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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 59 | Issue 2
Page Nos. 127-230

Online since Thursday, June 24, 2021

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EDITORIAL  

Mucormycosis: An epidemic amidst the pandemic Highly accessed article p. 127
Sharmila Devi Vadivelu
DOI:10.4103/tjosr.tjosr_78_21  
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EXPEDITED PUBLICATION, COMMENTARY Top

Transcutaneous retrobulbar amphotericin B and exenteration in rhino-orbital cerebral mucor mycosis: Do we know it all yet? Highly accessed article p. 131
Milind Naik
DOI:10.4103/tjosr.tjosr_83_21  
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EXPEDITED PUBLICATION, CURRENT OPINION Top

Expert opinion – Rhino-orbital-cerebral mucormycosis Highly accessed article p. 133
Mohan Rajan, M VS Prakash, R Malarvizhi, A Yogeswari, T Nirmal Fredrick, C Senthilnathan, A Murali Ariga
DOI:10.4103/tjosr.tjosr_81_21  
The COVID-19 pandemic has led to an increase in the incidence of rhino-orbital-cerebral mucormycosis (ROCM). Many states have declared the disease an epidemic and have made it notifiable. ROCM continues to be a challenge both to clinicians and patients. We have a stellar panel of experts, who are also part of the Tamilnadu mucormycosis advisory committee, who will be sharing pointers regarding the early diagnosis and challenges faced in the management of ROCM.
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REVIEW ARTICLE Top

Retinal vasculitis: An update with our experience Highly accessed article p. 137
Jyotirmay Biswas, Nipun Bagrecha, Puja Maitra
DOI:10.4103/tjosr.tjosr_41_21  
Retinal vasculitis is a sight-threatening inflammatory condition affecting the retinal vessels. It can occur due to several etiologies and spectrum of other ocular inflammatory conditions. It can occur as an isolated idiopathic condition, as a complication of infective or neoplastic disorders, or in association with systemic inflammatory disease. The various known etiologies have been discussed here with their characteristic features. Etiological diagnosis of retinal vasculitis can be challenging. Clinical examination, tailored laboratory investigations and multimodal imaging with fundus photography, fundus autofluorescence, fundus fluorescein angiography, indocyanine green angiography, swept-source optical coherence tomography (OCT), OCT angiography, B scan ultrasonography and in recent years widefield fundus fluorescein angiogram, imaging aids in the early diagnosis, monitoring and provides newer insights about these diseases. Newer treatment modalities and therapies such as immunomodulators and biologics have been added to the armamentarium against these sight-threatening conditions. Anti-vascular endothelial growth factor agents and laser photocoagulation are particularly beneficial to arrest the neovascularization process. The diagnosis of vasculitis may uncover an unknown underlying systemic cause. Early, effective, and prompt management can be vision saving and can minimize comorbidities. We feel that there is a necessity to update our knowledge on existing and newer trends in diagnosis, investigations, and management of retinal vasculitis. This review focuses on some of the basic concepts related to retinal vasculitis with an update.
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ORIGINAL ARTICLES Top

