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   Table of Contents - Current issue
January-June 2022
Volume 2 | Issue 1
Page Nos. 1-56

Online since Wednesday, October 5, 2022

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Medical ethics in practice – research p. 1
Narasimha M Kalipatnapu
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Pythium keratitis – A menacing masquerade p. 4
C V Gopala Raju, Madhu Uddaraju
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Clinical review on mucopolysaccharidosis and its ocular significance p. 5
P Jayasri, A Mary Stephen
A condition with deficiency of various enzymes which plays a crucial role in the degradation of glycosaminoglycans (GAG) is termed to be mucopolysaccharidosis (MPS). The disease entity is due to abnormal breakdown and diffuse accumulation of GAG in the various system including brain, eye, muscle, lungs, heart, and gastrointestinal system. The disease spectrum is highly varied from slight phenotypic changes to severe life-threatening illness. Morbidity, especially low visual acuity is due to the involvement of cornea (clouding of the cornea), optic nerve abnormality, and also retinopathy. Marked impairment of physical and intellectual function is common. The diagnosis is mostly clinical and advanced testing including enzyme assay and gene testing is required for typing and pinpoint diagnosis. The treatment options are limited in most cases as enzyme replacement therapy is not widely available and expensive. Bone marrow transplantation has been found to be successful but still a cumbersome option. Visual morbidity can be reduced by performing keratoplasty if corneal clouding is significant and visual prognosis is often guarded.
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A review of the management of pythium keratitis p. 11
Ramya Seetam Raju, C V Gopal Raju
Pythium keratitis is one of the chief etiologies of atypical microbial keratitis. It has an extremely grave prognosis. A low index of suspicion, its resemblance to fungal keratitis, and inappropriate diagnosis and management all contribute to the poor outcomes. The absence of adequate literature recommending a standard regimen further worsens the picture. Although Pythium resembles a fungus, it lacks ergosterol. Hence, antifungals are ineffective. While its successful management using antibiotics has been described, some conclude that surgery is the mainstay and recommend techniques to minimize recurrences. This review article aims to bring together the various modalities of diagnosis and therapy of Pythium keratitis. It focuses on the clues to clinical suspicion which would facilitate a prompt diagnosis. It also highlights the importance of high index of suspicion in presumed fungal keratitis with a poor response to antifungals. A search was carried out using PubMed and Google Scholar for articles in English language using the keywords: Pythium insidiosum, Pythium keratitis, management of Pythium keratitis, investigations in Pythium keratitis, Polymerase Chain Reaction in Pythium keratitis, diagnosis of Pythium keratitis, and treatment of Pythium keratitis. Articles were included if they were of high significance for this article. Case reports also were taken into consideration if they conveyed data of importance.
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Estimation of serum mineral levels in age-related macular degeneration p. 18
CS Sandhya, N G Prasoona Devi, Madhusudana Pulaganti, GK Shambhavi, V Padmavathi, J Sri Lalitha
Introduction: Age-related macular degeneration (ARMD) is a highly prevalent progressive retinal disorder which has multiple genetic, environmental, and nutritional risk factors, but the exact etiology is not yet fully understood. To unravel the mysterious etiology of ARMD, more than 100 different compounds have been analyzed in the blood, serum, plasma, aqueous, and vitreous humor for their association with AMD. The present study aims to estimate the serum levels of zinc (Zn), manganese (Mn), and selenium (Se) in ARMD patients when compared to normal. Aim: The aim of this study is to estimate the serum levels of Zn, Mn, and Se in ARMD patients and age-matched controls and to find out if any homeostatic alterations of these minerals occur in ARMD patients when compared to controls. Study Design: An observational study (pilot study). Methodology: 50 ARMD patients and 60 age matched controls included in the study were subjected to a detailed ocular examination . Fundus photography and Ocular Coherence Tomography were done in all ARMD patients. 5 ml of blood sample was collected from all cases and controls and sent for the estimation of serum levels of Zn, Mn, and Se. The results obtained were subjected to statistical analysis. Results: There was no statistically significant difference in the mean serum levels of Zn and Se between cases and controls. However, serum Mn showed a higher level in controls when compared to cases, and the difference was statistically significant. Conclusion: The present study showed a causal relationship between serum Mn level and ARMD.
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A knowledge, attitude, and practice study of diabetic retinopathy in an urban population p. 24
Ramya Reddy Keesara, Mohammed Ather, J M Lokabhi Reddy
Background: As the global prevalence of diabetes is on the rise, diabetic retinopathy (DR) is also projected to escalate. DR is one of the major causes of preventable blindness. Aims and Objectives: The rationale of this study is to ascertain and record knowledge, attitude, and practice (KAP) patterns among diabetics on diabetes and DR and to recognize the barriers to compliance to regular screening. Materials and Method: A cross-sectional study using a 43-point questionnaire was conducted in an urban population. Each response was assigned a score to attain aggregates and was further cataloged into “good,” “average/moderate,” and “poor” KAP categories using Microsoft Excel/SPSS (Statistical Package for the Social Sciences). Results: One hundred and ninety-six diabetics with a mean age of 59.89 ± 11.83 years were included in this study. “Good” knowledge scores seen in 28.6% showed a statistically significant association (P < 0.001) with “positive” attitude (28.6%) and “good” practice (33.7%) patterns. Women had better overall KAP scores. Good vision (65.6%) and unawareness (31.3%) were the major barriers to compliance. Conclusions: Awareness of DR is lagging even amid educated urban population. Establishing diabetic morbidity and retinopathy awareness with emphasis on necessity of timely screening and treatment might be the way forward in this pandemic period.
