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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 60 | Issue 2
Page Nos. 137-218

Online since Thursday, June 30, 2022

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GUEST EDITORIAL  

How to take a good slit lamp photograph? Highly accessed article p. 137
Naveen Radhakrishnan, N Ventakesh Prajna
DOI:10.4103/tjosr.tjosr_54_22  
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ORIGINAL ARTICLES Top

Role of trans-scleral diode cyclophotocoagulation in refractory glaucoma: A large retrospective study Highly accessed article p. 142
Nimrita Nagdev, Vidya Raja, Kumar Saurabh, Srilekha Reddy
DOI:10.4103/tjosr.tjosr_27_22  
Purpose: To study the efficacy and safety of Trans-scleral Cyclophotocoagulation (TS-CPC) to achieve adequate IOP reduction and a comfortable eye in refractory glaucoma. Material and Methods: The study was conducted at the glaucoma clinic of Aravind Eye Hospital, Madurai (TN). A total of 391 eyes of 317 patients treated from January 2019 – December 2019 with a minimum of 6 months and maximum follow-up up to 1 year were included in the study. Results: The Mean Pre-treatment IOP was 44.01 ± 14.06 mmHg. Mean post-treatment IOP at 1, 3, 6 months and up-to 1 year was 27.09 ± 14.07 mmHg, 22.65 ± 16.95 mmHg, 22.97 ± 16.60 and 22.88 ± 17.03mmHg, respectively. Complications encountered were pain and hypotony (1.7%). Conclusion: With the highest number of cases so far and with a longer follow-up period, we found that Trans-scleral Diode Cyclophotocoagulation is highly effective in lowering intraocular pressure. High success rate and low complication rate combined with portability, durability, and easy to learn technique make this procedure the treatment of choice for refractory and complex glaucoma.
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Optimal Time for Spectacle Prescription after Uneventful Clear Corneal Phacoemulsification Highly accessed article p. 147
Allapitchai Fathima, Sadasivan K Samyukta, Shivkumar Chandrasekaran, Meenakshi Ravindran, Ramakrishnan Rengappa
DOI:10.4103/tjosr.tjosr_149_21  
Purpose: In this advanced era, patients prefer to have reliable spectacle prescription after phacoemulsification at the earliest possible time. The purpose of this study is to find out the period of refraction stabilization after uneventful phacoemulsification in a tertiary eye care hospital in south India. Methodology: A prospective nonrandomized observational study at a tertiary surgical eye care centre in South India was conducted from January to June 2018, on 210 eyes of 210 consecutive patients with senile cataracts, who underwent uneventful phacoemulsification through 2.8 mm clear corneal incision. The refraction status of the subjects was evaluated at 1st week, 3rd week, and 3rd month postoperatively. One hundred seven patients were followed up till 3rd month. The remaining patients were followed up to 1 month. Patients were grouped into 1, 2, and 3 based on power variations in the range of 0–0.25 D, 0.5–0.75 D, 1 D, and more difference between visits, respectively. The changes were analyzed for spherical and cylindrical powers separately. Results: Almost 98.1% and 96.2% of patients were in Group 1 among spherical and cylindrical powers, respectively, when compared between second and third visits. About 84.3% and 67.1% were in Group 1 among spherical and cylindrical powers, respectively, when compared between first and second visits, but the difference was not statistically significant. The mean spherical equivalent showed no difference between all the three visits. Conclusion: Since there is no statistically significant difference of spherical and cylindrical values between visits, our prospective study concludes that reliable final refraction both by autorefraction and subjective refraction for spectacle prescription is possible as early as 1 week, in cases of clear cornea and quiet eye at 1 week postoperatively.
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In the era of OCT, is detection of early papilledema using Frisen scale grading valid? A study to evaluate the role of spectral domain-OCT in papilloedema among the population of hilly areas of Northern India p. 152
Shreyanshi Sharma, Rajeev Tuli, Sushil Ojha, Neeraj K Saraswat, Gaurav Sharma
DOI:10.4103/tjosr.tjosr_15_22  
Context: Papilloedema is defined as optic disc oedema secondary to raised intracranial pressure (ICP). Grading the degree of oedema using only subjective, examiner-dependent and non-quantitative fundoscopic classification like Modified Friesen Clinical Scale (MFS), may be subject to errors even when used by experienced examiners. The use of spectral-domain optical coherence tomography (SD-OCT), a non-invasive imaging technique, for early identification of raised ICP even before the clinical appearance of papilloedema by quantifying the thickness of the peripapillary retinal nerve fibre layer (ppRNFL) is crucial for such patients. Aims: To evaluate the ppRNFL using SD-OCT in patients with papilloedema. Settings and Design: Hilly North Indian population, Prospective case-control study. Methods and Material: From January 2018 to December 2018, a total of 45 patients diagnosed with papilloedema were included. Age and sex-matched controls were recruited. Detailed demographic information and the history of study subjects were noted. All subjects underwent systemic and detailed ophthalmic examination. Disc photographs were graded as per Modified Frisen Criteria (MFS). SD-OCT of the optic nerve head was done to provide a mean peripapillary RNFL thickness parameters in the different quadrants of the disc in each eye. Statistical Analysis Used: For analysis, statistical software SPSS version 23 and appropriate statistical tests were applied. P value < 0.05 was considered significant. Results: The median age of presentation was 36 years (Range 10–68 years). The male to female ratio was 1:1.3. The mean ppRNFL thickness of both right and left disc in all quadrants was significantly higher in cases in comparison to controls (P-value < 0.05 is significant). The average ppRNFL thickness in all the quadrants of both eyes was significantly higher in the mild grade of papilloedema in comparison to controls (P-value < 0.05 is significant). Conclusions: SD-OCT can be ordered as a routine important non-invasive investigation in addition to basic fundoscopic examination in all patients with papilloedema or suspected to have papilloedema.
