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   Table of Contents - Current issue
Coverpage
September-December 2021
Volume 14 | Issue 3
Page Nos. 131-209

Online since Wednesday, October 20, 2021

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EDITORIAL  

An overview of ophthalmic manifestations and prognostic factors of Behcet's disease in Omani patients Highly accessed article p. 131
Nadiya Al Kharousi, Washoo Mal
DOI:10.4103/ojo.ojo_270_21  
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EDITORIAL COMMENTARY Top

Chronic myeloid leukemia versus acute myeloid leukemia in patients with retinoblastoma p. 134
Ann-Marie Leahey, Carol L Shields
DOI:10.4103/ojo.OJO_241_2021  
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REVIEW ARTICLE Top

Systematic review: SARS-COV-2 contagion prevention measures in vision health professionals Highly accessed article p. 136
Liliana Perez.Peralta, Alma L Sauceda-Valenzuela, David Rivera-de La Parra, Angela Abril Suarez-Ajoleza, Ana Maria Beauregard-Escobar, Juan Alejandro Torres-Dominguez
DOI:10.4103/ojo.ojo_134_21  
The disease, which originated from the SARS-CoV-2 virus, is primarily transmitted by direct contact with infected individuals. Visual healthcare professionals perform clinical practices that pose a significant risk of infection due to their proximity with patients during the examination. This systematic review aims to identify preventive measures that will aid in reducing the risk of infection during standard appointments between patients and visual health professionals. A systematic review was done for articles published in indexed journals from December 2019 to December 2020. The search for these articles was done in 3 electronic databases. As part of the search criteria, articles were selected if they had the keywords (SARS-CoV-2), (COVID-19), and coronavirus combined with ophthalmology, optometry, eye care, and the eye. Once duplicated and unrelated items were eliminated, 36 articles of interest were selected. Seven sections were described in detail: telephone screening, (COVID-19) triage, decreasing transmission within shared spaces, hand washing, use of personal protective equipment Personal Protective Equipment (PPE), cleaning of diagnostic instruments, and use of telemedicine. This paper helps healthcare professionals to better understand the context of the “new normal” clinical practice. Visual health professionals and their patients must adhere to norms and use the indicated PPE during the consultation to safeguard each other.
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ORIGINAL ARTICLES Top

