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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 2 | Issue 4
Page Nos. 873-1011

Online since Monday, October 10, 2022

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EDITORIAL  

“Know your worth!” – Author ranking indices Highly accessed article p. 873
Rolika Bansal, Santosh G Honavar
DOI:10.4103/ijo.IJO_2165_22  
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CASE REPORTS Top

Cyclodamia fogging technique for unilateral accommodative spasm: A case study Highly accessed article p. 875
Devanshi M Dalal, Dhaivat Shah
DOI:10.4103/ijo.IJO_910_22  
Cyclodamia is a technique used for the determination of accommodative spasms. A 20-year-old healthy female presented a complaint of frontal headache for 1 month. In a previous checkup performed elsewhere, she was diagnosed with unilateral high myopia associated with amblyopia. In routine practice, the classic fogging technique is performed during the procedure of subjective correction. In the case of accommodative spasms, there are different techniques of fogging that can be used. The cyclodamia fogging technique should be used in routine practice to differentiate between the cases of excessive accommodation.
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A rare case of congenital unilateral dry eye Highly accessed article p. 877
Rajendra K Chaurasia, Jyotsana Singh, Areeba Shakeel
DOI:10.4103/ijo.IJO_745_22  
An 18-year-old girl presented to us with complaints of redness and photophobia in her right eye. She has been on irregular treatment since 6 years of age but never got completely relieved. We did a thorough examination and relevant investigations. On magnetic resonance imaging (MRI), right side lacrimal gland agenesis was present with normal left lacrimal glands, and a diagnosis of isolated congenital unilateral lacrimal gland agenesis was made.
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Rare presentation of toxic endothelitis because of mustard seeds and insect toxin p. 880
Anchal Tripathi, Sumedha Vats, Alok Sati, Ranjit Goenka
DOI:10.4103/ijo.IJO_1717_22  
Mustard seeds have been reported to cause contact dermatitis and even second-degree burns over the exposed skin. However, there have been no previous case reports on mustard seed-induced toxic endotheliitis. Mustard seeds have toxic compounds such as glycosides. There have been few reports on insect sting causing ocular changes. However, there have been no case reports on toxic endotheliitis caused because of rubbing of the eye containing a small insect. We report two such cases of toxic endotheliitis with rare presentation. Both the cases presented with intense photophobia and blurred vision in the affected eyes. The first case had a history of rubbing of an insect inside the eye. The other case had a history of husking mustard harvest a few hours prior to the occurrence of symptoms.
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An unusual case of sequential corneal perforation in pellucid marginal degeneration: A case report p. 882
Shreesha Kumar Kodavoor, Komal B Patekar, Ramamoorthy Dandapani
DOI:10.4103/ijo.IJO_334_22  
Spontaneous and sequential corneal perforation is rare in pellucid marginal degeneration (PMD) in the seventh decade of life. Hence, the importance of repeated follow-up, clinical examination along with serial corneal topography even in the seventh and eighth decades of life is of utmost importance in PMD. We report a case of spontaneous corneal perforation in a 64-year-old male patient with PMD having normal corneal thickness in the right eye which was managed with primary suturing and compression sutures. The other eye was absolutely normal with normal topographic findings. Over a period of four years of follow-up, the patient developed progressive diminution of vision in both eyes and was diagnosed with cataract. Temporal phacoemulsification with toric IOL implantation was done in both eyes, following which the left eye developed spontaneous perforation after a period of two months which was also managed with primary suturing and compression sutures.
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Post-Descemet's membrane endothelial keratoplasty Pseudomonas graft infection p. 886
Vishwa Shah, Indrajot Kaur, Neha Jain, Vikas Mittal
DOI:10.4103/ijo.IJO_1182_22  
To report evaluation and management of graft-host interface keratitis post-Descemet's membrane endothelial keratoplasty (DMEK). A 70-year-old lady with pseudophakic bullous keratopathy who underwent DMEK and developed interface interstitial keratitis on the first postoperative day. Cultures of corneal button revealed gram-negative bacilli (Pseudomonas aeruginosa). Prompt surgical intervention in the form of removal of donor Descemet's membrane and targeted antibacterial therapy helped in the complete resolution of infection. Descemet's stripping endothelial keratoplasty (DSEK) was performed postresolution of infection which yielded a good visual outcome for the patient. Donor rim culture helps immensely in identifying organisms in cases presenting in the early postoperative period.
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Atypical early presentation of graft suture infection p. 889
Mercedes Molero-Senosiain, Aarti Patel, Shalom Savant, Vijay Savant
DOI:10.4103/ijo.IJO_1041_22  
We report an atypical presentation of a corneal graft suture-related abscess. An 80-year-old female with a history of Moraxella and herpetic keratitis successfully treated with penetrating keratoplasty was noted to have a semi-circular pigmented line of keratic precipitates straddling a single suture during a routine follow-up appointment. After 48 hours of oral anti-viral and topical steroid therapy for presumed graft rejection, she developed a suture abscess with hypopyon. Treatment with intensive topical antibiotics was commenced, and the case resulted in complete resolution. Semi-circular endothelial keratic precipitates could be an early sign of suture infection.
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Gonioscopy-assisted transluminal trabeculotomy (GATT) in Indian eyes – A description of 1-year follow-up results of the GATT procedure in a series of patients with open-angle glaucoma in South India p. 891
Ganesh Venkataraman, M Manju, Premanand Chandran, Mrunali Dhavalikar, Menaka Vimalanathan, Abhipsa Sahu
DOI:10.4103/ijo.IJO_947_22  
Trabeculectomy is considered as the gold standard for surgical treatment of glaucoma. The use of conjunctiva to create a filtering bleb limits future surgical options. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an ab interno trabeculotomy technique that has the advantage of reducing the intra-ocular pressure (IOP) in a conjunctiva sparing manner. Ten eyes of eight patients underwent GATT and were followed up for a minimum period of 6 months. Eight eyes were not on any glaucoma medication till the end of their last follow-up, which ranged from 6 months to 1 year. Two eyes were advised to undergo additional glaucoma surgery. All eyes except one retained their visual acuity in the post-operative follow-up period. GATT is a promising technique for the treatment of mild to advanced open-angle glaucoma with an added benefit of sparing the conjunctiva for future interventions.
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Management of malignant glaucoma following cataract surgery in a nanophthalmic eye: A case report p. 894
Pooja Bhomaj, Ankita Madhavani
DOI:10.4103/ijo.IJO_555_22  
Nanophthalmos is a rare eye condition characterized by short axial length (<20 mm), high lens-to-eye volume ratio, thick sclera, angle closure, and high hypermetropia. Cataract surgery in nanophthalmic eyes is associated with a higher rate of complications compared to routine cataract surgery. We discuss a case of a nanophthalmic patient (axial length (AL) of 15.80 mm) who presented with angle closure glaucoma, underwent uneventful cataract surgery with in-the-bag intraocular lens (IOL) implantation. The patient developed postoperative uveal effusion followed by malignant glaucoma that was managed effectively by 25 G capsulo-zonulo-iridectomy with anterior vitrectomy. Timely management resolved the episode.
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CASE SERIES Top