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Optic atrophy in paediatric patients: A clinical review p. 158
Durga N S. Jasti, Akkayasamy Kowsalya, Sahithya Bhaskaran, Kanthallunarayanamoorthy Jayasri, Srinivasan Thanemozhi, Mahesh Kumar
DOI:10.4103/tjosr.tjosr_181_21  
Aim: The purpose of this study was to analyse paediatric optic atrophy in terms of aetiology and clinical presentation. Methodology: A retrospective review of records of children between 0 and 15 years diagnosed with optic nerve atrophy from January 2018 to December 2018 at a tertiary eye care centre was done. Results: Out of 40 children (80 eyes), 47.5% presented with defective vision, 12.5% with defective vision and strabismus. Mean age at presentation was 8.3 years. Mean visual acuity at presentation was 6/60. Hypoxic ischemic encephalopathy was noted in 30%, which was the most frequent cause followed by idiopathic in 15%, compressive aetiology in 10%, congenital in 10%, inflammatory in 10%, hydrocephalus in 7.5%, infection in 5%, traumatic in 5% and miscellaneous in 7.5%. Conclusion: Our study throws light on the prevalent causes of paediatric optic atrophy in Indian population which can aid in timely intervention and appropriate rehabilitation to improve the functional potential of these children.
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Retinal nerve fibre layer changes in optic neuritis in Indian population p. 162
Anand Ravikumar, Mukundhan Muraleedharan, Kasthuribai Hariharasubramanian, Sameer Chaudhary, Kowsalya Akkayasamy
DOI:10.4103/tjosr.tjosr_41_22  
Context: Retinal nerve fibre layer (RNFL) loss associated with optic neuritis has been documented in western literature. However, only one study documents the same in Indian eyes. The RNFL thickness varies from in different populations, and several genetic and environmental factors may have an impact on RNFL changes. Aims: To evaluate retinal nerve fibre layer changes using spectral domain optical coherence tomography associated with optic neuritis in Indian population. Settings and Design: This was a cross-sectional observational study conducted at a tertiary eye care hospital in India, in the department of Neuro Ophthalmology. Methods and Material: This was a cross-sectional observational study which included 20 patients who were diagnosed to have optic neuritis, three months to one year prior. SDOCT was done to measure RNFL thickness and the same was compared with fellow unaffected eyes and normative database. Results: Average RNFL thickness of unilaterally affected eye (80.77 ± 25.59 μm), was significantly reduced when compared to the unaffected eye (97.92 ± 24.46 μm) (P = 0.031) and the normative data of device (98 ± 1.0 μm) (P = 0.031). Average RNFL thickness of bilaterally affected eyes was (67.71 ± 27.09 μm), and significantly reduced when compared with the normative data (98.43 ± 0.76μm) (P < 0.001). Conclusions: An overall significant reduction in the RNFL thickness was observed in the affected eyes when compared to the fellow unaffected eyes and the normative database. This reduction was most pronounced in the temporal quadrant indicating the affliction of the papillomacular bundle.
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Dry eye disease in patients with alcohol use disorder p. 166
Lily Daniel, Mubeen Taj
DOI:10.4103/tjosr.tjosr_157_21  
Aim: To study the symptoms and signs of dry eye disease (DED) among individuals with alcohol use disorder (AUD). Subjects and Methods: This case-control study was conducted in the out patient Department of Ophthalmology in a medical college in South India over a period of twelve months, on a total of 172 eyes of 86 participants with 43 cases of alcohol use disorder (AUD) and 43 controls. The cases of AUD were 18 years or older and fulfilled the criteria of diagnosis of AUD as per the Diagnostic and Statistical Manual of Mental Disorders –5th edition (DSM-5). The controls were matched for age and sex with the cases. All cases and controls were subjected to the Ocular Surface Disease Index® (OSDI) questionnaire and Schirmer's test after assessment of their best-corrected visual acuity (BCVA). The cases were further assessed for tear breakup time (TBUT), fluorescein staining, and rose Bengal staining using slit lamp biomicroscopy followed by fundus examination. The Chi-square test, odds ratio, 95% confidence interval were calculated using the Statistical Packages for Social Sciences (SPSS) version 20 software. A P value of <0.05 was considered significant. Results: The mean age of cases was 45+/-11 years. Cases less than 40 years showed the highest proportion (44.2%) of DED with irritation being the most common symptom (24.4%). OSDI scores showed mild type of DED in 39.5% (P < 0.0001). Schirmer's indicated dry eyes in 38.3% (P < 0.0001) with OR of 12.1 in the right eye and 13.4 in the left eye. TBUT revealed marginal grade for dry eye in 44 eyes (51.2%) and definitive dry eye in 35 eyes (40.7%) In AUD, conjunctival and corneal staining with fluorescein were seen in 46 eyes (53.5%) with interpalpebral staining in 22 eyes (25.6%), inferior staining in 14 eyes (16.3%) and a combination of interpalpebral and inferior staining in 10 eyes (11.6%). Conclusion: Alcohol has a deleterious effect on the ocular surface and gives rise to DED. This implicates the necessity of regular ophthalmic screening including staining of the ocular surface to diagnose and treat DED in people with AUD especially in the age group between 18–40 years.
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REVIEW ARTICLES Top