Indications for penetrating keratoplasty in Iranian patients p. 144
Mojtaba Eidizadeh, Leila Ebadi-Soflou, Aashkan Safarzadeh Khoushabi
DOI:10.4103/ojo.ojo_18_21  
BACKGROUND: The outcome of penetration into keratoplasty (PK) related to corneal disease is responsible for corneal blindness. The aim of this study is to evaluate the indications and visual outcome of PK in Imam Khomeini Hospital in Kermanshah from March 2017 to March 2019. MATERIALS AND METHODS: Data were reviewed from the medical records of 115 PK done in the Department of Ophthalmology, Imam Khomeini Hospital, Kermanshah, from March 2017 to March 2019. Data analysis done using paired Student's t-test for hypothesis testing of grouped values of preoperative and the last follow-up best-corrected visual acuity in cases of optical and therapeutic grafts. P <0.05 was considered statistically significant. RESULTS: In this study, the data of 115 eyes of 108 patients were reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma, 34 (29.56%). Therapeutic keratoplasty was done for 26 patients. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (P = 0.0001) in best-corrected visual acuity improvement from 1.36 logMAR + 0.024 (standard deviation [SD]) preoperatively to 0.357 logMAR + 0.42 (SD) postoperatively and 1.4 logMAR + 0.000 (SD) preoperatively to 0.15 logMAR + 0.55 (SD) postoperatively for optical and therapeutic grafts, respectively. CONCLUSION: Active or treated infectious keratitis was one of the most important indications for keratoplasty. Symptoms of poor prognosis were more pronounced in this part of the country. Patients' vision after corneal transplantation was encouraging, especially in cases of optical keratoplasty.
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Complications associated with the use of two types of silicone oil in vitreoretinal surgeries: A single tertiary center experience in Oman p. 149
Mohamed Al-Abri, Ahmed Al-Hinai, Adil Al-Musalami, Huda Al-Ghaithi
DOI:10.4103/ojo.ojo_158_21  
OBJECTIVES: The objective of this study is to describe complications associated with the use of two types of silicone oil (SO) (1000 centistokes [cs] and 5000 cs) in vitreoretinal surgery in Oman. MATERIALS AND METHODS: This is a retrospective descriptive study on all patients who underwent vitreoretinal surgeries in which SO injection or removal was done. The study was conducted at Sultan Qaboos University Hospital between January 1, 2010, and December 31, 2017. Demographic data, lens status of the eye at the time of SO injection, type of SO used (1000 cs or 5000 cs), and complications associated with SO were collected. RESULTS: A total of 107 eyes of 103 patients were included in the study. SO 1000 cs was used in 66 eyes and SO 5000 cs was used in 41 eyes. A total of 29 eyes (27%) developed SO-related complications, which included SO emulsification in 14 eyes (13.1%), raised intraocular pressure (IOP) >21 mmHg in 19 eyes (17.8%), and band keratopathy in 4 eyes (3.7%). SO emulsification was seen in eight eyes (12.1%) in whom SO 1000 cs was used and in five eyes (12.2%) in whom SO 5000 cs (P = 1.000). CONCLUSION: SO was found to be a relatively safe adjunct in vitreoretinal surgery. SO-related complications such as SO emulsification, raised IOP, and band keratopathy were observed in less than one-third of study eyes. No difference was noted in emulsification rate between SO 1000 cs and SO 5000 cs. Further studies with larger sample size and longer follow-up period are warranted.
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Ocular and periocular tumors in 855 Asian Indian geriatric patients p. 153
Swathi Kaliki, Anthony Vipin Das
DOI:10.4103/ojo.OJO_174_20  
OBJECTIVE: The objective of this study was to describe the eye tumors in Asian Indian geriatric population (age >60 years) presenting to a multitier ophthalmology hospital network in India. METHODS: This was a retrospective study of 855 Asian Indian geriatric patients. RESULTS: During the 3-year study period, 855 geriatric patients were diagnosed with eye tumors. The mean age at presentation with an ocular or periocular tumor was 68 years (median, 67 years; range, 60–91 years). There were 458 (54%) benign tumors and 397 (46%) malignant tumors. The distribution of benign versus malignant tumors in different age groups was 324 (71%) versus 259 (65%) in 60–70 years, 116 (25%) versus 99 (25%) in 71–80 years, and 18 (4%) versus 39 (10%) in >80 years' age groups. The three most common benign tumors included eyelid cyst (n = 99, 22%), eyelid nevus (n = 50, 11%), and pseudotumor or nonspecific orbital inflammatory disease (n = 38, 8%). The three most common malignant tumors included ocular surface squamous neoplasia (OSSN) (n = 208, 52%), periocular sebaceous gland carcinoma (n = 68, 17%), and periocular basal cell carcinoma (n = 25, 6%). Overall, OSSN was the most common tumor in all age groups (22% of all tumors in 60–70 years, 27% in 71–80 years, and 39% in >80 years' age groups). CONCLUSION: Overall, there is an increasing trend of malignant tumors with increasing age. OSSN is the most common tumor in the geriatric population encountered in a referral-based comprehensive ocular oncology practice in India.
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Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence p. 157
Bipasha Mukherjee, Avriel Isaac Gudkar, Akshay Gopinathan Nair, Nisar Sonam Poonam, Md Shahid Alam
DOI:10.4103/ojo.ojo_462_20  
PURPOSE: Isolated cases of nasolacrimal duct obstruction (NLDO) secondary to rhino-orbito-facial reconstructive surgeries have been reported previously. We report the clinical profiles and management outcomes of a series of patients with iatrogenic INDO. MATERIALS AND METHODS: Case records of all patients who presented with secondary NLDO over 5 years were retrospectively analyzed. The case series included seven patients with NLDO secondary to orbito-facial surgeries. RESULTS: The study included six males and one female patient with a mean age of 29 ± 12.58 years. All the patients had a history of road traffic accidents following which they underwent an open reduction and internal fixation by maxilla-facial surgeons. All of them presented to the Ophthalmology outpatient department with epiphora following the surgical intervention. Imaging revealed the implants were responsible for obstructing the nasolacrimal ducts in all seven cases. Five patients underwent external dacryocystorhinostomy while dacryocystectomy was performed in two. Implant removal was necessary for five patients without any compromise on the structural integrity of the orbital walls. CONCLUSION: Precise knowledge of the orbital anatomy, especially that of the lacrimal drainage system is imperative for surgeons performing surgeries in the midface area. A multidisciplinary approach and inclusion of surgeons trained in lacrimal surgeries can prevent such avoidable complications.
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Surgical performance and the positivity rate for novel coronavirus (severe acute respiratory syndrome coronavirus 2) in an ophthalmic setup during the coronavirus disease 2019 pandemic p. 162
