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   Table of Contents - Current issue
July-December 2021
Volume 1 | Issue 1
Page Nos. 1-68

Online since Monday, November 1, 2021

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Reaching expectations - The need of the hour p. 1
Narasimha M Kalipatnapu
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Hope insight p. 3
P Namperumalsamy
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Publish and flourish p. 7
Santosh G Honavar, Rolika Bansal
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Resurgence of plasma sterilization: A review p. 9
NV Annapurna, N Rohit Goud, Swathi Nadella
Sterilization is the backbone of a health-care organization and ensures high-quality patient care. While the horizon of medical and surgical devices has undergone vast expansions, not many discoveries have been made as far as novel sterilization procedures are concerned. Steam sterilization remains the most widely used modality of sterilization of equipment to date in most health-care organizations. Its limitation lies in the fact that there are many medical and surgical devices in the market today which are heat and pressure sensitive and can be damaged by the high temperature and pressure levels of steam sterilization. Novel sterilization techniques which are helpful in the sterilization of such sensitive instruments that are being widely used today include ethylene oxide (ETO) gas sterilization and plasma sterilization. ETO sterilization requires the instruments to undergo aeration after the sterilization process, which takes a significant amount of time. Since the sterilized materials can be used only after the aeration period, stocking up of medical instruments is required which incurs extra cost and entails further investment in this regard. In the last few decades, there have also been concerns over the safety of ETO gas itself. Hence, attention has shifted to plasma sterilization which has spiked the interest of medical professionals due to both its safety and economic running costs. This article reviews the evolution of plasma sterilization along with its working principle, methods of inactivation of microorganisms, advantages, and disadvantages. A literature search using the keywords “plasma sterilization” was carried out in PubMed and Google Scholar platforms. Out of the suggestions available, the search was zeroed down to the most relevant articles and a few landmark articles, with focus on the origin of plasma sterilization as a procedure, methods of generation of gas plasma, phases of plasma sterilization, and antimicrobial properties of plasma. A review of articles comparing the efficacy of steam sterilization, ETO sterilization, and plasma sterilization was performed. Standard textbooks, as cited in the references, were referred to as required. The operation and maintenance instruction manual for low-temperature hydrogen peroxide sterilizer ACTIPLAZR model HP-3041, Hanshin Medical Co. Ltd, South Korea, 2019, was used as the primary reference when describing the working of the aforementioned model (HP-3041) of plasma sterilizer.
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Rhino-orbital-cerebral mucormycosis: A clinical guide for ophthalmologists p. 16
Srujana Laghimsetty, Y Sujatha, Vivekananda Reddy Muddam
This article aims to provide relevant clinical pearls to help in the diagnosis and treatment of Rhino-orbital-cerebral mucormycosis (ROCM). The main risk factors apart from SARS-CoV 19 infection for ROCM are uncontrolled diabetes mellitus, diabetic ketoacidosis, and steroid usage. The major clinical findings in the case of orbital involvement are loss or decrease of vision, ophthalmoplegia, proptosis, and panophthalmitis-like picture. Effective management of the disease lies in prompt diagnosis, adequate surgical debridement, and appropriate systemic antifungal therapy. With timely attention, we can save the vision, globe, and life of the patient.
