarce. Hence, we report a case of a patient, visiting Maratha Mandal&#39;s NGH Institute of Dental Sciences and Research Centre, Belgaum, seeking dental treatment presenting the typical features of EVC syndrome. 


A rare case report of pyogenic granuloma associated with external root resorption
SS Suprith, Leena Patil, Srinath Thakur

Journal of Interdisciplinary Dentistry 2019 9(1):39-43

This is a rare case in which external root resorption was associated with localized gingival enlargement (pyogenic granuloma) in the upper right central incisor in a 49-year-old male clinically presenting with recession and mobility in other areas. The enlargement was pedunculated measuring 1.5 cm &#215; 2 cm reddish pink in color, soft to fibrotic in consistency, and clinically diagnosed as pyogenic granuloma with chronic generalized periodontitis and endodontic lesion. Nonsurgical periodontal therapy was performed, enlargement was excised, and histopathological report was consistent with clinical report. Since it was associated with the cervical root resorption, the patient had to immediately undergo root canal treatment. The patient was observed for 4 months. The patient did not have any complaints, and the lesion was healed satisfactorily. For the esthetic purpose, gingival veneering was planned in the anterior region as there were root resorption and discoloration. After complete treatment, the gingiva is normal and healthy, and there was no sign of recurrence of the enlargement. The patient&#39;s periodontal condition is now routinely evaluated. 


Interdisciplinary approach in the management of medically compromised patient with drug-induced gingival enlargement
Archana Devanoorkar, Nagappa Guttiganur

Journal of Interdisciplinary Dentistry 2019 9(1):44-47

Drug-induced gingival overgrowth (DIGO) is one of the most common side effects of three important groups of drugs such as anticonvulsants, calcium channel blockers, and immunosuppressants. Calcium channel blockers are the important group of drugs in the management of cardiovascular diseases; however, they are associated with certain side effects such as DIGO in susceptible individuals. Nifedipine is the frequently involved drug; however, there are few cases of amlodipine-induced gingival enlargement as well. The case reported here is a 55-year-old medically compromised male patient on polypharmacy. Based on the clinical, radiographic investigations and medical history, he was diagnosed as having drug-induced gingival enlargement with chronic generalized periodontitis. The case was managed by nonsurgical periodontal therapy alone in addition to interdisciplinary approach and strict supportive periodontal therapy, which resulted in complete resolution of the gingival enlargement with restoration of normal gingival health. 


Ophthalmology

EDITORIAL 

Indian Journal of Ophthalmology – The journey so farp. 317
Santosh G Honavar
DOI:10.4103/ijo.IJO_303_19  
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GUEST EDITORIALTop

Current management options in primary angle closure disease Highly accessed articlep. 321
Ramasamy Krishnadas
DOI:10.4103/ijo.IJO_1932_18  
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ONE MINUTE OPHTHALMOLOGYTop

To prick or to poke? Highly accessed articlep. 324
Md. Shahid Alam, Vathsalya Vijay
DOI:10.4103/ijo.IJO_763_18  
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REVIEW ARTICLETop

Enigma of serpiginous choroiditisp. 325
Parthopratim Dutta Majumder, Jyotirmay Biswas, Amod Gupta
DOI:10.4103/ijo.IJO_822_18  
Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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COMMENTARYTop

Commentary: Serpiginous choroiditis—so near yet so farp. 333
Soumyava Basu
DOI:10.4103/ijo.IJO_1686_18  
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ORIGINAL ARTICLETop

Practice pattern of cataract surgeons when operating on seropositive patients Highly accessed articlep. 335
Parveen Rewri, Madhavi Sharma, Aprajita Lohan, Deepika Singh, Vibha Yadav, Aparna Singhal
DOI:10.4103/ijo.IJO_1437_18  
Purpose: The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines. Methods: The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05%. Results: Of 623 ophthalmologists contacted, responses of 479 (79%) ophthalmologists were analyzed. Maximum participants were in private practice (48%). During whole practicing carrier, 313 (65%; 95% confidence interval [CI]: 61–70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65%; 95% CI: 60–70) participants did not report their injury. Wearing "double gloves" during cataract surgery was the most common barrier adopted by participants. Conclusion: We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking.
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COMMENTARYTop

Commentary on: Practice pattern of cataract surgeons when operating on seropositive patientsp. 339
Mahipal Sachdev, Rashmi Deshmukh
DOI:10.4103/ijo.IJO_46_19  
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ORIGINAL ARTICLESTop