Md Shahid Alam, Suraj Mistry, Sudipta Das, Suchetna Mukherjee, Amitabh Kumar, Girish Shiva Rao
DOI:10.4103/ojo.ojo_61_21  
AIM: To describe, the impact of ongoing coronavirus disease 2019 (COVID-19) pandemic on ophthalmic surgeries at a tertiary eye care center of East India during and after the lockdown, and the positivity rate for novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). MATERIALS AND METHODS: A retrospective study of all ophthalmic surgeries performed during and after lockdown from April 1, 2020 to August 31, 2020, with comparison to the corresponding period in the previous year (2019) was done. Eligible patients were tested for novel coronavirus (SARS-CoV-2) preoperatively as per the institutional protocols. RESULTS: A total of 569 surgeries were performed during the study period compared to 3458 performed in 2019, (P = 0.00001). The maximum number of surgeries were performed in June (191, 33.57%) and July (189, 33.22%) and in the subspecialty of vitreo-retina (337, 59.23%) followed by cataract (101, 17.75%). The most common vitreoretinal procedures were intravitreal injections (223, 66.17%) and retinal detachment surgery (56, 16.62%). Emergency surgeries performed were 30 (5.275%) compared to 76 (2.20%) during the same duration in the previous year (P = 0.00004). Ninety-four (16.52%) cases were screened for COVID-19. A total of 10 (10.64%) cases tested positive for SARS-CoV-2. Only one of these cases was symptomatic. CONCLUSION: There was a drastic decline in the number of both elective and emergency surgeries during and after the lockdown period of the COVID-19 pandemic when compared to the corresponding previous year duration. The maximum number of surgeries was performed in the vitreoretinal subspecialty. The positivity rate for SARS CoV-2 amongst the patients tested was 10.64% and most of these patients were asymptomatic.
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A prospective study on epidemiology of dacryocystitis at a tertiary eye care center in Northern India p. 169
Joohi Khatoon, Syed Ali Raza Rizvi, Yogesh Gupta, Md Shahid Alam
DOI:10.4103/ojo.ojo_80_21  
AIM: The aim of this study is to study the prevalence, incidence, and the epidemiological characteristics of the patients of acquired dacryocystitis at a tertiary eye care center of Northern India. MATERIALS AND METHODS: It was a prospective, cross-sectional study carried out over a period of 2 years (July 2016–July 2018). The prevalence, incidence, and the epidemiological characteristics of acquired dacryocystitis were studied and analyzed. Chi-square test was used to test the qualitative distribution. RESULTS: A total of 212 cases were included in the study. The prevalence rate of dacryocystitis was 19.5 cases per 10,000 patients, and the incidence rate was 15 cases per 10,000 patients. Chronic dacryocystitis (183; 86.30%) was more commonly encountered clinical type than acute dacryocystitis. Majority of cases (204; 96.23%) were due to the primary acquired nasolacrimal duct (NLD) obstruction, whereas eight cases (3.78%) were due to the secondary acquired NLD obstruction. Females were more commonly affected (156; 73.58%). The mean age was 44.44 ± 18.95 (range: 12–86) years. Majority of the patients 108 (50.94%) belonged to 3rd–6th decades of life. The disease was more prevalent in people belonging to lower-middle socioeconomic class (92; 43.40%) living in rural areas (130; 61.32%) and the majority of them were housewives (125; 59%). CONCLUSIONS: The incidence and prevalence of acquired dacryocystitis were 15 and 19.5 cases per 10,000 patients. It was much more common in females of lower socioeconomic status and is seen commonly in the 3rd to 6th decades of life.
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Maximal levator resection versus Gore-Tex® sling for congenital blepharoptosis with poor levator function p. 173
Ahmed Said Dawood, Omar Abdelghany Hassan, Mohamed Othman El Sayed
DOI:10.4103/ojo.ojo_127_21  
BACKGROUND: Treating congenital blepharoptosis is often mandatory to clear the visual access and avoid amblyopia; however, when the levator function is poor, achieving a satisfactory long-term outcome is challenging. This study aimed to compare the outcomes of maximal levator resection (MLR) with those of frontalis suspension (FS) using Gore-Tex®, in the treatment of congenital blepharoptosis with poor levator function. PATIENTS AND METHODS: The study included 102 eyelids of 66 patients of mean age 4.3 ± 1.6 standard deviation (SD) years, randomly divided into two groups (51 eyes each). Group A: FS using Gore-Tex®, Group B: MLR. Postoperative outcomes were evaluated at 1, 6 and 12 months. Patients' ophthalmic examination including margin-reflex distance (MRD1) before and after surgery and postoperative complications were recorded. RESULTS: At the end of the follow-up, the mean MRD1 increased from 0.3 ± 0.7 SD mm in Group A, 0.4 ± 0.8 SD mm in Group B preoperatively, to 2.7 ± 0.5 SD mm and 2.9 ± 0.7 SD mm, respectively (P < 0.001 in both groups). Results of Group B were significantly higher than Group A (P = 0.047). Success was achieved in 77 eyelids (75.4%), distributed as follows: 36 eyelids (70.6%) in Group A, and 41 eyelids (80.1%) in Group B. The total recurrence rate was 6.9% (seven eyes), while other complications were recorded in 23 eyes (22.5%). CONCLUSION: MLR, compared to FS with Gore-Tex® sling, can be a more efficient surgical option to correct congenital blepharoptosis with poor levator excursion. Prominent postoperative lagophthalmos warrants close ocular surface observation in early follow-up weeks.
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Intravitreal Ozurdex has no short term influence on choroidal thickness and vascularity index in eyes with diabetic macular edema: A pilot study p. 179
Pukhraj Rishi, Aditya Verma, Zeeshan Akhtar, Rupesh Agrawal, Ashutosh Agrawal, Rekha Priya Kalluri Bharat, Ekta Rishi
DOI:10.4103/ojo.ojo_7_21  
AIM: To analyze choroidal parameters in eyes with diabetic macular edema (DME) treated with intravitreal Ozurdex. PATIENTS AND METHODS: Twenty eyes of 14 patients were included in this prospective study. Optical coherence tomography images were obtained before and 8–10 weeks after intravitreal Ozurdex injection; binarized and subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were calculated. RESULTS: Mean SFCT (treatment naïve; 242.22 ± 32.87 reduced to 218.10 ± 22.10, P = 0.158 and previously treated; 330.4 ± 56.72 reduced to 328.93 ± 50.55, P = 0.833) and mean CVI (treatment naïve; 0.64 ± 0.03 changed to 0.65 ± 0.04, P = 0.583 and previously treated; 0.65 ± 0.05 reduced to 0.64 ± 0.03, P = 0.208) showed no significant change. CONCLUSION: Intravitreal Ozurdex showed no significant effects on SFCT and CVI in eyes with DME over short term. Larger studies with longer follow-up may allow a better understanding.
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CASE REPORTS Top

