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   Table of Contents - Current issue
Coverpage
November 2016
Volume 64 | Issue 11
Page Nos. 793-865

Online since Tuesday, December 13, 2016

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EDITORIAL  

The world is your oyster! Highly accessed article p. 793
Sundaram Natarajan
DOI:10.4103/0301-4738.195589  PMID:27958199
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REVIEW ARTICLE Top

Update on pathology of ocular parasitic disease Highly accessed article p. 794
Dipankar Das, Varsha Ramachandra, Saidul Islam, Harsha Bhattacharjee, Jyotirmay Biswas, Akanksha Koul, Panna Deka, Apurba Deka
DOI:10.4103/0301-4738.195590  PMID:27958200
Parasites are a group of eukaryotic organisms that may be free-living or form a symbiotic or parasitic relationship with the hosts. Consisting of over 800,000 recognized species, parasites may be unicellular (Protozoa) or multicellular (helminths and arthropods). The association of parasites with human population started long before the emergence of civilization. Parasitic zoonotic diseases are prevalent worldwide including India. Appropriate epidemiological data are lacking on existing zoonotic parasitic diseases, and newer diseases are emerging in our scenario. Systemic diseases such as cysticercosis, paragonimiasis, hydatidosis, and toxoplasmosis are fairly common. Acquired Toxoplasma infections are rising in immune-deficient individuals. Amongst the ocular parasitic diseases, various protozoas such as Cystoidea, trematodes, tissue flagellates, sporozoas etc. affect humans in general and eyes in particular, in different parts of the world. These zoonoses seem to be a real health related problem globally. Recent intensification of research throughout the world has led to specialization in biological fields, creating a conducive situation for researchers interested in this subject. The basics of parasitology lie in morphology, pathology, and with recent updates in molecular parasitology, the scope has extended further. The current review is to address the recent update in ophthalmic parasites with special reference to pathology and give a glimpse of further research in this field.
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ORIGINAL ARTICLES Top

