Promoting TERT Promoter Mutations for Prognostication in Cutaneous Oncology

http://bit.ly/2T8Zi3z

Efficacy and safety of switching to ixekizumab in secukinumab nonresponder psoriatic patients: results from a multicenter experience

Abstract

Loss of efficacy of biological therapies in psoriatic patients is a well‐known event. Biological switching is common in clinical practice, especially in TNF‐α and IL‐12/23 inhibitors treatment^1,2. Recently, anti‐IL‐17A drugs such as secukinumab have provided a new therapeutic opportunity

This article is protected by copyright. All rights reserved.

http://bit.ly/2EJXtqr

Isotretinoin′s paradoxical effects in immortalized sebocytes

Abstract

in their recently published Research Letter, Burney et al.¹ reported that the short‐term exposure of cultured SEB‐1 immortalized sebocytes to isotretinoin (13‐cis retinoic acid), the most powerful sebum‐suppressive drug promoting sebocyte apoptosis in acne patients, paradoxically increased lipogenesis and upregulated the expression of sterol regulatory element‐binding protein 1 (SREBP1)

This article is protected by copyright. All rights reserved.

http://bit.ly/2EIDp7j

Masson’s tumor of the kidney: a case report

Intravascular papillary endothelial hyperplasia (known also as Masson's tumor) is a benign vascular lesion that commonly occurs in the skin and is rarely found in solid organs, especially in the kidney. In wha...

http://bit.ly/2A97PMz

Cardiac arrest associated with pneumorrhachis and pneumocephalus after epidural analgesia: two case reports

Epidural analgesia has become a common procedure to provide excellent pain relief with few complications. Pneumorrhachis and pneumocephalus are rare complications of unintentional dural puncture and injection ...

http://bit.ly/2Sgjgtb

More than bargained for: pneumomediastinum and subcutaneous emphysema associated with synthetic cannabinoid use

http://bit.ly/2EI9oo9

Bishop-Koop jejunostomy in an adult following proximal small bowel anastomotic breakdown

This case involves a proximal penetrating small bowel injury and the use of a Bishop-Koop anastomosis in a 33-year-old man. This case highlights the use of alternative methods used to prevent a proximal small bowel stoma in a rural setting. The Bishop-Koop anastomosis was originally designed for neonates in cases of intestinal anomalies such as atresia, volvulus and apple-peel syndrome. A literature search for the use of the Bishop-Koop anastomosis in adults, although scanty, is included in this article. We believe this article will benefit readers and that this method may be considered in breakdown of proximal small bowel injuries, to prevent a high-output stoma.

http://bit.ly/2EIcbOJ

Haemolacria in a 22-year-old boy

http://bit.ly/2EJlDSa

Curious reaction to intrathecal chemotherapy

http://bit.ly/2EDJtxH

Pleuropulmonary tuberculosis with spinal lesions due to metastatic malignancy differentiated definitively on imaging

A healthy 31-year-old man presenting with back pain was found to have multiple spinal enhancing lesions on MRI. An incidental asymptomatic large pleural effusion was identified on investigations for the back pain and pleural and pulmonary tuberculosis (TB) was subsequently diagnosed. The radiographical features on MRI spine were not typical of spinal TB and a Ga68 DOTATATE Positron Emission Tomography (PET)/CT confirmed metastatic paraganglioma with multiple bone metastases. Although metastatic paraganglioma is rare, this case highlights that even in young patients dual pathology needs to be considered. Most importantly, it is a reminder to physicians managing TB of the clues that help distinguish spinal TB from important alternative causes, including metastatic malignancy.

http://bit.ly/2EJacK5

Chlamydia ascites: a call for sexually transmitted infection testing

A 26-year-old gravida 2, para 2-0-0-2 woman with a recent uncomplicated vaginal delivery 10 weeks prior presented to our hospital with 5 weeks of abdominal swelling and discomfort. Four weeks after delivery, the patient began having right upper quadrant pain and was found to have cholelithiasis. She underwent an elective laparoscopic cholecystectomy 6 weeks prior to admission, but started to develop worsening abdominal swelling 1 week postoperatively. Abdominal distension and shifting dullness were present on examination. CT of the abdomen and pelvis was remarkable for moderate-volume ascites and mild enhancement of the pelvic peritoneum. Paracentesis removed 2.46 L of ascites fluid with 76% lymphocytic predominance. Results for Chlamydia trachomatis were positive in urine, cervical swab and ascitic fluid. Doxycycline was prescribed for a diagnosis of pelvic inflammatory disease exudative ascites. Since discharge, she has completed her antibiotic course and reports resolution of all symptoms without recurrence of ascites.

http://bit.ly/2ECyDbj

Removing the problem: parathyroidectomy for calciphylaxis

Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.

http://bit.ly/2EMkycn

PIBIDS syndrome in two Brazilian siblings

Trichothiodystrophy is a rare condition associated with autosomal recessive or X-linked dominant variants in the ERCC2, ERCC3, GTF2H5, MPLKIP, RNF113A or GTF2E2 genes. The genes associated to photosensitive trichothiodystrophy encode subunits of transcription factor IIH, involved in the nucleotide excision repair pathway. The disease is characterised by cysteine-deficient brittle hair along with other neuroectodermal abnormalities. It has a variable clinical expression and some cases might be associated with photosensitivity, resulting in the acronym PIBIDS (photosensitivity, ichthyosis, brittle hair, intellectual impairment, decreased fertility and short stature). We report clinical findings of two siblings diagnosed with trichothiodystrophy associated with marked photosensitivity.

http://bit.ly/2EFE21q

Chain of migrating ureteral calculi: a cat and mouse game

http://bit.ly/2EJactz

Early presentation of vertebral osteomyelitis following a transrectal ultrasound-guided prostate biopsy with delayed radiological findings

A transrectal ultrasound-guided (TRUS) prostate biopsy is a common diagnostic procedure which carries an expected risk of iatrogenic infections. These range from simple urinary tract infections to rare but serious infections requiring an admission to hospital. Here we present a rare case of vertebral osteomyelitis following a TRUS biopsy, with normal initial MRI and bone scintigraphy scans and delayed radiological findings on repeat MRI of the spine.

http://bit.ly/2EDNwdm

Metastatic renal cell carcinoma presenting as a cardiac tumour

http://bit.ly/2EK7i80

Multiple melanoma in a burns scar

It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumours, however, melanoma formation at these sites is extremely rare. This case report describes a burns case, which progressed to four melanomas in a 78-year-old male patient's little finger, 40 years after the initial incident. The patient underwent 3 mm punch biopsies, then digital amputation of the finger with pathology-proven melanoma. Histopathology investigation demonstrated three melanoma in situ and one invasive melanoma with a Breslow thickness of 1 mm. These findings are rare with few reports of melanoma in burn scars in the literature. This case report highlights the vigilance required from clinicians when performing skin examinations, and the importance of biopsies to newly pigmented lesions.

http://bit.ly/2ECmCmi

Multiple 'doughnut granulomas in a liver transplant patient with CMV reactivation

http://bit.ly/2EITgDy

Pyoderma gangrenosum of the breast

http://bit.ly/2EI9oVb

Pars plana vitrectomy in management of giant retinal tear and retinal detachment following iris-fixated anterior chamber phakic intraocular lens implantation

This case report describes a 26-year-old man presenting with a giant retinal tear (GRT) with retinal detachment (RD) following implantation of iris-fixated anterior chamber phakic intraocular lens (AC-PIOL) for high myopia and occurrence of intraoperative aberrations during vitrectomy due to the presence of AC-PIOL in situ. Posterior chamber PIOL have been well reported to be associated with GRT with RD. Very few reports exist of GRT with RD following AC-PIOL. Moreover, the presence of iris-fixated AC-PIOL, in this case, led to the formation of ghost images intraoperatively especially during crucial steps like induction of posterior vitreous detachment which has never been reported.

http://bit.ly/2EJDE2v

IgA nephropathy with diffuse alveolar haemorrhage

Immunoglobulin (Ig)A nephropathy is the most common cause of primary glomerulonephritis worldwide. While IgA nephropathy has been associated with a variety of other diseases, pulmonary complications are extremely rare. A 58-year-old man presented with a 2-week history of fever and exertional dyspnoea. A chest imaging revealed bilateral consolidation predominantly in upper lungs. Laboratory findings showed elevated serum creatinine with proteinuria and haematuria. Flexible bronchoscopy revealed diffuse alveolar haemorrhage, and IgA nephropathy was confirmed on a renal biopsy. He received prednisone with good effect. This case highlights the need to consider IgA nephropathy in the differential diagnosis of pulmonary renal syndrome.

http://bit.ly/2EF3JPp

Unusual presentation of eosinophilic fasciitis (EF) with a raised ALT

Eosinophilic fasciitis (EF) is a syndrome of unknown aetiology characterised by progressive collagenous thickening of the subcutaneous fascia. Limb oedema can precede the skin thickening and induration classically associated with EF. We describe a case of EF in a 31-year-old woman who presented to her general practitioner with lower limb oedema and stiffness. Blood tests in primary care showed a persistently raised alanine transferase (ALT). No hepatic cause for her raised ALT was found despite investigation. The unusual manner of her presentation led to delay in her referral to the autoimmune connective tissue disease (CTD) clinic. This case illustrates the importance of considering autoimmune CTD such as EF in young patients presenting with limb oedema and raised ALT, as early treatment influences prognosis and functional recovery.

http://bit.ly/2EJDyrF

Earlobe pulsation: a sign of tricuspid regurgitation

http://bit.ly/2EJjXY7

Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%

Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6 cm uterine fibroid in addition to a 5.9x5.4 cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.

http://bit.ly/2EKkpWv

Unusual cause of bladder and urethral stones in a child

http://bit.ly/2ECmAuG

M-CSF and IL-34 expression as indicators for growth in sporadic vestibular schwannoma

Abstract

Macrophage colony stimulating factor and IL-34 are associated with clinical vestibular schwannoma progression. Investigating the biology behind vestibular schwannoma progression helps understanding tumor growth. Inflammation is important in the microenvironment of neoplasms. Macrophages are major players in the intratumoral infiltrate. These tumor-associated macrophages are known to stimulate angiogenesis and cell growth. M-CSF and IL-34 are cytokines that can regulate tumor-infiltrating macrophages. They are expressed by tumors and form potential targets for therapy. The goal of this study was to investigate these cytokines in vestibular schwannomas and to see if their expression is related to angiogenesis, macrophage numbers, cystic degeneration, and volumetric tumor progression. Immunohistochemical expression of M-CSF and IL-34 was analyzed in ten fast-growing vestibular schwannomas and in ten slow-growing vestibular schwannomas. Expression M-CSF and IL-34 were compared between fast- versus slow-growing and cystic versus non-cystic tumors. Data on macrophage numbers and microvessel density, known from earlier research, was also included. All tumors expressed M-CSF and its expression was higher in fast-growing tumors (p = 0.003) and in cystic tumors (p = 0.035). CD163 expression was higher in tumors with strong M-CSF expression (p = 0.003). All tumors expressed IL-34 as well, but no significant differences were found in relation to clinicopathological characteristics. This study demonstrated the expression of M-CSF and IL-34 in vestibular schwannomas. The results suggest that M-CSF is related to macrophage activity and tumor progression, making it a potential target for therapy. If a similar assumption can be made for IL-34 remains unclear.

http://bit.ly/2BAWRzn

Radiotherapy for parapharyngeal space tumors

Publication date: Available online 21 December 2018

Source: American Journal of Otolaryngology

Author(s): William M. Mendenhall, Primoz Strojan, Jonathan J. Beitler, Johannes A. Langendijk, Carlos Suarez, Anne W. Lee, Alessandra Rinaldo, Juan P. Rodrigo, Robert Smee, Avraham Eisbruch, Louis B. Harrison, June Corry, Alfio Ferlito

Abstract

A wide variety of tumors, both benign and malignant, occur in the parapharyngeal space. Depending on histology and extent, treatment may include surgery and/or radiotherapy (RT). Herein we discuss the role of RT in the management of some of the more commonly encountered neoplasms, including salivary gland tumors, paragangliomas, schwannomas, and soft-tissue sarcomas.

http://bit.ly/2Aex6Fh

Investigating the role of octamer binding transcription Factor-4 (Oct-4) in oral cavity squamous cell carcinoma: A systematic review and meta-analysis

Publication date: Available online 21 December 2018

Source: American Journal of Otolaryngology

Author(s): Vasiliki Gliagias, Michael Wotman, Saori Wendy Herman, Peter Costantino, Dennis Kraus, Tristan Tham

http://bit.ly/2SlQDLf

Free thyroid transfer to anterolateral thigh for prevention of radiation induced hypothyroidism: An initial experience

Publication date: Available online 21 December 2018

Source: American Journal of Otolaryngology

Author(s): Rakesh Katna, Nikhil Kalyani, Akshay Deshpande, Mumbai Oncology Group – Head and Neck

Abstract

Aim

Radiation induced hypothyroidism (RIHT) is one of the commonest late side effects of radiation therapy and is seen in more than half of patients and affects quality of life significantly. We report our initial experience on feasibility of free microvascular transfer of thyroid gland out of radiation field to prevent development of RIHT.