Ligneous conjunctivitis exacerbated by Pseudomonas aeruginosa - Diagnostic and therapeutic approach p. 184
Madiha Tariq, Muhammad Abdullah Zahid, Taimoor Ashraf Khan, Hira Ghafar Shah
DOI:10.4103/ojo.ojo_64_21  
Ligneous conjunctivitis is a rare disease in which pseudomembranes develop on the mucosal surfaces of the eye. Only a handful of cases have been reported in the past 100 years. Although plasminogen deficiency is largely implicated in the pathogenesis of this condition, infectious agents are also thought to play a role in worsening the disease. Treatment is usually challenging. We present a case of 3-year-old female in whom a multidrug-resistant Pseudomonas aeruginosa was isolated from the culture of the pseudomembranes. To the best of our knowledge, this is the first time P. aeruginosa has been implicated as an exacerbation factor. Furthermore, we have given merit to the triple regimen of corticosteroids, heparin, and cyclosporine as being effective. We also added antibiotics to target the infectious organism.
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Chronic myelogenous leukemia in a child following treatment for bilateral retinoblastoma p. 187
Haitham Hilal Al-Mahrouqi, Anuradha Ganesh, Abdulhakim Al-Rawas, Vikas Khetan, Sana Al-Zuhaibi
DOI:10.4103/ojo.ojo_107_21  
A 3-year-old child was incidentally found to have chronic myelogenous leukemia (CML) during an admission for a routine ophthalmic examination under anesthesia. The child had received systemic chemotherapy and focal treatment for Groups C and D retinoblastoma in the right and left eye, respectively, when she was 7 months old. CML was treated with dasatinib, and the child attained a major molecular response. The child is now 3 years after treatment of CML, and the retinoblastoma remains inactive. CML following treatment of retinoblastoma is a rare occurrence. Long term and close monitoring of retinoblastoma patients who received systemic chemotherapy using serial blood tests is essential.
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Secondary intracranial hypertension in aplastic anemia: A case report and review of current concepts p. 190
Adil Al-Musalami, Alaa Elmanzalawy, Yasser Wali, Anuradha Ganesh
DOI:10.4103/ojo.ojo_79_21  
Intracranial hypertension (IH) when detected mandates prompt and appropriate therapy to avoid permanent visual impairment. We report a 7-year-old boy who presented to the emergency services with purpuric rashes and bruises. Peripheral blood smear and bone marrow aspiration confirmed the diagnosis of aplastic anemia. During admission, the child developed headache, nausea, vomiting, and diplopia. Ophthalmic examination revealed intermittent esotropia and bilateral papilledema. The findings on neuroimaging and lumbar puncture led to the diagnosis of secondary IH (SIH). The intracranial pressure normalized on treatment with oral acetazolamide, oral furosemide, and intravenous dexamethasone.
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CLINICAL IMAGES Top