Evaluation and correlation of stress scores with blood pressure, endogenous cortisol levels, and homocysteine levels in patients with central serous chorioretinopathy and comparison with age-matched controls p. 803
Abhishek Agarwal, Monika Garg, Nikhil Dixit, Rohini Godara
DOI:10.4103/0301-4738.195591  PMID:27958201
Context: Stress had been associated with the development of central serous chorioretinopathy (CSC). The study was designed to evaluate the effect of stress on other risk factors of CSC such as serum cortisol levels, serum homocysteine levels, and blood pressure (BP) in CSC patients. Aims: To compare stress scores, serum cortisol and serum homocysteine levels, and BP of CSC patients with that of control population and to correlate stress scores of CSC patients with BP, serum cortisol levels, and serum homocysteine levels. Materials and Methods: Stress scores, serum morning and evening cortisol levels, serum homocysteine levels, systolic and diastolic BP of 54 CSC patients were measured and compared with that of 54 age- and sex-related controls using Student's t-test. Stress scores of CSC patients were correlated with systolic and diastolic BP, serum morning and evening cortisol levels and serum homocysteine levels and Pearson correlation coefficient (r) were calculated. Results: Stress scores, serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP were all elevated in CSC patients as compared with age- and sex-related controls (P < 0.05). Stress scores of CSC patients were found to correlate strongly with serum homocysteine levels, serum morning and evening cortisol levels, and systolic and diastolic BP, with r values 0.82, 0.8, 0.8, 0.8, and 0.81, respectively (P < 0.0001). Conclusions: Stress scores were elevated in CSC patients and were strongly correlated with serum homocysteine and cortisol levels and BP.
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Genomic identification of human vaccinia virus keratoconjunctivitis and its importance as a laboratory-acquired infection p. 806
Zahra Movahedi Motlagh, Azam Mokhtari, Mohammadreza Mahzounieh
DOI:10.4103/0301-4738.195592  PMID:27958202
Context: Vaccinia virus (VACV) is a member of orthopoxvirus genus of the family Poxviridae. VACVs are enveloped, double-stranded DNA viruses. Several species of this family, for example, molluscum contagiosum, smallpox, deerpox, horsepox, rabbitpox, and VACVs may cause conjunctivitis. Aims: Given the high incidence of keratoconjunctivitis in Iran (approximately 3.6%-53.9%) and insufficient clinical diagnostic measures, laboratory tests for detection of its causes and determination of accurate keratoconjunctivitis/conjunctivitis prevalence due to different pathogens are essential. Settings and Design: In this research, conjunctival samples collected from 100 patients with keratoconjunctivitis signs were referred to an eye hospital of Iran. Subjects and Methods: After DNA extraction, polymerase chain reaction (PCR) was carried out for detection of VACV. PCR-positive products were further subjected to DNA sequencing. Statistical Analysis Used: The results were analyzed using Chi-square test. Results: In this study, 28% of the samples were positive and a statistically significant relationship obtained between working in medical or research laboratories and VACV prevalence (P < 0.05). Conclusions: This study showed a high rate of VACV keratoconjunctivitis, and therefore, further studies for its prevention and control are necessary.
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A previously unidentified deletion in G protein-coupled receptor 143 causing X-linked congenital nystagmus in a Chinese family p. 813
Jing Liu, Yanlei Jia, Lejin Wang, Juan Bu
DOI:10.4103/0301-4738.195593  PMID:27958203
Background: Congenital nystagmus (CN) is characterized by conjugated, spontaneous, and involuntary ocular oscillations. It is an inherited disease and the most common inheritance pattern is X-linked CN. In this study, our aim is to identify the disease-causing mutation in a large sixth-generation Chinese family with X-linked CN. Methods: It has been reported that mutations in four-point-one, ezrin, radixin, moesin domain-containing 7 gene (FRMD7) and G protein-coupled receptor 143 gene (GPR143) account for the majority patients of X-linked nystagmus. We collected 8 ml blood samples from members of a large sixth-generation pedigree with X-linked CN and 100 normal controls. FRMD7 and GPR143 were scanned by polymerase chain reaction (PCR)-based DNA sequencing assays, and multiplex PCR assays were applied to detect deletions. Results: We identified a previously unreported deletion covering 7 exons in GPR143 in a Chinese family. The heterozygous deletion from exon 3 to exon 9 of GPR143 was detected in all affected males in the family, while it was not detected in other unaffected relatives or 100 normal controls. Conclusions: This is the first report of molecular characterization in GPR143 gene in the CN family. Our results expand the spectrum of GPR143 mutations causing CN and further confirm the role of GPR143 in the pathogenesis of CN.
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Results and safety profile of trainee cataract surgeons in a community setting in East Africa p. 818
Nikolaos Mavrakanas, Kazim A Dhalla, Jerry Jecha, Imani Kapesa, Capucine Odouard, Ian Murdoch
