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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 60 | Issue 3
Page Nos. 219-276

Online since Monday, September 26, 2022

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EDITORIALS  

Passing on the baton Highly accessed article p. 219
Sharmila Devi Vadivelu
DOI:10.4103/tjosr.tjosr_87_22  
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From the editor's desk p. 221
Jeyanthan Soundarapandian
DOI:10.4103/tjosr.tjosr_89_22  
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REVIEW ARTICLE Top

A review on technology and different probes in transscleral cyclophotocoagulation p. 222
M Salu, Murali Ariga, Pratheeba D Nivean, M Nivean
DOI:10.4103/tjosr.tjosr_45_22  
Glaucoma is a chronic progressive optic neuropathy, characterised by retinal ganglion cell loss leading to optic nerve head changes and visual field defects. The control of intraocular pressure remains a key determinant factor in the management of glaucoma. Cyclodestructive procedures target the epithelium of ciliary processes, thereby reduces the aqueous formation. Cyclodestructive procedures have advanced from initial cyclodiathermy to micropulse diode laser cyclophotocoagulation (CPC). The various probes used in transscleral CPC (TSCPC) include G-probe delivery device and G-probe illuminate delivery device for continuous wave TSCPC and micropulse P3 probe for micropulse diode laser TSCPC. This review article provides details on design of probes and their technology.
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ORIGINAL ARTICLES Top

Quality of life among prosthetic shell users – Questionnaire based p. 227
Pratheeba D Nivean, Chitra Padavettan, N Kheerthana, Anshika Shah, M Nivean
DOI:10.4103/tjosr.tjosr_158_21  
Purpose: The aim is to determine the psychological factor, driving capability, and the influence of the device among working professionals based on questionnaire. Methods: A qualitative questionnaire-based cross-sectional study was conducted among participants of a tertiary eye care center in Chennai from March 2020 to August 2020. The questionnaire consisted of participant demographics, psychological care, driving, and prosthetic support and maintenance-related questions. The responses were recorded over telephone and analysed using SPSS Statistics. Result: About 30 participants of age 9 years and above were included after obtaining consent. The average age was found to be 38.8 ± 12.7 years with 46.7% (n = 14) males and 53.3% (n = 16) females. Anophthalmic participants exhibit a substantial change in psychological feelings following ocular prosthesis. Participants found to be motivated after the cosmetic change brought about by prosthesis, and therefore had a higher output on work factor. In terms of driving, 90% of the subjects were comfortable using protective devices for safety measures. They found greater satisfaction in customised manually built prosthesis than computerised prosthesis. The former had smooth edge finish with reduced prosthetic motility, which has made the patient gain satisfaction, improving care and maintenance, and the handling of ocular prosthesis. Conclusion: The use of ocular prosthesis was found to decrease depression, insecurity, inferiority complex with minimal difficulty in activities of daily living, and no difficulty in driving with prosthesis. The quality of life improved with the use of customised prosthetic shells.
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Safety and efficacy of selective laser trabeculoplasty in secondary ocular hypertension following deep anterior lamellar keratoplasty p. 232
Premanand Chandran, Vinoth Arunaachalam, Mrunali Dhavalikar, Menaka Vimalanathan, Ganesh V Raman
DOI:10.4103/tjosr.tjosr_48_22  
Purpose: To evaluate the safety and efficacy of selective laser trabeculoplasty (SLT) in eyes with secondary ocular hypertension (OHT) following deep anterior lamellar keratoplasty (DALK). Methods: Retrospective review of patients who underwent SLT for increased intraocular pressure (IOP) following DALK between January 2014 and December 2016. Patients with a minimum follow-up of one year were included. Results: A total of seven eyes (seven patients) were analysed. The mean IOP reduced from 24.6 ± 11.1 to 15.3 ± 3.2 (p = 0.04), 14.2 ± 1.3 (P = 0.15) and 14 ± 1.4 (P = 0.09) mm Hg at one, two, and three years post-SLT respectively. The mean number of antiglaucoma medications (AGMs) reduced from 2.3 ± 1.1 to 0.2 ± 0 at one year, and 0 ± 0 at two and three years (P < 0.05). All eyes had clear graft during the entire follow-up, and there was no inflammation or signs of rejection post-SLT. Conclusions: SLT reduces IOP as well as the number of AGMs in eyes with OHT following DALK.