Anterior nodular scleritis – tuberculosis or granulomatosis with polyangiitis? A series of three cases p. 897
G Nageswar Rao, Gazal Patnaik, G Prasanna, Prasanta Padhan, Nidhi Sinha
DOI:10.4103/ijo.IJO_751_22  
Scleritis is a chronic destructive inflammatory disorder. It has various systemic associations, including granulomatosis with polyangiitis (GPA). However, anterior nodular scleritis being the initial manifestation of GPA is rare. Being in an endemic country of tuberculosis (TB), it is imperative to exclude any possibility of active or latent TB before institution of immunosuppressive agents. Similarly, the vice versa should be kept in mind. We present three cases of persistent anterior nodular scleritis even after treatment with antitubercular treatment (ATT). Subsequent recurrences led to the evaluation and diagnosis of GPA with multisystem involvement. Treatment with immunosuppressive therapy led to successful recovery.
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COMMENTARY Top

Commentary: Scleritis in granulomatosis with polyangiitis: Is tuberculosis a masquerader? p. 899
MS Balamurugan, Anjana Somanath
DOI:10.4103/ijo.IJO_2002_22  
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CASE REPORTS Top

The traumatic iris sunset p. 902
Priyanka Gandhi, Aesha Hastak, Reshma Ramakrishnan, Saurabh Shrivastava
DOI:10.4103/ijo.IJO_257_22  
Cataract extraction with intra-ocular lens (IOL) implantation is the most common sight-restoring surgery performed in the elderly. Blunt trauma is usually associated with severe ocular damage and grave consequences in post-operative eyes. Here, we report a case of a 70-year-old male, who suffered from blunt ocular trauma following one and a half month of phacoemulsification in the right eye. Phaco-tunnel wound was healthy, the iris was crumpled and settled at the bottom of anterior chamber, and the IOL was in the bag. There was no wound dehiscence. This is a rare presentation as the majority of reported cases had wound dehiscence and iris expulsion.
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Letrozole-induced bilateral acute intermediate uveitis with cystoid macular edema p. 904
Rajlaxmi Virkar, Madhuri Meshram, Amit S Nene, Onkar H Pirdankar, Pushpanjali Ramteke, Smitesh Shah
DOI:10.4103/ijo.IJO_747_22  
The purpose is to report a rare case of letrozole-induced bilateral acute intermediate uveitis (IU) with cystoid macular edema (CME). A 29 years old female undergoing infertility treatment came with complaints of progressive diminution of vision in both eyes. Clinical evaluation and optical coherence tomography (OCT) revealed IU with CME in both eyes. Intravitreal steroid injections and discontinuation of oral letrozole led to the resolution of IU with CME. Thus, all patients who are treated with letrozole should undergo periodic ophthalmic screening for timely diagnosis and treatment.
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CASE REPORT Top