Three-dimensional digital visualization of phacoemulsification and intraocular lens implantationp. 341
Zhuyun Qian, Hongxia Wang, Hua Fan, Dong Lin, Wensheng Li
DOI:10.4103/ijo.IJO_1012_18  
Purpose: To evaluate the feasibility and safety of heads-up three-dimensional (3D) vision system for phacoemulsification and intraocular lens (IOL) implantation surgery. Methods: In this prospective, randomized controlled study, 20 eyes with age-related cataract received phacoemulsification and IOL implantation and were randomly divided into "heads-up" 3D vision group and conventional surgery group. Ocular and surgical parameters such as surgery time, pre and postoperative best-corrected visual acuity (BCVA), and corneal endothelial cells density were recorded and statistically analyzed. Results: The result showed significant postoperative improvement of BCVA in both groups. There was no difference in either mean surgery time or postoperative mean endothelial cell density between the 3D group and the conventional group. No major complication occurred during surgery in either group. Conclusion: The heads-up 3D vision system is suitable and safe for cataract phacoemulsification and IOL implantation. This technique can be of widespread use.
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Confounding sizing in posterior chamber phakic lens selection due to white-to-white measurement biasp. 344
Joaquín Fernández, Manuel Rodríguez-Vallejo, Javier Martínez, Ana Tauste, Elisa Hueso, David P Piñero
DOI:10.4103/ijo.IJO_613_18  
Purpose: To assess the agreement in the white-to-white (WTW) measurement with two different devices, the reproducibility and the probability of confusing sizing (PCS) in selecting a different implantable collamer lens (ICL). Study Design: Retrospective observational case series. Methods: Images of 192 eyes were captured with both devices. The WTW was measured automatically (OA) and manually (OM) with the Orbscan and Keratograph (KA and KM) by one examiner who repeated a total of four measures. A second examiner conducted a single manual measure for each device over the same image. The ICL sizing was computed for each measure of WTW and the PCS was calculated as the percentage of cases for which the confronted or repeated measure resulted in a different size of the ICL. The critical WTWs with highest PCS were identified. Results: KM overestimated the WTW versus OM in 0.13 ± 0.18 mm (P < 0.001) but not in the automated method comparison, 0.01 ± 0.19 mm (P = 0.58). Inter-examiner reproducibility (R) was higher with OM than with KM, and the intra-examiner R decreased with the average of two measures in both cases. The PCS was higher with the increase of mean differences, the limits of agreement (LoAs), and R. WTWs from 11.1 to 11.2 mm, 11.6 to 11.7 mm, and 12.3 to 12.4 mm resulted in higher PCS. Conclusion: The mean difference is not enough to apply conversions between devices and the LoAs and R should be considered. Special attention should be taken for WTWs with higher PCS.
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Iris varix: 10-year experience with 28 eyesp. 350
Puneet Jain, Paul T Finger
DOI:10.4103/ijo.IJO_1253_18  
Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices. Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used. Results: The mean (±SD) age was 58.3 ± 12.5 years (median 57.5, range 37–81). Patients were 57.7% male and 27% hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16–20/40). Intraocular pressures were 16 mmHg (10–23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75%. A single varix was seen in 64% and 36% appeared multiple. Varix orientation was radial in 57% and circumferential in 21%. Combined radial and circumferential varix orientation was noted in 18%. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36%. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3–129), 96.4% eyes were stable and one (3.6%) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred. Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.
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Profile of childhood glaucoma at a tertiary center in South Indiap. 358
Sirisha Senthil, Swathi Badakere, Jonnadula Ganesh, Rashmi Krishnamurthy, Siddharth Dikshit, Nikhil Choudhari, Chandrasekhar Garudadri, Anil K Mandal
DOI:10.4103/ijo.IJO_786_18  
Purpose: To describe the prevalence of various types of childhood glaucomas, their clinical features and treatment methods. Methods:We prospectively included consecutive children with glaucoma presenting to glaucoma clinic for the first time between March 2013 and May 2014. We classified childhood glaucomas as per the classification proposed by Congenital Glaucoma Research Network. Results:Of the 275 children (449 eyes) with glaucoma during this period, primary glaucomas constituted 56% (n = 252 eyes of 145 children), including 169 eyes (37.64%) of 97 children with primary congenital glaucoma (PCG), 16 eyes (3.56%) of 10 children with infantile glaucoma, and 67 eyes (14.9%) of 38 children with juvenile open angle glaucoma. Among these, 85% (214 eyes of 107 children) had bilateral involvement. Secondary glaucomas constituted 44%; they were glaucoma associated with ocular