Material and methods

A prospective pilot study was undertaken during August 2017 to May 2018. Six Patients with stage III/IV patients of oral cavity cancers who required wide excision/composite resections with microvascular free flap (ALT) reconstruction and adjuvant radiation therapy were enrolled. A written informed consent was obtained from all patients prior to the procedure.

Results

The mean age of cohort was 51 years with tongue most common site of primary cancer. The free transfer of thyroid gland to anterolateral thigh was done using microvascular technique. The mean additional time for procedure was 51 min. All patients had successful transfer with no associated immediate complications. Patients were followed up with Tc99 scan, USG Doppler and biochemical assay at routine intervals in peri and postoperative period to assess the anatomical and physiological function of the transferred gland. At median follow up of 8 months, 5 patients were euthyroid and remaining one had biochemical hypothyroidism. All patients had functional thyroid gland in anetrolateral thigh. Five patient were alive, one patient died due to disease.

Conclusion

This is a small and early feasibility study for free thyroid gland transfer and validates the previously published data. The selected group of patients who have high chances of developing RIHT may benefit from this strategy. Further validation of the technique may be explored in a larger cohort.

http://bit.ly/2Aex2W3

Blood eosinophils may predict radiographic sinus opacification in patients with chronic rhinitis

Background

The association between chronic rhinosinusitis (CRS) and chronic rhinitis remains unclear. The aim of this study was to estimate the predictive factors for sinus opacification in chronic rhinitis patients without obvious CRS.

Methods

We retrospectively studied a total of 332 adult patients with chronic rhinitis who visited our clinic from January 2015 to December 2017. All of the patients underwent endoscopic examination, allergy test, and osteomeatal‐unit computed tomography. The subjects were assigned to the normal sinus (NS) group (Lund‐Mackay score [LMS] <5) and sinus opacification (SO) group (LMS ≥5).

Results

A total of 288 patients were eligible for this study. Of them, 183 (63.5%) were classified in the NS group and 105 (36.5%) in the SO group. Total immunoglobulin E (IgE) level and peripheral blood eosinophil count were significantly higher in the SO than NS group (p = 0.031 and p < 0.0001, respectively). Using Pearson correlation coefficients, we determined that eosinophil count had a positive correlation with the LMS (r = 0.282). In logistic analysis, the interquartile range increase (0.19 × 10⁹/L) of the eosinophil count was significantly associated with SO (odds ratio [OR] 1.76; 95% confidence interval [CI], 1.30 to 2.39). After adjusting for age, gender, smoking, drinking, and underlying disease, the interquartile range increase of the eosinophil count increased the odds of SO to 1.69‐fold; this increase was statistically significant (p = 0.007; 95% CI, 1.17 to 2.43).

Conclusion

Peripheral blood eosinophil count is an independent predictor of CRS in patients with chronic rhinitis.

http://bit.ly/2EHRKl7

Analysis of anterior and posterior maneuvers to enhance intraconal exposure

Background

The medial and inferior recti encompass the ideal surgical corridor to approach the intraconal space endonasally. Here, we describe 3 different maneuvers to achieve greater access to orbital contents through an expanded endonasal approach (EEA).

Methods

Four human cadaver heads were dissected bilaterally (n = 8). EEA to the medial intraconal orbit was executed. The following 3 maneuvers were performed: (1) anterior: extraocular muscles control (EOM); (2) posterior: annulus of Zinn (AZ) release; and (3) anterior/posterior combined. Measurements of the inferior and medial rectus corridor at the level of anterior ethmoidal artery (AEA) and posterior ethmoidal artery (PEA) and extent of optic nerve and medial rectus visualization was performed before and after each maneuver.

Results

Medial rectus length (MRL) and optic nerve length (ONL) achieved were 1.72 ± 0.28 cm and 0.85 ± 0.2 cm, respectively. Mean caudal‐rostral distances between the rectus muscles at the level of the AEA and PEA were 3.45 ± 0.7 mm and 1.30 ± 0.3 mm, respectively. After EOM control, mean caudal‐rostral distances at the same level were as follows: AEA 4.90 ± 1.15 mm (p = 0.009) and PEA 1.70 ± 0.20 mm (p = 0.016). With AZ release, MRL was 2.20 ± 0.7 cm (p = 0.002) and ONL was 1.30 ± 0.2 cm (p = 0.003), with mean rostral‐caudal distance at the level of AEA at 4.03 ± 0.8 mm (p = 0.16) and PEA at 1.71 ± 0.36 mm (p = 0.039). Mean caudal‐rostral distances achieved with AZ release and EOM control were as follows: AEA 5.6 ± 1.2 mm (p = 0.001) and PEA 2.15 ± 0.4 mm (p = 0.001).

Conclusion

Progressive access to the orbital contents is afforded with the 3 delineated maneuvers. The magnitude of access is optimized with the combined maneuver. The actual anterior/posterior location of the target will determine which maneuvers are required.

http://bit.ly/2EFghqg

Tonsillectomy using the BiZact: A pilot study in 186 children and adults

Abstract

1.The BiZact tonsillectomy device, produced by Medtronic (Minneapolis, MN, USA), was approved for market use in Australia by the Therapeutics Good Administration (TGA) in 2016 and is a new device for tonsillectomy

2.Results from this pilot study of 186 patients demonstrate a post‐operative hemorrhage rate of 4.3% similar to rates described by other studies.

3.BiZact tonsillectomy allows for a shortened operative time in the hands of both experienced and training surgeons with a median time of 5.1 minutes (range 1.5 – 26.5 minutes).

4.BiZact tonsillectomy is associated with reduced intraoperative blood loss with less than 1mL of blood loss observed in 71 (38.2%) cases and between 1‐10mL loss observed in 81 (43.5%) cases in this report.

5.This study demonstrates safety and feasibility of this device as a pilot study towards undertaking a prospective randomized trial comparing it to other tonsillectomy techniques.

This article is protected by copyright. All rights reserved.

http://bit.ly/2rZkf5z

Pathogen reservoir hypothesis investigated by analyses of the adenotonsillar and middle ear microbiota

Publication date: Available online 21 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): James Johnston, Michael Hoggard, Kristi Biswas, Carmen Astudillo‐García, Fiona J. Radcliff, Murali Mahadevan, Richard G. Douglas

Abstract

Introduction

Adenotonsillar and middle ear diseases result in some of the most frequently performed operations in the pediatric population worldwide. The pathogen reservoir hypothesis (PRH) suggests that the adenoids act as a reservoir of bacteria which play a potential pathogenic role in otitis media. Evidence supporting this hypothesis is limited. This study sought to comprehensively determine and compare associations between the adenotonsillar and middle ear bacterial microbiota within individual patients via next-generation sequencing and microbial network analyses.

Methods

Bacterial 16S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of ten pediatric patients undergoing adenotonsillectomy and ventilation tube insertion for otitis media with effusion. At the time of surgery, swabs were taken from the adenoid surface, tonsil crypts and middle ear clefts (through the myringotomy incision).

Results

The most abundant sequences within the bacterial community at genus level across all anatomical sites were Fusobacterium, Haemophilus, Neisseria, and Porphyromonas. There was an observable difference in the relative abundance of bacterial communities, with a higher proportion of Haemophilus and Moraxella in the adenoid when compared with the middle ear. Furthermore, only one module (consisting of 4 bacterial OTUs) from one patient was identified through microbial network analyses to be significantly associated between middle ear and adenoid. In addition, microbial network analysis revealed that the adenoid and tonsil microbiota share greater similarity than do the adenoid and middle ear.

Conclusion

The results of this study suggest that the adenoid microenvironment does not correlate to the middle ear microenvironment. A future study at the species level, and over time, is required to further investigate whether the differing relationship between the microbiota of the adenoid and middle ear rejects the pathogen reservoir hypothesis.

http://bit.ly/2rOsfGn

Transcriptomic and lipidomic profiling of eicosanoid / docosanoid signalling in affected and non‐affected skin of human atopic dermatitis patients

Abstract

Lipoxygenases (LOX) and cycloxygenase (COX) are the main enzymes for PUFA‐metabolism to highly bio‐active prostaglandins, leukotrienes, thromboxanes, lipoxines, resolvins and protectins. LOX and COX pathways are important for the regulation of pro‐inflammatory or pro‐resolving metabolite synthesis and metabolism for various inflammatory diseases such as atopic dermatitis (AD). In this study we determined PUFAs and PUFA‐metabolites in serum as well as affected and non‐affected skin samples from AD‐patients and the dermal expression of various enzymes, binding proteins and receptors involved in these LOX and COX pathways. Decreased EPA and DHA levels in serum and reduced EPA level in affected and non‐affected skin were found; in addition n3/n6‐PUFA ratios were lower in affected and non‐affected skin and serum. Mono‐hydroxylated PUFA‐metabolites of AA, EPA, DHA and the sum of AA, EPA and DHA metabolites were increased in affected and non‐affected skin. COX1 and ALOX12B expression, COX and 12/15‐LOX metabolites as well as various lipids, which are known to induce itch (12‐HETE, LTB4, TXB2, PGE2 and PGF2) and the ratio of pro‐inflammatory vs pro‐resolving lipid mediators in non‐affected and affected skin as well as in the serum of AD patients were increased, while n3/n6‐PUFAs and metabolite ratios were lower in non‐affected and affected AD‐skin. Expression of COX1 and COX‐metabolites were even higher in non‐affected AD‐skin. To conclude, 12/15‐LOX and COX pathways were mainly upregulated, while n3/n6‐PUFA and metabolite ratios were lower in AD‐patients skin. All these parameters are a hallmark of a pro‐inflammatory and non‐resolving environment in affected and partly in non‐affected skin of AD‐patients.

This article is protected by copyright. All rights reserved.

http://bit.ly/2Ab8vB4

Five-year outcomes of sparing level IB in node-positive, human papillomavirus–associated oropharyngeal carcinoma: A safety and efficacy analysis

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): R.B. Ross, A. Juloori, V. Varra, M.C. Ward, S. Campbell, N.M. Woody, E. Murray, P. Xia, J.F. Greskovich, S.A. Koyfman, N.P. Joshi

Abstract

Introduction

The conformality of modern intensity modulated radiation therapy (IMRT) allows avoidance of the submandibular glands (SMG) in select patients, potentially improving late xerostomia. This study explores the safety and efficacy of this approach in select oropharyngeal carcinoma (OPC) patients.

