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   2017| January-June  | Volume 4 | Issue 1  
    Online since April 20, 2017

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Conjunctivitis progressing into endophthalmitis in an eye with an old scleral buckle and its managements
Logandran Vijaya Kumar, L M Evelyn Tai, Widad Mohd Yusof, Wan Hazabbah Wan Hitam
January-June 2017, 4(1):23-26
Conjunctivitis is a common eye infection but can be sight-threatening in patients with previous sclera buckles. A 73-year-old man who had right eye scleral buckle surgery two decades ago presented with right eye acute conjunctivitis, for which a topical antibiotic was prescribed. The right eye vision was 6/18, the conjunctiva was not chemosed, the anterior chamber remained quiet, and the fundus was unremarkable. A week later, he returned complaining of right eye painful and blurring of vision. The right eye vision had deteriorated to hand movements. Examination showed right lid swelling, chemosed conjunctiva, exposed scleral buckle, anterior chamber cells, and dense vitritis. These clinical features were suggestive of right eye endophthalmitis. Emergency intravitreal injections, early scleral buckle removal, and vitrectomy with silicone oil tamponade were performed. The patient was also treated with intravenous and topical antibiotics. The final right eye vision was preserved to 6/18. Simple conjunctivitis can progress into endophthalmitis in a patient with a scleral buckle. Prompt surgical management gives the best outcome.
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Densiron-68 in the treatment of retinal detachment associated with inferior proliferative vitreoretinopathy or caused by lower or posterior breaks
Ayman Ahmed Alkawas, Elsadek Abdelaziz Maaly, Basem Mohammed Ibrahim, Mukhtar Amin Al-Humiari
January-June 2017, 4(1):9-14
Aim: The aim of this study is to demonstrate the efficacy and complications of heavy silicone oil (Densiron-68®) in the treatment of retinal detachment (RD) with inferior, posterior breaks, or associated with proliferative vitreoretinopathy (PVR). Materials and Methods: A prospective interventional noncomparative case series study of 25 eyes of 25 patients. Inclusion criteria were patients having RD arising from PVR, posterior breaks or inferior retinal breaks between 4 and 8 o'clock hours. Primary vitrectomy followed by Densiron-68 injection was performed for each patient. The study protocol involved at least 8 visits: 1st day, 1, 2, 3 weeks 1, 2, 3, and 6 months. Densiron-68 removal was performed after 2–3 months. The assessment of retinal attachment, visual acuity (VA), and complications were recorded. Results: Final anatomical success was 84% (21 of 25) cases which increased to 92% with second intervention. Mean final VA improved from mean logarithm of minimum angle of resolution of 1.89 (0.66) preoperatively to 1.094 (0.29) postoperatively. The most common complications were cataract in 60% of phakic eyes, and early emulsification in 32%. Conclusion: Densiron-68 could be used to support the lower retina in cases with RD associated with PVR, inferior, or posterior breaks. It gives a better tamponade to the inferior retina in the in the supine or upright positioning of the patient with high anatomical success rate.
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Changes in subfoveal choroidal thickness in diabetic macular edema
Haitham Younis Al-Nashar
January-June 2017, 4(1):1-5
Purpose: The objective of this study is to detect the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) with the use of enhanced depth imaging optical coherence tomography (EDI-OCT). Patients and Methods: One hundred and eighty eyes were included in this prospective nonrandomized study. They were divided into three groups, each including sixty eyes; Group I with patients with DME, Group II included diabetic patients without maculopathy, and Group III were normal persons. All eyes were examined with fluorescein angiography to detect the retinopathy stage, and all eyes were examined by EDI spectral domain-OCT to measure the thickness of the choroid. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured in all groups to find the correlation between them and SFCT. Results: The SFCT was significantly decreased in DME group (215.12 5.6 μm) compared with the other two groups (in Group II, it was 253.1 9.3 μm and in Group III, it was 255.93 9.2 μm) (P < 0.001). A negative correlation (r = −0.6) was detected between CMT and SFCT in patients with DME while no correlation between them was found in other two groups (in Group II, r = 0.17 and Group III, r = 0.2). A significant correlation (r = 0.5) was observed between BCVA and SFCT in Group I, while in other two groups, no correlation between the two measures was detected (in Group II, r = −0.1 and Group III, r = −0.1). Conclusion: In eyes with DME, there is a choroidal thinning on EDI OCT. There is a negative correlation between SFCT and CMT in eyes with DME.