anomalies 18% (n = 80 eyes), glaucoma associated with acquired conditions (steroid induced and traumatic glaucoma) 14% (n = 61 eyes), glaucoma following congenital cataract surgery 7.6% (n = 34 eyes), and glaucoma associated with systemic or syndromic conditions 5% (n = 22 eyes). In primary glaucomas, boys and girls were equally affected (1:1), and more boys (3.8:1) had acquired glaucomas. Close to 80% PCG eyes were managed surgically with combined trabeculotomy and trabeculectomy (CTT). Majority of secondary glaucomas were managed medically. Conclusion: In our cohort, PCG was the most common childhood glaucoma and CTT was the most common surgery performed in these eyes. Steroid-induced and traumatic glaucomas were the most common acquired glaucomas; appropriate measures should be taken to avert these preventable glaucomas in children.
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Surgical outcomes of phacoemulsification/goniosynechialysis with and without endocyclophotocoagulation in patients with chronic angle closure glaucomap. 366
Ketaki Panse, Crystal Le, Margaret Hubbell, Ramesh S Ayyala
DOI:10.4103/ijo.IJO_895_18  
Purpose: To compare surgical outcomes of patients after phacoemulsification with goniosynechialysis (phaco/GSL) versus phaco with GSL and endocyclophotocoagulation (phaco/GSL/ECP) in patients with chronic angle closure glaucoma (CACG) through 12-month follow-up. Methods: A retrospective, nonrandomized, comparative case series was performed. Patients with CACG who underwent phaco in combination with either GSL alone (group 1) or GSL with ECP with intracameral injection of kenalog (group 2) from 2011 to 2018 were included. Group 1 included 6 eyes of 6 patients and group 2 included 11 eyes of 10 patients. All surgeries were performed by a single surgeon (RSA). Primary outcome measures included changes in intraocular pressure (IOP), visual acuity (VA), failure based on IOP (>18 or <6 mmHg at 1 year), and secondary operative procedures and complication rates. Data were analyzed using a paired two-tailed T-test. Results: The mean preoperative IOP decreased from 23.5 ± 11.2 to 14.2 ± 2.4 mmHg (P < 0.0073) in group 1 and 24.4 ± 8.2 to 14.5 ± 2.7 mmHg (P < 0.0001) in group 2. The mean % IOP reduction was 33.7% in group 1 and 34.2% in group 2. The mean improvement in VA (logMAR units) was 0.24 (P = 0.085) in group 1 and 0.13 (P = 0.657) in group 2. The mean number of topical meds decreased from 2.50 ± 1.76 to 1.80 ± 1.64 in group 1 (P = 0.513) and from 2.82 ± 1.25 to 1.17 ± 0.98 in group 2 (P = 0.014). Conclusion: Phaco/GSL and phaco/GSL/ECP both achieve a significant reduction in IOP without the complications associated with traditional glaucoma filtration surgeries.
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Pachydrusen in Indian population: A hospital-based study Highly accessed articlep. 371
Sumit Randhir Singh, Avadhesh Oli, Sashwanthi Mohan, Abhilash Goud, Mohammed A Rasheed, Kiran K Vupparaboina, Jay K Chhablani
DOI:10.4103/ijo.IJO_1173_18  
Purpose: To report the prevalence of pachydrusen in Indian population and their characteristics in relation to subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI) in comparison to eyes with soft drusen and subretinal drusenoid deposits (SDD) in age-related macular degeneration (AMD). Methods: The study was a retrospective, cross-sectional study involving patients with a diagnosis of dry AMD in at least one eye. The diagnosis of soft drusen, SDD, and pachydrusen was made on the basis of color fundus photograph and optical coherence tomography (OCT). SFCT and CVI was calculated and compared among the different subtypes of drusen. Results: A total of 169 eyes (143 dry and 26 wet AMD) of 85 patients with a mean age of 67.67 ± 9.57 years were included. In eyes with dry AMD, pachydrusen were seen in 12 eyes (8.4%) with a mean (±SD) SFCT of 289.66 ± 91.01 μ. The difference in SFCT was statistically significant (P = 0.001) using analysis of variance (ANOVA) test. The eyes with pachydrusen had significantly thickened choroid compared to the eyes with SDD (30 eyes; 21.0%) or combination of soft drusen and SDD (29 eyes; 20.3%) but not soft drusen (72 eyes; 50.3%). The difference of CVI in different subgroups was significant (P = 0.03). One eye in wet AMD group had concurrent pachydrusen. Comparison of SFCT and CVI in wet AMD and fellow dry AMD eyes were not significant. Conclusion: In Indian eyes with dry AMD, prevalence of pachydrusen (8.4%) is slightly lower compared to western literature (11.7%) and is associated with thicker choroid and higher CVI.
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Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitisp. 376
Puja Maitra, Dhivya Ashok Kumar, Amar Agarwal
DOI:10.4103/ijo.IJO_650_18  