Glauco skills for the millennial glaucoma specialist p. 171
Shweta Tripathi, Madhu Bhadauria, Chandrima Paul, Murali Ariga
DOI:10.4103/tjosr.tjosr_24_22  
Clinical skills training in Glaucoma is an intergral for the Glaucoma specialist of tomorrow. We discuss the various modalities and resources for glaucoma skills training.
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The Basics of Scientific Writing p. 175
Thanuja Gopal Pradeep, NS Murthy, Deepthi R H
DOI:10.4103/tjosr.tjosr_182_21  
Writing a scientific article remains a challenge to many medical professionals. The importance of scientific writing is understood by many, but the process seems daunting. In this article, we attempt to embark upon the reader on the importance of publishing and the reasons to publish. We discuss the main elements that are essential to be included in a basic article. We enumerate how to organise thoughts and ideas and discuss the nuances that one needs to be aware of while writing a scientific article. It is a comprehensive article that helps the reader to understand the principles of scientific writing.
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CASE REPORTS Top

Tapping and Autologous Serum - A Novel Technique for Macular Hole p. 183
Taranpreet K Chitkara, Preetam Singh, Vipan K Vig, Rajbir Singh
DOI:10.4103/tjosr.tjosr_165_21  
We describe here a case of a large, chronic idiopathic macular hole in a patient which was treated using autologous blood serum in combination with tapping the macular hole edges. We achieved successful macular hole closure and improvement in postoperative visual acuity. According to the literature, inverted flap technique continues to be the most accepted form of technique. It also requires experience and skill on the part of surgeon, on the contrary autologous serum in combination with tapping the macular hole edges is a simple, effortless, and relatively non-traumatic option. The combined use of tapping the macular hole edges and applying autologous blood serum is advantageous because the autologous blood serum in proper position probably acts like a natural glue to the tapped edges of macular hole and promotes the proliferation of glial cells. This novel combination technique may be particularly advantageous in chronic or recalcitrant holes particularly large macular holes.
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Indirect Traumatic Optic Neuropathy with Associated Charles Bonnet Syndrome p. 186
Shenouda Girgis, Aditya Sethi, Sahebaan Sethi, Vaibhav Sethi, Reena Sethi, Arun Sethi
DOI:10.4103/tjosr.tjosr_28_21  
We report a case of an 84-year-old female who presented following a fall from standing height. There was immediate loss of vision in the right eye. On day 3 of admission, the patient described seeing hallucinations in the right eye. She described seeing children playing in the garden while sitting in the hospital bed. She was found to have an indirect traumatic optic neuropathy with an associated Charles Bonnet syndrome. The patient underwent conservative management and on 2 weeks follow-up her right eye vision improved to hand motions. To our knowledge, there is no reported case of this kind in the literature.
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Posterior choroidal effusion following uneventful cataract surgery p. 189
B Koshal Ram, Anusha Koshal Ram, S Balasubramanian
DOI:10.4103/tjosr.tjosr_47_21  
Posterior choroidal effusion occurs in the setting of sudden changes in intraocular pressure which facilitates the influx of fluid in the suprachoroidal space. The reason for sudden intraocular pressure fluctuation can be due to varied causes such as filtering surgery, use of antiglaucoma medication. In our case, it was following an uneventful cataract surgery in which the patient presented with a choroidal elevation on the first postoperative day. He was treated with systemic steroids and the choroidal elevation settled in 2 weeks. We present a serial optical coherence tomography imaging of the patient which showed a resolution.
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Concurrent occurrence of thyroid-associated orbitopathy and idiopathic orbital inflammatory diseases p. 191
Sarala Sankar, Bhagwati Wadwekar
DOI:10.4103/tjosr.tjosr_154_21  