Prevalence and etiology of glaucoma emergencies during coronavirus disease-2019 lockdown at a tertiary eye center in India p. 148
Premanand Chandran, Abhipsa Sahu, Menaka Vimalanathan, Siva Prasanna Thilagar, Vinoth Arunaachalam, Mrunali Dhavalikar, Ganesh V Raman
DOI:10.4103/tjosr.tjosr_177_20  
Aim: This study aims to report the prevalence and etiology of emergencies in glaucoma during coronavirus disease-2019 lockdown at a tertiary eye care center in India. Materials and Methods: Retrospective case study. Patients who presented with acute onset of pain, redness, blurred vision, and intraocular pressure (IOP) >21 mm Hg between March 25 and May 3, 2020 were included in the study and those who came for scheduled follow-up visit were excluded from the study. Results: Two hundred and ninety-four patients were seen in glaucoma services during the study, of which 43 patients (eyes) met the inclusion criteria. Mean age of the study population was 56.4 ± 16.7 years. Mean visual acuity at presentation was 4/60 and mean IOP was 37.9 ± 10.5 mm Hg. Most common etiology for seeking emergency glaucoma care was secondary glaucoma post vitreoretinal surgery (27.9%), followed by lens-induced glaucoma (25.5%), neovascular glaucoma (11.6%), primary angle closure disease (9.3%) of which 4.6% had acute primary angle closure, inflammatory glaucoma (9.3%), closed globe injury (6.9%), and others (9.3%). 37% of eyes underwent surgery, 5% eyes underwent laser and 58% eyes were treated medically. Conclusions: The prevalence of emergency in glaucoma was 14.6% during the lockdown. Secondary glaucoma constitutes 88.4% and primary glaucoma constitutes only 11.6% of emergency in glaucoma.
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Efficacy of two vertically integrated teaching–learning methods – The ocular basic science workshop versus lecture in enhancing knowledge and skills of ocular examination techniques and underlying principles in second clinical year medical students: A prospective interventional study p. 152
Anika Amritanand, Danica Lyngwa, Nimmy Thomas, Ann Eapen, Jeffrey Immanuel, Timothy Prabhu, Supraja Srivatsava, Upasana Kachroo, Aby S Charles, Rajalakshmi Subramanian, Anandit John Mathew, Aarwin Joshua, Joshua Paul, Jeyanth Suresh Rose
DOI:10.4103/tjosr.tjosr_14_21  
Purpose: The purpose of the study was to compare the efficacy of two vertically integrated teaching–learning methods, a peer-led ocular basic science workshop (OBSW) versus lecture by ophthalmology faculty, in enhancing the underlying basic science knowledge and examination skills of ophthalmic clinical tests among second clinical year medical students. Design: This was a prospective, interventional comparative study. Students were randomly assigned to peer-led OBSW and interactive lecture-based method of teaching by a faculty. Change in knowledge was assessed using pre and post multiple-choice question test score. Quantitative assessment of clinical examination skills between the two groups was done using objective structured clinical examination (OSCE) at 2-week postintervention. All assessors were blinded. Student's attitude toward the teaching–learning methods was assessed using a 5-point Likert scale. Setting: This study was conducted in the departments of ophthalmology, anatomy, and physiology of a tertiary care medical college in southern India. Participants: Second clinical year students starting their ophthalmology rotation, 5 peer teachers, and 47 students were recruited. All completed the study. Results: Post intervention, there was a significant change in basic science knowledge from baseline among both the arms. Mean improvement in posttest score immediately following the OBSW was 9.25 (standard deviation [SD]: 3.34, 95% confidence interval (CI): 7.84–10.66, t = 13.57, P = 0.00) and 7.83 (SD: 3.66), 95% CI: 6.24–9.41, t = 10.24, P = 0.00) after the lecture. The improvement in scores continued in the 2-week posttest scores. There was no statistically significant difference in the OSCE scores between the two groups. Conclusions: The vertically integrated OBSW and lecture methods were equally effective in improving knowledge and clinical skills of basic ocular examination skills among the second clinical year medical students.
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A cross-sectional study of the prevalence of computer vision syndrome and dry eye in computer operators p. 160
Sanjeev Verma, Urmi Midya, Shalini Gupta, Yogesh Shukla
DOI:10.4103/tjosr.tjosr_173_20  
Aim: To study the prevalence of computer vision syndrome (CVS) and dry eyes in computer operators. Materials and Methods: The cross-sectional study was conducted at teaching institute. Hundred participants were included in our study according to the inclusion criteria. Questionnaire was prepared to ask symptoms of CVS. Ocular surface disease index (OSDI), refraction, Schirmer's test 1, and tear film break-up time (TBUT) were performed. Data were collected and analyzed by SPSS software. Results: The prevalence of CVS was 74%. In the study population, 61 were male and 39 were female. Mean age was 29.58 years (7.85). Most of the participants were of age 21–30 years. Depending on the working hours, most of the participants (37.84%) were working for 4–8 h. About 37.84% of participants were working for 4–8 h. The most common eye complaint was eye strain. According to the OSDI score, mild dry eye was present in 23 individuals and moderate dry eye was present in 41 individuals. According to Schirmer's test 1, dry eye was present in 59% in the right eye and 58% in the left eye. According to TBUT, dry eye was present 59% in the right eye and 57% in the left eye. Dry eye was diagnosed in 59 (59.0%) individuals. Conclusion: The prevalence of CVS has increased due to the increased use of computer in our daily life. Its prolonged use causes dry eyes and inefficiency in their working, though most computer users are unaware of this fact. Hence, a lot of work has to be done to aware the community about the disease.
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Ocular manifestations of psoriasis: A case-control study p. 164
Rishit D Shah, Jasmita Satapathy, Pradeep Kumar Panigrahi, Bikash Ranjan Kar, Ramesh Chandra Mohapatra
DOI:10.4103/tjosr.tjosr_7_21  
Background: Psoriasis is primarily a skin disorder with many extracutaneous manifestations. Relationship between eye lesions and psoriasis has been reported in literature. However, much data are not available on ocular manifestations of psoriasis in the Indian population. Objective: The objectives of this study were to assess the frequency of ocular manifestations in psoriasis and to correlate it with factors such as age, gender, duration of disease, type of psoriasis, and severity of psoriasis. Materials and Methods: A total of 100 patients with psoriasis and 100 healthy controls were enrolled in the study. Clinical types of psoriasis, duration of disease, site of involvement, and severity of psoriasis were noted. Slit lamp examination, fluorescein staining of ocular surface, and fundoscopy were done for both groups. Dry eye evaluation was performed by measuring the values of Schirmer 1 and tear film breakup time. Results: Prevalence rate of ocular involvement in psoriasis was found to be 61% as compared to 30% in controls. Most common ocular finding was conjunctival hyperaemia (47%) followed by dry eye (36%) and blepharitis (27%). Scalp psoriasis was found to be significantly associated with blepharitis (P < 0.0001). There was corneal involvement in 9 cases and uveitis in three cases. No correlation was found between the frequency of ocular manifestations and factors such as age, gender, duration, and the severity of psoriasis. Conclusion: Ocular manifestations in psoriasis are common and they affect mostly the anterior segment of the eye. Routine ophthalmological evaluation is important in these patients for early diagnosis, which in turn can prevent sight threatening complications.
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CASE REPORTS Top