Purpose: To study the epiretinal membrane (ERM) profile on the spectral-domain optical coherence tomography (SDOCT) in eyes with uveitis. Methods: In this prospective observational study, macula of uveitic eyes were evaluated by SDOCT (Cirrus, model 5000) for ERM. ERM was quantified (in microns) and were followed up along with the best-corrected visual acuity (BCVA) and treatment profile for 1 year. ERM morphology (focal, global, or mixed) and characteristics (thickness at fovea, maximum thickness, and location of maximum thickness in relation to fovea) were documented. Changes in altered foveal contour, cystoid macular edema (CME), and central foveal thickness were also noted. BCVA was noted when the inflammation subsided and it was correlated to specific ERM characteristics. SDOCT characteristics were compared in three treatment groups (no oral steroids, oral steroids with, and without immunomodulators). Results: Thirty-four eyes of 25 patients were evaluated. Mean logMAR BCVA decreased from 0.25 to 0.35 (P = 0.005). Foveal involvement with ERM (P = 0.011), lost foveal contour (P = 0.043), and ellipsoid layer disruption (P = 0.017) were associated significantly with reduced BCVA. Focal attachment of ERM was more commonly associated with CME (P = 0.03). Median ERM thickness showed significant increase (P < 0.001). Significant ERM progression from parafoveal to foveal (P = 0.02), significant progression of the thickest area of ERM closer to fovea (P = 0.0006) indicated a strong tendency of foveal involvement and this was correlated with worse BCVA (P= 0.009, r = −0.44) Oral steroids/immunomodulators showed no significant benefit on ERM progression. Conclusion: ERM progression in uveitis has a tendency to involve the fovea and is associated with significant vision loss, particularly in foveal ERM, focal attachment, and IS-OS disruption. Oral steroids and immunomodulators have no role in halting progression.
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Oral versus single intravenous bolus dose antibiotic prophylaxis against postoperative surgical site infection in external dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction – A randomized studyp. 382
Jenil Sheth, Suryasnata Rath, Devjyoti Tripathy
DOI:10.4103/ijo.IJO_616_18  
Purpose: To compare the efficacy of a single perioperative bolus dose of intravenous antibiotic versus postoperative oral antibiotic prophylaxis for prevention of surgical site infection (SSI) in external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (PANDO). Methods: This was a prospective randomized controlled study with a noninferiority design. Patients undergoing external DCR surgery were randomized into two groups A and B. Patients in group A received a single bolus dose of intravenous cefazolin 1 g at surgery, whereas those in group B received oral cephalexin 500 mg postoperatively twice a day for 5 days. Allocation concealment was ensured by sequentially numbered opaque sealed envelopes (SNOSEs). Both groups were advised identical postoperative local wound care regimens. Any clinical evidence of SSI at 4 weeks of follow-up in either group was the main outcome measure. Results: In all, 338 patients randomized into two groups of 169 patients each participated in this study. At follow-up of 4 weeks, only one patient in group B developed postoperative SSI. None in group A developed postoperative SSI. Other potential risk factors for postoperative SSI were also analyzed by univariate and multivariate analyses but none achieved statistical significance in either group. Conclusion: Our results demonstrate that a single bolus dose of perioperative intravenous antibiotic offers adequate prophylaxis against postoperative SSI and compares favorably with the more commonly used oral antibiotic prophylaxis in external DCR for PANDO in our population and our practice scenario.
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Prevalence of ocular morbidity among tribal children in Jawadhi hills, southern India: A cross-sectional studyp. 386
KM Mahesh, Deepa John, Anuradha Rose, Padma Paul
DOI:10.4103/ijo.IJO_795_18  
Purpose: Childhood blindness is second to cataract in terms of blind person years; population-based prevalence of ocular morbidity among tribal children has not been studied. We conducted this study to determine the prevalence of ocular morbidity in tribal children age 15 years or younger in Jawadhi hills, southern India. Methods: A population-based cross-sectional study was conducted in four tribal villages where all children below 15 years of age were invited to participate in the study. After appropriate consent/assent, an optometrist assessed uncorrected vision refraction and best-corrected visual acuity using suitable techniques. A comprehensive ophthalmic examination was also done by an ophthalmologist to determine the presence of ocular morbidity. Children requiring cycloplegic refraction or further treatment were referred to the base hospital. Results: Among 260 children examined, the prevalence of ocular morbidity was 10.8% [95% confidence interval (CI): 6.3–13.7]. Vitamin A deficiency (VAD) was the foremost morbidity: 4.6% (95% CI 1.6–6.3) followed by refractive error (2.7%). Three (10.7%) children had more than one ocular morbidity. Nearly 1 in 10 tribal children suffer from ocular morbidity and 1 in 57 had low vision. Conclusion: VAD is a public health problem in this tribal region which requires immediate intervention with prophylaxis and treatment. Uncorrected refractive errors in school-age children also need to be attended.
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PHOTO ESSAYTop

