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January-April 2011 Volume 4 | Issue 1
Page Nos. 1-44
Online since Monday, March 14, 2011
Accessed 82,165 times.
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EDITORIAL COMMENTARY |
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Cortical visual impairment in children - A new challenge for the future? |
p. 1 |
Meenakshi Swaminathan DOI:10.4103/0974-620X.77654 PMID:21713233 |
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REVIEW ARTICLE |
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Inflammatory glaucoma |
p. 3 |
Sonam A Bodh, Vasu Kumar, Usha K Raina, B Ghosh, Meenakshi Thakar DOI:10.4103/0974-620X.77655 PMID:21713239Glaucoma is seen in about 20% of the patients with uveitis. Anterior uveitis may be acute, subacute, or chronic. The mechanisms by which iridocyclitis leads to obstruction of aqueous outflow include acute, usually reversible forms (e.g., accumulation of inflammatory elements in the intertrabecular spaces, edema of the trabecular lamellae, or angle closure due to ciliary body swelling) and chronic forms (e.g., scar formation or membrane overgrowth in the anterior chamber angle). Careful history and follow-up helps distinguish steroid-induced glaucoma from uveitic glaucoma. Treatment of combined iridocyclitis and glaucoma involves steroidal and nonsteroidal anti-inflammatory agents and antiglaucoma drugs. However, glaucoma drugs can often have an unpredictable effect on intraocular pressure (IOP) in the setting of uveitis. Surgical intervention is required in case of medical failure.
Method of Literature Search : Literature on the Medline database was searched using the PubMed interface. |
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ORIGINAL ARTICLES |
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Combined intravitreal bevacizumab with phacoemulsification in visually significant cataract and visually significant exudative maculopathy |
p. 10 |
Ahmad Mansour, Ziad F Bashshur, Tarek A Sibai, Abla Mehio-Sibai, Rola N Hamam DOI:10.4103/0974-620X.77656 PMID:21713234Purpose : We investigated the visual outcome of combined phacoemulsification with intravitreal bevacizumab, in eyes with dense cataract and visually significant exudative maculopathy.
Materials and Methods : Prospective longitudinal pilot study of consecutive patients treated by two surgeons in 2006, using intravitreal bevacizumab at the end of phacoemulsification. The historical control group consisted of consecutive subjects with exudative maculopathy and dense cataract treated by the same surgeons with the help of phacoemulsification without intravitreal bevacizumab prior to 2006.
Results : Thirty-one treated patients had the mean (SD) logMar best corrected visual acuity improving from - 1.48 (0.50) preoperatively to - 0.67 (0.38) in the first postoperative week ( p < 0.001), to - 0.64 (0.40) in the first postoperative month ( p < 0.001), and to - 0.62 (0.42) ( p < 0.001) on the last follow-up (mean 4.2 months, range 1 - 9 months). Fourteen control patients had the mean (SD) logMar best corrected visual acuity improving from - 1.78 (0.79) preoperatively, to - 0.91 (0.53) in the first postoperative week ( p < 0.001), to - 0.86 (0.45) in the first postoperative month ( p < 0.001), and to - 0.90 (0.47) ( p < 0.001) on the last follow- up (mean 19.6 months, range 1 - 49 months). Initial visual acuities, final visual acuities, and percentage of visual improvement at one month were all not significantly better in the intervention compared to the control group at one month. In the study group, the fovea was flattened at the one-month follow-up, by 90-diopter slit lamp examination and / or Optical coherence tomography.
Conclusion : The combination of intravitreal bevacizumab and phacoemulsification is beneficial for maximal visual rehabilitation in the first postoperative month. |
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Ocular status and functional adaptation of visually challenged children of a special school in Oman |
p. 17 |
Rajiv Khandekar, Rikin Shah, Manali Shah, Salah Al Harby, Urmi Vora, Faiza Al Balushi DOI:10.4103/0974-620X.77657 PMID:21713235Introduction : We assessed the ocular status and visual adaptation among children studying at a school for visually disabled children in Muscat, Oman.
Materials and Methods : This descriptive study was conducted in 2009-2010. We assessed the visual and ocular status of the participants. They were interviewed to elicit the past history of eye problems and management. They also expressed their visual adaptation in their 'day-to-day' life, and their ambitions.
Result : We examined and interviewed 47 participants (29 male and 18 female). The mean age of the participants was 19.7 years (Standard deviation 5.9 years). Twenty-six of them were blind since birth. Phthisical eyes, disfigured eyes and anophthalmic sockets were noted in 19, 58, and six eyes of participants. Twenty-six (55.5%) participants had visual disabilities due to genetic causes, since birth. In 13 participants, further investigations were needed to confirm diagnosis and determine further management After low vision training, 13 participants with residual vision could be integrated in the school with normal children. One participant was recommended stem cell treatment for visual restoration. Five children were advised reconstructive orbital surgery. The participants were not keen to use a white cane for mobility. Some participants, 16 / 28 (57%), with absolute blindness, were not able to read the Braille language. Singing and playing music were not very well-accepted hobbies among the participants. Nineteen participants were keen to become teachers.