Adalimumab in Vogt–Koyanagi–Harada disease: A case report Highly accessed article p. 906
Tingting Chen, Guodong Li, Qinglan Mao, Yingying Zhang
DOI:10.4103/ijo.IJO_2902_21  
A 30-year-old Chinese woman presented to the ophthalmology department with bilateral blurry vision.; she was diagnosed with incomplete Vogt–Koyanagi–Harada (VKH). The treatment consisted of prednisolone infusion followed by a change of oral hormones. However, adalimumab subcutaneous injection was used instead because of the ineffectiveness of hormone therapy and the patient's reluctance to take oral hormones. After effective monotherapy with adalimumab, the inflammation was stable and inactive without recurrence at follow-up.
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COMMENTARY Top

Commentary: Treatment of refractory uveitis with Vogt Koyanagi Harada disease p. 909
Sivaraman Balamurugan, Somanath Anjana
DOI:10.4103/ijo.IJO_961_22  
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CASE REPORT Top

Tofacitinib in juvenile idiopathic arthritis-associated uveitis p. 911
Kalpana Babu, Vidya Mooss, Anand Prahalad Rao
DOI:10.4103/ijo.IJO_789_22  
Tofacitinib, a Jannus kinase inhibitor, is used in the treatment of rheumatoid arthritis and recently has been used to treat polyarticular juvenile idiopathic arthritis (JIA). In this case report, we report the resolution of refractory anterior uveitis (OS) in a 5-year-old girl with polyarticular JIA. She had failed conventional immuno-modulation (methotrexate, mycophenolate mofetil, and oral steroids). As she could not afford adalimumab, tofacinitib was added, resulting in resolution of anterior uveitis. During the last follow-up (after 8 months), her best corrected visual acuity is 6/9 (OD) and 6/12 (OS). Tofacitinib may be considered as a cost-effective option for refractory JIA-associated uveitis in the developing world.
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COMMENTARY Top

Commentary: Janus kinase inhibitors and juvenile idiopathic arthritis associated uveitis p. 913
Padmamalini Mahendradas, Sai B Mishra, Srinivasan Sanjay, Ankush Kawali, Bhujang K Shetty
DOI:10.4103/ijo.IJO_1776_22  
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CASE REPORTS Top