DOI:10.4103/0301-4738.195594  PMID:27958204
Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. Results: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). Conclusion: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications.
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Revision of trabeculectomy filtering blebs with mitomycin C: Long term results p. 822
Maria Tulidowicz-Bielak, Ewa Kosior-Jarecka, Tomasz Żarnowski
DOI:10.4103/0301-4738.195596  PMID:27958205
Aim: The aim of the study is to assess the outcomes of transconjunctival mitomycin C (MMC)-augmented revision in eyes with failed trabeculectomy. Materials and Methods: This is a retrospective, noncomparative case series. One hundred and twenty-one eyes of 113 consecutive glaucoma patients with previously failed trabeculectomy who underwent transconjunctival revision with at least 12 months of follow-up were initially included in the study. The success was determined on the basis of intraocular pressure (IOP) alone. The main outcome measures were IOP, best-corrected distance visual acuity, complications, bleb appearance, lens status, visual field progression, and time between primary trabeculectomy and MMC revision. The main purpose of the study was to determine the efficacy of a single MMC-augmented needle revision. Results: Mean follow-up was 2.3 years. Twelve months after revision, IOP had declined from 26.1 ± 8.4 mmHg to 14.1 ± 4.8 mmHg (P < 0.05) and remained 16.0 ± 5.6 mmHg at 24 months, 15.7 ± 5.8 mmHg at 48 months, and 15.2 ± 4.0 mmHg at 60 months. Complete success was achieved in 53% of cases, 84% achieved qualified success, and 16% were classified as failures 12 months after revision. Early complications developed in 45 of the initial 121 eyes (37.2%). Conclusions: Transconjunctival MMC-augmented revision appears to be a safe and useful tool in reducing IOP and re-establishing filtration after trabeculectomy failure. This simple procedure has a high rate of success and helps avoid other surgical interventions which are more destructive for the conjunctiva.
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Pearl necklace sign in diabetic macular edema: Evaluation and significance p. 829
Kshirasagar Ajay, Fiona Mason, Bipin Gonglore, Ajay Bhatnagar
DOI:10.4103/0301-4738.195597  PMID:27958206
Purpose: (1) The purpose of this study was to describe significance and prevalence of the newly reported pearl necklace spectral domain optical coherence tomography (SDOCT) sign, in diabetic macular edema (DMO), (2) to track the course of this sign over a period of at least 10 months. Materials and Methods: The pearl necklace SDOCT sign refers to hyperreflective dots in a contiguous ring around the inner wall of cystoid spaces in the retina, recently described for the first time in 21 eyes with chronic exudative maculopathy. A retrospective analysis was performed of SDOCT images of all patients presenting to the DMO referral clinic of a tertiary eye care center, over a period of 24 months. Images of patients displaying this sign were sequentially analyzed for at least 10 months to track the course of the sign. Results: Thirty-five eyes of 267 patients (13.1%) were found to display the pearl necklace sign. Twenty-eight eyes responded to intravitreal ranibizumab treatment with resolution of edema. In 21 eyes, the dots coalesced to form a clump, visible in the infrared fundus photograph as hard exudates; in seven eyes, dots disappeared without leaving visible exudates. In three eyes, the sign was seen in subfoveal cystoid spaces, with subsequent development of hard exudates, and drop in visual acuity of 20 letters or more. Conclusion: Pearl necklace SDOCT sign is not infrequent in DMO. This sign is a precursor to hard exudates in the majority of cases. If this sign is seen subfoveally, drop in visual acuity can be expected, despite treatment.
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Cataract surgery in mobile eye surgical unit: Safe and viable alternative p. 835
Rajesh Pioneer Sangameswaran, Gajendra Kumar Verma, Narayanan Raghavan, Jayaraj Joseph, Mohanasankar Sivaprakasam
DOI:10.4103/0301-4738.195599  PMID:27958207
Aim: The aim of this study was to evaluate the utility and safety of a mobile eye surgical unit (MESU) in providing quality cataract surgery for the indigent rural population with poor access to quality eye care. Materials and Methods: Two buses connected by a vestibule were built to meet the requirements for a self-sufficient operation theater (OT). In every camp, safe transportation of units, good alignment of buses, safe water, and maintenance of sterile environment were achieved with optimal utilization of OT. Results: Two thousand and twenty-one patients in 21 remote locations underwent cataract surgery in MESU between 2012 and 2015. Visual outcome was 6/9 or better in 79.3%, posterior capsular rupture in 0.91%, zonulardialysis in 0.3%, aphakia in 0.2%, iridodialysis in 0.2%, and there was no incidence of endophthalmitis. Conclusion: MESU is a safe alternative in combating preventable blindness due to cataract in far-off villages and tribal areas by providing quality eye care at the patient's doorstep. This model has a great potential for duplication in other parts of India.
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PHOTO ESSAY Top