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An observational study of the correlation between axial length and retinal nerve fibre layer thickness in myopic eyes in a tertiary care centre in south india p. 235
A Rajeshwari, VK Malathi
DOI:10.4103/tjosr.tjosr_177_21  
Objective: To assess the correlation between axial length and retinal nerve fibre layer (RNFL) thickness in myopic eyes in a tertiary care hospital in a two-year period (August 2017 to June 2019). Methods: Institutional ethics committee approval was obtained. Written and informed consent was obtained from all the participants. One hundred eyes of 58 patients were screened. Myopic patients with > -0.50 D myopia in the age group of 18 to 40 years with intraocular pressure (IOP) <20 mm Hg were included in the study. Patients with a history of ocular trauma, glaucoma, ocular surgeries, optic nerve or macular diseases, pathological myopia, and media opacities were excluded from the study. An ophthalmic evaluation was done by assessing the visual acuity, IOP, slit-lamp examination, and perimetry using Humphrey field analyser II (Swedish interactive threshold algorithm SITATM testing strategy). After dilating the pupils with Tropicamide plus, posterior segment evaluation was done using a 90 D lens with slit lamp bio-microscopy as well as indirect ophthalmoscopy and 20 D lens. The axial length was measured using Lenstar LS 900. Optical Coherence Tomography (OCT) images were obtained using a 3 D OCT 1 Maestro machine by a single observer. Results: There was a statistically significant association between axial length and RNFL thickness in myopic eyes (P = 0.0003). As the axial length of the eyeball increases, the RNFL thickness decreases in all four quadrants except the temporal quadrant, producing a statistically significant negative correlation (r = -0.3551). Conclusion: There is a statistically significant association between axial length and RNFL thicknesses in all quadrants except the temporal quadrant. The negative correlation between axial length and RNFL thickness would be useful in avoiding misdiagnosis of glaucoma since RNFL thickness is low in both glaucoma and myopia.
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Comparison of ocular pathologies between children attending rural and urban schools in south india: A retrospective analysis p. 240
Sabyasachi Chakrabarty, Meenakshi Ravindran, Madhavi Ramanatha Pillai, Shivkumar Chandrashekharan, Neelam Pawar, Mohammed Sithiq Uduman
DOI:10.4103/tjosr.tjosr_26_22  
Aims: To assess the differences in ocular morbidity with/without visual impairment between rural and urban school-going children using a two-step screening strategy. Methods: Data obtained by a hospital team from school camps conducted between the 1st of February 2019 and the 31st of December 2019, in schools with a strength of at least 1,000 students were reviewed retrospectively. The differences in ocular pathologies between the rural and urban cohorts were evaluated. A P < 0.05 was considered significant. Results: Out of 25,132 students (nurban = 12,562; nrural = 12,570), 14.44% (nurban = 1,585; nrural = 2,044; P < 0.001) were selected for evaluation by the hospital team after a primary screening by their class teachers. A statistically significant difference was noted in the frequency of refractive errors (urban = 6.8%; rural = 6.0%; P = 0.01), allergic conjunctivitis (urban = 0.2%; rural = 0.05%; P = 0.001), and amblyopia (urban = 0.03%; rural = 0.12%; P = 0.009) between urban and rural children. Simple and compound myopic astigmatism were significantly more common in urban children (p < 0.001 and 0.03 respectively). There was no significant difference in the incidence of spectacle use (P = 0.11) between the two cohorts. A Cochran--Armitage trend test revealed a statistically significant increase in the proportion of myopia with age among the children evaluated by the hospital team (p < 0.001). Conclusion: Allergic eye disease and myopic astigmatism are commoner in urban children. Routine ophthalmic screening is required to identify uncorrected refractive errors and amblyopia, especially in rural school children.