Neurosyphilis masquerading as papillodema unmasked by tell-tale vitreous cells and peripapillary hemorrhages p. 915
Mayur R Moreker, Darshan Pandya, Rakesh Singh, Vibhor Pardasani, Sonali Shah
DOI:10.4103/ijo.IJO_1537_22  
A 35-year-old lady presented with headache and diminution of vision in both eyes for 30–35 days. She was being treated for idiopathic intracranial hypertension with documented high intracranial pressures. In view of the past history of positive blood RPR and the current picture of peripapillary hemorrhage along with papillodema and telltale vitreous cells, we suspected neurosyphilis and repeated Blood-CSF TPHA, both of which were positive. She was treated with a single dose of benzathine penicillin G 1.2 MIU I.M and tablet doxycycline 100 mg twice a day for 14 days, with oral acetazolamaide, to achieve resolution of symptoms and improvement of vision.
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Severe bilateral retrobulbar optic neuritis in a patient with psoriasis-associated sacroiliitis – A case report p. 918
Ashok Kanakamedla, Madhu Kumar, Om Shrivastava, Simakurthy Sriram, Jayamadhury Gudimetla
DOI:10.4103/ijo.IJO_606_22  
Bilateral (B/L) simultaneous severe loss of vision and a lack of pain are indicative of an inflammatory optic neuropathy, which has been reported mostly in the systemic auto-immune disorders and defines as 'atypical' optic neuritis. The cause of inflammation in atypical optic neuritis can be an immune-related or infection or vitamin B12 deficiency. Here in this article, we report a 31-year-old male with a known case of psoriasis presented to us with complaints of sudden severe bilateral vision loss diagnosed as bilateral atypical optic neuritis because of psoriasis. This study emphasizes to recognize and monitor patients with auto-immune disorders such as psoriasis for possible development of atypical optic neuritis.
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Ophthalmic manifestations and outcome in Takayasu arteritis: An interventional case report p. 921
Shalini Singh, Jawahar L Goyal
DOI:10.4103/ijo.IJO_850_22  
A patient with Takayasu arteritis (TA) with marked ischemia of the retina and choroid underwent successful treatment with stent implantation. The left common carotid artery was markedly narrowed. However, the left subclavian artery showed narrowing at its ostium and proximal segment with narrowing at the origin of the left vertebral artery. The patient underwent left subclavian balloon angioplasty with left vertebral artery stenting. This led to drastic resolution of micro-aneurysms and improvement of vision. Stenting for hypo-perfusion of ophthalmic circulation in cases of TA has rarely been reported, and to our knowledge, this is the rare case report of improved clinical and visual outcome following stent placement.
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Ophthalmic artery occlusion in a patient with sickle cell trait and hyperhomocysteinemia p. 923
Vijaya Sahu, Himanshu Kashyap
DOI:10.4103/ijo.IJO_1476_22  
Ophthalmic artery occlusion is a rare, blinding condition seen in patients with disorders like hypertension, hyperlipidemia, and hypercoagulable state. We report a unique case of ophthalmic artery occlusion in a patient with sickle cell trait and hyperhomocysteinemia. A 23-year-old male presented with a complaint of loss of vision in the right eye for the last two days. There is a history of right-sided hemiparesis due to a thromboembolic event. He is a carrier of sickle cell trait. Fundus showed a pale disc, attenuated artery and vein. OCT revealed foveal thinning and thick posterior hyaloid. ERG showed an extinguished scotopic and photopic response.
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A case of presumed bilateral central retinal artery occlusion following methanol poisoning p. 926
Maamouri Rym, Maamouri Hela, Brahmi Nozha, Cheour Monia
DOI:10.4103/ijo.IJO_344_22  
It is well established that methanol poisoning induces commonly acute toxic optic neuropathy. Herein, we describe a case of unusual ocular manifestation. A 35-year-old male presented with painless, bilateral, and simultaneous sudden onset of severe visual loss following methanol poisoning. The visual acuity was 20/200 in the right eye and limited to a finger count in the left eye. Fundus color photography showed a bilateral sub-total central retinal artery occlusion (CRAO). A methanolemia carried out following the hemodialysis returned to 0.2g/l. To the best of our knowledge, this is the first case reporting CRAO after methanol poisoning. Our report under-scores the importance of early ophthalmic examination of patients with acute methanol poisoning and suggests that it could induce acute CRAO because of retinal artery vasospasm.
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A case of bilateral cystoid macular edema after rituximab infusion p. 929
Alexandros Rouvas, Nikolaos Bouratzis, Nikolaos Gouliopoulos
DOI:10.4103/ijo.IJO_951_22  
A 65-year-old man experienced sudden bilateral vision loss after rituximab infusion. Best corrected visual acuity was 1/10, and cystoid macular edema was identified. A bilateral rituximab-induced cystoid macular edema was diagnosed, and an intravitreal dexamethasone implant was applied. The exudative phenomena resolved, and the visual acuity rose to 8/10. Another rituximab infusion was followed by vision loss and recurrence of macular edema. A dexamethasone implant was reapplied, which showed great results. This is a rare case of rituximab-induced bilateral macular edema, which recurred after a second infusion. We also present an alternative treatment consisting of intravitreal dexamethasone implant.
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Neovascular glaucoma in atypical central serous chorioretinopathy and pachychoroid disease p. 932
Aparna Rao, Srikanta Kumar Padhy
DOI:10.4103/ijo.IJO_995_22  
We report an atypical central serous chorioretinopathy (CSCR) with pachychoroid disease and consequent recalcitrant neovascular glaucoma (NVG). A 45-year-old man with persistent subretinal fluid, pachychoroid and bilateral large areas of capillary nonperfusion exudative detachment, and CSCR presented with raised intraocular pressure (IOP) and neovascular glaucoma. Failure after trabeculectomy with mitomycin-C mandated the implantation of Ahmed glaucoma valve followed by two epiconjunctival MMC applications over the AGV plate/bleb in the hypertensive phase. He was also started on 25 mg oral eplerenone twice a day for the first month, followed by 25 mg once a day over the next two months, followed by intravitreal bevacizumab injection. The retinal neovascularization regressed along with normalization of IOP at over eight months follow-up.
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Epiretinal neovascularization with vitreomacular traction in a case of proliferative diabetic retinopathy with macular telangiectasia type 2 p. 935
Vivek Chaitanya, Divyansh Mishra, Mahesh P Shanmugam, Rajesh Ramanjulu, Keshav Lahoti
DOI:10.4103/ijo.IJO_729_22  
A 58-year-old female presented with macular telangiectasia (MacTel) type 2 with proliferative diabetic retinopathy (PDR) and also showed vitreomacular traction (VMT) with epiretinal neovascularization (ERN) in both the eyes. Post-vitrectomy with anti-vascular endothelial growth factor (anti-VEGF) injection in the right eye, there was complete resolution of previously noted ERN, probably due to release of VMT, making this a compelling case of traction as one of the pathophysiology of ERN in MacTel type 2 in our case.