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Evaluation of prediction accuracy of Barrett Total Keratometry Universal II formula using swept-source optical biometry p. 35
Surekha Mannem, C V Gopal Raju, M Padmini, Ramya Seetam Raju
Purpose: The purpose of this study was to evaluate the prediction accuracy of Barrett Total Keratometry (TK) Universal II formula using swept-source optical coherence tomography (SS-OCT)-based optical biometer. Materials and Methods: One hundred and thirty-five eyes of 135 patients from Visakha Eye Hospital, Visakhapatnam, India, were prospectively enrolled in this study. Ocular parameters were measured using IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Emmetropic spherical equivalent intraocular lens (IOL) power was calculated with Barrett TK Universal II formula using TK and Sanders–Retzlaff–Kraff (SRK)/T formula using standard keratometry. Selected IOL power and predicted refractive errors were recorded. Postoperative manifest refraction was measured at 1 month. Absolute prediction errors (APEs), mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ± 0.25, ±0.50, and ±1.00 D of predicted refraction were calculated for each formula. Results: Barrett TK Universal II formula using TK values showed low APEs, MAE, and MedAE. There were a higher percentage of eyes with APE within ±0.25, ±0.50, ±0.75, and ±1.00 D. This formula gave better results when compared to SRK/T formula using K value. However, it was not statistically significant. Conclusion: IOL power calculation using SS-OCT-based optical biometer and Barrett TK Universal II gives better results with the least APE and using TK provides superior refractive outcomes which would be beneficial for the patients undergoing phacoemulsification with toric or multifocal IOLs.
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Evaluation of fundus autofluorescence patterns in patients with central serous chorioretinopathy - A prospective, observational study p. 40
Vasanthi Sannapuri, Vasudev Palimar, V Umamaheshwar
Aim: The aim of the study was to evaluate the patterns of fundus autofluorescence (FAF) and analyze the association between FAF and swept-source optical coherence tomography (SS-OCT) in idiopathic central serous chorioretinopathy (CSCR). Materials and Methods: 65 eyes of 65 patients were prospectively included in this study. Patients underwent a complete ophthalmologic examination. We classified patterns on FAF imaging into five types as blocked FAF, mottled FAF, hyper-FAF, hyper/hypo-FAF, and descending tract pattern. Each FAF pattern was then analyzed based on the SS-OCT findings. Results: Blocked FAF pattern was seen in 47.69% of patients, mottled in 7.69%, hyper in 23.07%, hyper/hypo in 18.46%, and descending tract in 3.07%. There is a significant difference between FAF patterns in all subjects (P < 0.0001). The blocked FAF pattern (mean [M] = 0.20, standard deviation [SD] = 0.14) showed the best visual acuity among all others. The descending tract FAF pattern group (M = 0.54, SD = 0.08) and hyper/hypo-FAF pattern group (M = 0.38, SD = 0.28) showed the least favorable visual prognosis in our study. The intact ellipsoid zone on the SS-OCT was mostly found in the blocked FAF group, and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the SS-OCT was seen in one patient of the descending tract group only. Conclusions: The association between FAF and SS-OCT findings was analyzed in patients with idiopathic CSCR in our study. Detailed investigation using FAF could help estimate the duration of CSCR.
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Amelanotic choroidal melanoma presenting as tubercular granuloma p. 47
Sashwanthi Mohan, Dilip Mishra, Vishal Raval
A 52-year-old woman presented to our outpatient department with chief complaints of progressive diminution of vision in the left eye for 1 year. She did receive antitubercular treatment for 1 year in view of presumed choroidal lesion of tubercular origin. However, the lesion continued to increase in size and hence the patient came for second opinion. Multimodal imaging such as ultrasonography (A and B scan) along with indocyanine green angiography was suspicious for malignant choroidal melanoma. A diagnostic fine-needle aspiration biopsy confirmed the clinical diagnosis of amelanotic variant of choroidal melanoma. The patient subsequently underwent treatment with plaque brachytherapy. At 3-month follow-up, the tumor regressed with reduction in height as well as surrounding retinal pigment epithelial atrophy.
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Unusual extraconal presentation of orbital cavernous hemangioma p. 51
Harikrishnan Marappan, Deepika Makam, Keerthi Ballela
A 27-year-old male patient complained of dull aching pain in the right eye (RE) for 3 months. On examination, the patient had mild proptosis of RE with downward displacement and fullness in superotemporal quadrant. No palpable mass was felt, and finger insinuation was possible, the swelling did not change in size on bending, coughing, and not pulsatile, and no bruit was heard. Visual acuity, color vision, and confrontation were normal. Mild ptosis with minimal abduction and elevation restriction was noted. MRI orbits revealed well defined fusiform, lobulated, extraconal soft tissue lesion in the superotemporal aspect causing abaxial proptosis with scalloping and thinning of bony orbital roof. Histopathology reveals features suggestive of cavernous hemangioma. Even though the most common location of cavernous hemangioma is intra-conal, its extra- conal occurrence also possible and needs high suspicion.
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The remaining quarter of a pie: Concurrence of two neuro-ophthalmic entities in a patient p. 54
Anitha S Maiya, Gaargi Shashidhar
Concurrence of two different neuro-ophthalmic entities in a single patient is rare. The second disease entity may get incidentally detected when the patient is evaluated for one pathology. Such coincidences may be seen in patients having systemic diseases with microvascular complications, such as diabetes mellitus and hypertension. Herein, we report a case of a 62-year-old female patient who was detected to have bilateral inferior altitudinal hemianopia with right homonymous hemianopia as a result of bilateral anterior ischemic optic neuropathy with left occipital lobe infarct.
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