Wire lid retractor – A new use of wire eye speculump. 391
Ankita Aishwarya, Prabha Gupta, Uma S Tiwari
DOI:10.4103/ijo.IJO_1119_18  
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A case of posterior ciliary artery occlusion following pneumatic reposition of the Descemet membranep. 392
Alok C Sen, Gaurav M Kohli, Ashish Mitra, Pawan P Malhotra
DOI:10.4103/ijo.IJO_1273_18  
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Double trouble: Microspherophakia with Axenfeld-Rieger anomalyp. 394
Jyoti Shakrawal, Harathy Selvan, Arpit Sharma, Dewang Angmo
DOI:10.4103/ijo.IJO_978_18  
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Intracameral migration of collagen matrix implantp. 395
Jitender Phogat, Manisha Rathi, Sumit Sachdeva, Brijesh Takkar, Sumeet Khanduja
DOI:10.4103/ijo.IJO_754_18  
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Ocular albinism with bilateral ocular coloboma – A rare associationp. 397
Vishal Raval, Srinivas Rao, Taraprasad Das
DOI:10.4103/ijo.IJO_1182_18  
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Presumed tubercular choroidal nodule following adalimumab therapy for juvenile idiopathic arthritisp. 399
Harshit Vaidya, Parthopratim Dutta Majumder, Jyotirmay Biswas
DOI:10.4103/ijo.IJO_1149_18  
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Juxtapapillary Focal Choroidal Excavationp. 400
Pulak Agarwal, Shayeri Roy, Shorya Vardhan Azad, Vinod Kumar
DOI:10.4103/ijo.IJO_1299_18  
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Juxtapillary choroidal excavation with polypoidal choroidal vasculopathy: An unusual associationp. 401
Maitreyi Chowdhury, Pukhraj Rishi
DOI:10.4103/ijo.IJO_1307_18  
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Multimodal imaging characteristics of acute macular neuroretinopathyp. 403
Kumar Saurabh, Rupak Roy, Dhaivat Shah, Sugandha Goel, Samarth Mishra, Deepak Senger
DOI:10.4103/ijo.IJO_969_18  
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External ophthalmomyiasis due to Oestrus ovisp. 404
Parthopratim Dutta Majumder, Pankaj Jeswani, Narayanaperumal Jeyathilakan, Jyotirmay Biswas
DOI:10.4103/ijo.IJO_1391_18  
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OPHTHALMIC IMAGESTop