Ocular involvement in a case of dystrophic epidermolysis bullosa with conjunctival blistering without eyelid or corneal disease: A rare case report p. 169
Shyam Sundar Das Mohapatra, Dipankar Das, Harsha Bhattacharjee
DOI:10.4103/tjosr.tjosr_117_20  
Epidermolysis bullosa (EB) is an autoimmune mucocutaneous disorder associated with abnormalities of the basement membrane zone of skin and mucous membranes, characterized by blister formation in response to minor trauma. Ocular involvement is common in autosomal dominant variant of dystrophic EB (DDEB), but the incidence of involvement of ocular structures varies widely among different patients as well as among different subtypes. Conjunctival blistering without eyelid or corneal disease is one of the most common ocular manifestations. Here, we present a rare case of DDEB in a 4-year-old boy with conjunctival blister formation without eyelid or corneal involvement. The patient was managed conservatively with lubricating eye drops, and the conjunctival blister resolved subsequently. The major treatment modality is the use of ocular lubricants. Protection of eye from minor trauma such as rubbing is most important to prevent ocular complications.
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Severe ischemic retinopathy with vasculitis and role of multimodal imaging in asymptomatic patient with systemic lupus erythematosus p. 172
Srinivas Talari, Vinit Jayendra Shah, Syed Mohideen Abdul Khadar, Syed Saifuddin Adeel, Shobita Nair
DOI:10.4103/tjosr.tjosr_151_20  
Systemic lupus erythematosus (SLE) is a systemic disease with multiorgan involvement including eyes. We report a 37-year-old female, a known SLE case for 4 years, who came to our clinic to screen for hydroxychloroquine toxicity. Fundus showed changes of ischemic retinopathy, confirmed on optical coherence tomography angiography and fundus fluorescein angiography. Our case illustrates the importance of multimodal imaging and its correlation with systemic disease activity in SLE patients.
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Opacification of intraocular lens: A rare misdiagnosed postoperative façade p. 175
Niranjan Karthik Senthil Kumar, Malarvizhi Raman, A Anuradha, S Sheela
DOI:10.4103/tjosr.tjosr_164_20  
Intraocular lens (IOL) opacification can be one of the rare differential diagnoses for delayed decrease in postoperative vision in patients undergoing cataract surgery. A 73-year-old female presented with the complaints of diminished vision in her operated eye 4 years after a surgery for her cataract. After meticulous evaluation, the patient was diagnosed with opacification of IOL, and appropriate IOL exchange was done. The patient regained vision to 6/12. Hence, it is crucial to keep this cause of postoperative decrease in vision and manage accordingly to restore useful vision.
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Bilateral corneal clouding of lecithin cholesterol acyltransferase deficiency – A rare case report p. 178
S Uma Maheshwari, M Muthayya, P Thiyagarajan, G Barathi
DOI:10.4103/tjosr.tjosr_184_20  
A 44-year-old female patient presented to our department with bilateral corneal opacity since childhood. History of similar complaints was elicited among her family members. Best-corrected visual acuity in both eyes was 6/9 with bilateral stromal corneal clouding extending from limbus to limbus, with no evidence of vascularization/deposits/scarring. Intraocular pressure and fundus examination were normal in both eyes. Further systemic evaluation showed increased triglycerides, low high-density lipoprotein, anemia, and proteinuria with elevated renal parameters. Renal biopsy showed secondary membranous nephropathy arising in a background of lecithin cholesterol acyltransferase (LCAT) deficiency. Severe visual impairment prompts keratoplasty in such patients. Bilateral stromal corneal clouding is important to detect potentially associated systemic diseases such as mucopolysaccharidosis/lipidosis, LCAT deficiency, fish-eye disease, and corneal dystrophy. The case is being reported to stress the importance of systemic evaluation and follow-up in a case of bilateral corneal clouding due to its varied systemic differentials.
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Elephant skin and droopy lids: A rare case report of touraine-solente-gole syndrome p. 181