Methods

Patients with T1-2N+ human papillomavirus (HPV)-associated OPC treated with definitive IMRT at one institution from 2009 to 2014 were identified. Patients were divided into 3 groups: bilateral level IB targeted (A, n = 16), a single level IB targeted (B, n = 61), and bilateral IB spared (C, n = 9). Outcomes were reviewed to identify the rate of level IB regional recurrence. Odds ratios were calculated for xerostomia between groups.

Results

Level Ib was targeted in 93 instances (54.1%) and avoided in 79 instances (45.9%). Mean SMG doses were significantly lower when level IB was spared compared to when targeted (37.5 Gy vs 67.5 Gy; P < 0.0001). Median doses to oral cavity decreased with increasing level Ib sparing (40.7 Gy [A] vs 35.4 Gy [B] vs 30.7 [C]; P = 0.002). The rate of late grade ≥2 xerostomia was significantly lower in patients with bilateral 1b sparing (53% in A vs 0% in C; P = 0.007). Sparing 1b unilaterally resulted in a non-significant decrease in late grade ≥2 xerostomia (P = 0.181). No regional failures were identified in levels IB (median follow up = 59.3 months).

Conclusion

Sparing level IB is safe in T1-2N+ HPV+ OPC. Avoiding level Ib translates into significantly lower SMG and oral cavity doses. Larger studies are needed to validate these findings and the impact of this technique.

http://bit.ly/2V4bgx5

Predictors of cisplatin-induced ototoxicity and survival in chemoradiation treated head and neck cancer patients

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Wendy A. Teft, Eric Winquist, Anthony C. Nichols, Sara Kuruvilla, Suzanne Richter, Christina Parker, Peggy Francis, Maureen Trinnear, Jelena Lukovic, Nedal Bukhari, Yun-Hee Choi, Stephen Welch, David A. Palma, John Yoo, Richard B. Kim

Abstract

Objectives

Cisplatin-induced ototoxicity is a common permanent consequence of curative chemoradiation for locally advanced head and neck squamous cell carcinoma (HNSCC). Predictors of ototoxicity in HNSCC were examined.

Materials and methods

In this prospective, observational cohort study, 206 adult HNSCC patients underwent audiometric testing at baseline, during and after treatment with cisplatin-based chemoradiation. Ototoxicity was defined as ≥grade 2 audiometric change from baseline (CTCAE v4.02). Relationships between clinical and pharmacogenetic (TPMT, COMT, ACYP2, CTR1, OCT2, MATE1, ABCC2, ABCC3, and ABCG2) covariates and ototoxicity, progression-free (PFS) and overall survival (OS) were assessed by Cox regression.

Results

Weekly cisplatin resulted in lower ototoxicity risk while PFS and OS were similar compared to high dose cisplatin (P = 0.00035; HR = 0.18; 95% CI, 0.07–0.46). COMT (rs9332377) carriers had higher ototoxicity risk (P = 0.00556; HR = 1.72; 95% CI, 1.17–2.52) while MATE1 (rs2289669) A/A carriers were protected from ototoxicity (P = 0.01062; HR = 0.46; 95% CI, 0.26–0.84). Absence of the protective MATE1 allele among those who carry the risk allele in COMT predicted increased ototoxicity risk, (P = 0.00414; HR = 3.22; 95% CI, 1.45–7.17 and P = 0.00022; HR = 4.89; 95% CI, 2.11–11.36). Survival outcomes did not differ between carriers of protective or risk alleles.

Conclusions

Weekly cisplatin dosing, COMT and MATE1 are predictors of ototoxicity without affecting treatment efficacy. COMT and MATE1 genotyping and weekly dosing may be a potential strategy for mitigating cisplatin-induced ototoxicity in HNSCC.

http://bit.ly/2PWMTNZ

Basophil activation testing in occupational respiratory allergy to low molecular weight compounds

Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2T2XAR9

Letter to the Editor regarding “Lymphedema in patients with hidradenitis suppurativa: a systematic review of published literature”

http://bit.ly/2AdgCgz

Necrotoxic spider bite: a successful noninvasive wound management

http://bit.ly/2SgQPem

Systemic comorbidities associated with rosacea: a multicentric retrospective observational study

Abstract

Background

Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities.

Methods

This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician‐administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities.

Results

The study included 1,195 rosacea patients and 621 controls without rosacea aged 18–85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity‐ and duration‐dependent manner.

Conclusion

Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.

http://bit.ly/2AbdKkx

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Abstract

Background

This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin.

Methods

A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy.

Results

Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46).

Conclusion

Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.

http://bit.ly/2UZYsbb

Construct validity of a low‐cost medium‐fidelity endoscopic sinus surgery simulation model

Objective

Assess construct validity of a low‐cost medium‐fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training.

Methods

Fellowship‐trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist.

Results

Thirty‐two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task‐specific checklist.

Conclusions

This study demonstrated the construct validity of the low‐cost medium‐fidelity ESS model.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2PY3FMO

Evaluation of spin in the abstracts of otolaryngology randomized controlled trials

Objective

Spin, the misrepresentation and distortion of research findings, has been shown to affect clinical decision making. Spin has been found in randomized controlled trials (RCTs) published in various fields of medicine, but no study has tested for the presence of spin in otolaryngology RCTs. The purpose of this study is to evaluate the abstracts of RCTs found in the otolaryngology literature for spin.

Methods

In this cross‐sectional analysis, we analyzed the abstracts of RCTs for spin using a pilot‐tested form. Double data extraction was performed by two blinded authors, and discrepancies were resolved using mutual discussion.

Results

Out of the 534 PubMed citations retrieved by our search string, 162 parallel‐group RCTs with clearly defined primary and secondary endpoints were identified. Further analysis identified 47 trials with nonsignificant primary outcomes, which were then evaluated for spin. Spin was identified in 33 of the 47 (70%) abstracts. Spin was found in the results sections of 25 (53%) of the included abstracts and was found in the conclusion section of 27 (57%) of the abstracts. Spin was not present in the titles of any of the included studies.

Conclusion

Spin was common in our sample of otolaryngology RCTs. Spin may potentially create false impressions about the true validity of a drug or intervention. Further research needs to test for potential clinical implications of spin in the otolaryngology literature.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2V2CrIu

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

Objectives

To compare long‐term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM).

Study Design

A retrospective analysis of the National Cancer Database (2010–2014).

Methods

Patients with clinical tumor (T)1 and T2 oropharyngeal squamous cell carcinomas (OPSCC) were classified into those receiving TORS versus nonrobotic surgery versus TLM. Univariate and multivariate survival analyses were conducted with chi‐square tests; Kaplan‐Meier log‐rank test; and Cox multivariate, logistic regression, and multinomial regression modeling.

Results

We identified 2,224 OPSCC TORS patients; 6,697 nonrobotic surgery patients; and 333 TLM patients. The majority of patients were white males with a mean age of approximately 59 years. No significant difference was noted between the cohorts in tumor stage; however, TORS patients were more likely to have nodal (N)1 to N3 disease than nonrobotic surgery and TLM patients, respectively (69.8% vs. 62.0% vs. 59.7%, P < 0.001).

TORS was associated with a lower likelihood of positive margins when compared to nonrobotic surgery, although not TLM (nonrobotic surgery: hazard ratio [HR] 1.51, P < 0.001, TLM: HR 1.13, P = 0.582). TORS was associated with lower likelihood of postsurgical chemoradiotherapy (TLM: HR 2.07, P < 0.001, nonrobotic surgery: 1.65, P < 0.001) but not adjuvant radiotherapy alone (TLM: HR 1.06, P = 0.569, nonrobotic surgery: 0.96, P = 0.655). On multivariate Cox analysis of overall survival, the use of TORS was not associated with increased survival (TLM: HR 1.31, P = 0.233, nonrobotic surgery: HR 1.12, P < 0.303).

Conclusion

The advantages of TORS for early‐stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2PSPCId

Endoscope‐assisted resection of intravestibular Schwannoma: A video case report

Intravestibular schwannomas are a rare cause of unilateral sensorineural hearing loss. Management of these tumors involves translabyrinthine resection, for which complete visualization around the angles of the vestibule may be limited under an operating microscope. We present the first reported case of an endoscope‐assisted resection of an intravestibular schwannoma, along with the operative video recording. Using additional information gained from endoscopic examination of the tumor and its resection site, we also propose a mechanism by which this patient's intravestibular schwannoma caused hearing loss. Use of the endoscope in resection of intravestibular schwannomas may have advantages over the traditional operating microscope in improving visualization of the narrow and angled vestibule, confirming the integrity of surrounding structures, and ensuring complete tumor removal. Laryngoscope, 2018

http://bit.ly/2V004l4

Polysomnography outcomes in children with small tonsils undergoing drug‐induced sleep endoscopy–directed surgery

Objectives/Hypothesis

The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug‐induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE‐directed surgery in children with small tonsils. We hypothesize that DISE‐directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population.

Study Design

Retrospective chart review.

Methods

A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6‐year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE‐directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre‐ and postoperative PSG parameters were compared using paired t tests.

Results

Average age was 7 ± 4 years old at the time of surgery. The most common DISE‐directed intervention was supraglottoplasty (n = 23). DISE‐directed surgery significantly improved mean apnea‐hypopnea index (AHI) from 14.4 to 8.0 (P = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O₂ nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance.

Conclusions

DISE‐directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE‐directed approach in this patient population.

Level of Evidence

4 Laryngoscope, 2018

http://bit.ly/2PW4rdk

In‐office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review

Objectives

To review available information regarding in‐office procedures for benign vocal fold lesions (BVFL).

Methods

PubMed term search on office/awake laryngeal procedures for any of the following specific lesions: Reinke's edema (RE), polyps, nodules, varices, vocal process granuloma, and vocal fold (VF) scar.

Results

In‐office ablative and nonablative laser procedures have been described for BVFL, including RE, polyps, varices, and granuloma. Fiber‐based lasers used include potassium titanyl phosphate, pulsed dye laser, and more recently CO₂. In‐office intralesional steroid injection (ISI) for BVFL targets the inflammatory process involved with the lesion and may induce regression of polyps, nodules, RE, and granuloma. Botulinum toxin‐induced "voice rest" has been described as adjunctive treatment for refractory VF nodules or vocal process granuloma. Most in‐office techniques for treating BVFL rely on induction of lesion regression rather than complete lesion removal, as in conventional operative microsurgery. When treating VF scarring, in‐office procedures aim to alter the wound‐healing process; ISI targets the inflammatory phase and angiolytic lasers target the proliferative phase.

Conclusion

In‐office procedures for BVFL apply new technology that can potentially lower risk and cost. Although numerous case series have shown the potential of these procedures, data that thoroughly compares outcomes with those of microlaryngoscopic techniques is needed. Laryngoscope, 2018

http://bit.ly/2V42kaU

Oral tongue squamous cell carcinoma survival as stratified by age and sex: A surveillance, epidemiology, and end results analysis

Objectives/Hypothesis

To utilize the Surveillance, Epidemiology, and End Results (SEER) database to elucidate differences in predictors of survival in oral tongue squamous cell carcinoma (OTSCC) as stratified by age and sex.

Study Design

Retrospective, population‐based database analysis.

Methods

The SEER registry was utilized to calculate survival trends for patients with OTSCC between 1973 and 2012. Patient data were then stratified by age (≤40 years vs. >40 years) and sex, then analyzed with respect to race, stage, grade, and treatment modalities. Overall survival (OS) and disease‐specific survival (DSS) were calculated and compared.

Results

There were 16,423 cases of OTSCC identified, with 526 and 706 young female and male patients, respectively. Young female patients had improved OS and DSS as compared to young male patients (75% vs. 67% at 5 years), which is better than older patients (P < .001). Younger patients were more likely to receive surgery (P < .001) and combination surgery and radiation (P < .001) as compared to older patients. On multivariate analysis, tumor stage was uniformly associated with worse OS and DSS (P < .05), with surgery predicting improved OS and DSS in all groups except young females (P < .05). Higher tumor grade predicted worse OS and DSS in older patients, but not younger patients (P < .05).