Fluorescein angiography of subretinal neovascular membrane in parafoveal telangiectasia type II demonstrating retino-retinal, retino-subretinal anastomosis p. 840
Bharathi Megur, Deepak Megur, Sandeep Reddy
DOI:10.4103/0301-4738.195600  PMID:27958208
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BRIEF COMMUNICATIONS Top

Glial heterotopia in an adult: A rare orbital mass p. 843
Divya Dabir Sundaresh, SR Mangala Gouri
DOI:10.4103/0301-4738.195602  PMID:27958209
Heterotopic glial tissue is very rare in the orbit. Our case was an adult, which is unique since most cases reported in literature involve children. We describe a case of a 60-year-old man who presented with an orbital mass, which histopathologically revealed heterotopic glial tissue.
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Endoillumination (chandelier) assisted scleral buckling for a complex case of retinal detachment p. 845
Shreyas Temkar, Brijesh Takkar, Shorya Vardhan Azad, Pradeep Venkatesh
DOI:10.4103/0301-4738.195603  PMID:27958210
Endoilluminator-assisted scleral buckling combines the advantages of scleral buckling for its external approach and pars plana vitrectomy for its better visual visualization in the management of retinal detachment (RD). It has recently been proven to be safe and efficacious in simple cases. This report discusses successful management of a complex case of RD in a patient with the single functioning eye, where vitrectomy was expected to have a complicated course.
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Toric multifocal intraocular lens implantation in a case of bilateral anterior and posterior lenticonus in Alport syndrome p. 847
Jeevan S Ladi, Nitant A Shah
DOI:10.4103/0301-4738.195606  PMID:27958211
We report the first case of toric multifocal intraocular lens (IOL) implantation in both the eyes of a young patient of Alport syndrome with anterior and posterior lenticonus with a successful outcome. An 18-year-old female patient presented with progressively blurred vision in both eyes since 4-5 years not improving with glasses. Refraction showed high myopia with astigmatism; however, the vision did not improve beyond 6/60 with glasses correction. Clinical examination on slit lamp showed anterior and posterior lenticonus bilaterally with a classical oil droplet appearance. We performed clear lens extraction by phacoemulsification with toric multifocal IOL implantation in both eyes. Postoperatively, the patient achieved an excellent refractive outcome with the unaided vision of 6/9, N6 in both eyes.
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Association of bilateral, multiple presumed retinal astrocytic proliferations with combined hamartoma of retina and retinal pigment epithelium in a 9-year-old male child with neurofibromatosis type 2 p. 850
Pukhraj Rishi, Raj Shri Hirawat, Aditya Verma
DOI:10.4103/0301-4738.195609  PMID:27958212
Neurofibromatosis type 2 (NF-2) is characterized by multifocal proliferation of neural crest-derived cells. The characteristics finding of NF-2 is bilateral vestibular schwannomas. Combined hamartoma of retina and retinal epithelium (CHRRPE) is another associated finding. A 9 year-old-male child presented with left eye decreased vision for 3 months. Visual acuity was 0.0 and 0.8 LogMAR in the right and left eye, respectively. Left fundus showed an elevated, pigmented lesion with surface wrinkling and vascular tortuosity suggestive of CHRRPE with multiple presumed retinal astrocytic proliferations in mid-periphery. He had multiple café-au-lait spots. Optical coherence tomography confirmed clinical findings. Magnetic resonance imaging brain showed bilateral acoustic neuroma. Recognition of this rare finding as presenting feature of NF-2 can lead to earlier diagnosis which is vital to appropriate surveillance and possible surgical intervention. It is recommended that children with CHRRPE be screened for NF-2.
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Opsoclonus myoclonus ataxia syndrome due to falciparum malaria in two Indian children p. 852
Kallol Bose, Sudip Saha, Md Rahiul Islam, Chayan Chakraborty, Mustakim Laskar
DOI:10.4103/0301-4738.195611  PMID:27958213
Opsoclonus-myoclonus ataxia (OMA) syndrome is rare in children, mostly caused by neuroblastoma. Here, we present two very rare cases presenting with OMA due to falciparum malaria. Both of them responded to a high dose of adrenocorticotrophin hormone and intravenous immunoglobulin without recurrence and complication.
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The "correct shake" for "handshake" in glued intrascleral fixation of intraocular lens p. 854
Priya Narang, Amar Agarwal
DOI:10.4103/0301-4738.195613  PMID:27958214
We hereby describe the correct method to perform a "handshake technique" and easy transfer of haptics from one hand to another for glued intrascleral fixation of an intraocular lens (glued IOL). The procedure was implemented in 57 cases that necessitated the application of performing a glued IOL procedure and it resulted in an appropriate and easy externalization of haptic in all the cases. The surgeons' positioning with reference to the scleral flap is an essential component and the surgeon should always be positioned perpendicular to the plane of scleral flaps and the plane of haptic maneuver. The surgeons who intend to perform glued IOL should adopt this technical point.
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Congenital keratoglobus with blue sclera in two siblings with overlapping Marshall/Stickler phenotype p. 856
Serhat Imamoglu, Vedat Kaya, Ebru Yalin Imamoglu, Kemran Gok
DOI:10.4103/0301-4738.195615  PMID:27958215
We aimed to describe congenital keratoglobus with blue sclera in two siblings with overlapping Marshall/Stickler phenotype. Two sisters (ages four and six) with bilateral high astigmatism were evaluated by slit-lamp microscopy. Corneal topography and pachymetry maps were also obtained. Slit-lamp examination revealed that both corneas were globular in shape with peripheral corneal thinning. Pachymetry maps showed diffuse corneal thinning. Two siblings had in common the features of keratoglobus, blue sclera, atypical face, hearing loss, and hypermobile joints. We tentatively diagnosed the sisters as having an overlapping Marshall-Stickler phenotype based on clinical and radiological findings. Marshall-Stickler syndrome may exist in the differential diagnosis of keratoglobus with blue sclera.
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LETTERS TO THE EDITOR Top

Adaptive optics study of photoreceptors layer damage from presumed sun exposure: A case report p. 860
Giuseppe Lo Giudice, Anton Giulio Catania, Alessandro Galan
DOI:10.4103/0301-4738.195619  PMID:27958216
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Decompression retinopathy after intravitreal bevacizumab and anterior chamber paracentesis in a patient with neovascular glaucoma p. 861
Eung Suk Kim, Seung-Young Yu, Sang Beom Han, Moosang Kim
DOI:10.4103/0301-4738.195620  PMID:27958217
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Comments regarding "A case of perforating injury of eyeball and traumatic cataract caused by acupuncture" p. 863
Hai Lu, Bo Zhang, Haomin Liu, Chunhong Zhang
DOI:10.4103/0301-4738.195624  PMID:27958218
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Authors' reply p. 864
Han Shuang, Kong Yichun
DOI:10.4103/0301-4738.195626  PMID:27958219
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