Rita Hepsi Rani, V Sweetha, Thendral Velmurugan
DOI:10.4103/tjosr.tjosr_149_20  
Touraine-Solente-Gole syndrome which is also known as pachydermoperiostosis is a multisystem disorder that affects bone, skin including eyelids, gastrointestinal system, and endocrine system. We report this case for the rare presentation of floppy lids and ptosis in a patient with a complete form of Touraine-Solente-Gole syndrome.
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Orbital dermoid presenting as ptosis with monocular elevation deficiency p. 184
Vathsalya Vijay, Bipasha Mukherjee
DOI:10.4103/tjosr.tjosr_110_20  
Orbital dermoids are the most common benign orbital cysts accounting for 14% of all orbital masses. They are choristomas resulting from entrapment of ectoderm into the mesenchymal tissue at sites of embryologic bony fusion. Their clinical presentations vary based on the location, size, and their effects on the adnexa and orbital structures. We report a case of orbital dermoid presenting as ptosis with monocular elevation deficiency (MED). A 9-year-old boy presented with drooping of left upper eyelid since birth for which frontalis suspension surgery was done elsewhere at 5 years of age. One year later, the ptosis recurred. On examination, child had severe ptosis, inferior dystopia, and restricted elevation in the left eye. A soft nontender mass was palpated in the superior quadrant of left orbit. Imaging was suggestive of dermoid. Excision biopsy confirmed the diagnosis. At 6-week follow-up, the child regained full elevation and is awaiting ptosis correction. Superior deep dermoids may clinically mimic MED. Management includes complete excision of cyst with correction of residual ptosis as staged procedure. This case is being reported for its rare presentation and to insist the importance of performing a thorough orbital examination in all cases of congenital ptosis to avoid mismanagement.
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Axenfeld's anomaly with ocular hypertension: A case report and review of literature p. 187
Annamalai Odayappan, Kavitha Srinivasan
DOI:10.4103/tjosr.tjosr_13_21  
Anterior segment dysgenesis refers to a spectrum of developmental anomalies which occurs due to aberration in the migration and differentiation of the neural crest cells. Here, we describe a young male who was referred for ophthalmic evaluation by a general physician with a white ring at the corneo-scleral junction. He had 6/6 vision but with raised intraocular pressure in both eyes. Slit-lamp evaluation revealed posterior embryotoxon and fundus examination showed no optic nerve damage. Gonioscopy revealed a prominent Schwalbe's line with multiple irido-trabecular adhesions suggestive of Axenfeld anomaly. Patients with Axenfeld anomaly are at increased risk of developing glaucoma in late childhood or early adulthood. Patients with such anomalous findings should be evaluated and followed up for glaucoma.
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Hydrops as the presenting sign and “inverted bell sign” as a diagnostic sign of atypical pellucid marginal degeneration p. 190
Venugopal Anitha, Meenakshi Ravindran, Aditya Ghorpade
DOI:10.4103/tjosr.tjosr_5_21  
To report a case of, atypical pellucid marginal degeneration (PMD) with hydrops and to describe the inverted bell sign as the diagnostic feature in topography. A 40-year-old male presented to us with acute pain, redness, and loss of vision. On examination, hydrops was noted in the superior cornea in the right eye and advanced PMD in the left eye. The typical topographic signs of PMD have been described. The conservative management of hydrops in our case resulted in improvement in visual acuity. Early diagnosis and treatment of this condition with regular follow-up are essential for a good visual prognosis in these patients.
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Diagnosis and management of post - traumatic pearl iris cyst p. 193
KS Siddharthan, Shraddha Shah, Jagdeesh Kumar Reddy
DOI:10.4103/tjosr.tjosr_185_20  