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A comparative study of conjunctival-limbal autograft with fibrin clot and glue techniques for pterygium p. 21
Vishnu Teja Gonugunta, Kirti Nath Jha, Krishnagopal Srikanth, Chinmayee Pabolu
Introduction: Pterygium is a common conjunctival disorder seen in tropical countries. Surgery is the permanent treatment. Various methods of graft fixation include sutures, fibrin clot, and glue techniques. Fibrin clot (autologous serum) technique involves the utilization of the patient's oozed blood from the episcleral vessels to serve as natural glue adhering the graft to the underlying sclera, whereas commercial glue involves the use of two components for firm adherence of the graft. Aim: The aim of this study is to observe and compare the complication rates, outcomes, and recurrence with fibrin clot and glue techniques for pterygium. Materials and Methods: One hundred and twenty-six eyes of 126 patients with primary pterygium were operated under peribulbar anesthesia by a single surgeon after doing the routine clinical examination. Group A included 63 eyes where the fibrin clot technique was used for graft adherence and Group B included 63 eyes where commercial glue was used for fixing the graft. Pterygium was excised, and a conjunctival-limbal autograft was taken from the superior bulbar conjunctiva of the same eye. In the fibrin clot (autologous serum) technique, natural hemostasis was encouraged, and the graft was placed over the oozed blood, left undisturbed for 10 min. In the glue technique, hemostasis was achieved and graft was transplanted over the glue and left undisturbed for 2 min. Eye patch was removed the next day of surgery. Preoperative and postoperative photographs were taken. Standard postoperative treatment was given. Follow-up was carried on day (postoperative day) 1, 15, 30, 90, 180, and 300. Results: The mean surgical time was 29.3 and 19.6 min in Group A and Group B, respectively. Graft retraction and graft edema were noted in four patients (6.3%) in fibrin clot technique, and graft edema was noted in five patients (7.9%) in Group B, which resolved on subsequent visits with conservative management. No recurrence was noted in either group. No other postoperative complications were noted in both groups. Conclusion: Fibrin clot (autologous serum) and glue techniques do not use sutures, thus avoid the cost of sutures and suture-related discomfort and complications. Fibrin clot (autologous serum) is more economical than the glue technique. Cosmetic outcome in the immediate postoperative period is better with glue than fibrin clot technique. Long-term outcome is the same in both groups. Autologous serum avoids the transmission of prion diseases possible with glue method. Both the techniques are equally safe and efficient.
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Mohsin's schoolchildren eye screening program - Analysis of the results p. 26
Pandiri Venkatagiri Syamala, Ramya Seetam Raju, C V Gopal Raju, Rednam Ahikrishna, A V N Chetty
Aim of the Study: To determine the prevalence of ocular morbidity among government schoolchildren from Mohsin's Schoolchildren Eye Screening Program. Design: A school-based, observational study design. Participants: Schoolchildren between 1st and 10th standards across various government schools. Materials and Methods: Students of 429 government schools of Visakhapatnam were covered under this eye screening program. It was a three-staged program. In the first stage, 84,727 students were screened for visual impairment and the presence of any abnormality by trained teachers or optometrists. In the second stage, those who were identified were subjected to a detailed ocular examination and refraction in the school premises by trained optometrists. Glasses were dispensed for those who improved to normal visual acuity and treatment was given for minor ailments by optometrists, residents and ophthalmologists requiring further evaluation were referred to the base hospital for examination and appropriate management by an ophthalmologist in the third stage. Results: 84,727 children from 429 schools were screened. Ocular morbidity was 6.07%. Refractive error was the most common ocular disorder identified in 3.74% with a significantly high rate among secondary schoolchildren (P < 0.001). Other common abnormalities found were color blindness (1.25%), allergic conjunctivitis (0.12%), squint (0.08%), infective conjunctivitis (0.02%), amblyopia (0.02%), and lid and adnexal disorders (0.02%). Conclusion: Ocular morbidity is a significant problem among schoolchildren. Visual impairment due to refractive errors is common and can be corrected by prescribing glasses. School screening programs are effective and essential in identifying ocular morbidity in schoolchildren.
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Ophthalmic practice in current COVID crisis p. 32
Sudhakar Potti, Eswar Sakare
Corona virus (covid-19) pandemic has shaken the entire world, its wide spread transmission has restricted everybody's day to day life, ophthalmologists are no exception, but in greater danger, as most of ophthalmologic examinations include close contact between patient and doctor, increasing the risk of transmission of deadly covid-19 virus. Adopting certain measures in ophthalmic practice reduces the transmission risk. Various ophthalmic manifestations of covid 19 includes follicular conjunctivitis, viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, Central retinal vein occlusion (CRVO), Central retinal artery occlusion (CRAO) Cerebrovascular accident (CVA) with vision loss, Mucormycosis etc. For this review, literature search was conducted in PubMed and Google Scholar databases by using terms coronavirus, SARS-CoV-2, COVID-19, ophthalmology, ophthalmologist, telemedicine in ophthalmology and their combinations to gather efficient information that can enhance the daily practice. Most important modifications include personal protective equipment, environmental measures (air ventilation, instrument handling), administrative measures (physical distancing, triage setup). Vaccination plays a crucial role in hampering the effect of covid crisis, it should be given significant importance and extensive awareness. Telemedicine can change the entire scenario in doctor-patient relationship and everyone should have thorough knowledge about its guidelines. All these measures need gigantic efforts in reducing the covid-19 effect, paving the path for the “NEW-NORMAL”.