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A comparative study of central corneal thickness changes in bevel-up and bevel-down phacoemulsification p. 246
Varshav Gore, Ayushi Choudhary, Mamta Agrawal, Abha Shah, Jesmin Alex
DOI:10.4103/tjosr.tjosr_146_21  
Introduction: Many techniques that have been developed but the risk for corneal endothelium damage and posterior capsule rupture still exist. It is believed that corneal endothelium is minimally damaged when the tip is bevel down in phacoemulsification surgeries. There is a difference between ophthalmologists with respect to the position of tip in phacoemulsification, and hence we conducted this study. Methodology: Thirty patients were evaluated in this study, both eyes of all the patients were operated using phacoemulsification; the right eye of all patients was operated with the bevel-up phaco tip and the left eye of all patients was operated using bevel-down phaco tip. The central corneal thickness (CCT) was taken and compared on preoperative day, immediate postoperatively, and on postoperative day 1, day 14, and 1 month in bevel-up and bevel-down phacoemulsification. Results: The mean CCT on day 14 in bevel-up phacoemulsification was 593.40 ± 18.11 and in bevel-down phacoemulsification was 585.37 ± 26.60, and on day 30 in bevel-up phacoemulsification was 573.53 ± 16.27 and bevel-down phacoemulsification was 561.80 ± 18.20. It can be observed that there was no significant difference in the CCT on day 0, day 1, and day 14; however, on day 30, there is a significant difference in the bevel up versus bevel down. Conclusion: In our study, it was observed that there was no significant difference in the CCT on day 0, day 1, and day 14; however, on day 30, there is a significant difference in the bevel up versus bevel down. Hence, it is observed that the corneal endothelial loss is less in bevel down when compared to bevel-up phacoemulsification.
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Prevalence of aqueous deficient dry eye and common ocular surface changes among salt workers p. 250
Sharanyaa Krishnamoorthy, Rajalakshmi Selvaraj, Udayasankar Soubramanianae, Vanaja Vaithianathan, Arun Tipandjan
DOI:10.4103/tjosr.tjosr_145_21  
Background: India is the third-largest salt-producing country in the world and Tamil Nadu is the second largest salt-producing state in India. Salt production is one of the most hazardous occupations, which affects the eye and skin primarily. This study was done for assessing the common ocular surface changes among salt workers in Marakkanam, which is a block of Villupuram district in Tamil Nadu. Methodology: It is a cross-sectional study for 2 months among 253 salt workers with minimum exposure of 6 months after taking informed consent. Those with systemic diseases and other ocular surface disorders were excluded from this study. After performing Schirmer's test, an ophthalmic evaluation was done for ocular surface disorders. Results: The prevalence of aqueous deficient dry eye (ADDE) in salt workers is 38.30%. The prevalence of pterygium is 39.50%. The prevalence of pinguecula is 29.64%. Males (46%) are affected more than females (28%) because males are held in the salt pan where sandy and outdoor environments increase the risk of the development of pterygium. Salt pan workers (47%) who work amidst salt crystals and a sandy environment have an increased risk of developing pterygium, than the dry salt workers (24%). Conclusion: ADDE and pterygium are highly prevalent among salt workers. It will also guide the salt workers to know their ocular conditions and the need for a regular ocular check-up to safeguard their eyes.