Conclusions

OTSCC appears to present with relatively heterogeneous characteristics across different age groups and sexes. Despite the rising incidence of OTSCC in young individuals, our study demonstrates that young patients have improved survival rates compared to older patients.

Level of Evidence

NA Laryngoscope, 2018

http://bit.ly/2PYCEch

Nasal obstruction symptom evaluation score outcomes after septorhinoplasty

Objectives/Hypothesis

The time interval at which Nasal Obstruction Symptom Evaluation (NOSE) scores stabilize after functional septorhinoplasty has not been determined. Our goal was to characterize longitudinal trends of patient‐reported outcomes of nasal obstruction using the NOSE survey instrument following functional septorhinoplasty.

Study Design

Prospective longitudinal cohort study.

Methods

Adult patients (≥18 years) with nasal obstruction who underwent functional septorhinoplasty by three different surgeons at a single academic, tertiary referral center were identified. NOSE scores were obtained preoperatively and prospectively during three postoperative intervals defined as early (1–3 months), middle (4–6 months), and late (≥10 months.) Longitudinal analysis included repeated measures analysis of variance and adjustments for multiple comparisons.

Results

A total of 49 patients met inclusion criteria. For the total cohort, mean NOSE scores significantly improved between preoperative and early postoperative evaluations (71.4, standard deviation [SD] ± 17.0 vs. 24.2, SD ± 19.5; P < .001) but did not significantly change between early and middle (20.6, SD ± 19.1; P = .543) or middle and late (23.1, SD ± 24.9; P > .999) time intervals.

Conclusions

Patients with nasal obstruction who undergo functional septorhinoplasty can be expected to have significant improvement in self ‐reported nasal obstruction as early as 1 to 3 months postoperatively with a continued, durable, long‐standing benefit lasting at least 10 months after surgery. Future studies can consider the 3‐month time frame as a proxy for 1 year outcomes to help reduce survey burden.

Level of Evidence

2c Laryngoscope, 2018

http://bit.ly/2V42lvu

Endoscopically assisted transstomal primary repair of an acquired tracheoesophageal fistula

http://bit.ly/2PY3DEG

Aquagenic pruritus and the JAK2 V617F mutation

http://bit.ly/2Sn2vfC

Axillary granular parakeratosis with osmidrosis successfully treated with topical maxacalcitol

http://bit.ly/2CsBi5M

Analysis of patients with drug‐induced pemphigoid using the Japanese Adverse Drug Event Report database

Abstract

To clarify the incidence of drug‐induced pemphigoid in Japan, we conducted a database search and analysis using the Japanese Adverse Drug Event Report database (JADER). Among the cases recorded in JADER between April 2004 and November 2017, we targeted "pemphigoid" and analyzed the patients' backgrounds, drug involvement, time of pemphigoid onset, outcomes and year reported. For cases where three or more drugs were reportedly involved, the signal index was calculated using the reporting odds ratio (ROR) method. The total number of reported pemphigoid cases was 769. Males accounted for 58% (446 cases) and patients over the age of 60 years accounted for 82% (630 cases). The most frequently reported causative drug was vildagliptin (288 cases), followed in order by sitagliptin phosphate hydrate (102 cases), teneligliptin hydrobromide hydrate (86 cases), linagliptin (64 cases) and furosemide (46 cases). For the 27 causative drugs, the safety signal was detected by the ROR method. The median time to onset tended to be long for these drugs. For vildagliptin with the largest reported number, the value was 508 days (range, 2–1871). Analysis of outcomes demonstrated recovery or improvement in 66.3% of cases. Analysis of the years in which reports had been published revealed that the number of pemphigoid cases has increased rapidly in recent years. Our survey was able to reveal useful data on the incidence of drug‐induced pemphigoid. We expect that these results will aid the early detection and treatment of this condition.

http://bit.ly/2SZuBxE

Basophil activation testing in occupational respiratory allergy to low molecular weight compounds

Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies. Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex. Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use. Correspondence to Johanna Feary, Department of Occupational Lung Disease, Royal Brompton Hospital, London SW3 6LR. Tel: +44 20 7594 7968; e-mail: j.feary@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2T2XAR9

Microbial keratitis: Significant increase in Gram-positive bacterial infection

Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49
Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma
DOI:10.4103/ijo.IJO_500_18  
Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonas spp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years.
http://www.ijo.in/currentissue.asp?sabs=y

Giant cell arteritis related arteritic anterior ischemic optic neuropathy

http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_1_142_248176_f1.jpg

: Clinico-pathological correlation

Mohit Dogra, Ramandeep Singh, Mangat R Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:

Dr. Mohit Dogra
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012 
India

DOI: 10.4103/ijo.IJO_881_18

A 63-year-old male presented with sudden painless vision loss in his right eye of 2 day duration. He had no perception of light, Relative afferent pupillary defect (RAPD), pale disc edema along with an inferotemporal branch retinal artery occlusion [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d. Clinical diagnosis of arteritic anterior ischemic optic neuropathy was made, and systemic examination revealed repeated bouts of fever and right sided scalp tenderness.^[1],[2] Right side temporal artery biopsy revealed giant cell arteritis. The patient was treated with intravenous pulse steroids and immunosuppressive therapy.^[2],[3] In cases of severe vision loss with pale disc edema, giant cell arteritis should be kept in mind.^[4],[5]

Figure 1: (a) showing pale disc edema (blue arrows) with an inferotemporal branch retinal artery occlusion, (b and c) showing "wedge shaped" equatorial choroidal infarcts on fluorescein angiogram, and (d) right side temporal artery biopsy at 200× magnification showing intimal proliferation with breaks in the internal elastic lamina (yellow arrows) with extravasation of red blood cells in the tunica media (black arrow) with minimal inflammatory cells, suggestive of vasculitis Click here to view

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Hayreh SS, Podhasky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998;125:509-20.
2.	Wayand CM, Bartley GB. Giant cell arteritis: New concepts inpathogenesis and implications of management. Am J Ophthalmol1997;123:392-5.
3.	Guevara M, Kollipara CS. Recent advances ingiant cell arteritis. CurrRheumatol Rep 2018;20:25.
4.	HayrehSS. Management of ischaemic optic neuropathy. Indian J Ophthalmol 2011;59:123-36.
5.	Attaseth T, Vanikieti K, Poonyathalang A, Preechawat P, Jindahra P, Wattanatranon D. Anterior ischemic optic neuropathydue tobiopsy-provengiant cell arteritisin Thai patients. ClinOphthalmol 2015;9:1071-5.

Neurogranin as Cerebrospinal Fluid Biomarker for Alzheimer Disease: An Assay Comparison Study

Willemse, EAJ; De Vos, A; Herries, EM; Andreasson, U; Engelborghs, S; van der Flier, WM; Scheltens, P; ... Teunissen, CE; + view all Willemse, EAJ; De Vos, A; Herries, EM; Andreasson, U; Engelborghs, S; van der Flier, WM; Scheltens, P; Crimmins, D; Ladenson, JH; Vanmechelen, E; Zetterberg, H; Fagan, AM; Blennow, K; Bjerke, M; Teunissen, CE; - view fewer (2018) Neurogranin as Cerebrospinal Fluid Biomarker for Alzheimer Disease: An Assay Comparison Study. Clinical Chemistry , 64 (6) pp. 927-937. 10.1373/clinchem.2017.283028 .

http://bit.ly/2GzMqlr

Tauomics and Kinetics in Human Neurons and Biological Fluids

Zetterberg, H; (2018) Tauomics and Kinetics in Human Neurons and Biological Fluids. Neuron , 97 (6) pp. 1202-1205. 10.1016/j.neuron.2018.02.030 .

http://bit.ly/2R7vQxx

A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older

Arnoldussen, IAC; Sundh, V; Backman, K; Kern, S; Ostling, S; Blennow, K; Zetterberg, H; ... Gustafson, DR; + view all Arnoldussen, IAC; Sundh, V; Backman, K; Kern, S; Ostling, S; Blennow, K; Zetterberg, H; Skoog, I; Kiliaan, AJ; Gustafson, DR; - view fewer (2018) A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older. Journal of Alzheimer's Disease , 63 (4) pp. 1325-1335. 10.3233/JAD-180099 . Green open access

http://bit.ly/2GNA0qv

Excited state wavepacket dynamics in NO 2 probed by strong-field ionization

Forbes, R; Boguslavskiy, AE; Wilkinson, I; Underwood, JG; Stolow, A; (2017) Excited state wavepacket dynamics in NO 2 probed by strong-field ionization. The Journal of Chemical Physics , 147 (5) , Article 054305. 10.1063/1.4996461 . Green open access

http://bit.ly/2AeYRgS

Time-resolved multi-mass ion imaging: Femtosecond UV-VUV pump-probe spectroscopy with the PImMS camera

Forbes, R; Makhija, V; Veyrinas, K; Stolow, A; Lee, JWL; Burt, M; Brouard, M; ... Hockett, P; + view all Forbes, R; Makhija, V; Veyrinas, K; Stolow, A; Lee, JWL; Burt, M; Brouard, M; Vallance, C; Wilkinson, I; Lausten, R; Hockett, P; - view fewer (2017) Time-resolved multi-mass ion imaging: Femtosecond UV-VUV pump-probe spectroscopy with the PImMS camera. The Journal of Chemical Physics , 147 (1) , Article 013911. 10.1063/1.4978923 . Green open access

http://bit.ly/2SdtsT2

On the mechanism of the electrophysiological changes and membrane lesions induced by asbestos fiber exposure in Xenopus laevis oocytes

Bernareggi, A; Conte, G; Constanti, A; Borelli, V; Vita, F; Zabucchi, G; (2019) On the mechanism of the electrophysiological changes and membrane lesions induced by asbestos fiber exposure in Xenopus laevis oocytes. Scientific Reports (In press).

http://bit.ly/2AaxxRc

Vacuum ultraviolet excited state dynamics of the smallest ring, cyclopropane. II. Time-resolved photoelectron spectroscopy and ab initio dynamics

Coates, MR; Larsen, MAB; Forbes, R; Neville, SP; Boguslavskiy, AE; Wilkinson, I; Sølling, TI; ... Schuurman, MS; + view all Coates, MR; Larsen, MAB; Forbes, R; Neville, SP; Boguslavskiy, AE; Wilkinson, I; Sølling, TI; Lausten, R; Stolow, A; Schuurman, MS; - view fewer (2018) Vacuum ultraviolet excited state dynamics of the smallest ring, cyclopropane. II. Time-resolved photoelectron spectroscopy and ab initio dynamics. The Journal of Chemical Physics , 149 (14) , Article 144311. 10.1063/1.5044402 .

http://bit.ly/2SeDR0U

Biosynthesis and characterization of a novel, biocompatible medium chain length polyhydroxyalkanoate by Pseudomonas mendocina CH50 using coconut oil as the carbon source

Basnett, P; Marcello, E; Lukasiewicz, B; Panchal, B; Nigmatullin, R; Knowles, JC; Roy, I; (2018) Biosynthesis and characterization of a novel, biocompatible medium chain length polyhydroxyalkanoate by Pseudomonas mendocina CH50 using coconut oil as the carbon source. Journal of Materials Science: Materials in Medicine , 29 , Article 179. 10.1007/s10856-018-6183-9 .

http://bit.ly/2AbaOo1

Social media platforms in translator training: Socialising or separating?