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Anterior segment optical coherence tomography features of ocular siderosis in a missed intra-ocular foreign body p. 939
Devika Singh, SP Kruthika, Devashish Dubey, Neeraj Shah
DOI:10.4103/ijo.IJO_974_22  
A 40-year-old gentleman with a history of repaired corneal perforation with anterior chamber hyphema was referred to the cornea clinic for suspected blood staining of the cornea. Diffuse corneal ocular siderosis and blood staining can present with a similar clinical picture. We describe the anterior segment optical coherence tomography features in our case which helped us differentiate between these presentations.
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Ocular schwannoma masquerading as amelanotic choroidal melanoma: A case report p. 941
Navneet Sidhu, Anchal Gera, Neiwete Lomi, Seema Sen
DOI:10.4103/ijo.IJO_596_22  
A 29-year-old male was incidentally diagnosed with amelanotic choroidal melanoma in the nasal quadrant of the right eye following an ocular examination due to accidental entry of an insect in the eye. The patient underwent right eye stereotactic Gamma Knife radiosurgery. The tumor mass showed regression six months after therapy. After 12 months, the patient presented again with diminution of vision with recurrence of choroidal mass and total retinal detachment. He underwent a right eye enucleation. Histopathological examination revealed spindle-shaped cells arranged in fascicles and immune stain positivity for S-100 and negative for HMB-45 and Melan-A—suggestive of schwannoma.
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Modified Nishida procedure for hypertropia following traumatic laceration of the inferior rectus p. 944
Anupam Sahu, Deepshikha Agrawal
DOI:10.4103/ijo.IJO_723_22  
Isolated inferior rectus transection is a rare outcome of ocular trauma, leading to hypertropia and debilitating diplopia in primary and reading positions. The modified Nishida procedure is an easy-to-perform, minimally traumatizing, reversible, ciliary vessel sparing muscle transposition procedure that is ideal for post-traumatic scenarios. We report our experience with the modified Nishida procedure in a case of a lost inferior rectus after traumatic laceration.
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Superior rectus recession combined with lateral rectus recession and Y-split surgery for exotropia with large comitant innervational hypertropia in a case of type III Duane retraction syndrome p. 948
Vibha Baldev, Suma Ganesh
DOI:10.4103/ijo.IJO_421_22  
The aim of this study is to report a case of hypertropia with severe globe retraction and innervational upshoot present in type III Duane retraction syndrome (DRS) and its management. We report a case of a 24-year-old male with type III DRS with large hypertropia and exotropia, 90° upshoot (grade 4) on attempted adduction, globe retraction on adduction and depression and significant face turn. MRI brain and orbit revealed absence of right abducens nerve with relative low position of horizontal rectus muscles, representing the bridle effect, with normal inferior rectus and superior rectus. The case was managed by performing right eye lateral rectus recession with Y-split for the severe upshoot and superior rectus recession for the hypertropia. Recession of the superior rectus muscle along with lateral rectus recession with Y-split is a safe and effective treatment of type III DRS cases with hypertropia and exotropia.
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An interdisciplinary approach to the management of cerebral visual impairment: A case report p. 952
Mahalakshmi Mojjada, Navaneetha Ampolu, Prathyusha Potharaju, Beula Christy
DOI:10.4103/ijo.IJO_636_22  
We herein present a case of a 14-month-old child presented in the pediatric ophthalmology clinic, who sustained a head injury and had unconsciousness and status epilepticus. The child was diagnosed to have cerebral visual impairment (CVI), hemiplegic cerebral palsy (CP), and global delay in developmental areas. After 167 center-based sessions and 120 home-based sessions of therapeutic intervention, a significant development in the child's functioning was noted and quantified using standard assessment tools like CVI range assessment and Developmental journal for babies and young children with visual Impairment (DJVI). At the age of 2.5 years, the CVI range assessment showed that the child from phase II has moved to phase III of visual development. On the DJVI scale, the child improved from performing 33% age-appropriate activities to 81% activities. This case is a clear example to show the importance of early intervention, an interdisciplinary team approach, and parental motivation and involvement in successful management.
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Ophthalmic manifestation of Hereditary Sensory and Autonomic Neuropathy – Five-year follow up Highly accessed article p. 955
Praveen Dhanapal, Niharika Chaurasia, Anupreeti Jain
DOI:10.4103/ijo.IJO_1420_22  
Hereditary Sensory and Autonomic Neuropathy (HSAN) is a rare genetic disorder that usually begins in childhood. It is associated with sensory dysfunction (depressed reflexes, altered pain and temperature perception). We report a case of an orphan and adopted girl child with HSAN type IV masquerading as keratomalacia with normal developmental milestones, absent sensation to pain and temperature, bilateral absent corneal reflexes, corneal xerosis, anhidrosis, and trophic ulcers in both hands and feet.
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Large internal carotid - ophthalmic artery aneurysm with anterior optic pathway compression p. 957
Divya Deepthi Shyamala, Vivek Lanka, Deepthi Slesser, Prudhvinath Reddy, Ganne Pratyusha
DOI:10.4103/ijo.IJO_1035_22  
Internal carotid-ophthalmic artery aneurysms (IC-OA) are rare lesions that become symptomatic only when they are quite advanced or when complicated by subarachnoid hemorrhage (SAH). We report a case of IC-OA aneurysm in a middle-aged lady who presented with relative afferent pupillary defect, optic disc pallor, significant color vision impairment, and rather preserved visual acuity in the right eye. Magnetic resonance imaging revealed a fuso-saccular aneurysm of the ophthalmic segment causing a pressure effect on the optic nerve. This case emphasizes the importance of careful ocular examination supplemented by neuro-imaging in cases of unexplained visual loss. Early detection can prevent a potentially fatal subarachnoid hemorrhage.
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Bilateral blindness with a single bullet injury p. 959
Gazella B Warjri, Abhijeet Beniwal, Vimal Vashistha, Sanjay Sharma, Rebika Dhiman, Rohit Saxena
DOI:10.4103/ijo.IJO_380_22  
Gunshot injuries are a rising concern, which can have ocular involvement in almost 2% of cases. We present a case of a 35-year-old woman with accidental gunshot injury with no perception of light Oculus Uterque (OU). OD had disk pallor and OS, a repaired corneoscleral perforation. The bullet entered the left orbit perforating the left globe, crossed over to the opposite side, and exited through the right temple. Noncontrast computed tomography (NCCT) head revealed comminuted fractures of the roof, lateral and medial orbital walls. Multiple tiny bony fragments and foreign bodies were seen in the retrobulbar region of OD in relation to the optic nerve near the optic disk. This case highlights that gunshot injuries to the eye have high morbidity, but they are largely preventable as most injuries are unintentional, as was seen in this case. The priority should be to spread awareness and sensitize the masses regarding preventive factors.