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Choroidal thickness and choroidal vascularity index in diabetic retinopathy and diabetic macular edema – A clinical study p. 254
Sozhamadevi Subramaniyan, Venkatesh Perumal, Jaya Prabha Balachandar
DOI:10.4103/tjosr.tjosr_18_22  
Purpose: To evaluate the choroidal thickness and choroidal vascularity index (CVI) in various stages of diabetic retinopathy and to assess its significance in diabetic macular edema. Materials and Methods: 166 eyes of 83 patients were evaluated in this study. 116 eyes were with various stages of diabetic retinopathy and 50 eyes were non-diabetic healthy controls. Spectral Domain Optical Coherence Tomography (SD OCT) was done for all patients. The choroidal thickness and the macular thickness at the fovea, 500 μm nasal, temporal, superior and inferior to the fovea were measured manually, and CVI was calculated as the ratio between the total choroidal area and the luminal area using ImageJ software. Results: The mean age of the study group was 55.95 ± 10.57 years and that of the control group was 53.33 ± 11.28 years. The choroidal thickness was significantly decreased in patients with proliferative diabetic retinopathy (p < 0.005). CVI was inversely proportional to the severity of diabetic retinopathy and was statistically significant (p < 0.01 to 0.005). In eyes with DR and macular edema a significant decrease in choroidal thickness (p = 0.019) was observed; however, the decrease in CVI was not significant (p = 0.056). Conclusion: In diabetic retinopathy, the choriodal thickness and CVI decreases as the severity of the retinopathy increases. Choroid plays an important role in disease progression. But in eyes with diabetic retinopathy associated with or without macular edema, there is no significant difference in CVI.
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Pattern of ophthalmic manifestations among COVID-19 survivors attending eye clinic in a tertiary care centre p. 259
Jasmita Satapathy, Alpana Mishra, Yamijala N Srija, Chinthala Navyasree, Japesh Thareja
DOI:10.4103/tjosr.tjosr_134_21  
Background: Almost every organ of the body including the eye can be affected in post-acute coronavirus disease 2019 (COVID-19) syndrome. Objective: To describe the pattern of ocular manifestations among recovered COVID-19 patients. Materials and Methods: An observational cross sectional study was conducted in the department of ophthalmology by recruiting patients who had recovered from COVID-19 and had attended eye clinic between 1 April 2021 and 30 June 2021. Comprehensive ophthalmological examination was performed in all participants. Results: A total 85 patients were enrolled (53 males and 32 females). Their mean age was 46.03 ± 16.2 years. The mean duration between positive real-time reverse transcription polymerase chain reaction test report for COVID-19 and the day of visit to eye clinic was 47.5±24.1 days. At least one ocular sign was present in 54 (63.5%) patients. The most common presenting ocular symptom was irritation (40%) followed by redness (29.4%). Frequently encountered ocular signs were conjunctival hyperaemia (37.6%), follicular conjunctivitis (30.6%), Keratoconjunctivitis (2.4%), central serous chorioretinopathy (3.5%), branch retinal vein occlusion (1.2%) and rhino-orbital mucormycosis (3.5%). Conclusion: Wide variety of ophthalmic manifestations can occur among COVID-19 survivors, some of which can also be sight threatening and hence they should not be ignored.
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CASE REPORTS Top

A case of embolic non-arteritic anterior ischaemic optic neuropathy in a young patient p. 264
R Kokila Priya, Arthi Mohankumar, Priya Sivakumar
DOI:10.4103/tjosr.tjosr_7_22  
We report a rare case of unilateral non-arteritic anterior ischaemic optic neuropathy (NAAION) of embolic origin in a 47-year-old male caused by hypertriglyceridaemia and significant atherosclerotic stenosis of bilateral carotid arteries. The fundus fluorescein angiogram showed features supportive of an embolic aetiology. After left carotid endarterectomy and lipid-lowering therapy, there was complete resolution of disc oedema. Embolic anterior ischaemic optic neuropathy (AION) contributes to less than 10% of total AION cases and is often underevaluated. This case report emphasises the importance of thorough systemic evaluation by the ophthalmologist in patients with AION and the role of fundus fluorescein angiography (FFA) in establishing the aetiology in AION cases.
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Bilateral multiple retinal artery macroaneurysms with coexistent diabetic retinopathy p. 266
Roshni Mohan, M Arthi
DOI:10.4103/tjosr.tjosr_173_21  
To discuss the clinical profile of retinal artery macroaneurysms (RAMs), its presentation, rarity, complexity in diagnosis and management modalities. RAMs are seen commonly in elderly females who have associated systemic hypertension. Most of these aneurysms undergo spontaneous involution due to fibrosis while others may result in vascular leakage with macular oedema and haemorrhage into various layers of retina. Long-standing exudation may result in the development of cystoid macular oedema (CME), macular hole, macular exudate, retinal gliosis, and atrophy. Since the arterioles are high-flow vessels, it ruptures under high pressure resulting in haemorrhages at various levels – vitreal, preretinal, intraretinal, and subretinal. Multiple RAMs maybe hereditary, inherited in an autosomal recessive pattern presenting with recurrent vitreous haemorrhage. Treatment is to ensure rapid resolution of haemorrhage and exudation thereby facilitating early visual recovery and avoiding permanent visual loss. Referral to a physician is essential for the management of hypertension and associated systemic illnesses. Here we describe a case of multiple bilateral macroaneurysms with coexistent diabetic retinopathy.
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A rare case report of oculosporidiosis from South India: 'Fish Egg' appearance means a lot p. 269
Vishnu Teja Gonugunta, Datta Dipankar, TS Sujatha, Dhanya Kuppuraj, Chinmayee Pabolu, Shanthi D Radhakrishnan
DOI:10.4103/tjosr.tjosr_160_21  
To emphasise the importance and possibility of a rare infective condition caused by Rhinosporidium seeberi presented with a vascular mass. A 50-year-old male presented with complaints of a recently noted red mass in his left eye causing irritation. Ocular examination revealed the presence of a large, red vascular mass with numerous greyish-white spots (Fish egg-like appearance) on its surface with feeder vessels. A provisional diagnosis of conjunctival hemangioma was made and planned for excision. The mass was excised and sent for biopsy. It did not require grafting. Histopathological examination revealed a structure of polypoidal mucosal inflammation studded with multiple double-walled sporangia containing endospores in a swiss cheese pattern suggestive of rhinosporidiosis. Rhinology consultation was normal. No recurrence is noted during the follow-up period of 18 months. Bulbar conjunctival involvement is relatively rare. 'Fish egg' appearance aids in the diagnosis and histopathology confirms it. Excision is the only treatment.
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PHOTO ESSAY Top

Multiple evanescent white dot syndrome p. 272
M Arthi, Chokkahalli K Nagesha, Harshal P Gondhale
DOI:10.4103/tjosr.tjosr_10_22  
Multiple evanescent white dot syndrome (MEWDS) was described by Jampol et al. in 1984 in 11 young patients who had unilateral transient retinal pigment epithelium (RPE) granularity and white dots at the level of RPE with vitreous cells[1]. It is predominantly a disease of the photoreceptors with occasional involvement of the outer nuclear layer. Inflammatory microglial activation and changes in deeper retinal circulation contribute to the features of MEWDS[2]. Patients are usually young females and may have a preceding history of flu-like illness. This reversible condition involves the photoreceptors causing reduced amplitudes in the full field and multifocal electroretinogram (mfERG), which recovers with the resolution of the disease[3]. We present a case of MEWDS in a young female with typical clinical features with spontaneous improvement in symptoms with observation.
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OPHTHALMIC IMAGES Top

Dynamic tube movement of Aurolab aqueous drainage implant associated with recurrent iritis p. 275
Vijayalakshmi A Senthilkumar, Kousalya Pavan
DOI:10.4103/tjosr.tjosr_16_22  
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Impending tube corneal touch in congenital glaucoma p. 276
Sharmila R Rajendrababu, Vijayalakshmi A Senthilkumar
DOI:10.4103/tjosr.tjosr_189_20  
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