Conclusions : Children with visual disabilities need to be periodically assessed. The underlying causes of visual disabilities should be further explored to facilitate prevention and genetic counseling. Participants had visual adaptation for daily living and had ambitions for the future. |
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Role of antimetabolites in recalcitrant idiopathic orbital inflammatory syndrome |
p. 21 |
Yamini Priya, Suneetha Nithyanandam, Manjoo S Reddy DOI:10.4103/0974-620X.77658 PMID:21713236Background : High-dose systemic steroids are the primary modality of treatment for idiopathic orbital inflammatory syndrome (IOIS). Occasionally patients experience a relapse of symptoms on tapering steroids or require large doses of steroid, predisposing them to the adverse effects of steroids.
Aim : We present our experience with the management of three patients with recalcitrant IOIS, with immunosuppressive therapy, using antimetabolites.
Materials and Methods : A retrospective review of the medical records of the patients being reported. Results: Two patients were treated with Methotrexate and one with Azathioprine for a duration of 6-24 months. Two patients were symptom-free three years after stopping the medication. One was doing well clinically with methotrexate therapy alone, when he was lost to follow-up after six months. No adverse effects of immunosuppressive therapy were encountered.
Conclusion : High-dose systemic steroid therapy is the first-line treatment for IOIS, but in refractory or steroid-dependent cases, immunosuppressive therapy with antimetabolites is a safe and effective treatment alternative to steroids. However, treatment with antimetabolites warrants close monitoring for complications like bone marrow suppression and liver dysfunction, especially because long-term treatment is required. |
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CASE REPORTS |
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A rare case of adult onset retinoblastoma |
p. 25 |
Sunil Kumar Singh, Dipankar Das, Harsha Bhattacharjee, Jyotirmay Biswas, Ganesh Kuri, Kasturi Bhattacharjee, Hemlata Deka, Akshay Chandra Deka DOI:10.4103/0974-620X.77659 PMID:21713237Retinoblastoma usually manifests before five years of age. Retinoblastoma in an adult is extremely rare. Twenty-three cases of retinoblastoma in adults 20 years or older have been reported in world literature. We report a case of adult onset retinoblastoma in a 29-year-old female. Our patient had unilateral endophytic retinoblastoma with vitreous seeds and calcification on ultrasonography. She underwent enucleation with silicone ball implantation and the diagnosis was confirmed histopathologically. The diagnosis of retinoblastoma should be kept in mind in cases presenting with a white mass lesion of unknown etiology, in the fundus of an adult. |
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Hemorrhagic intraretinal macrocyst: Differential diagnoses and report of an unusual case |
p. 28 |
Pukhraj Rishi, Ekta Rishi, Pratik Ranjan Sen, Tarun Sharma DOI:10.4103/0974-620X.77660 PMID:21713238Retinal 'cysts' may be single or multiple, ranging from two-to-ten disc diameters in size, and occur in eyes with longstanding retinal detachment. The authors describe a retinal macrocyst larger than ten disc diameters, with a blood-filled cavity, and its ultrasound findings. Improved retinal nourishment following retinal reattachment gradually reverses the process responsible for cystic degeneration, with the eventual collapse of the cyst (within days or weeks). Surprisingly, this giant cyst did not collapse for almost three years despite retinal reattachment. The internal mobile echogenic contents were suggestive of blood. The possible reason of blood in the cyst could be rupture of the retinal blood vessels in the cyst cavity. This could be a recurrent phenomenon, which did not allow the cyst to collapse. The Hemorrhagic Intraretinal Macrocyst needs to be differentiated from mimicking clinical conditions, namely, retinoschisis, choroidal melanoma, subretinal abscess, choroidal hemangioma, and the like. It could take up to a few years to collapse spontaneously, following successful retinal reattachment. |
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CLINICAL IMAGES |
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Sudden onset isolated complete third nerve palsy due to pituitary apoplexy |
p. 32 |
Batuk Diyora, Naren Nayak, Sanjay Kukreja, Hanmant Kamble DOI:10.4103/0974-620X.77661 PMID:21713240 |
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Congenital bilateral ectropion in lamellar ichthyosis |
p. 35 |
Chandana Chakraborti, Partha Tripathi, Gautam Bandopadhyay, Dayal Bandhu Mazumder DOI:10.4103/0974-620X.77662 PMID:21713241 |
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Retinal pigment epithelial changes after trypan blue-assisted internal limiting membrane peeling for idiopathic macular hole |
p. 37 |
Pukhraj Rishi, Ekta Rishi, Abhishek Kothari DOI:10.4103/0974-620X.77663 PMID:21713242 |
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CLINICAL QUIZ |
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67-year-old male with right eye discharge |
p. 39 |
Anya A Trumler DOI:10.4103/0974-620X.77664 PMID:21713243 |
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LETTERS TO THE EDITOR |
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Optic nerve infiltration in relapse of acute lymphoblastic leukemia |
p. 40 |
Mohammad Javed Ali, Santosh G Honavar DOI:10.4103/0974-620X.77665 PMID:21713244 |
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Combined posterior flap and anterior suspended flap external dacryocystorhinostomy |
p. 40 |
Ved Prakash Gupta, Pragati Gupta, Rigved Gupta DOI:10.4103/0974-620X.77666 PMID:21713245 |
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SELECTED ABSTRACTS |
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Selected Abstract |
p. 43 |
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