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A rare case in a child with mild trichothiodystrophy associated with ERCC2 gene p. 962
Rajendran Janani, Prakash Chermakani, Periasamy Sundaresan, Shashikant Shetty, Kshama Rai
DOI:10.4103/ijo.IJO_1217_22  
A 7-year-old girl with bilateral cataracts, along with photosensitivity, was suspected to have xeroderma pigmentosum. Further dermatological examination confirmed the proband had dry skin, brittle hair, high-arched palate, and ichthyosis. The proband underwent bilateral cataract surgery. Her best corrected visual acuity (BCVA) improved to 6/9 in both eyes. Polarizing light microscopic observation of the proband eyebrow hair shaft resembled tiger tail-like stripes, which is an authentic clinical feature associated with trichothiodystrophy (TTD). Furthermore, on whole exome sequencing (WES) of the proband, mutations in the ERCC2 gene were found to be strongly associated with TTD1.
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Bilateral allergic contact dermatitis due to Netarsudil p. 965
Mithun Thulasidas, Ajita Sasidharan, Tanvi Gupta
DOI:10.4103/ijo.IJO_1750_22  
Netarsudil is a rho-associated coiled-coil-containing protein kinase inhibitor and norepinephrine transporter inhibitor, which decreases the intra-ocular pressure by increasing the aqueous outflow and decreasing the aqueous production. However, netarsudil has been reported to cause adverse effects attributed to its vasodilator property. The common side effects associated with its use are conjunctival hyperemia, corneal verticillata, and conjunctival hemorrhages. This report describes a case of allergic contact dermatitis 3 months after initiating netarsudil eye drops in a 78-year-old man.
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Demodicosis: An unusual masquerade of basal cell carcinoma p. 967
Gayatri Fulse, B Jayashree, Vikas Menon, Radhakrishnan Shanti
DOI:10.4103/ijo.IJO_645_22  
A 75-year-old female presented with swelling and redness on the left lower lid away from the lid margin since 10 days. The best corrected visual acuity in both eyes is 6/6 and N6. On examination, an erythematous ulcerative lesion with rolled edges and central necrosis on the left malar area was seen clinically mimicking basal cell carcinoma. Excision biopsy was performed, and the histopathology report revealed an inflamed follicle with intra-follicular demodex folliculorum with ulceration and suppurative abscess with necrotizing destruction of hair follicles. The patient was treated with topical ciprofloxacin ointment. Follow-up after 3 weeks showed complete resolution of the lesion with no recurrence at 3 months.
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Out of the box - Traumatic autoenucleation: A case report p. 969
Meghana Tanwar, Sakshi Kumar
DOI:10.4103/ijo.IJO_948_22  
A 53-year-old gentleman, presented with an alleged history of seizures at home during which he suffered trauma to his left eye leading to prolapse of the globe. This globe luxation was associated with lid lacerations and active bleeding from the orbit. The lacerations were repaired, the globe was enucleated, and eventually, a prosthesis was fit for cosmesis. Autoenucleation usually occurs in patients with psychiatric illness or drug abuse and rarely in cases of accidental trauma. We present this case report to highlight the clinical presentation of such a trauma with complications, which might be overlooked while treating such patients.
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Orbital intramuscular lipoma with bone erosion: A case report and review of literature p. 971
Sirin Lueangaram, Rosana Pittayapongpat, Lisa Kittisangvara, Nutsuchar Wangtiraumnuay
DOI:10.4103/ijo.IJO_248_22  
This report highlights a rare case of a benign orbital intramuscular lipoma mimicking a malignant tumor with unusual sphenoid wing destruction. A 2-year-old female patient presented with proptosis of the left eye, left temporal fullness, and motility disturbance during abduction. Brain and orbital computed tomography revealed an inhomogeneous enhancing density partially circumscribed mass in the left extraconal space (36.6 × 34.4 × 34.2 mm) with bone erosion of the greater wing of the left sphenoid bone. The clinical and radiologic findings suggested rhabdomyosarcoma. Histopathology revealed diffuse infiltration of mature adipocytes in the striated muscle. An intramuscular lipoma, a rare subtype of benign lipoma, can mimic malignant orbital tumors due to adjacent bone erosion.
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Post-traumatic orbital subperiosteal hematoma presenting as proptosis with Curvularia keratitis p. 974
Saroj Gupta, Deepayan Sarkar, Gresshma Nechikaddu
DOI:10.4103/ijo.IJO_773_22  
A 13-year child presented with protrusion of the left eye (LE) with redness, pain, and diminution of vision following blunt head trauma. The best-corrected visual acuity (BCVA) in the LE was hand movement. On examination, LE had abaxial proptosis with lagophthalmos and severe exposure keratopathy. There was a large corneal ulcer with feathery margins and superficial brown pigmentation, confirmed as Curvularia spp. on microbiological assessment. A computed tomography (CT) scan of the orbit and brain demonstrated superior subperiosteal hematoma of the orbit and frontal epidural hematoma. Aspiration of blood from subperiosteal orbital hematoma resulted in an immediate reduction of proptosis. The epidural hematoma resolved spontaneously. Treatment with topical and systemic antifungal agents resulted in complete healing of the keratitis with a residual leucomatous corneal opacity. Emergency treatment of subperiosteal orbital hematoma through needle aspiration helps in the early resolution of proptosis, exposure keratopathy, and visual loss.
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Orbital metastasis from breast carcinoma presenting as an osteoblastic lesion p. 977
Raghav Goel, Yinon Shapira, Sandy Patel, Dinesh Selva
DOI:10.4103/ijo.IJO_463_22  
A 66-year-old female presented with a swollen and itchy eyelid for 4 weeks. A computed tomography (CT) scan revealed a lesion epicentered in the greater wing of the sphenoid and anterior lateral and superior orbital walls, predominantly showing osteoblastic features. Magnetic resonance imaging (MRI) demonstrated further calvarial and pachymeningeal involvement. Biopsy of the lesion demonstrated a poorly differentiated carcinoma. A distant history of breast cancer (20 years) prompted specific immunochemistry that confirmed breast carcinoma metastases. Staging positron emission tomography-computed tomography (PET) revealed multisystem spread. This report highlights the fact that breast carcinoma metastasis may rarely present with a predominantly osteoblastic lesion in the orbit.
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Childhood IgG4-related orbital disease: A delayed diagnosis p. 980
Rachna Meel, Seema Kashyap, Meenakshi Wadhwani, Mandeep S Bajaj, Sanjay S Sharma
DOI:10.4103/ijo.IJO_481_22  
IgG4-related disease is a multisystem disorder characterized by tumefactive lesions comprising of IgG4-bearing plasma cells with fibrosis. We report a case of pediatric IgG4-related orbital disease that was diagnosed 12 years after its first clinical manifestation and we present sequential imaging findings of the case.
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PHOTO ESSAY Top