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Excellent results of scleral buckling in the era of microincision vitreous surgery
Balbir Khan, Vartika Sobat Anand, Amit Wasil, Meenu Kashyap
January-June 2017, 4(1):6-8
Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Materials and Methods: Retrospective analysis of fifty eyes of fifty patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2014 to August 2015. Results: Primary retinal reattachment rate of 41 patients was achieved with single surgery, but final anatomical success was 94% with additional pars plana vitrectomy with silicone oil injection and with vitrectomy with epiretinal membrane removal. The mean follow-up was 6 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.
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Optic nerve head disorders in a hilly state of india: a retro/prospective study
Anubhav Chauhan, Kulbhushan Prakash Chaudhary, Gian Chand Rajput
January-June 2017, 4(1):15-19
Aim: To study the pattern/distribution of optic nerve head disorders in the hilly terrain of Himachal Pradesh (altitude ranging from 500 to 4500 m above sea level). Subjects and Methods: It is a retro/prospective study of patients with retinal diseases attending the general ophthalmology clinic of a tertiary care facility at Shimla from August 2008 to April 2013. Out of 5600 patients, 4323 were taken as a sample. The data were taken from the hospital records and thereafter analyzed to determine their age, sex distribution, and diagnosis. All patients underwent visual acuity, refraction, slit lamp examination, and fundus evaluation. The diagnosis was confirmed from fundus clinic records and evaluation of fundus photographic records retroprospectively. The photographs were taken on the fundus camera (KOWA'S FUNDUS CAMERA VX-10) and fundus fluorescein angiography done where ever indicated. Using the inbuilt software in KOWA VX 10 FUNDUS CAMERA, cup-disc ratio calculation was done. Results: Among the 139 (3.24%) patients of congenital optic nerve head disorders, the most common entity was optic nerve head hypoplasia. Out of 248 (5.73%) cases of acquired optic nerve head disorders-nonglaucomatous (NG), optic atrophy-NG was the most common. There were 532 (12.31%) cases of glaucoma suspects. Conclusion: Optic nerve head disorders appear to be a major public health problem in India as well as Shimla hills. The present study shall help us in planning the management of such disorders in the hilly state of Himachal Pradesh to reduce the visual morbidity arising out of such disorders.
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Retinitis pigmentosa and congenital ocular toxoplasmosis: a rare coexistent case presentation
Sourav Kumar Bose, Vishal Katiyar, Sanjiv Gupta
January-June 2017, 4(1):20-22
Retinitis pigmentosa (RP) is the term used for a group of disorders that are characterized by inherited, progressive dysfunction, cell loss, and eventual atrophy of retinal tissue. Ocular toxoplasmosis can cause blindness secondary to the retinitis present in the posterior pole of the eye or vitreoretinal complications in the acute or recurrent form of the disease. A 30-year-old male patient presented with the complaint of diminution of vision of both eyes since birth, especially at night. The best corrected visual acuity was hand movement perception in the right eye and finger counting close to face in the left eye with projection of rays full in all quadrants (both eyes). Fundus photograph and optical coherence tomography macula confirmed fundal changes characteristic of RP and large, punched out, healed macular scar, preliminarily appearing as a congenital toxoplasmosis scar. A thorough literature search revealed only one such previously reported case report.
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Near-infrared imaging of the choroid in the evaluation of neurofibromatosis
T Lekha, Uddaraju Venkata Sai Shanthi, Jeevamala Mercy Janaki
January-June 2017, 4(1):27-29
Near Infrared (NIR) imaging of the fundus with Spectral Domain Optical Coherence Tomography (OCT) with Enhanced Depth Imaging (EDI) is a useful tool to detect choroidal abnormalities in patients with Neurofibromatosis type 1 (NF1). Choroidal neurofibromas were considered rare as it was undetectable by conventional Ophthalmoscopy. NIR imaging utilizes long wavelength Infrared light with good transmission through retinal pigment epithelium providing superior visibility of choroid. We describe 2 female patients aged 20 and 15 years respectively who presented with atypical features of NF1 like unilateral Lisch nodules (first case) and bilateral early Lisch nodules (second case). Fundus examination was normal in both patients. NIR imaging revealed Choroidal neurofibromas as bright patchy lesions with corresponding irregular hyper reflectance on OCT with EDI in both cases, confirming the diagnosis of NF1. This simple, fast and non invasive imaging modality may be recommended in the routine evaluation of patients with NF1.
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