Epithelial iris cysts still comprise a mystery with regard to pathogenesis, modes of presentation, and response to treatment. Here, we report an 8-year-old boy who presented with a pearly white iris cyst, 2-year postcorneal tear repair. After Anterior segment optical coherence tomography confirmation, an en block resection of the cyst was done. Eleven months later the patient presented with recurrence of the iris cyst. This recurrence was due to incomplete removal of the epithelial tissue lining the pearly cyst. Ultrasound bio-microscopy (UBM) was done to delineated the posterior extent of the cyst, and a sector iridectomy with a 4 mm margin around the cyst was done. Our case reinforces the fact that delineating the extent of these iris cysts posteriorly with UBM is mandatory in all cases, and it provides a basis for surgical resection for favorable visual outcomes.
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Anterior and nasal transposition of inferior oblique muscle p. 196
A Sasikala Elizabeth, S Kalpana Narendran
DOI:10.4103/tjosr.tjosr_4_21  
We report the case of a 20-year-old woman who presented with residual esotropia, dissociated vertical deviation (DVD), and inferior oblique over-action (IOOA) who underwent horizontal rectus muscle surgery and anterior and nasal transposition of the inferior oblique muscle. Postoperatively, she was orthotropic and showed resolution of DVD and IOOA providing an excellent motor outcome.
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Diclofenac-induced papilledema p. 199
Abhinay Ashok, Sathyan Parthasarathi, Prasanna Venkatesh Ramesh
DOI:10.4103/tjosr.tjosr_36_20  
A 32-year-old female came to the outpatient with complaints of headache. She was taking tablet diclofenac over the counter for the same without proper prescription from the doctor. On examination, anterior segment appeared normal with vision in both eyes 6/9 partial not improving with pinhole. Intraocular pressures were 14 mmHg and 13 mmHg in the right and left eye, respectively. Fundus examination by 90 D slit-lamp biomicroscopy showed blurring of disc margins. On fundus photograph examination, it revealed that the disc margins of both eyes were blurred, indicating grade four papilledema (Frisen papilledema grading system). The patient was administered anti edema measures for her condition and after a month; there were symptomatic improvement with the fundus photography confirming the resolution of papilledema. The patient was advised against nonsteriodial anti-inflammatory drugs in the future as there is a likely chance of the same idiosyncratic reaction, after a thorough systemic work-up was done to rule our other causes of the same.
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Bilateral metastasis to optic nerve head – Interesting case report series p. 202
Isha Agarwalla, Dipankar Das, Harsha Bhattacharjee, Ganesh Kuri, Bhavya Mehta, Mohit Garg, Anand Bhosale
DOI:10.4103/tjosr.tjosr_39_20  
Most intraocular metastatic tumors occur in the uveal tract, while isolated metastasis to the optic nerve is rarely found. Breast and lung cancers are the tumor types metastasizing to the eye most frequently; however, metastases of prostate cancer, melanoma, gastrointestinal tract, and renal tumors have also been reported. We describe three rare cases of optic nerve metastasis from primary carcinoma in brain, bone, and ano-rectum, which were not found in the literature previously. Bilateral optic disc edema in a patient with primary tumor elsewhere should be evaluated completely to rule out metastasis.
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Rarest rare emerging again: A case report of mauriac syndrome p. 205
Elango Vidhya, Krishnamurthy Ilango, Sankar Muthuramalingam
DOI:10.4103/tjosr.tjosr_24_20  
This is a case report of a young male with poorly controlled type 1 diabetes mellitus who presented with the clinical features of diabetic ketoacidosis. On examination, he had severe growth retardation, elevated liver enzymes, advanced diabetic eye disease, and other diabetes-related microvascular complications. Along with the other clinical features, the patient was diagnosed as a case of Mauriac syndrome. Mauriac syndrome, initially described by Mauriac in 1930, is one of the causes of growth retardation and elevated liver enzymes in poorly controlled diabetic patients. Patients with poorly controlled type 1 diabetes must be closely observed for sexual maturation and growth. An early intervention with optimal therapy to bring glycemic control combined with a close follow-up would help avoid such late complications.
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PHOTO ESSAY Top