Bandage contact lens – The master masquerader p. 984
Amrita Joshi, Sanjay K Mishra, Alok Sati, Pradeep Kumar
DOI:10.4103/ijo.IJO_196_22  
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Steroids: Double-edged sword in graft rejection p. 986
Aafreen Bari, Manpreet Kaur, Sridevi Nair, Jeewan S Titiyal
DOI:10.4103/ijo.IJO_699_22  
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Retained intra-ocular foreign body in the anterior chamber angle p. 988
Premanand Chandran, Siva Prasanna Thilagar, Prabhu Vijayaraghavan
DOI:10.4103/ijo.IJO_547_22  
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Nd:YAG laser membranectomy for fibrin pupillary block after uneventful cataract surgery p. 990
Surbi Taneja, Mahipal S Sachdev, Mansi Johri, Swati Singh
DOI:10.4103/ijo.IJO_478_22  
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The triad of concentric premacular hemorrhages, Roth spots, and koilonychia p. 992
Kushal Delhiwala, Rushik Patel, Bakulesh Khamar
DOI:10.4103/ijo.IJO_1405_22  
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Accidental total retinectomy p. 994
Bruttendu Moharana, Bhumija Bhatt, Sucheta Parija
DOI:10.4103/ijo.IJO_1270_22  
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Non-arteritic ischemic optic neuropathy because of occlusion of the temporal short posterior ciliary artery from thrombotic emboli p. 995
Naresh B Kannan, Anirban Chakrabarti, Chitaranjan Mishra, Girish Baliga, Karthik K Arumugam
DOI:10.4103/ijo.IJO_857_22  
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Giant bulbar conjunctival retention cyst presenting with complete blepharoptosis p. 997
Shruthi Gunda, Kavya B Madhuri, Mansoor Mohammad, Dilip K Mishra, Anasua G Kapoor
DOI:10.4103/ijo.IJO_1679_21  
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OPHTHALMIC IMAGES Top