Bilateral spontaneous lens capsule rupture in Alport's syndromep. 406
Monica Lohchab, Ritu Arora
DOI:10.4103/ijo.IJO_1089_18  
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Ultra-wide field imaging of giant circumferential chorioretinal fold following post-operative hypotonyp. 407
Brijesh Takkar, Sudarshan Khokhar, Divya Agarwal, Pradeep Venkatesh
DOI:10.4103/ijo.IJO_1483_18  
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Multicolor imaging in neovascularization of discp. 408
Sugandha Goel, Barun Garg, Ankit V Shah, Samarth Mishra, Kumar Saurabh, Rupak Roy
DOI:10.4103/ijo.IJO_1522_18  
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CASE REPORTSTop

Successful treatment of conjunctival lymphangiectasia accompanied by corneal dellen using a high-frequency radiowave electrosurgical devicep. 409
Shin-Myeong Choi, Kyung Hyun Jin, Tae Gi Kim
DOI:10.4103/ijo.IJO_1109_18  
A 62-year-old man presented with a 1-month history of right eye pain unresponsive to artificial tears and topical steroids. At presentation, bullous yellowish fluid collection was noted in the nasal conjunctiva. Corneal thinning and opacity were observed at the 3 o'clock position of the cornea. High-frequency radiowave ablation and biopsy were performed at the affected area. Conjunctival lymphangiectasia was confirmed by excisional biopsy. An improvement in the degree of corneal dellen and chemosis was evident 1 week after ablation. Use of a high-frequency radiowave electrosurgical device may be a simple and effective treatment option for symptomatic conjunctival lymphangiectasia.
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Utility of multicolor optic disc photography in evaluation of glaucomatous optic disc in myopic eyes: A novel approachp. 412
Tamonash Basu, Barun Garg, Samarth Mishra, Sugandha Goel, Rupak Roy, Kumar Saurabh
DOI:10.4103/ijo.IJO_1385_18  
Interpretation of optic disc cupping and neuroretinal rim is challenging in myopic eyes because of large, shallow, and tilted disc, myopic crescent, and macular degeneration. Color and red-free optic disc photographs do not reveal the cup/disc ratio often in myopic eyes. We report characteristics of multicolor optic disc photography in three myopic eyes. All eyes underwent multicolor imaging Spectralis SDOCT system (Heidelberg Engineering, Germany). Owing to use of three laser lights in a confocal design, multicolor optic disc photography was able to delineate the neuroretinal rim and optic cup more clearly than color and red-free optic disc photographs.
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Curious case of retrolental mass: An unusual tele-screening artifactp. 415
Ratnesh Ranjan, Parag K Shah, Venkatapathy Narendran
DOI:10.4103/ijo.IJO_1318_18  
We are presenting a case of premature baby born at 32 weeks of gestation who was under regular follow-up with our retinopathy of prematurity (ROP) tele-screening team. During final follow-up at 41 weeks of postconceptional age, anterior segment image captured with RetCam showed a retrolental mass lesion in right eye resembling retinoblastoma or medulloepithelioma. The baby was referred to our base hospital for further evaluation, where a detailed examination showed no retrolental lesion or intraocular mass. This is the first case where imaging artifact, despite use of high-quality imaging system by well-trained staff, during ROP tele-screening appeared like a retrolental mass lesion and resulted in false-positive referral.
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OCT angiography features of paracentral acute middle maculopathyp. 417
Amravi Shah, Pukhraj Rishi, Charanya Chendilnathan, Soni Kumari
DOI:10.4103/ijo.IJO_1249_18  
Paracentral acute middle maculopathy (PAMM) refers to retinal lesions with changes in the inner nuclear layer on spectral domain optical coherence tomography (OCT). PAMM is associated with retinal vascular pathology involving the deep capillary plexus. We report two cases of PAMM in Indian subjects using multimodal imaging highlighting the OCT angiography (OCTA) findings. The first case is of a middle-aged female with a paracentral scotoma with SS-OCT (swept-source optical coherence tomography) and OCTA findings suggestive of "chronic" PAMM. The second case presented with sudden decreased vision, and multiple creamy white lesions suggestive of "acute" PAMM, imaging features depicting a possible venular obstruction. These cases demonstrate the importance of considering PAMM as a differential diagnosis in patient presenting with nonspecific visual complains and apparently normal ophthalmic examination. The recognition of PAMM should prompt an appropriate evaluation and investigation.
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Vitreous hemorrhage as the presenting feature of peripheral exudative hemorrhagic chorioretinopathy in Indian eyesp. 419
Neha Goel
DOI:10.4103/ijo.IJO_714_18  
Five Indian patients presenting with unilateral vitreous hemorrhage (VH) underwent pars plana vitrectomy (PPV) and were found to have lesions suggestive of peripheral exudative hemorrhagic chorioretinopathy (PEHCR). All eyes had extensive sub-retinal hemorrhage; three also showed an elevated mass lesion. The temporal retina anterior to the equator was the most commonly affected site. Exudative manifestations were absent in all. No recurrences occurred over a mean follow-up of 17.5 months. Although PEHCR is reported to be rare in Asians, this series demonstrates that it can present as VH in Indians as well. Unless the macula has irreversible damage, a favorable outcome can be obtained with PPV alone.
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Staphylococcus lugdunensis endophthalmitis following dexamethasone intravitreal implant Highly accessed articlep. 424
Silvia Olivia Salceanu, Dina Hamada, Ramona Gabriela Ursu, Ahmed Abdelwahab Saad
DOI:10.4103/ijo.IJO_720_18  
We present a unique case of endophthalmitis with Staphylococcus lugdunensis following dexamethasone intravitreal implant for branch retinal vein occlusion associated with cystoid macular edema. Patient did not show favorable clinical response after vitrectomy and intravitreal antibiotics; so, we decided to repeat vitrectomy, remove the steroid implant and fill the eye with silicon oil, and repeat intravitreal vancomycin. Vision has improved from hand movements at presentation to counting fingers at 1.5 m after second vitrectomy and final visual acuity 3 months later after silicon oil removal was 6/36.
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Commentary: Endophthalmitis following intravitreal injection of dexamethasone implantp. 426
Ekta Rishi, Pradeep T Manchegowda
DOI:10.4103/ijo.IJO_1809_18  
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Chandelier-assisted scleral buckling in an eye with longstanding inert foreign body with fresh rhegmatogenous retinal detachmentp. 429
Madhu Kumar, Vinaya Kumar Konana, Ashok Kanakamedla, Dilip Kumar, Jayamadhury Gudimetla
DOI:10.4103/ijo.IJO_1361_18  
Intraocular foreign bodies (IOFBs) present in varied manners which in turn necessitate their removal in majority of the cases. A stone foreign body can remain inert inside the eye for years. Retinal detachment in eyes following penetrating trauma with an IOFB is common, but a combination of fresh rhegmatogenous retinal detachment in an eye with a longstanding inert stone foreign body is extremely rare. We report a case of a 50-year-old male with rhegmatogenous retinal detachment with a longstanding stone foreign body, where we managed such a scenario with a chandelier-assisted, sutureless, scleral buckle without removing the stone foreign body.
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Commentary: Revival of scleral buckling technique with Chandelier illuminationp. 431
Ekta Rishi, Pradeep T Manchegowda
DOI:10.4103/ijo.IJO_1964_18  
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Primary ocular presentation of tuberous sclerosis – A case reportp. 433
Nancy M Rajasekaran, Saban Horo, Thomas Kuriakose
DOI:10.4103/ijo.IJO_925_18  
A 25-year-old man presented with decreased vision in the left eye with hypopigmented elevated subretinal lesion over the optic disk with abnormal vasculature, subretinal and retinal hemorrhages, and fluid in the macula. An area of high spike over the disk with corresponding orbital shadowing was seen on B scan ultrasonography. Fundus fluorescein angiography revealed abnormal vasculature. Systemic examination revealed facial angiofibroma, ashleaf spot, and dental pits with multiple cortical tubers on CT brain. Intravitreal injection of bevacizumab led to visual and tomographic improvement. Abnormal retinal vascularization and exudation in young individuals may be a presenting feature in tuberous sclerosis.
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Retinoblastoma discordance in families with twinsp. 436
Aloysius Abraham, Kannan Thirumalairaj, Namrata Gaikwad, Veerappan Muthukkaruppan, Alla G Reddy, Kumarasamy Thangaraj, Usha Kim, Ayyasamy Vanniarajan
DOI:10.4103/ijo.IJO_1245_18  
Retinoblastoma has an increased inheritance risk of germline RB1 mutations in offspring and siblings, especially twins. Three families, each having one retinoblastoma-affected twin, were selected for genetic analysis and DNA profiling. Germline RB1 mutations were found in all probands. DNA profiling carried on similar-looking twins of families I and II, proved them to be fraternal. This study demonstrates the importance of genetic analysis of RB1 gene for risk prediction in retinoblastoma families. It also emphasizes that DNA profiling is a mandate for genetic screening of families with twins, thus adding a new dimension in counseling of retinoblastoma.
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LETTERS TO THE EDITORTop