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Visual fields in glaucoma - An overview p. 38
GR Reddy
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Conjunctival tuberculosis: A report of two cases p. 55
Ramya Seetam Raju, C V Gopal Raju, C Rupali
India has the highest burden of tuberculosis (TB) in the world. In the last few years, there has been a re-emergence of the disease. Ocular TB is a form of extrapulmonary TB. Conjunctival TB is a relatively rare presentation of ocular TB. This report describes two such cases of TB of conjunctiva. One case presented with redness and pain in the right eye of 1-month duration. Examination revealed a conjunctival nodule. The other case presented with a mass in the left eye which showed a pink nodule. The presence of a conjunctival nodule with unresponsiveness to topical steroids and antibiotics was the common feature in both cases. Histopathology showed tuberculous inflammation and antituberculous therapy helped in the resolution of the lesions. Thus, in cases of conjunctival nodules unresponsive to steroids, TB should be suspected and a timely biopsy should be done, especially in a country like ours, which is endemic for TB.
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Featureless retina in diabetic retinopathy p. 58
Aditya Kapoor
Featureless retina is usually seen in patients with type one diabetes mellitus and is frequently misdiagnosed as asymmetric diabetic retinopathy (DR). It is characterized by retinal neovascularization with the absence of retinal lesions such as retinal hemorrhages, cotton wool spots, and intraretinal microvascular abnormalities, features which are typical of proliferative DR. Fundus fluorescein angiography is particularly helpful in these cases as it reveals extensive areas of capillary dropout and neovascularization. It is of utmost importance to anticipate its presence and manage these patients appropriately to prevent blinding consequences. This article offers some clinical insights for better diagnosing and managing such patients.
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A case report of conjunctival ophthalmomyiasis by oestrus ovis with insights into its morphology, life cycle, and clinical presentation p. 60
Vishnu Teja Gonugunta, Datta Dipankar, Chinmayee Pabolu
Conjunctival ophthalmomyiasis is an infestation of larvae on the conjunctiva. The larvae of sheep botfly (Oestrus ovis) can be the cause of ocular irritation in occupationally predisposed individuals like shepherds. External (conjunctival) ophthalmomyiasis can progress to severe form of internal ophthalmomyiasis. We report the presence of live motile larvae of sheep botfly on the conjunctiva of a patient, shepherd by occupation presenting with irritation in the eye. Diffuse ocular examination was normal until everted lid examination revealed two white larvae with black dots at their head end crawling fast on the tarsal conjunctiva. Removal of the larvae is the only treatment, and treatment of the cattle as well, is essential to prevent recurrence and also to increase the cattle yield.
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Anterior chamber angle foreign body masquerading as corneal edema p. 62
Pandiri Venkatagiri Syamala, Ramya Seetam Raju, C V Gopal Raju
Open globe injuries (OGIs) with intraocular foreign bodies are a common presentation in ophthalmic practice. Foreign bodies in the angle of the anterior chamber have been described earlier. In this report, two such cases of foreign bodies in the angle, identified on gonioscopy, are described. One case presented with pain and redness of 6-month duration with trauma 3 years ago. Examination revealed corneal edema and a foreign body in the angle. In the other case, early gonioscopy was performed and an angle foreign body was identified. In both cases, the foreign bodies were removed with good visual results. An OGI with a foreign body embedded in the angle was the common feature in both cases which presented as late corneal edema in the first one. Thus, in cases of any OGIs, gonioscopy should be performed as early as possible, so that complications leading to visual loss can be prevented.
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Bietti's crystalline dystrophy p. 65
Adline Harris, CS Sandhya
Bietti's crystalline dystrophy (BCD) is a relatively rare tapetoretinal degeneration with marginal corneal dystrophy characterized by subepithelial corneal crystals at the limbus and intraretinal crystals in the posterior pole with atrophy of the retinal pigment epithelium and choroidal sclerosis caused by a mutation in the CYP4V2 gene. In this article, we present a case of a middle-aged female with a history of gradual, progressive, painless diminution of vision in both eyes showing multiple diffuse yellowish crystalline structures in the fundus with atrophy of underlying structures. Spectral domain-ocular coherence tomography of macula revealed bilateral multiple hyperreflective dots with outer retinal tubulations. Electroretinogram showed subnormal scotopic and photopic responses. Although very few cases of BCD have been reported, a wide knowledge about the disease is necessary to diagnose early and hence to uplift the quality of life to the patient by providing low visual aids and visual rehabilitation.
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