Bolanos-Garcia-Escribano, A; Ketola, A; (2018) Social media platforms in translator training: Socialising or separating? trans-kom , 11 (2) pp. 183-200.

http://bit.ly/2SeDQdm

Advance Care Planning in Nursing Homes - Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

Aasmul, I; Husebo, BS; Sampson, EL; Flo, E; (2018) Advance Care Planning in Nursing Homes - Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS). Frontiers in Psychology , 9 , Article 2284. 10.3389/fpsyg.2018.02284 . Green open access

http://bit.ly/2A9cXAw

Comparative analysis of H2-diesel co-combustion in a single cylinder engine and a chassis dynamometer vehicle

Talibi, M; Hellier, P; Watkinson, M; Ladommatos, N; (2019) Comparative analysis of H2-diesel co-combustion in a single cylinder engine and a chassis dynamometer vehicle. International Journal of Hydrogen Energy , 44 (2) pp. 1239-1252. 10.1016/j.ijhydene.2018.11.092 . Green open access

http://bit.ly/2SemYmT

CSF total tau levels are associated with hippocampal novelty irrespective of hippocampal volume

Düzel, E; Berron, D; Schütze, H; Cardenas-Blanco, A; Metzger, C; Betts, M; Ziegler, G; ... Jessen, F; + view all Düzel, E; Berron, D; Schütze, H; Cardenas-Blanco, A; Metzger, C; Betts, M; Ziegler, G; Chen, Y; Dobisch, L; Bittner, D; Glanz, W; Reuter, M; Spottke, A; Rudolph, J; Brosseron, F; Buerger, K; Janowitz, D; Fliessbach, K; Heneka, M; Laske, C; Buchmann, M; Nestor, P; Peters, O; Diesing, D; Li, S; Priller, J; Spruth, EJ; Altenstein, S; Ramirez, A; Schneider, A; Kofler, B; Speck, O; Teipel, S; Kilimann, I; Dyrba, M; Wiltfang, J; Bartels, C; Wolfsgruber, S; Wagner, M; Jessen, F; - view fewer (2018) CSF total tau levels are associated with hippocampal novelty irrespective of hippocampal volume. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring , 10 pp. 782-790. 10.1016/j.dadm.2018.10.003 . Green open access

http://bit.ly/2AcuTtX

Dendritic cell-expressed common gamma-chain recruits IL-15 for trans-presentation at the murine immunological synapse [version 1]

Beilin, C; Choudhuri, K; Bouma, G; Malinova, D; Llodra, J; Stokes, D; Shimaoka, M; ... Burns, S; + view all Beilin, C; Choudhuri, K; Bouma, G; Malinova, D; Llodra, J; Stokes, D; Shimaoka, M; Springer, T; Dustin, M; Thrasher, A; Burns, S; - view fewer (2018) Dendritic cell-expressed common gamma-chain recruits IL-15 for trans-presentation at the murine immunological synapse [version 1]. Wellcome Open Research 10.12688/wellcomeopenres.14493.1 . Green open access

http://bit.ly/2Sftlqd

New insights into the composition of Indian yellow and its use in a Rajasthani wall painting

Tamburini, D; De Fonjaudran, CM; Verri, G; Accorsi, G; Acocella, A; Zerbetto, F; Rava, A; ... Cather, S; + view all Tamburini, D; De Fonjaudran, CM; Verri, G; Accorsi, G; Acocella, A; Zerbetto, F; Rava, A; Whittaker, S; Saunders, D; Cather, S; - view fewer (2018) New insights into the composition of Indian yellow and its use in a Rajasthani wall painting. Microchemical Journal , 137 pp. 238-249. 10.1016/j.microc.2017.10.022 . Green open access

http://bit.ly/2SfsvK5

Interventions integrating health and academic interventions to prevent substance use and violence: a systematic review and synthesis of process evaluations

Tancred, T; Paparini, S; Melendez-Torres, GJ; Fletcher, A; Thomas, J; Campbell, R; Bonell, C; (2018) Interventions integrating health and academic interventions to prevent substance use and violence: a systematic review and synthesis of process evaluations. Systematic Reviews , 7 , Article 227. 10.1186/s13643-018-0886-3 . Green open access

http://bit.ly/2A9NzL6

Prospects and challenges of environmental DNA (eDNA) monitoring in freshwater ponds

Harper, LR; Buxton, AS; Rees, HC; Bruce, K; Brys, R; Halfmaerten, D; Read, DS; ... Haenfling, B; + view all Harper, LR; Buxton, AS; Rees, HC; Bruce, K; Brys, R; Halfmaerten, D; Read, DS; Watson, HV; Sayer, CD; Jones, EP; Priestley, V; Machler, E; Murria, C; Garces-Pastor, S; Medupin, C; Burgess, K; Benson, G; Boonham, N; Griffiths, RA; Handley, LL; Haenfling, B; - view fewer (2019) Prospects and challenges of environmental DNA (eDNA) monitoring in freshwater ponds. Hydrobiologia , 826 (1) pp. 25-41. 10.1007/s10750-018-3750-5 . Green open access

http://bit.ly/2Sft0DX

Developing a Dynamic Web-GIS Based Landslide Early Warning System for the Chittagong Metropolitan Area, Bangladesh

Ahmed, B; Rahman, MS; Islam, R; Sammonds, P; Zhou, C; Uddin, K; Al-Hussaini, TM; (2018) Developing a Dynamic Web-GIS Based Landslide Early Warning System for the Chittagong Metropolitan Area, Bangladesh. ISPRS International Journal of Geo-Information , 7 (12) , Article 485. 10.3390/ijgi7120485 . Green open access

http://bit.ly/2AeYF18

The challenges and potential utility of phenotypic specimen-level phylogeny based on maximum parsimony

Tschopp, E; Upchurch, P; (2018) The challenges and potential utility of phenotypic specimen-level phylogeny based on maximum parsimony. Earth and Environmental Science Transactions of the Royal Society of Edinburgh 10.1017/S1755691018000877 . (In press).

http://bit.ly/2AbJ4zn

Fault Detection in Wastewater Treatment Systems Using Multiparametric Programming

Mid, EC; Dua, V; (2018) Fault Detection in Wastewater Treatment Systems Using Multiparametric Programming. Processes , 6 (11) , Article 231. 10.3390/pr6110231 . Green open access

http://bit.ly/2Sl4txq

Vanadium Oxide Oligomers and Ordered Monolayers Supported on CeO2(111): Structure and Stability Studied by Density Functional Theory

Penschke, C; Paier, J; Sauer, J; (2018) Vanadium Oxide Oligomers and Ordered Monolayers Supported on CeO2(111): Structure and Stability Studied by Density Functional Theory. Journal of Physical Chemistry C , 122 (16) pp. 9101-9110. 10.1021/acs.jpcc.8b01998 .

http://bit.ly/2Ab8U6A

Ophthalmology

http://www.ijo.in/currentissue.asp?sabs=y

Indian Journal of Ophthalmology – On the right path Santosh G Honavar Indian Journal of Ophthalmology 2019 67(1):1-2

Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required? Jatinder Bali, Rohit Garg, Renu T Bali Indian Journal of Ophthalmology 2019 67(1):3-6

Hypopigmented fundus in a young male Nawazish Fatma Shaikh, Vinod Kumar Indian Journal of Ophthalmology 2019 67(1):7-7

Current concepts in crosslinking thin corneas Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev Indian Journal of Ophthalmology 2019 67(1):8-15 Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.

Management of Duane retraction syndrome: A simplified approach Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):16-22 Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well.

Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement Manca Tekavcic Pompe, Alki Liasis, Richard Hertle Indian Journal of Ophthalmology 2019 67(1):23-30 Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording.

Commentary: "Current" consensus: Electrodiagnostics in eye Nripen Gaur, Pradeep Sharma Indian Journal of Ophthalmology 2019 67(1):30-31

Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu Indian Journal of Ophthalmology 2019 67(1):32-36 Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns.

Commentary: Assessment of limbal ischemia in ocular burns Naveen Radhakrishnan, N Venkatesh Prajna Indian Journal of Ophthalmology 2019 67(1):37-37