Background: The coexistence of thyroid-associated orbitopathy (TAO) and idiopathic orbital inflammatory diseases (IOID) is rare. They mimic each other clinically, and it is challenging to differentiate the two. We are presenting a case of bilateral proptosis resulting from concomitant TAO and IOID. Case Report: A 44-year-old female presented with swelling, pain, and protrusion of both eyes for one month. She had a past history of trauma in the right eye (RE) 15 years ago. Her best-corrected visual acuity in RE was hand movements and 20/30 in the left eye (LE). There was lid edema, conjunctival congestion, chemosis with axial proptosis, and restricted extraocular movements in both eyes (BE). The anterior segment of RE revealed sequels of old anterior traumatic uveitis and it was normal in the LE. The B scan done in BE showed enlargement of all extraocular (EOM). CT scan orbit showed enlargement of all the EOM belly and tendon insertions. Thyroid profile found to have high anti-TPO (thyroid peroxidase) suggestive of Hashimoto's thyroiditis. The patient was started on intravenous methylprednisolone and showed significant improvement. Conclusion: TAO and IOID can present together. This case report highlights the need for clinicians to be aware of this condition.
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Traumatic phacocele – A rare case of lens dislocation p. 195
K Rajasekar, M Sangamithira, Rohini Krishnan, Sivakalai Ramakrishnan, Aswathi Vedalmaji
DOI:10.4103/tjosr.tjosr_13_22  
Traumatic phacocele is a rare case of lens dislocation following blunt trauma with only a few case reports in the literature. The risk of phacocele following blunt trauma is escalated in elderly patients due to increased scleral rigidity and hard nucleus. We report a case of a 70-year-old lady who sustained blunt trauma to her left eye with a wooden stick. On examination, a subconjunctival mass was noted with surrounding subconjunctival haemorrhage in the superonasal position in the left eye. The anterior segment showed left eye corneal oedema with total hyphaema and the fundus showed no view due to total hyphaema. B-scan ultrasonography of her left eye showed a vitreous haemorrhage with retinal detachment. Wound exploration was done and the lens was removed. Suturing of the scleral defect was also done. Postoperatively she had the perception of light. The visual outcome depends on timely management and associated ocular complication.
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Dissimilar Maculopathies after Electrical Shock Injury: A Rare Case Report p. 198
Hemalata Deka, Kanika Godani, Saurabh Deshmukh, Manabjyoti Barman, Ronel Soibam
DOI:10.4103/tjosr.tjosr_147_20  
High electrical current can cause serious ocular injuries resulting in permanent vision loss, besides life-threatening complications. A 56-year-old man presented with diminution of vision in both eyes. The past medical history revealed occupational exposure to high-voltage electrical current 10 years ago. Fundus showed a foveal scar in the left eye and a dull foveal reflex in the right eye. Optical coherence tomography revealed foveal thinning in the right eye and foveal scarring in the left eye. This report thus highlights a case of dissimilar electric shock maculopathies depending on the distance of the eye from the point of entry of electric current.
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Bilateral pigmented paravenous chorioretinal atrophy in a patient with tuberculosis – A case report p. 200
Sanyukta Joshi, Mihir Trivedi, Chhaya Shinde
DOI:10.4103/tjosr.tjosr_170_21  
Pigmented paravenous chorioretinal atrophy (PPCRA) refers to unilateral or bilateral pigmentation along retinal veins with changes on fundus autofluorescence and electroretinography (ERG). PPCRA cases have usually been noted as sporadic and its association with tuberculosis has rarely been demonstrated. Here, we report a case of PPCRA in a young female with tuberculosis and fundus autofluorescence and ERG findings suggestive of macula involving bilateral PPCRA. This case demonstrates the presence of PPCRA in a patient with active tuberculosis and importance of considering PPCRA as a diagnosis in patients of tuberculosis with mild diminution of vision.
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OPHTHALMIC IMAGES Top

'Bread Crumbs' of granular corneal dystrophy: Through the looking glass (Scheimpflug Imaging) p. 203
Prasanna Venkatesh Ramesh, Prajnya Ray, Aji Kunnath Devadas, Shruthy Vaishali Ramesh, Meena Kumari Ramesh, Ramesh Rajasekaran, Akshay Surendran
DOI:10.4103/tjosr.tjosr_188_21  
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Inverted 'Echinops Setifer' Shaped Traumatic Sign in the Fundus – Contemporaneous Subfoveal Choroidal Rupture with Epiretinal Membrane Post Blunt Trauma p. 205
Prasanna Venkatesh Ramesh, Aji Kunnath Devadas, Prajnya Ray, Shruthy Vaishali Ramesh, Anugraha Balamurugan, Meena Kumari Ramesh, Ramesh Rajasekaran, Banasmita Mohanty
DOI:10.4103/tjosr.tjosr_187_21  
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PHOTO ESSAYS Top

Orbital Mucormycosis in Covid- 19: A Case Presentation p. 207
Rajakannan Durairaj
DOI:10.4103/tjosr.tjosr_168_21  
A 53–year-old male presented with a left eye swelling, proptosis, loss of vision, and complete ophthalmoplegia. Orbital mucormycosis is leading to the diagnosis of COVID 19,the patient was treated for the same. The author wants to insist that Orbital mucormycosis can develop in COVID-19 patients with comorbidities and patients under treatment with corticosteroidsfor COVID-19, which requires prompt diagnosis and management.
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Herpes zoster's varied clinical presentation in Covid-19 p. 210
Rajakannan Durairaj
DOI:10.4103/tjosr.tjosr_167_21  
A 52-year-old woman with Covid-19 on treatment presented with left eye pain and skin lesion on face. Diagnosed clinically as herpes zoster ophthalmicus in Covid-19. Confirmed by slitlamp biomicroscopy and fluorescein staining, Patient was treated for the same.In this brief report the author would like to insist that Covid-19 affects the immune system and thus increases the risk of herpes zoster. Patients require prompt diagnosis and treatment to prevent complications.
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Hair Shaft in the Lacrimal Punctum: A Rare Presentation p. 212
V Nishant Janardhana Raju, Sudhakar Potti, Harika Anne
DOI:10.4103/tjosr.tjosr_103_20  
We report a rare case of 18-year-old male presenting with redness, watering and pain in right eye for past 2 days. He was diagnosed as bacterial conjunctivitis elsewhere and started on gentamycin (0.3%) eye drops four times a day to which symptoms are not relieved. Slit lamp examination of right eye revealed sectoral congestion confined to nasal bulbar conjunctiva temporal to plica semilunaris, which was initially confused with inflamed pinguecula and episcleritis. Careful examination of ocular adnexa led to revelation of hair shaft in the upper lacrimal punctum and timely removal of the hair shaft helped us in alleviation of patients morbidity.
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PHOTO QUIZ Top

Photo Quiz p. 214
Deepthi Mudduluru, Anitha Venugopal, Aditya Ghorpade
DOI:10.4103/tjosr.tjosr_11_22  
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LETTER TO THE EDITOR Top

Online survey as a data collection tool – The good, the bad, and the ethics p. 217
Fayiqa Ahamed Bahkir
DOI:10.4103/tjosr.tjosr_174_20  
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