Visible iris sign - A sign with significance p. 999
Bijnya B Panda, Bhumija Bhatt, Nikita Dash
DOI:10.4103/ijo.IJO_1082_22  
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Multiple inert fiberglass corneal foreign bodies in a pediatric patient p. 1000
Heather V Broyles, Joseph W Fong, Robert S Lowery
DOI:10.4103/ijo.IJO_2574_21  
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“Fetus” shaped Bruckner reflex in hypermetrope with superior ectasia p. 1001
Amber A Bhayana, Priyanka Prasad, Manpreet Kaur
DOI:10.4103/ijo.IJO_733_22  
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Coronavirus in the eye - A Case of Zonular Cataract p. 1002
Shivani Shipra, Ramesh Rajasekaran, Prasanna Venkatesh Ramesh, Prajnya Ray
DOI:10.4103/ijo.IJO_1210_22  
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Lenticular deposits of intravitreal triamcinolone acetonide p. 1003
Richa Agarwal, Alka Tripathi, Mohit Agarwal
DOI:10.4103/ijo.IJO_2535_21  
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Dislocated trans scleral-fixated intraocular lens: Hanging man sign! p. 1004
Nikhil Agrawal, Seema Meena, Kavita Bhatnagar, Kirti Jai Singh, Manjaree Tandon
DOI:10.4103/ijo.IJO_897_22  
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Double dislocation of intraocular lens p. 1005
Bholesh Ratna, Satyaprakash Tiwary
DOI:10.4103/ijo.IJO_1263_22  
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Paracentral acute middle maculopathy as a presenting feature of idiopathic intracranial hypertension p. 1006
Ramanuj Samanta, Gitanjli Sood, Sreeram Jayaraj, Jyoti Kumari, Neha Preet, Ajai Agrawal
DOI:10.4103/ijo.IJO_1079_22  
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Unilateral upper eyelid ectopic cilia in a 4-year-old child p. 1007
Sandip Sarkar, Srihari Balaraj, Nirupama Kasturi, Hemanth Ramachandar
DOI:10.4103/ijo.IJO_922_22  
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Fluorescein staining in orbital echinococcosis p. 1008
Dipankar Das, Kasturi Bhattacharjee, Shyam Sundar Das Mohapatra, Saidul Islam, Sheesham Singh, Apurba Deka
DOI:10.4103/ijo.IJO_899_22  
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INVITED COMMENTARY Top

Atypical presentations of multiple evanescent white dot syndrome p. 1009
Balamurugan Sivaraman, Anjana Somanath
DOI:10.4103/ijo.IJO_1265_22  
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Pro-imaging strategies in syphilitic uveitis: What is really intriguing? p. 1010
Sivaraman Bala Murugan
DOI:10.4103/ijo.IJO_675_22  
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