A solitary retinal hemangioblastoma p. 208
Syed Saifuddin Adeel, Syed Mohideen Abdul Khadar, Vinit Jayendra Shah, Shobita Nair
DOI:10.4103/tjosr.tjosr_150_20  
Retinal hemangioblastoma is a rare benign retinal vascular tumor that occurs sporadically or in association with von Hippel-Lindau (VHL) disease. If associated with VHL, it can be multiple and/or bilateral. All retinal hemangioblastoma cases should be investigated for the presence of associated tumors such as central nervous system hemangiomas and visceral abdominal tumors. Herewith, we report a case of solitary capillary hemangioma in a young male.
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All that glitters is not cornea: A case of crystalline lens extrusion p. 210
Harinikrishna Balakrishnan, M Rajkumar
DOI:10.4103/tjosr.tjosr_126_20  
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Bilateral incomplete schwalbe ring in axenfeld–rieger anomaly p. 212
Sharmila Rajendrababu, Vijayalakshmi A Senthilkumar
DOI:10.4103/tjosr.tjosr_9_21  
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Malignant hypertension – Optical coherence tomography grading and optical coherence tomography characteristics p. 214
Priya Rasipuram Chandrasekaran
DOI:10.4103/tjosr.tjosr_161_20  
This photo essay describes the fundoscopic and optical coherence tomography (OCT) grading and characteristics of hypertensive retinopathy (HTR). A 34-year-old male presented with decreased vision of 20/40 N10 in both eyes following diagnosis of malignant hypertension. Fundus examination showed papilledema, intraretinal transudates, cotton wool spots, arteriovenous crossing changes, and superficial and deep hemorrhages with a partial macular star consistent with Grade 4 HTR. OCT macula revealed changes in the nerve fiber layer, outer nuclear layer, outer plexiform layer, and outer photoreceptor layer comprising inner segment/outer segment (OS) layer, external limiting membrane, and cone OS tips under the fovea with varied central subfoveal thickness. The fundoscopy grading of HTR was Keith–Wagener–Barker Grade 4 and that of OCT grading was Ahn Grade 3.
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EXPEDITED PUBLICATION, OPHTHALMIC IMAGES Top