Urbach–wiethe disease: Hyalinosis cutis et mucosae p. 196
Prabrisha Banerjee, Bipasha Mukherjee
DOI:10.4103/ojo.ojo_29_21  
Urbach-Wiethe Disease is an uncommon entity with autosomal recessive inheritance. We describe the clinical and histopathological findings of lipoid proteinosis in this clinical image. Cicatricial alopecia, atrophic scar on face, moniliform blepharosis and alopecia are the characteristic features of this disease entity. Hoarseness of voice and seizure can also be seen in these patients. Skin biopsy confirms the diagnosis. Multidisciplinary involvement is recommended for the management of these cases.
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Ocular Neisseria gonorrhea in a patient on immune checkpoint inhibitors p. 198
Anuoluwapo Sopeyin, Michael Minchul Park, Renelle Pointdujour-Lim
DOI:10.4103/ojo.ojo_331_20  
Although immune checkpoint inhibitors have revolutionized the treatment of cancers, their role in the pathogenesis of chronic infections remains unclear. Here, we present the case of a patient on a cocktail of checkpoint inhibitors who presented with severe bilateral gonococcal conjunctivitis, orbital cellulitis and vitritis, without a history of genital infection.
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Fractured dexamethasone implant (OZURDEX®) following intravitreal injection p. 201
Saud M Aljohani, Abdulaziz M Al-Shehri, Khalid R Al-Rubaie
DOI:10.4103/ojo.ojo_31_21  
Dexamethasone implant (Ozurdex™) is a relatively safe medication with few adverse events can happen. We demonstrate clinical course and images of a rare case of fractured intravitreal Ozurdex™ implant that observed immediately following injection and its final outcome.
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LETTERS TO THE EDITOR Top

Artificial intelligence to predict ocular manifestation of COVID-19 p. 203
Dimple Nagpal, Nayan Gupta
DOI:10.4103/ojo.ojo_464_20  
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Complications of leech therapy directly on the eyes p. 205
Seyed-Hashem Daryabari, Seyed Rahim Hassanpour, Mahdi Morshedi
DOI:10.4103/ojo.ojo_129_21  
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Methicillin-resistant Staphylococcus aureus carriers among eye health staff p. 207
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
DOI:10.4103/ojo.ojo_204_21  
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CLINICAL QUIZ Top

A young male with unilateral mydriatic sluggish pupil p. 208
Ruminder Kaur, Renu Thakur
DOI:10.4103/ojo.OJO_80_2020  
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