Are ophthalmic conferences losing their relevance and how to reverse this trend?p. 440
Suresh K Pandey, Vidushi Sharma
DOI:10.4103/ijo.IJO_1898_18  
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Unilateral corneal edema in young: A diagnostic dilemmap. 442
Manisha Singh, Neha Kapoor, Virender S Sangwan
DOI:10.4103/ijo.IJO_1895_18  
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Response to comment on 'Unilateral corneal edema in young: A diagnostic dilemma'p. 442
Dewang Angmo, Harathy Selvan, Aswini K Behera, Pramod K Suman
DOI:10.4103/ijo.IJO_2079_18  
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Indian Journal of Ophthalmology – The journey so far
Santosh G Honavar

Indian Journal of Ophthalmology 2019 67(3):317-320



Current management options in primary angle closure disease
Ramasamy Krishnadas

Indian Journal of Ophthalmology 2019 67(3):321-323



To prick or to poke?
Md. Shahid Alam, Vathsalya Vijay

Indian Journal of Ophthalmology 2019 67(3):324-324



Enigma of serpiginous choroiditis
Parthopratim Dutta Majumder, Jyotirmay Biswas, Amod Gupta

Indian Journal of Ophthalmology 2019 67(3):325-333

Serpiginous choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as serpiginous-like choroiditis (SLC) and multifocal serpiginoid choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC. 


Commentary: Serpiginous choroiditis—so near yet so far
Soumyava Basu

Indian Journal of Ophthalmology 2019 67(3):333-334



Practice pattern of cataract surgeons when operating on seropositive patients
Parveen Rewri, Madhavi Sharma, Aprajita Lohan, Deepika Singh, Vibha Yadav, Aparna Singhal

Indian Journal of Ophthalmology 2019 67(3):335-339

Purpose: The aim of this study is to know practice pattern of cataract surgeons when operating on patients, positive for blood-borne viral infections (BBVIs), namely, hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. We also studied their awareness, knowledge, and attitude toward universal precautions and guidelines. Methods: The telephonic survey enrolled practicing cataract surgeons, who were interviewed to record responses pertaining to their practice using an open-ended questionnaire. We studied statistical significance of difference of frequency of prick injuries in topical versus peribulbar anesthesia, and phacoemulsification versus manual small incision cataract surgery by employing Chi-square test. Significance of proportion was calculated using z-test. For all statistical calculations, significance level was set at 0.05&#37;. Results: Of 623 ophthalmologists contacted, responses of 479 (79&#37;) ophthalmologists were analyzed. Maximum participants were in private practice (48&#37;). During whole practicing carrier, 313 (65&#37;; 95&#37; confidence interval [CI]: 61&#8211;70) participants admitted having suffered injury with needle or sharp instruments; of these, 204 (65&#37;; 95&#37; CI: 60&#8211;70) participants did not report their injury. Wearing &#8220;double gloves&#8221; during cataract surgery was the most common barrier adopted by participants. Conclusion: We found high prevalence of occupational-related sharp injuries among ophthalmologists in this survey. Majority of them were aware of universal precautions, but adherence to postexposure prophylaxis was lacking. 