Ruling out the obvious – Our tryst with rhino-orbital-cerebral mucormycosis p. 216
Arumuga S Nainar, Amogh Laxman Jambagi
DOI:10.4103/tjosr.tjosr_79_21  
Atypical presentation of a typical disease can often leave the ophthalmologist looking for a needle in a haystack. Owing to the collateral damage caused by the COVID-19 pandemic, epidemics of rhino-orbital-cerebral mucormycosis (ROCM) are on the rise. It is a deadly fungal disease that invades tissues and causes infarction. We would like to present a case of ROCM who presented with persistent unilateral headache with otherwise normal ophthalmological findings.
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OPHTHALMIC IMAGES Top

Accuracy of Scheimpflug Imaging (Sirius) in Detecting Subclinical Keratoconus ..Know Your Indices p. 218
Shruthy Vaishali Ramesh, Bharat Gurnani, Kirandeep Kaur, Prasanna Venkatesh Ramesh, Meena Kumari Ramesh, Ramesh Rajasekaran
DOI:10.4103/tjosr.tjosr_143_20  
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Migration of silicone oil through aurolab aqueous drainage implant p. 220
Sharmila Rajendrababu, Vijayalakshmi A Senthilkumar
DOI:10.4103/tjosr.tjosr_182_20  
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Trichiasis causing corneal deposits p. 222
Sashwanthi Mohan, Sujatha Mohan
DOI:10.4103/tjosr.tjosr_11_21  
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Blunt trauma induced serpentiform retinal detachment and dislocated lens p. 224
Vijayalakshmi A Senthilkumar, Techi Dodum Tara
DOI:10.4103/tjosr.tjosr_1_21  
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Double Pterygium with Pythium Keratitis p. 225
Bharat Gurnani, Shivanand Narayana, Josephine Christy, Kirandeep Kaur
DOI:10.4103/tjosr.tjosr_183_20  
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BRIEF COMMUNICATIONS Top

Head Canting – A Motor Adaptation p. 226
Kirandeep Kaur, Fredrick Mouttapa, Bharat Gurnani
DOI:10.4103/tjosr.tjosr_111_20  
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PHOTO QUIZ Top

Photo quiz: Holistic integrative ophthalmology with multiplex imaging - Part II p. 228
Shruthy Vaishali Ramesh, Prasanna Venkatesh Ramesh, Prajnya Ray, Anugraha Balamurugan, VG Madhanagopalan
DOI:10.4103/tjosr.tjosr_38_21  
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Photo Quiz Answers p. 230
Shruthy Vaishali Ramesh, Prasanna Venkatesh Ramesh, Prajnya Ray, Anugraha Balamurugan, VG Madhanagopalan
DOI:10.4103/2589-4528.319282  
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