Dopamine levels in human tear fluid Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu Indian Journal of Ophthalmology 2019 67(1):38-41 Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer&#39;s strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 &#177; 11.80 pg/ml (mean &#177; SEM), 279 &#177; 14.8 pg/ml (mean &#177; SEM), and 470.4 &#177; 37.64 pg/ml (mean &#177; SEM) in the plasma and in the tears collected using Schirmer&#39;s strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels.  EDITORIAL   Indian Journal of Ophthalmology – On the right path  p. 1 Santosh G Honavar DOI:10.4103/ijo.IJO_2074_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta GUEST EDITORIAL Artificial intelligence (AI) in healthcare and biomedical research: Why a strong computational/AI bioethics framework is required?  p. 3 Jatinder Bali, Rohit Garg, Renu T Bali DOI:10.4103/ijo.IJO_1292_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ONE MINUTE OPHTHALMOLOGY Hypopigmented fundus in a young male  p. 7 Nawazish Fatma Shaikh, Vinod Kumar DOI:10.4103/ijo.IJO_1834_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta REVIEW ARTICLES Current concepts in crosslinking thin corneas  p. 8 Rashmi Deshmukh, Farhad Hafezi, George D Kymionis, Sabine Kling, Rupal Shah, Prema Padmanabhan, Mahipal S Sachdev DOI:10.4103/ijo.IJO_1403_18   Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Management of Duane retraction syndrome: A simplified approach p. 16 Nripen Gaur, Pradeep Sharma DOI:10.4103/ijo.IJO_967_18   Duane retraction (or co-contraction) syndrome is a congenital restrictive strabismus which can occur either as an isolated entity or in conjunction with other congenital anomalies and is now listed as a congenital cranial dysinnervation disorder. It is characterized by co-contraction of horizontal recti on attempted adduction causing globe retraction along with variable amounts of upshoots or downshoots. It may have limited abduction or adduction or both and present as esotropic, exotropic, or orthotropic Duane. The diagnosis of this disease is usually clinical. However, recent research has provided a greater insight into the genetic basis of this disease paving a way for a greater role of genetics in the diagnosis and management. This disease can have a varied presentation and hence the treatment plan should be tailor-made for every patient. The indications for surgery are abnormal head posture, deviations in the primary position, retraction and narrowing of palpebral aperture and up- or downshoots during adduction, and sometimes also to improve abduction. The arrival of newer surgical techniques of periosteal fixation (PF) of lateral rectus (LR), partial vertical rectus transposition, or superior or inferior rectus transposition in addition to LR recession with Y-split has vastly improved the management outcomes, providing not only primary position orthophoria but also increased binocular visual fields as well. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CONCENSUS CRITERIA Visual electrodiagnostics and eye movement recording - World Society of Pediatric Ophthalmology and Strabismus (WSPOS) consensus statement p. 23 Manca Tekavcic Pompe, Alki Liasis, Richard Hertle DOI:10.4103/ijo.IJO_1103_18   Visual electrodiagnostics and eye movement recording are important additional clinical tools in evaluation, diagnosing and management of ophthalmic and neurological disorders. Due to their objectiveness and non-invasiveness they can play an important role in pediatric ophthalmology. The WSPOS (World Society of Pediatric Ophthalmology and Strabismus) consensus statement gives insight into basic principles and highlights the clinical application of both visual electrodiagnostic tests and eye movement recording. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: "Current" consensus: Electrodiagnostics in eye p. 30 Nripen Gaur, Pradeep Sharma DOI:10.4103/ijo.IJO_1590_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLE Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns  p. 32 Ka Wai Kam, Chaitali N Patel, Neda Nikpoor, Marco Yu, Sayan Basu DOI:10.4103/ijo.IJO_945_18   Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Assessment of limbal ischemia in ocular burns p. 37 Naveen Radhakrishnan, N Venkatesh Prajna DOI:10.4103/ijo.IJO_1432_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Dopamine levels in human tear fluid p. 38 Niyati Seshagiri Sharma, Suraj Kumar Acharya, Archana Padmanabhan Nair, Jyoti Matalia, Rohit Shetty, Arkasubhra Ghosh, Swaminathan Sethu DOI:10.4103/ijo.IJO_568_18   Purpose: To determine the levels of dopamine in tear fluid and demonstrate the use of tear fluid as a non-invasive source for dopamine measurements in humans. Methods: The study cohort included 30 clinically healthy individuals without any pre-existing ocular or systemic conditions. Matched tear fluid (using Schirmer's strips and capillary tubes) and plasma were collected from the subjects. Dopamine levels were evaluated using direct competitive chemiluminescent enzyme-linked immunosorbent assay (ELISA), dopamine kit (Cloud Clone Corp, TX, USA). Results: Significantly higher dopamine levels were found in the tear fluid compared to plasma in the study subjects. The level of dopamine was 97.2 ± 11.80 pg/ml (mean ± SEM), 279 ± 14.8 pg/ml (mean ± SEM), and 470.4 ± 37.64 pg/ml (mean ± SEM) in the plasma and in the tears collected using Schirmer's strips and capillary tubes, respectively. Conclusion: Dopamine was detectable in all the tear fluid samples tested and was also found to be at a higher concentration than in plasma samples. Tear fluid can be used as a non-invasive sample source to monitor dopamine levels. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Pythium keratitis in South India: Incidence, clinical profile, management, and treatment recommendation p. 42 Ravula Hasika, Prajna Lalitha, Naveen Radhakrishnan, Gunasekaran Rameshkumar, N Venkatesh Prajna, Muthiah Srinivasan DOI:10.4103/ijo.IJO_445_18   Purpose: To study the demographic profile, clinical features, treatment outcome, and ocular morbidity of microbiologically proven Pythium keratitis in South India. Methods: A retrospective analysis of clinical records of microbiologically proven Pythium keratitis at a tertiary eye care referral center in South India from January 2016 to November 2017 was performed. Demographic details, predisposing risk factors, microbiological investigations, clinical course, and visual outcome were analyzed. Results: Seventy-one patients with microbiologically proven Pythium keratitis were identified. The mean age was 44(±18.2) years with an increase in male preponderance and 50% were farmers. Duration of delay at time of presentation to the hospital was a mean of 14(±7.2) days. The visual acuity at baseline ranged from 6/6 to no light perception (median 2.1 logMAR). A combination of 5% natamycin and 1% voriconazole was given to 42% patients, and natamycin alone was given to 39.4% patients. 1% itraconazole eye drops alone was initiated in 7 (10%) patients and 3 among this group responded. Therapeutic keratoplasty (TPK) was performed in 48 (67.6%) patients. None of the primary grafts remained clear after a period of 1 month. Twenty-six eyes (54.2%) had graft reinfection and all these eyes either developed anterior staphyloma (4) or were eviscerated (3) and 13 eyes became phthisical. The remaining 22 patients who had TPK resulted in failed graft. Among these, re-grafts were performed in 6 patients, of which 5 were doing well at the last follow-up. Conclusion: We report a large series of patients with Pythium keratitis. Promoting early and differential diagnosis, awareness of clinicians and specific treatment options are needed for this devastating corneal disease. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Pythium insidiosum keratitis p. 47 Prashant Garg DOI:10.4103/ijo.IJO_1491_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES Types of organisms and in-vitro susceptibility of bacterial isolates from patients with microbial keratitis: A trend analysis of 8 years p. 49 Sujata Das, Ruchipriya Samantaray, Aparajita Mallick, Srikant K Sahu, Savitri Sharma DOI:10.4103/ijo.IJO_500_18   Purpose: To report the distribution and trends of types of organisms and antibiotic susceptibility of the bacterial isolates obtained from patients with microbial keratitis. Methods: Microbiology records of culture-positive microbial keratitis that underwent a diagnostic corneal scraping and cultures were reviewed. Fungal, bacterial, and parasitic culture results and antibiotic susceptibility profile of bacteria were analyzed and comparisons were made between two halves of the study period (2007–2010 vs. 2011–2014). Results: A total of 3981 corneal scrapings were processed during the 8-year study period. Pathogen was recovered in culture in 1914 (48.1%) samples. Fungi, bacteria, and parasites constituted 38.7%, 60%, and 1.3% of the total isolates, respectively. The common fungal isolates were Aspergillus spp. (224/868, 25.8%) and Fusarium spp. (200/868, 23.0%), while common Gram-positive bacteria were Streptococcus pneumoniae (217/1125, 19.3%) and Staphylococcus aureus (185/1125, 16.4%), and common Gram-negative bacteria was Pseudomonasspp. (99/219, 45.2%). There was no significant difference in proportion of bacterial (P = 0.225) and fungal (P = 0.421) keratitis between the first half and second half of the study period. There was a significant increase in proportion of Gram-positive isolates (P = 0.015) [353/758 (46.6%) vs. 772/1482 (52.1%)] and decrease in proportion of Gram-negative organisms (P = 0.044) [88/758 (11.6%) vs. 131/1482 (8.8%)] in the recent years. In-vitro antibiotic susceptibility testing showed decrease in susceptibility to moxifloxacin for Pseudomonas spp. (P = 0.016) in recent years. Conclusion: Prevalence of fungal and bacterial keratitis has remained unchanged over the years. This study shows a significant increase in Gram-positive bacterial infection and decrease in Gram-negative bacterial infection of the cornea in the recent years. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The novel model: Experimental optical coherence tomography–guided anterior segment imaging chick embryo model p. 54 Resat Duman, Tolga Ertekin, Rahmi Duman, Esra Aslan, Mehmet Cem Sabaner, Ersan Çetinkaya DOI:10.4103/ijo.IJO_263_18   Purpose: The aim of this study was to present an experimental optical coherence tomography (OCT)–guided anterior segment (AS) imaging chick embryo model. Through this model, we aimed to reveal similarities and differences between human cornea, AS tissues, and chick embryo tissues by quantitative image analysis. Methods: Ex vivo, the chick embryos' globes were determined by detailed AS camera of spectral-domain (SD)-OCT in 10 fertilized specific pathogen-free eggs on the 20th day. Quantitative image analysis of anterior chamber tissues was performed with SD-OCT in detail. After imaging, cross sections of the chick embryo globes containing cornea with anterior chamber were histologically examined and compared with human tissues. The similarities of our model with data in the human cornea and AS studies in the literature were compared. Results: SD-OCT imaging was able to successfully delineate the AS tissues of chick embryos such as the cornea, iris, lens, pupil, conjunctiva, ciliary body, anterior chamber, and lens. Quantitative semi-automated measurements showed the following: mean central corneal thickness: 213.4 ± 7.05 μm (197–223 μm), mean anterior chamber depth: 878.9 ± 41.74 (804–919 μm), mean anterior chamber area: 2.43 ± 0.16 mm2 (2.17–2.73 mm2), mean corneoscleral junction (limbal) thickness: 322.8 ± 20.05 μm (289–360 μm), and mean iris thickness: 230.4 ± 13.27 μm (203–245 μm). In addition, detailed histological comparisons of the AS tissues with human tissues were evaluated to be very similar. Conclusion: In conclusion, this chick embryo model mimics human tissues and it can be considered as a platform for the study of teratogen-induced malformations and AS dysgenesis during gestation of AS tissues. In addition, this study demonstrates the feasibility of SD-OCT in the quantitative assessment of AS structures in chick embryo model. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparative analysis of retropupillary iris claw versus scleral-fixated intraocular lens in the management of post-cataract aphakia p. 59 Nivean Madhivanan, Sabyasachi Sengupta, Manavi Sindal, Pratheeba Devi Nivean, Maitri Arun Kumar, Murali Ariga DOI:10.4103/ijo.IJO_326_18   Purpose: To compare the visual outcomes and complications between the eyes receiving retropupillary iris claw intraocular lens (IOL) and scleral-fixated IOL (SFIOL) for post-cataract aphakia. Methods: Medical records of consecutive patients who had iris claw IOL and SFIOL surgery from January 2010 to March 2015, with > 1 year of follow up were retrospectively analyzed. The surgical technique was based on individual surgeon preference. The best-corrected distance visual acuity (BCDVA), previous surgery, surgical technique, and complications were analyzed. Results: Retropupillary iris claw IOL was fixated in 48 eyes (46%) and SFIOL was performed in 56 eyes. Iris claw was performed more frequently at the time of primary cataract surgery (56%) compared to SFIOL (14%) (P < 0.001). At 1 month postoperative, BCDVA was significantly better in the SFIOL group [0.7 ± 0.5 logarithm of minimum angle of resolution (logMAR) in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P < 0.001] but this difference did not persist at 1 year (0.4 ± 0.4 logMAR in iris claw vs. 0.3 ± 0.2 logMAR in SFIOL, P = 0.56). Eyes with iris claw IOL experienced significantly more postoperative iritis (17%), intraocular pressure spikes (10%), and ovalization of the pupil (16%). Conclusion: Retropupillary iris claw IOL fixation is as safe as SFIOL for visual rehabilitation of post-cataract aphakia. Visual rehabilitation following iris claw IOL might take longer than SFIOL. Ovalization of the pupil is the commonest adverse effect reported with this type of IOL design. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL) p. 64 Shweta Walia, Santosh Kashyap, V Bhaisare, P Rawat, N Kori DOI:10.4103/ijo.IJO_447_18   Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant. Results: Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis p. 69 Jitender Jinagal, Gaurav Gupta, Aniruddha Agarwal, Kanika Aggarwal, Madhuri Akella, Vishali Gupta, Deepti Suri, Anju Gupta, Surjit Singh, Jagat Ram DOI:10.4103/ijo.IJO_713_18   Purpose: To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. Methods:Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. Results: 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. Conclusion: Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Linear discriminant score for differentiating early primary open angle glaucoma from glaucoma suspects p. 75 Gunjan A Deshpande, Prashant K Bawankule, Dhananjay V Raje, Moumita Chakraborty DOI:10.4103/ijo.IJO_678_18   Purpose: To determine the diagnostic accuracy of a linear discriminant function (LDF) based on macular ganglion cell complex (GCC), optic nerve head (ONH) and retinal nerve fibre layer (RNFL) for differentiating early primary open-angle glaucoma (POAG) from glaucoma suspects. Methods: In this cross-sectional study, data from consecutive 127 glaucoma suspects and 74 early POAG eyes were analysed. Each patient underwent detailed ocular examination, standard automated perimetry, GCC and ONH and RNFL analysis. After adjusting for age, gender and signal strength using the analysis of covariance; Benjamin–Hochberg multiple testing correction was performed to detect truly significant parameters to calculate the LDF. Subsequently, diagnostic accuracy of GCC and ONH and RNFL were determined. The obtained LDF score was evaluated for diagnostic accuracy in another test set of 32 suspect and 19 glaucomatous eyes. Data were analysed with the R-3.2.1 (R Core Team 2015), analysis of variance, t-test, Chi-square test and receiver operating curve. Results: Among all GCC parameters, infero temporal had the best discriminating power and average RNFL thickness and vertical CDR among ONH and RNFL parameters. LDF scores for GCC had AUROC of 0.809 for a cut-off value 0.07, while scores for ONH and RNFL had AUROC of 0.903 for a cut-off value − 0.24. Analysis on combined parametric space resulted in avg RNFL thickness, vertical CDR, min GCC + IPL and superior GCC + IPL as key parameters. LDF scores obtained had AUROC of 0.924 for a cut-off value 0.1. The LDF was applied to a test set with an accuracy of 84.31%. Conclusion: The LDF had a better accuracy than individual GCC and ONH and RNFL parameters and can be used for diagnosis of glaucoma. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Linear discriminant score for differentiating early primary open angle glaucoma from suspects p. 81 Sushmita Kaushik DOI:10.4103/ijo.IJO_1506_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES The impact of primary open-angle glaucoma: Comparison of vision-specific (National Eye Institute Visual Function Questionnaire-25) and disease-specific (Glaucoma Quality of Life-15 and Viswanathan 10) patient-reported outcome (PRO) instruments p. 83 Suresh Kumar, Sahil Thakur, Parul Ichhpujani DOI:10.4103/ijo.IJO_798_18   Purpose: To compare a general vision-specific patient-reported outcomes (PRO) instrument, National Eye Institute Visual Function Questionnaire-25 (NEIVFQ-25) with two disease-specific PRO instruments, Glaucoma Quality of Life-15 (GQL-15), and Viswanathan 10 in patients with varying severity of primary open angle glaucoma (POAG). Methods: This hospital-based, prospective study enrolled 140 glaucoma patients. The patients were classified into mild, moderate, and severe glaucoma based on visual field defects. All these patients were administered the three PRO instruments and the results were statistically analyzed. Results: All the three instruments showed high internal consistency (Cronbach's alpha for GQL-15, NEIVFQ-25, and Viswanathan 10 were 0.918, 0.937, and 0.929, respectively) There was a statistically significant difference between patients with mild, moderate, and severe POAG with all instruments (P ≤ 0.001). The instruments correlated well across several parameters especially the peripheral vision and glare/dark adaptation. The disease-specific scales however are simpler and faster to administer. Conclusion: All three instruments were reliable in assessment of mild, moderate, and severe glaucoma. They correlated strongly with each other in most of the related subscales, domains, and questions. NEIVFQ-25 additionally gave information regarding the general, psychological, and social effects of the disease. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta The evaluation of intraocular pressure fluctuation in glaucoma subjects during submaximal exercise using an ocular telemetry sensor p. 89 Banu Bozkurt, Nilsel Okudan, Muaz Belviranli, Ayse Bozkurt Oflaz DOI:10.4103/ijo.IJO_585_18   Purpose: To evaluate the effect of acute submaximal exercise on intraocular pressure (IOP) fluctuations in open-angle glaucoma (OAG) subjects using an ocular telemetry sensor (OTS, Sensimed TriggerFish®). Methods: Twelve OAG subjects aged 45–65 years with no medical limitation for exercise were included in this prospective study. A submaximal exercise test was performed using a cycle ergometer for 20 min during which OTS voltages and metabolic parameters were recorded continuously. IOP voltages taken before, during, and after exercise were compared using the Friedman test and correlations with the metabolic parameters were evaluated using the Spearman analysis. Results: In two subjects, the OTS stopped functioning after a few hours. Median OTS measurements were 37.60 mVeq 10 min before exercise [interquartile range (IQR) 137.27], 51.75 (IQR 121.2), 62.35 (IQR 123.72), 54.6 (IQR 141.3), and 59.7 mVeq (IQR 196.7) during exercise (4 time points, 5 min apart), and 50.7 (IQR 147.35) and 64.2 mVeq (IQR 103.25) 10 and 30 min after exercise and the change was statistically non-significant (P = 0.66). No correlations were found between OTS and metabolic parameters measured at the same time points (P > 0.05). Nocturnal acrophase pattern was detected in five subjects (50%), diurnal acrophase in two patients, and double-hump in two patients. Median IOP voltages in the morning, afternoon/evening, and night were 335.84, 149.15, and 341.38 mVeq, respectively (P < 0.001). Conclusion: Continuous IOP monitoring did not reveal a remarkable voltage change in OAG patients during or immediately after exercise, but nocturnal IOP peaks in half of the patients. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Surgical outcomes of repeat trabeculectomy augmented with high dose mitomycin C p. 95 Sharmila Rajendrababu, Sujani Shroff, Sangeeta Vivek Patil, Mohammed Sithiq Uduman, Ashok Vardhan, SR Krishnadas DOI:10.4103/ijo.IJO_682_18   Purpose: To evaluate the surgical outcomes of repeat trabeculectomy augmented with risk factor adjusted mitomycin C (MMC) exposure in eyes with previous failed trabeculectomy. Methods: Case records of 38 eyes of 37 patients with previous failed filter who underwent repeat trabeculectomy with MMC were reviewed retrospectively. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP) reduction, requirement of anti-glaucoma medications, postoperative complications, and surgical success (defined as IOP of ≤21 mmHg and >5 mmHg along with 20% reduction from preoperative IOP with or without adjuvant medications) at 1-year postoperatively. Statistical analysis was done using the STATA 14.1 (Texas, USA). Results: Patient's mean age was 46.41 (±20.43) years and the mean preoperative IOP was 32.73 (±9.26) mmHg which reduced to 16.22 (±7.08) mmHg postoperatively at 12 months (P < 0.001). Mean number of anti-glaucoma medications reduced from 2.76 (±0.83) preoperatively to 1.89 (±0.95) postoperatively (P < 0.001). Surgical success was observed in 81.1% at 1 year (n = 30). Eyes that received MMC >3 min had a postoperative mean IOP of 12.50 (±3.23) mmHg compared to 23.08 (±7.19) mmHg with MMC <3 min (P < 0.001). Seven eyes (18.4%) developed postoperative complications, and all were seen in eyes that received MMC >3 min (P = 0.033). Conclusion: Repeat trabeculectomy with MMC, used in higher concentration and exposure time altered according to individual risk factor plays a crucial role in the success and hence it could be considered as a viable option before planning a tube surgery. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Visual rehabilitation of patients with low vision in uveitis p. 101 Sarika Gopalakrishnan, Sridharan Sudharshan, Rajiv Raman, Velu Saranya, Parthopratim Dutta Majumder, Jyotirmay Biswas DOI:10.4103/ijo.IJO_875_18   Purpose: To elucidate the clinical profile of visual impairment (VI) and rehabilitation of the uveitic patients with irreversible low vision. Methods: Retrospective analysis of visual rehabilitation of patients with uveitis suffering from poor vision with low vision devices (LVD). Results: Most common cause of uveitis was choroiditis (46.29%), followed by retinitis (25.92%), retinochoroiditis (18.51%), and chronic panuveitis sequelae (9.25%). Of these 54 cases, 35.18% had moderate VI, 25.92% had severe VI, 20.37% had mild VI, and 18.51% had profound VI or blindness. Statistically significant improvement (P < 0.05) in near vision was seen in choroiditis (52%) and retinitis (72%), whereas clinically significant improvement in distance vision was found in patients with choroiditis. Most commonly prescribed LVD was half-eye prismatic spectacle magnifier (22.2%). Conclusion: Rehabilitation of the uveitic patients with low vision is challenging. LVD may be a beneficial tool in these patients to help them perform their day-to-day activities independently. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to anti-vascular endothelial growth factor of abnormal retinal vascular net in para foveal telangiectasia group II images on optical coherence tomography-angiography p. 105 Ketan Saoji, Avinash Pathengay, Jay Chhablani, Bhavik Panchal, Shreyansh Doshi, Merlin Saldanha DOI:10.4103/ijo.IJO_374_18   Purpose: To identify optical coherence tomography-angiography (OCT-A) findings to predict treatment response during anti-vascular endothelial growth factor (VEGF) therapy in eyes with para foveal telangiectasia (PFT) group II. Methods: In this retrospective series, Twelve eyes of seven patients diagnosed with PFT group II without evidence of sub-retinal neovascular membrane (SRNVM) clinically or on spectral domain-OCT (SD-OCT) were included. All patients underwent OCT-A on the Topcon DRI OCT Triton® with 4.5 mm macula scans. The patients with abnormal vascular nets were further classified into type A and B nets and administered intravitreal anti-VEGF therapy. Visual acuity and size of type A and B nets were evaluated pre- and post-injection. Paired t- test and intraclass correlation were used to analyse data. Results: Patients with type A net showed significant improvement in visual acuity (logMAR 0.38, P = 0.0047). The size of type A net showed statistically significant decrease (P = 0.0008) on 6 month follow up. Type B net did not show statistically significant difference in visual acuity or size following anti-VEGF therapy. Conclusion: OCT-A plays an important role in early detection of possible neovascular nets (type A), in the absence of obvious SRNVM. Treatment decisions based on OCT-A may be helpful to achieve better visual outcome. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Clinical and electrophysiological results of eye muscle surgery in 17 patients with downbeat nystagmus p. 109 Richard W Hertle, Ashraf Ahmad DOI:10.4103/ijo.IJO_703_18   Purpose: To test the hypothesis that eye muscle surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function. Methods: This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye muscle surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software. Results: Patients' age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1–10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV. Conclusion: This study supports the hypothesis that eye muscle surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta PHOTO ESSAY Simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts p. 116 Rama Rajagopal, Pratik V Kataria, Sudharshan Sridharan, Krishna Kumar, Kuzhanthai Lily Therese, Poongulali Selvamuthu DOI:10.4103/ijo.IJO_902_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Atypical presentation of macular corneal dystrophy managed by Descemet stripping endothelial keratoplasty p. 118 Sunita Chaurasia, Dilip K Mishra DOI:10.4103/ijo.IJO_602_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Peripheral ulcerative keratitis: An extremely rare case presentation after Paederus (beetle) injury p. 120 Nitin N Tiwari, Shreesha K Kodavoor, Dandapani Ramamurthy, Shreyas Ramamurthy, Jayamani Ravi, Mohamed Faizal DOI:10.4103/ijo.IJO_605_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Ultrasound biomicroscopic appearance of accessory iris membrane p. 122 Natasha Gautam Seth, Himanshu Kashyap, Ajay Jurangal, Surinder Singh Pandav DOI:10.4103/ijo.IJO_927_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Posterior lenticonus masquerading as posterior capsular rupture following blunt trauma p. 123 Pooja Jain, Jawahar Lal Goyal DOI:10.4103/ijo.IJO_879_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Double rosette cataract: A striking image! p. 124 Aditya Sethi, Srikanth Ramasubramanian DOI:10.4103/ijo.IJO_941_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Transcorneal tube extrusion: Anterior segment optical coherence tomography–aided management p. 126 Shikha Gupta, Gunjan Saluja, Abadh Kishore Chaurasia, Aswini Kumar Behera, Viney Gupta DOI:10.4103/ijo.IJO_416_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Multimodal imaging characteristics of refractile drusen p. 128 Samarth Mishra, Sugandha Goel, Subham Sinha Roy, Barun Garg, Marina Parvin, Kumar Saurabh, Rupak Roy DOI:10.4103/ijo.IJO_867_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A case report of anterior visual pathway aplasia p. 129 Jakkidi Prathibha Reddy, Prabhu M Shanker, Geetha Ganesan, Rajesh Prabu DOI:10.4103/ijo.IJO_256_18   [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Eccrine intraepidermal poroma of the eyelid p. 131 Sukriti Ahuja, Apjit Kaur, Madhumati Goel, Shivanjali Raghuvanshi, Ajay