Commentary on: Practice pattern of cataract surgeons when operating on seropositive patients
Mahipal Sachdev, Rashmi Deshmukh

Indian Journal of Ophthalmology 2019 67(3):339-340



Three-dimensional digital visualization of phacoemulsification and intraocular lens implantation
Zhuyun Qian, Hongxia Wang, Hua Fan, Dong Lin, Wensheng Li

Indian Journal of Ophthalmology 2019 67(3):341-343

Purpose: To evaluate the feasibility and safety of heads-up three-dimensional (3D) vision system for phacoemulsification and intraocular lens (IOL) implantation surgery. Methods: In this prospective, randomized controlled study, 20 eyes with age-related cataract received phacoemulsification and IOL implantation and were randomly divided into &#8220;heads-up&#8221; 3D vision group and conventional surgery group. Ocular and surgical parameters such as surgery time, pre and postoperative best-corrected visual acuity (BCVA), and corneal endothelial cells density were recorded and statistically analyzed. Results: The result showed significant postoperative improvement of BCVA in both groups. There was no difference in either mean surgery time or postoperative mean endothelial cell density between the 3D group and the conventional group. No major complication occurred during surgery in either group. Conclusion: The heads-up 3D vision system is suitable and safe for cataract phacoemulsification and IOL implantation. This technique can be of widespread use. 


Confounding sizing in posterior chamber phakic lens selection due to white-to-white measurement bias
Joaquín Fernández, Manuel Rodr&#237;guez-Vallejo, Javier Mart&#237;nez, Ana Tauste, Elisa Hueso, David P Pi&#241;ero

Indian Journal of Ophthalmology 2019 67(3):344-349

Purpose: To assess the agreement in the white-to-white (WTW) measurement with two different devices, the reproducibility and the probability of confusing sizing (PCS) in selecting a different implantable collamer lens (ICL). Study Design: Retrospective observational case series. Methods: Images of 192 eyes were captured with both devices. The WTW was measured automatically (OA) and manually (OM) with the Orbscan and Keratograph (KA and KM) by one examiner who repeated a total of four measures. A second examiner conducted a single manual measure for each device over the same image. The ICL sizing was computed for each measure of WTW and the PCS was calculated as the percentage of cases for which the confronted or repeated measure resulted in a different size of the ICL. The critical WTWs with highest PCS were identified. Results: KM overestimated the WTW versus OM in 0.13 &#177; 0.18 mm (P &#60; 0.001) but not in the automated method comparison, 0.01 &#177; 0.19 mm (P &#61; 0.58). Inter-examiner reproducibility (R) was higher with OM than with KM, and the intra-examiner R decreased with the average of two measures in both cases. The PCS was higher with the increase of mean differences, the limits of agreement (LoAs), and R. WTWs from 11.1 to 11.2 mm, 11.6 to 11.7 mm, and 12.3 to 12.4 mm resulted in higher PCS. Conclusion: The mean difference is not enough to apply conversions between devices and the LoAs and R should be considered. Special attention should be taken for WTWs with higher PCS. 


Iris varix: 10-year experience with 28 eyes
Puneet Jain, Paul T Finger

Indian Journal of Ophthalmology 2019 67(3):350-357

Purpose: The purpose of this study is to describe the clinical characteristics, multimodality imaging findings, and clinical course of iris varices. Methods: Retrospective, noncomparative, observational case series of 28 eyes of 26 patients with iris varices, diagnosed between 2007 and 2017, has been used. Results: The mean (&#177;SD) age was 58.3 &#177; 12.5 years (median 57.5, range 37&#8211;81). Patients were 57.7&#37; male and 27&#37; hypertensive. Varices were bilateral in two patients. The mean and median visual acuities were both 20/20 (range 20/16&#8211;20/40). Intraocular pressures were 16 mmHg (10&#8211;23 mmHg). Secondary glaucoma did not occur. The inferotemporal iris quadrant was affected in 75&#37;. A single varix was seen in 64&#37; and 36&#37; appeared multiple. Varix orientation was radial in 57&#37; and circumferential in 21&#37;. Combined radial and circumferential varix orientation was noted in 18&#37;. One had independent radial and circumferential varices in separate quadrants. A single episcleral sentinel blood vessel directed to the varix was present in 36&#37;. Ultrasound biomicroscopy (UBM) showed a slightly increased mean iris thickness of 0.8 mm and multiple echolucent iris stromal vascular channels. Iris angiography showed no leakage of dye. Managed by observation over a mean follow-up of 37.7 months (range, 3&#8211;129), 96.4&#37; eyes were stable and one (3.6&#37;) regressed. No corectopia, ectropion uveae, hyphema, or metachronous anterior segment benign or malignant tumors occurred. Conclusion: Iris varix is primarily located in the inferotemporal quadrant and not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy. Iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.