Arya DOI:10.4103/ijo.IJO_547_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta OPHTHALMIC IMAGES Bilateral acute depigmentation of iris p. 133 Sonam Yangzes, Simar Rajan Singh, Jagat Ram DOI:10.4103/ijo.IJO_847_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARIES Commentary: Bilateral acute depigmentation of iris p. 134 S Bala Murugan DOI:10.4103/ijo.IJO_1512_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta OPHTHALMIC IMAGES When color matters: Waardenburg syndrome p. 135 Tarjani V Dave, Rajeev R Pappuru, Vivek P Dave DOI:10.4103/ijo.IJO_889_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Subluxated spherophakic lens: Zonules still not relinquished p. 136 Vanita Pathak-Ray DOI:10.4103/ijo.IJO_1154_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta "Triangle sign" in Morgagnian cataract p. 137 Saurabh Deshmukh, Harsha Bhattacharjee, Krati Gupta DOI:10.4103/ijo.IJO_940_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Sunflower cataract in chalcosis bulbi p. 137 Richa Agarwal, Yashpal Goel, Kamlesh Anand DOI:10.4103/ijo.IJO_1035_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Optical coherence tomography of intraocular lens glistening p. 138 Koushik Tripathy, Uma Sridhar DOI:10.4103/ijo.IJO_1031_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An eye within an eye p. 139 Kowsigan Magesan, Parthopratim Dutta Majumder, Vikas Khetan DOI:10.4103/ijo.IJO_1135_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Free floating pigmented vitreous cyst p. 140 Vinod Kumar, Shreyans Jain, Amber Amar Bhayana, B Shilky Singh DOI:10.4103/ijo.IJO_855_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Choroidal vasculature without angiography p. 141 Raja Narayanan, Kyoko Ohno-Matsui DOI:10.4103/ijo.IJO_780_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Giant cell arteritis related arteritic anterior ischemic optic neuropathy: Clinico-pathological correlation p. 142 Mohit Dogra, Ramandeep Singh, Mangat R Dogra DOI:10.4103/ijo.IJO_881_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Ligneous conjunctivitis in a Dandy–Walker syndrome: A rare case report p. 143 Arjun Srirampur, Muralidhar Ramappa, Sunita Chaurasia, Geeta Vemuganti DOI:10.4103/ijo.IJO_772_18   Ligneous conjunctivitis (LC) is a rare form of pseudomembranous conjunctivitis seen in children, perhaps due to plasminogen deficiency, which manifest as a chronic refractory pseudomembranous conjunctivitis. LC cases are incapable in maintaining their fibrinolytic activity due to plasminogen deficiency; consequently, transudates of plasma assume as a thick, gelatinous, woody membranes over the mucosal surfaces. This is a short case report on a child with a LC, who presented with recurrent pseudomembranous conjunctivitis in conjunction with progressive congenital hydrocephalus due to aqueductal stenosis (Dandy–Walker syndrome). This rare association was clinically confirmed and prompt corrective surgical measures were instituted. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Treatment of corneal neovascularization with topical aflibercept in a case of exposure keratopathy following cerebellar astrocytoma surgery p. 145 Sibel Aksoy DOI:10.4103/ijo.IJO_418_18   In this report, we report the case of a 7-year-old boy with corneal neovascularization due to exposure keratopathy following cerebellar astrocytoma surgery. Corneal surface healing was achieved with topical treatment and therapeutic contact lens, after which topical steroid was administered for stromal haze and corneal neovascularization. After 2 months of steroid therapy failed, corneal neovascularization responded well to topical aflibercept administration, showing complete regression. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Shewanella algae keratitis p. 148 Chelsey A Bravenec, Rahul T Pandit, Hilary A Beaver DOI:10.4103/ijo.IJO_617_18   A 75-year-old male with a right eye history of chronic dry eye syndrome, glaucoma status post tube shunt, and Fuchs dystrophy status post Descemet stripping endothelial keratoplasty followed by penetrating keratoplasty (PKP) presented with a 2.7 × 4.2 mm corneal ulcer, culture positive for Shewanella algae and Klebsiella oxytoca. A topical antibiotic regimen of gentamicin 14 mg/mL and vancomycin 50 mg/mL was administered according to culture sensitivities. There was concurrent use of loteprednol 0.5% (Lotemax Gel, Bausch and Lomb, Rochester, NY, USA) and later addition of erythromycin 0.5% ointment. The corneal ulcer improved with antibiotic therapy but was complicated by poor patient follow-up. Descemetocele formation prompted PKP in the right eye. The graft was successful and visual acuity improved from a low of light perception to maximum of 20/200 Snellen. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Emerging corneal pathogens: First report of Pseudopestalotiopsis theae keratitis p. 150 Sayali Sane, Savitri Sharma, Ranjith Konduri, Merle Fernandes DOI:10.4103/ijo.IJO_791_18   A 55-year-old lady developed a corneal ring infiltrate following trauma with a wooden stick. 10% KOH mount of corneal scrapings revealed septate hyaline fungal filaments. White feathery colonies with shiny black dots grew on potato dextrose agar. Characteristic features of Pestalotiopsis spores were seen on Lactophenol cotton blue mount. DNA sequencing showed 99% similarity with Pseudopestalotiopsis theae. Complete resolution was noted with topical and oral antifungals. To the best of our knowledge, this is the first report of Pseudopestalotiopsis keratitis following trauma with vegetative matter highlighting the role of DNA sequencing in identification of rare fungi. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta In vivo confocal microscopy and anterior segment optical coherence tomography follow-up of cysteamine treatment in corneal cystinosis p. 153 Huseyin Baran Ozdemir, Mehmet Cüneyt Özmen, Zeynep Aktas, Murat Hasanreisoglu DOI:10.4103/ijo.IJO_736_18   A 36-year-old female presented initially with photophobia and visual deterioration. After examination and laboratory tests, patient was diagnosed with cystinosis. Cysteamine drops 4 × 1 drops/day was given as treatment for 1 year. During follow-up, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) was performed. Photophobia was relieved and IVCM obtained the decrease in size and density of corneal crystals 1 year after. Depth of corneal crystals did not change but crystal density score reduced with cysteamine treatment. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Femtosecond laser-assisted successful management of subluxated cataractous lens with vitreous in anterior chamber p. 155 Jeewan S Titiyal, Manpreet Kaur, Anubha Rathi, Ruchita Falera DOI:10.4103/ijo.IJO_764_18   Femtosecond laser-assisted cataract surgery was performed in a case of posttraumatic cataract with six clock hours subluxation and vitreous in the anterior chamber (AC). Femtosecond laser pretreatment allowed a closed-chamber creation of corneal incisions, capsulotomy, and lens fragmentation with minimal sudden lens-diaphragm movements and zonular stress. Integrated imaging systems allowed customization of the size and position of capsulotomy and nuclear fragmentation, based on the extent and site of subluxation. Presence of vitreous in AC did not hamper femtosecond laser application. Triamcinolone-assisted vitrectomy was performed before phacoemulsification and after implanting the intraocular lens (IOL). Postoperative uncorrected visual acuity was 20/20 with a stable IOL. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Angiostrongylus cantonensis in anterior chamber p. 158 Uma Sharan Tiwari, Ankita Aishwarya, Shashi Gandhi, Priya Sisodia DOI:10.4103/ijo.IJO_843_18   Live worm in anterior chamber is a rare finding. We hereby report a case of ocular Angiostrongylus cantonensis, which, to the best of our knowledge, is the third case report from India. A 70-year-old female presented with the complaints of watering and foreign body sensations in right eye since 2 months. On examination, a translucent worm of approximately 15 mm length was found freely moving in anterior chamber. Patient underwent surgical removal of live worm, which was identified as A. cantonensis. Educating people regarding importance of hygiene is important for prevention of worm infestation. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta COMMENTARY Commentary: Angiostrongylus cantonensis in anterior chamber p. 161 S Bala Murugan DOI:10.4103/ijo.IJO_1511_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Acute hypertensive uveitis as the first presentation of multiple sclerosis p. 163 Melissa Kate Shields, Sumu Simon, WengOnn Chan, Jagjit S Gilhotra DOI:10.4103/ijo.IJO_345_18   Ophthalmic manifestations of multiple sclerosis are frequent including acute optic neuritis, ocular motor disturbances and intermediate uveitis. We report an unusual case of multiple sclerosis presenting as acute hypertensive uveitis. A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. Intraocular pressure was 55mmHg and 14 mmHg on the right and left respectively. He had a right relative pupillary defect and a left internuclear ophthalmoplegia. Vitreous cells were present in the right eye and there was peripheral sclerosis and periphlebitis superior temporally. MRI Brain and Spine revealed multiple T2 hyperintense lesions consistent with multiple sclerosis. Multiple sclerosis may present initially with an acute elevation of intraocular pressure and intermediate uveitis. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Familial Blau syndrome:First molecularly confirmed report from India p. 165 Mahesh Janarthanan, Chanchal Poddar, S Sudharshan, Luis Seabra, Yanick J Crow DOI:10.4103/ijo.IJO_671_18   Blau syndrome (BS) is a rare autoinflammatory disorder characterized by the clinical triad of arthritis, uveitis, and dermatitis due to heterozygous gain-of-function mutations in the NOD2 gene. BS can mimic juvenile idiopathic arthritis (JIA)-associated uveitis, rheumatoid arthritis, and ocular tuberculosis. We report a family comprising a mother and her two children, all presenting with uveitis and arthritis. A NOD2 mutation was confirmed in all the three patients – the first such molecularly proven case report of familial BS from India. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An unusual case of multifocal central serous chorioretinopathy with low serum cortisol managed using eplerenone p. 167 Kanika Aggarwal, Aniruddha Agarwal, Vishali Gupta DOI:10.4103/ijo.IJO_651_18   In this report, we describe a rare case of a 44-year-old Asian male with acute central serous chorioretinopathy (CSC) with bullous exudative retinal detachment. Endocrinology evaluation revealed hypothalamic–pituitary–adrenal axis suppression with low serum cortisol. Furthermore, neuroimaging revealed the presence of a pituitary microadenoma. He was treated with systemic eplerenone and hydrocortisone. After 12 weeks, bullous detachment completely resolved. Our case is a unique description of acute CSC with underlying low serum cortisol levels that responded to treatment with mineralocorticoid antagonist. This case highlights the various endocrine abnormalities other than the raised serum cortisol that can occur in patients with CSC. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta LETTERS TO THE EDITOR Commentary: Double-layer sign" on spectral domain optical coherence tomography in pachychoroid spectrum disease p. 171 Jay Chhablani, Spoorti K R Mandadi DOI:10.4103/ijo.IJO_1456_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Commentary: Multiple small branch retinal arteriolar occlusions following coil embolization of internal carotid artery aneurysm p. 172 Swarna Biseria Gupta DOI:10.4103/ijo.IJO_683_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Comparative analysis of non-absorbable 10-0 nylon sutures with absorbable 10-0 vicryl sutures in pediatric cataract surgery p. 173 Amit Mohan, Pradhnya Sen, Elesh Jain DOI:10.4103/ijo.IJO_877_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries p. 174 Arjun Srirampur, Anupama Kalwad, Pasyanthi Balijepalli, Kavya Reddy Katta DOI:10.4103/ijo.IJO_723_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries p. 175 Thomas Kuriakose, Smitha Jasper, Sherina Thomas DOI:10.4103/ijo.IJO_1769_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema p. 176 Sohan Singh Hayreh DOI:10.4103/ijo.IJO_1308_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema p. 177 Uppal Gandhi, Jay Chhablani, Preeti P Chhablani DOI:10.4103/ijo.IJO_1771_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 178 Ramanuj Samanta DOI:10.4103/ijo.IJO_1642_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy p. 179 Srikant Padhi, Vinod Kumar DOI:10.4103/ijo.IJO_1739_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 180 Koushik Tripathy, Arpan Chaudhuri DOI:10.4103/ijo.IJO_1654_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy p. 181 Srikant Padhi, Vinod Kumar DOI:10.4103/ijo.IJO_1740_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting p. 181 Devesh Kumawat, Pranita Sahay, Dheepak Sundar, Rohan Chawla DOI:10.4103/ijo.IJO_1384_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting p. 182 Gloria P Trujillo-Sanchez, Alejandro Gonzalez-De la Rosa, Jose Navarro-Partida, Luis Haro-Morlett, Juan C Altamirano-Vallejo, Arturo Santos DOI:10.4103/ijo.IJO_1516_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Association of obesity and age-related macular degeneration in Indian population p. 183 Brijesh Takkar DOI:10.4103/ijo.IJO_1124_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Association of obesity and age-related macular degeneration in Indian population p. 184 Durgasri Jaisankar, Gayathri Swaminathan, Rupak Roy, Vaitheeswaran Kulothungan, Tarun Sharma, Rajiv Raman DOI:10.4103/ijo.IJO_1342_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment p. 185 Simar Rajan Singh, Mohit Dogra, Mangat Ram Dogra DOI:10.4103/ijo.IJO_1107_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Response to comment on: Sandwich technique using a combination of perfluoropropane and silicone oil for inferior retinal detachment p. 185 Sumit Randhir Singh, Deven Dhurandhar, Jay Chhablani DOI:10.4103/ijo.IJO_1290_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta