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   Table of Contents - Current issue
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January-March 2022
Volume 2 | Issue 1
Page Nos. 1-336

Online since Friday, January 7, 2022

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EDITIORIAL  

Indian Journal of Ophthalmology Case Reports – A year old and thriving! Highly accessed article p. 1
Santosh G Honavar
DOI:10.4103/ijo.IJO_48_22  
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CASE REPORTS Top

Objective Scheimpflug imaging of the healing cascade and repair process of striate keratopathy with the concept of optical blooming Highly accessed article p. 3
Prasanna V Ramesh, Shruthy V Ramesh, K Aji, Prajnya Ray, Meena K Ramesh, Ramesh Rajasekaran
DOI:10.4103/ijo.IJO_933_21  
To our knowledge, assessment of striate keratopathy (SK) is subjectively done with slit-lamp bio-microscopic examination, which is the most common practice. In this manuscript, we have reported the role of objective scheimpflug imaging modality, in decoding the healing and repair process of SK, post prolonged cataract surgery. The quantitative and qualitative framing of this pathology with hyperreflective and hyporeflective hot spots (optical blooming) has never been reported in the literature before. In addition to the imaging of the cascadic events of SK in default colour, the role of digital calipers in the measurement of corneal thickness in SK (in inverse colour) is also highlighted. This manuscript throws light on the unique features of scheimpflug imaging technology, for the possible consideration of it as a routine post-operative investigation in patients undergoing prolonged or complicated cataract surgery, in quantifying their SK.
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Bedside sutureless amniotic membrane transplantation in acute Stevens–Johnson syndrome: Report of two cases Highly accessed article p. 6
Parul Chawla Gupta, Surbhi Khurana, Keshavamurthy Vinay, Sendhil Muthu Kumaran, Shraddha Limbu, Vijay Kumar Sharma, Jagat Ram
DOI:10.4103/ijo.IJO_193_21  
Toxic epidermal necrolysis and Stevens–Johnson syndrome (SJS) are part of a spectrum of blistering diseases after hypersensitivity reaction to drugs, with ocular involvement in 69%–84% cases. The role of amniotic membrane transplantation (AMT) has been well established in the patients of SJS in reducing chronic long-term morbidity and sequelae. Herein, we present a report of 2 cases where bedside sutureless AMT was done within the first 5 days of onset. Amniotic membrane was secured in a symblepharon ring made using Ryle's tube. Both the cases had favorable outcomes and show the role of bedside and urgent AMT in these eyes.
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A new surgical technique for severe ocular surface burns: Full ocular surface transplantation Highly accessed article p. 9
Fikret Akata, Hanife T Akcam, Erdem Yuksel, Fulya Yaylacioglu
DOI:10.4103/ijo.IJO_1854_20  
To describe a new surgical technique for severe ocular surface burn. A 46-year-old man suffering from bilateral sequelae of chemical injury had “allograft limbal, conjunctival, and corneal transplantation” combined with amniotic membrane transplantation and symblepharon ring implantation. The patient received mycophenolate mofetil and tacrolimus for systemic immunosuppression therapy. No intraoperative or postoperative complications were noted. After the 24 months follow-up period, the cornea was clear, and visual acuity increased from hand movement to 20/400. Allograft limbo-conjunctival-corneal transplantation (full ocular surface transplantation) might be a seminal and life-saving procedure for selected cases with severe bilateral ocular surface burn.
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Conjunctival oculosporidiosis-associated ciliary staphyloma, managed with scleral patch graft using box sutures Highly accessed article p. 14
Mona Bhargava, Aditi Johri, Aditi D Ghosh, Raj S Paul, Rishi Gupta, Jyotirmay Biswas
DOI:10.4103/ijo.IJO_532_21  
To report four cases of oculosporidiosis associated with scleral thinning and staphyloma formation, including recurrent bulbar conjunctival oculosporidiosis, retrospective reviews of case records of four patients with bulbar conjunctival oculosporidiosis were undertaken. All cases were managed with excision of growth followed by diathermy and scleral patch graft. Box sutures were used for securing the graft in place, followed by oral dapsone therapy. This case series describes successful management of oculosporidiosis and associated scleral ectasia even in a recurrent case. It also highlights the utility of box sutures for securing scleral patch grafts.
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Acute psychosis after refractive surgery Highly accessed article p. 17
Mohamed I Asif, Suman K Meena, Jeewan S Titiyal, Manpreet Kaur
DOI:10.4103/ijo.IJO_1816_21  
A 20-year-old male with no previous history of systemic or mental illness underwent femtosecond laser-assisted in situ keratomileusis (LASIK) in both eyes. A suction loss was experienced during surgery in the left eye. Repeat docking was performed, and subsequent surgery was uneventful. In the postoperative period, the uncorrected distance visual acuity (UDVA) was 20/20 in both eyes; however, the patient developed behavioral changes and acute psychotic symptoms, which subsided with anti-psychotics over 3 weeks. Acute psychosis following ocular surgeries is rare; however, a strong suspicion should be kept if any behavioral changes are noted in the postoperative period. Timely psychiatric referral and adequate management are essential to achieve optimal outcomes.
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Roberts syndrome with bilateral corneal opacity: A case report p. 19
Mukaddes Damla Ciftci, Cumali Degirmenci, Elif Demirkilinc Biler, Tahir Atik, Onder Uretmen
DOI:10.4103/ijo.IJO_487_21  
Roberts syndrome (RBS) is a rare autosomal recessive genetic disorder. Mutation in the ESCO2 (establishment of cohesion 1 homologue 2) gene has been reported to cause disease. Patients with RBS may have many ophthalmologic pathologies such as hypertelorism, down slating palpebral fissures, corneal opacity, and congenital cataract. Here, we report the case of two siblings who were diagnosed with RBS and were followed in our clinic.
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Bowman's membrane corneal dystrophy in a case of McDonough syndrome: A new association p. 21
Parul Jain, Ritu Arora, Abhilasha Sanoria, Akshay K Singh
DOI:10.4103/ijo.IJO_1249_21  
Ocular features described as part of the McDonough syndrome include eyelid anomalies like blepharophimosis and ptosis in conjunction with motility defects of the eye with the presence of strabismus. We report a unique case of an 11-year-old child with facial and systemic features characteristic of the McDonough syndrome who presented with decreased vision in both eyes secondary to Bowman's membrane corneal dystrophy. This could represent a new association in the spectrum of the features of the McDonough syndrome or it could even represent a syndrome that has not yet been described. Moreover, it is important to rule out the presence of Bowman's membrane dystrophy as a cause for decreased vision in such patients.
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A rare case of myelin oligodendrocyte glycoprotein antibody disease with keratoconus p. 23
Sunny Makkar, Nisha Ahuja, Sonal Khandelwal
DOI:10.4103/ijo.IJO_1683_21  
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) consists of a group of inflammatory demyelinating disorders generally associated with optic neuritis and acute disseminated encephalomyelitis (ADEM). We present a case report of MOGAD, who along with optic neuritis and seizures was detected to have keratoconus. No association of keratoconus with this condition has been documented in the literature. The presence of keratoconus is just an incidental finding or has an association with MOGAD needs to be ascertained by studies and documentation of similar cases. Further data need to be collected to establish any association between the two.
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Novel management of spontaneous onset sclerocorneal cyst in a child p. 26
Jai A Kelkar, Aditya S Kelkar, Priyanka S Singhvi
DOI:10.4103/ijo.IJO_941_21  
A 2-year-old girl was referred for management of swelling on the nasal side in the right eye. On ophthalmic examination, the right eye showed a subconjunctival cyst extending into the anterior corneal stroma on the nasal side. Ultrasound biomicroscopy of the right eye showed a fluid-filled cystic lesion involving the cornea, with no communication with the anterior chamber. Examination under anesthesia revealed an intrastromal sclerocorneal cyst over the nasal half of cornea, not involving pupillary axis. The cyst was drained, anterior cyst wall excised, scleral lips glued together, and the bare corneoscleral bed covered with amniotic membrane with no recurrence.
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Shield ulcer following corneal collagen cross-linking p. 28
Richa Agarwal, Parul Jain
DOI:10.4103/ijo.IJO_520_21  
A 10-year-old boy presented with right-eye (RE) hyperemia, tearing, photophobia, and diminution of vision. There was a history of right-eye corneal collagen cross-linking (CXL) done 1 month back for keratoconus. Slit-lamp examination showed a corneal ulcer in the right eye. The upper tarsal conjunctiva showed hyperemia and multiple papillae in both eyes. He was diagnosed to be a case of bilateral keratoconus with vernal keratoconjunctivitis (VKC) and shield ulcer in the right eye. He was treated with topical steroids and 2% cyclosporine but the shield ulcer remained unchanged. The patient was then undertaken for surgical removal of plaque, after which, the ulcer re-epithelialized completely in 2 weeks.
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Keratoconus in Marfan syndrome: Is it a paradox? p. 30
Shivananda Narayana, Bidisha Mahapatra, Kunal Mandli
DOI:10.4103/ijo.IJO_616_21  
Ocular manifestations of Marfan syndrome (MFS) include features such as ectopia lentis (most common), increased axial length, and flat cornea. Reports of keratoconus in such patients are limited. We report tomographic findings consistent with keratoconus in a patient with MFS. A 15-year-old male presented with gradually progressive decreased vision in both eyes. External physical features being consistent with MFS, on ocular examination, was found to have very high average keratometries bilaterally with tomographic evidence of advanced keratoconus. Although a rare presentation, concurrent MFS and keratoconus should be considered when reviewing the ocular health of MFS patients and appropriate management steps should be taken upon the diagnosis.
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Acute corneal perforation in advanced keratoglobus p. 33
Sujatha Mohan, D Sujitha
DOI:10.4103/ijo.IJO_752_21  
Keratoglobus is a noninflammatory ectatic disorder characterized by thinning from limbus to limbus resulting in globular protrusion of the cornea. This is a case report of acute corneal perforation in a 15-year-old female came to our outpatient department. She had also been diagnosed as keratoglobus in the right eye. Now, she has been presented with acute corneal perforation with micro leak in the right eye. She has been treated with cyanoacrylate glue followed by bandage contact lens. On the next day, penetrating keratoplasty was done. Her postoperative vision improved to 6/60.
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A rare association of dyschromatosis universalis hereditaria and bilateral corneal ulcer p. 36
Mamta Singh, Bibhuti P Sinha, Bhaskar Kumar
DOI:10.4103/ijo.IJO_656_21  
Dyschromatosis universalis hereditaria (DUH) is a rare entity in the Indian subcontinent presenting with generalized pigmented macule all over the body. We report a case of a 13-year-old patient of DUH with bilateral gradual progressive diminution of vision and increasing white opacity for the past 5 years. The patient presented with a bilateral central corneal ulcer. The microbiological report of the corneal scraping sample was negative. The ulcer responded to topical gatifloxacin eye drop, and the epithelial defect healed with excessive brown pigmentation in both eyes. Whether this bilateral keratopathy and healing with pigmentation are a part of the spectrum of DUH or not needs to be evaluated further.
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A case of double hypopyon secondary to Serratia keratitis after penetrating keratoplasty p. 39
Ajit Kumar, Ashi Khurana, Mohit Sharma
DOI:10.4103/ijo.IJO_1924_21  
We report a case of a 39-year-old male who underwent therapeutic penetrating keratoplasty in his left eye. Three weeks after the procedure, he presented with complaints of blurred vision, redness in the eye, and ocular pain after trauma by insect bite four days back. Slit-lamp examination revealed central epithelial defect with deep stromal infiltrate accompanied by a double hypopyon. Serratia sp. was isolated on cultures. Serratia marcescens was confirmed on the VITEK 2 system. Isolated organism was sensitive to imipenem. Fortified imipenem 1% eye drop was started on a half-hourly basis. At six weeks follow-up, resolving infiltrate with significant corneal scarring and vascularization was seen.
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Mucor keratitis versus Pythium keratitis: A clinical and microbiological dilemma p. 41
Pratima Vishwakarma, Bhupesh Bagga, Savitri Sharma
DOI:10.4103/ijo.IJO_714_21  
In the pre-COVID-19 (coronavirus disease 2019) times, a 68-year-old male presented with complaints of decreased vision and whitish discoloration of the right eye. On slit-lamp examination, there was a whitish infiltrate with fuzzy margins measuring 7 mm × 6.5 mm along with <1 mm hypopyon. On microbiological examination of the corneal scraping, KOH (potassium hydroxide) + CFW (calcofluor white stain) mount revealed aseptate, broad, fungal filaments that were initially interpreted as Pythium species, but the growth on the culture was of Mucor species. The patient was managed with antifungal medications. On further follow-up, a complete resolution of the keratitis was achieved. This case highlights the importance of smear and culture correlation in such cases where the filaments of Mucor species closely mimick that of the Pythium species on microscopic examination of corneal scraping.
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Epithelial hypertrophy - an unusual representation of herpes simplex keratitis Highly accessed article p. 44
Sudhakar Potti, Eswar Rao Sakare
DOI:10.4103/ijo.IJO_1369_21  
Herpes simplex virus (HSV) keratitis is believed to be an important cause of infectious blindness, mainly resulting from stromal opacification. It has multiple manifestations with involvement of the individual layers of the cornea (epithelium, stroma, and endothelium). We report a rare presentation of HSV keratitis, a clinical representation that includes epithelial hypertrophy and subepithelial activity with the appearance of multiple fronds of vessels arising from superficial vascularization with infiltration, which reduced on administration of topical corticosteroids and systemic antivirals. Epithelial hypertrophy also regressed over time.
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An atypical case of viral endotheliitis Highly accessed article p. 46
K Srinivas Prasad, Saarang Hansraj
DOI:10.4103/ijo.IJO_1601_21  
A 48-eight-year-old male presented with redness and blurred vision in his right eye for the past 10 days, sudden in onset, with circumciliary congestion and corneal edema. On examination localized disciform corneal edema, with multiple keratic precipitates, was seen and diagnosed as corneal endotheliitis. Specular microscopy showed endothelial morphological changes with pseudoguttae. Anterior chamber paracentesis subjected to polymerase chain reaction detected varicella zoster virus. He was treated with topical 3% acyclovir gel, homatropine eye drops, 1% prednisolone acetate, and 0.5% timolol maleate. Prednisolone acetate was tapered over 14 weeks. His visual acuity at presentation was 6/36, which improved to 6/9 after 4 weeks of treatment and the final visual acuity was 6/6.
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An unusual case of Candida parapsilosis causing infectious crystalline keratopathy in Steven–Johnson syndrome p. 49
Pratima Mishra, Sanjay K Mishra, Alok Sati, Sonali V Kumar, Pradeep Kumar, Ravi Chauhan
DOI:10.4103/ijo.IJO_1544_21  
A 41-year-old female, a known case of Steven–Johnson syndrome (SJS) with ocular involvement, had a pthisical right eye (RE) and a history of mucous membrane grafting (MMG) in the left eye. Two weeks post-MMG, the patient developed a pearly white crystalline anterior stromal infiltrate suggestive of infectious crystalline keratopathy (ICK). The Gram stain showed gram-positive, round-to-oval budding cells and the culture on sheep blood agar showed smooth white yeast colonies. VITEK 2 compact automated microbiology system-enabled species-level identification was Candida parapsilosis in addition to the antifungal sensitivity. Based on the sensitivity report, the patient responded well to oral fluconazole and topical voriconazole with corneal scar formation. Clinical and microbiological evaluations of ICK in an unusual setting like SJS is prudent for a successful outcome.
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COMMENTARY Top

Commentary: Fungal infections causing infectious crystalline keratopathy p. 51
Uma Sridhar, Koushik Tripathy
DOI:10.4103/ijo.IJO_2219_21  
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CASE REPORTS Top

Clinical profile of infectious crystalline keratopathy – Case series with varied risk factors and etiology p. 53
Vaibhav Khanna, Kanika Chhabra, Josephine S Christy
DOI:10.4103/ijo.IJO_341_21  
This case series of six patients with infectious crystalline keratopathy (ICK) aims to highlight the varying risk factors, clinical presentation, and its outcome. We also report a post DALK (deep anterior lamellar keratoplasty) and post corneal tattooing infection uniquely presenting as ICK. The most common etiological organism (four out of six) was the Streptococcus species. Two other rare organisms identified were Burkholderia cepacia and Candida albicans. Five out of six patients healed with medical treatment with an overall average duration of 7 weeks (2–14 weeks), and only one patient required therapeutic penetrating keratoplasty.
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Mooren's ulcer with nonrhegmatogenous Descemet's membrane detachment (type-1), persisting after cataract surgery with clear cornea p. 57
Sangeeta Wagh, Harminder S Dua
DOI:10.4103/ijo.IJO_387_21  
Acute hydrops is very rarely reported in the setting of Mooren's ulcer. Our patient with bilateral Mooren's ulcer, being managed with immunomodulation, presented with sudden decrease in vision in the left eye, and was diagnosed to have acute hydrops with a type1 non-rhegmatogenous pre-Descemet's layer and Descemet's membrane detachment.(DMD) Her corneal stromal edema resolved with conservative management and she regained a vision of 20/80 following cataract surgery, with an evident persistent DMD and a clear cornea.
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Tectonic Tenon transplants for four different corneal melts p. 59
Radhika Natarajan, Nimisha Nagpal
DOI:10.4103/ijo.IJO_1700_21  
Tenon's tissue with good tensile strength, pliability, and availability is a valuable patch graft resource for small corneal perforations. We have extended its tectonic use to other corneal melts and leaks with anatomic success. Tenon's patch graft (TPG) was employed for tissue building in four different corneal melts: Mooren's ulcer, leaking cicatrix, persistent epithelial defect, and perforation. The minimum follow-up was six months. TPG is less resource-intensive and longer lasting than cyanoacrylate glue and multilayered-amniotic grafts. It is safe, providing good tectonic outcomes not only in corneal perforations but also in melts secondary to infective, immune, and toxic causes.
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Corneal hydrops following deep anterior lamellar keratoplasty with spontaneous resolution p. 61
Vandhana Sundaram, Jagdeesh K Reddy, Siddharthan S Kuttappalayam, Samruddhi S Dani
DOI:10.4103/ijo.IJO_1649_21  
Deep anterior lamellar keratoplasty (DALK) is often the surgery of choice in patients with advanced keratoconus. Corneal hydrops post-DALK is a rare occurrence with only one case reported so far, where the patient eventually underwent a penetrating keratoplasty due to failure of Descemet's membrane reattachment. Here, we present a case of a ten-year-old boy who had corneal hydrops 18 months post uneventful DALK with spontaneous resolution. Late corneal hydrops post DALK with spontaneous resolution is rare and has not been reported so far.
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Late-onset spontaneous Descemet's membrane detachment in penetrating keratoplasty - A case report p. 64
Revathi Rajaraman, Prabhu Vijayaraghavan, Arjun Velayudhan Nair
DOI:10.4103/ijo.IJO_1664_21  
We present a case of acute graft edema due to late-onset Descemet's membrane detachment (DMD) in a penetrating keratoplasty done two decades ago for keratoconus. A 48-year-old male presented with defective vision and redness in the right eye. The absence of the anterior chamber (AC) inflammation, keratitic precipitates, and the presence of glistening reflex in the AC, with a double contour along the inferotemporal graft host junction, suggested an acute hydrops in the graft. An anterior segment optical coherence tomography (ASOCT) confirmed DMD with the absence of an obvious tear. In the region of the double contour, a lamellar flap/fold of DM beyond the graft host junction (GHJ) but within the detachment and stroma was noted. Descemetopexy with intracameral sulfur hexafluoride gas and compression sutures along the region of the double contour restored graft clarity and vision. A DMD should be considered as a possible cause of acute edema and can be often misdiagnosed as graft rejection.
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An alternative technique for persistent Descemet's membrane detachment following phacoemulsification: Our clinical experience p. 66
Rahul Bhatia, Nitika Beri, PK Sahu, GK Das
DOI:10.4103/ijo.IJO_270_21  
Descemet's membrane detachment (DMD) is an uncommon complication of cataract surgery. The prognosis depends upon the prompt recognition and management of DMD. The use of various modalities such as AS OCT, Schiemflug imaging and pachymetry helps in proper diagnosis and selecting appropriate management options. Majority of the DMD are small and spontaneously resolve on their own. For small and limited DMD, Medical management with observation are suffice. For persistent large DMD, descemetopexy with the use of expansile gases have been used to tamponade the DM. Use of HELP algorithm has led to objective assessment of DMD and thinning the grey line between either going for observation or intervention with various modalities available. If descemetopexy fails, corneal venting incision can be used as a last resort before going for Keratoplasty. Keratoplasty still remain the treatment of choice for long standing and persistent DMD.
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Late-onset Descemet's membrane detachment secondary to presumed interface fluid syndrome after uneventful deep anterior lamellar keratoplasty for keratoconus p. 69
Sugaranjini Galiyugavaradhan, Vinay S Pillai, Abhilash Nair
DOI:10.4103/ijo.IJO_929_21  
A forty-year-old male underwent an uneventful big-bubble deep anterior lamellar keratoplasty (DALK) for keratoconus in the right eye. Suture removal was attempted 15 months post-surgery and led to temporal graft host dehiscence that required resuturing of the graft. The patient presented 4 months later with increased intraocular pressure (IOP), graft edema, and nasal Descemet membrane detachment (DMD). IOP control with medication led to reduction and total resolution of DMD and a clear graft. We postulate that the DMD, in this case, was caused by a mechanism similar to the interface fluid syndrome (IFS) that occurs in post-laser in situ keratomileusis (LASIK) eyes and should be considered as a differential diagnosis for DMD following DALK.
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Non-Descemet stripping endothelial keratoplasty in an adolescent with aphakia and glaucoma drainage device p. 72
Seung Ah Chung, Beeran Meghpara, Jade M Price, Alex V Levin
DOI:10.4103/ijo.IJO_1725_21  
We describe the case of a 14-year-old patient with secondary endothelial failure that was treated with non-Descemet stripping endothelial keratoplasty (nDSEK). To our knowledge, this is the first report on nDSEK in the setting of aphakia and a glaucoma drainage device in a child.
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Unilateral isolated type 3 persistent pupillary membrane: A rare case report p. 74
Naresh Desinayak, Amita Panda
DOI:10.4103/ijo.IJO_1082_21  
We report a 65-year-old male with unilateral type 3 persistent pupillary membrane, which was an incidental finding and was not a contributing factor for his presented symptom of diminished vision. Persistent pupillary membrane is a frequently encountered congenital anomaly of iris in routine ophthalmological practice. Different clinical types of persistent pupillary membrane do exist. However, this clinical variety is a rare one to be reported so far in the existing literature.
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Bilateral posterior subcapsular lens deposits associated with membranoproliferative glomerulonephritis in a 6-year-old child: A case report p. 76
Rym Maamouri, Abir Boussetta, Ouederni Meriem, Sassi Hela
DOI:10.4103/ijo.IJO_396_21  
A 6-year-old girl with membranoproliferative glomerulonephritis (MPGN) was referred for a systematic ophthalmological examination. Her visual acuity was 20/20 in both eyes, and detailed slit examination showed bilateral posterior subcapsular lens deposits. She was treated with corticosteroid and immunosuppressive therapy. Ophthalmological examination 10 months later showed a significant decrease of the lens deposits. To the best of our knowledge, this is the first case reporting lens deposits in MPGN. It warns us to perform a detailed examination of the anterior segment and correct management of the pathology in order to be able to reduce these deposits.
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Capsular bag distention syndrome in a child: A case report p. 78
Jyoti Matalia, Sushma Tejwani, Ashwini Chandramouli
DOI:10.4103/ijo.IJO_101_21  
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Cataract following Nd:YAG peripheral iridotomy in a case of phakic intraocular lens implantation p. 81
Praveen Subudhi, Sweta Patro, Silla Sitaram, B N R Subudhi
DOI:10.4103/ijo.IJO_1811_21  
A 27-year-old female presented with defective vision in her right eye for the past 6 months. Her presenting visual acuity was 4/60. She had a history of axial myopia since childhood. She underwent Phakic IOL surgery 3 years prior. On clinical examination, there was a patent peripheral iridotomy with an underlying focal anterior capsular and a subcapsular cataract with a posterior subcapsular component. She was scheduled for removal of the phakic IOL and phacoemulsification of the cataractous lens with implantation of a multipiece monofocal lens. The postoperative UDVA was 6/9, and the near visual acuity was N8. The patient had persistent good vision for the first postoperative year.
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Misalignment of a toric introaocular lens and reoperation after phacoemulsification with implantation of AT TORBI 709M: A case report p. 84
Chao Gao, Xiaolei Lin, Yi Luo
DOI:10.4103/ijo.IJO_2570_20  
We aimed to report a case of two-time misalignment of a toric intraocular lens (IOL) AT TORBI 709M shortly after cataract surgery and the solution to the problem. A 53-year-old man had progressively decreased vision in his left eye (OS) for more than 5 years. The uncorrected visual acuity was 20/100 in the left eye. Phacoemulsification and toric IOL implantation (AT TORBI 709M, +16.5D with cyl +2.5D) were smoothly performed in the left eye. Only 1 week after surgery, the toric IOL became misaligned. So repositioning surgery was performed 1 month later. However, the toric IOL misalignment reoccurred only 1 day after repositioning surgery. Finally, 2 weeks after repositioning surgery, toric lens replacement (Rayner T-flex Aspheric, +17.0D with cyl +2.5D) was performed in the left eye. The toric IOL became stable in the next 2 months. We concluded that Toric IOLs with larger size are more stable in larger eyes.
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iTrace - A diagnostic tool in iris-claw intraocular lens tilt p. 87
Arut A Priya, Bala Saraswathy, Navaneeth Sagam, Kalpana Narendran
DOI:10.4103/ijo.IJO_1835_21  
An increase in higher-order aberration caused by tilt and decentration of the intraocular lens can lead to a decrease in visual function following cataract surgery. We report a rare presentation of iris-claw IOL tilt in spite of good enclavation and an easy and effective diagnostic tool in iris-claw IOL tilt by iTrace, a ray-tracing aberrometer. To the best of our knowledge, no previous studies or case reports have mentioned this technology to diagnose iris-claw IOL tilt.
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Scleral-fixated intraocular lens opacification p. 90
Teresa Salvá-Palomeque, Inés Contreras, Diego Ruiz-Casas
DOI:10.4103/ijo.IJO_1723_21  
Carlevale IOL is a hydrophilic acrylic single-piece lens specifically designed for intrascleral sutureless fixation. IOL opacification has not been reported for this lens, although there are no studies with long follow-up periods yet. We describe herein two cases of Carlevale IOL opacification six and ten months after surgery. Neither of the two patients had inherent risk factors for opacification, except for vitrectomy surgery in both and air tamponade in case 2. It is necessary for surgeons to report these cases in order to identify if opacification is a significant complication for this IOL.
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Postoperative high astigmatism - Refractive surprise following manual small-incision cataract surgery p. 92
Balasaraswathy , A Arut Priya, Kalpana Narendran, Navaneeth Sagam
DOI:10.4103/ijo.IJO_1445_21  
Postoperative astigmatism plays an important role in the final visual outcome of cataract surgery. In small-incision cataract surgery, proper tunnel construction is of utmost importance for good structural integrity, leading to sutureless self-sealing wounds with lesser astigmatism. We report a case of postoperative high astigmatism following manual small-incision cataract surgery due to large, irregular, superficial, and more anterior corneal entry that lead to poor tunnel valve effect and wound sagging. This resulted in a poor postoperative unaided visual outcome.
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Bilateral sequential manual small incision cataract surgery as the management of phacomorphic glaucoma in a rare case of Werner's syndrome p. 95
Rakesh Shakya, Navjot S Ahluwalia, Rohil Paes, Dhairya V Parikh, BK Jain
DOI:10.4103/ijo.IJO_450_21  
We present a case of Werner's syndrome (WS), which is a rare progressive hereditary disorder characterized by accelerated aging. Bilateral cataracts are one of the cardinal signs of WS. The clinical characteristics of our patient met the diagnostic criteria of “Probable WS” according to the International Registry of Werner Syndrome. Our patient presented with bilateral phacomorphic glaucoma. Previous reports involving single case of WS, cataract surgery was performed by clear corneal phacoemulsification. Our patient underwent immediate bilateral sequential manual small incision cataract surgery (IBSCS) with intraocular lens implantation. We highlight the fact that bilateral cataract surgery with Manual small incision cataract surgery (M-SICS) for phacomorphic glaucoma is a safe choice for patients with Werner's syndrome.
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Management of microspherophakia and angle-closure glaucoma in Goldenhar syndrome p. 98
Vijayalakshmi A Senthilkumar, Chinmayee Pradhan, Sharmila Rajendrababu, Chitaranjan Mishra, Naresh B Kannan
DOI:10.4103/ijo.IJO_958_21  
Goldenhar syndrome is a congenital craniofacial syndrome, and the classical triad includes epibulbar dermoid, preauricular skin tags, and vertebral anomalies. The association between glaucoma and Goldenhar syndrome has been sparsely reported in literature as case reports. We describe a rare presentation of bilateral microspherophakia and secondary angle-closure glaucoma in a 29-year-young male with Goldenhar syndrome. To the best of our knowledge, this is the first case report describing the association between microspherophakia and Goldenhar syndrome.
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Optic nerve head cupping in a preterm infant revealing congenital hypothyroidism p. 101
Abhinav Dhami, Gaurav Gupta, Nimrata B Dhami, Sachreet K Sidhu, Ravinder K Malhi, Gobinder S Dhami
DOI:10.4103/ijo.IJO_1406_21  
We report a case of a male preterm infant with gestational age of 35 weeks evaluated for retinopathy of prematurity. On examination, the infant showed bilateral advanced optic nerve cupping head with cup disc ratio of 0.9. With a suspicion of optic nerve hypoplasia, the infant was referred to the treating pediatrician for reevaluation and to rule out systemic disorders, cranial hemorrhage, and periventricular leukomalacia. Cranial ultrasound ruled out periventricular leukomalacia. At 39 weeks of gestational age, the infant was re-admitted with the neonatologist for respiratory distress, protuberant abdomen, and tongue fasciculation. Systemic workup revealed hypothyroidism with T3 levels of 0.76 ng/ml, T4 7.1 μg/dl, and thyroid stimulating hormone 0.5 μIU/ml. Congenital hypothyroidism has a known predisposition (43%) for developing optic nerve hypoplasia. We present a unique case of congenital hypothyroidism with optic nerve head cupping presenting as a plausible variant of optic nerve hypoplasia.
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Primary tubes in siblings of a South Indian family with total aniridia and glaucoma p. 103
Vijayalakshmi A Senthilkumar, Thandra Sai Shreya, Sharmila Rajendrababu, R Krishnadas
DOI:10.4103/ijo.IJO_867_21  
Aniridia is an uncommon hereditary bilateral panocular disorder affecting not only the iris but also the cornea, anterior chamber angle, lens, retina, and optic nerve with associated life-threatening conditions. Glaucoma is associated with aniridia in around 50% of the cases and usually develops in the first two decades of life. The treatment of glaucoma is challenging and often needs surgical intervention to achieve adequate intraocular pressure (IOP) control in cases refractory to medical treatment. Here, we report the familial nature of aniridia with secondary glaucoma and discuss the challenges in the management with a comprehensive review of the literature. The elder one, a 16-year-old girl presented with absolute glaucoma in the right eye and high IOP with advanced disk damage in the left eye for which she underwent a non-valved glaucoma drainage implantation. The younger one, a 12-year-old boy presented with a high IOP of more than 40 mmHg in both eyes (OU) for which he underwent sequential glaucoma drainage devices (GDD) implantation in OU. The intermediate-term outcomes in both of them showed a well-placed Aurolab aqueous drainage implant (AADI) tube with adequately controlled IOP.
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A new ophthalmological application of Nd:YAG laser: Reopening of the occluded central hole of Visian implantable collamer lens in the treatment of acute angle - closure glaucoma p. 106
Efekan Coskunseven, Belma Kayhan
DOI:10.4103/ijo.IJO_1441_21  
This report presents a new application of Nd:YAG laser for reopening the occluded central hole of Visian implantable collamer lens (EVO Visian ICL). A 23-year-old female underwent EVO Visian ICL implantation in the left eye. After 6 hours postoperatively, the patient presented with an increase in pain and intraocular pressure (IOP) despite antiglaucomatous medication. Acute angle-closure glaucoma with anterior chamber shallowing and deposition of fibrinoid material within the central hole of ICL was diagnosed. Fibrin deposits blocking the central hole were disrupted with Nd:YAG laser. With restoration of aqueous flow, IOP decreased to normal levels without any additional medication.
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Glaucoma management dilemma in a patient with Allgrove syndrome p. 109
Maninee Suman, Sathya T Ravilla, Keerthi , S Ashok Vardhan
DOI:10.4103/ijo.IJO_3680_20  
AAA syndrome or Allgrove syndrome is a rare multisystem disorder. The ocular manifestations reported in the literature include alacrima, keratoconjunctivitis sicca, corneal melts, lacrimal gland atrophy, pupillary abnormalities, accommodative dysregulation, amblyopia, and optic atrophy. We report here the occurrence of glaucoma in a patient with AAA syndrome, which has not been reported earlier, and also discuss the multiple difficulties in managing glaucoma in the presence of the underlying ocular and systemic conditions.
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Bilateral cyclodialysis cleft following fire cracker injury managed by combined exocyclopexy and silicone oil endotamponade - An interesting case report p. 112
Vijayalakshmi A Senthilkumar, Thandra S Shreya, Naresh B Kannan, Sharmila Rajendrababu, Chitaranjan Mishra, Dhipak Arthur
DOI:10.4103/ijo.IJO_1110_21  
Cyclodialysis creates a direct communication between the anterior chamber and suprachoroidal space leading to ocular hypotony probably caused by an increased uveoscleral outflow and hyposecretion of the ciliary body. The sequelae of cyclodialysis include chronic ocular hypotony, anterior chamber shallowing, cataract, choroidal effusions, retinal and choroidal folds, hypotonus maculopathy, and ultimately loss of vision. Cyclodialysis clefts are a relatively rare condition usually caused by severe ocular trauma, and hence, the surgical repair techniques in the literature are limited. We present a case of post-traumatic bilateral cyclodialysis cleft with a successful outcome following combined exocyclopexy and silicone oil endotamponade.
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Cosmetic iris prosthesis and severe visual loss p. 116
Ashutosh Dayal, Parivadhini Annadurai, Mona Khurana, Lingam Vijaya
DOI:10.4103/ijo.IJO_1344_21  
We report a case of a 39-year-old male who presented with bilateral severe diminution of vision, raised intraocular pressures despite maximal therapy, and corneal edema with endothelial decompensation six years following cosmetic iris prosthesis implantation. Right eye had progressed to glaucomatous optic atrophy, while the left eye showed advanced glaucomatous damage. The patient underwent iris implant removal with Ahmed glaucoma valve implantation in the left eye to achieve adequate control of the intraocular pressures. This case report highlights the dangers and risk of serious vision-threatening complications associated with these implants. Patients must be made aware of the possible complications, and their use should be discouraged in normal eyes.
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COMMENTARY Top

Commentary: Cosmetic iris implants - A clinical and ethical dilemma in ophthalmology p. 118
Samendra Karkhur, Priti Singh, Darshana Koshti, Bhavana Sharma
DOI:10.4103/ijo.IJO_2528_21  
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CASE REPORTS Top

A perplexing case of bilateral Vogt-Koyanagi-Harada syndrome p. 120
Rehna Rasheed, Kannisha Shah, Gopal S Pillai, CB Mithun, Natasha Radhakrishnan, Pooja Kandula
DOI:10.4103/ijo.IJO_1522_21  
Vogt–Koyanagi–Harada (VKH) disease presents as a bilateral granulomatous panuveitis with systemic manifestations. We report a 60-year-old female who presented with features suggestive of VKH and was treated with steroids and immunosuppression. Although thorough investigation ruled out tuberculosis (TB) at presentation, she developed neurotuberculosis 2 months after initiating treatment. The primary diagnosis of VKH was hence revisited. Since both VKH and TB uveitis can present as chronic granulomatous panuveitis, it is important to differentiate between them. Once started on immunosuppression, patients should be kept on close follow-up for early detection of development of infections or reactivation of latent TB.
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Neurosyphilis rebound in youth: A case report p. 123
Facundo Urbinati, Francisco Zamorano-Martín, Patricia Gutiérrez-Castaño, María García-Lorente, Iván Pérez de Pedro, Margarita Jódar-Márquez
DOI:10.4103/ijo.IJO_1317_21  
Syphilis is a systemic sexually transmitted disease that can be presented with very varied ocular symptoms. We present the case of a 27-year-old patient with ocular inflammation and bilateral papilledema who was finally diagnosed as neurosyphilis. We want to highlight the importance of taking this diagnosis into account in the event of any ocular inflammation of unknown cause.
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Inadvertent ocular perforation with hypodermic needle during saline irrigation p. 126
Karan Kumarswamy, Arjun Velayudhan Nair
DOI:10.4103/ijo.IJO_1641_21  
We present a case of globe perforation with hypodermic needle during saline irrigation. A 24-year-old presented with sudden onset defective vision during saline wash in his left eye. Patient on examination had hypotony and mild lid edema. Scleral wound was only apparent after staining; rest of the anterior segment was within normal limits. Posterior segment showed vitreous hemorrhage with retinal tear nasal to disc and adjacent commotio retinae. Patient was given tapering topical antibiotic steroid eye drops and kept under close observation. On his final follow-up 6 weeks after the initial injury, vitreous hemorrhage was resolving; the retinal tear had scarred with a choroidal rupture. Hypodermic-needle injuries are often complicated by the development of endophthalmitis. Our patient did not develop endophthalmitis, possibly due to the needle being sterile. He regained good vision and was saved from devastating consequences as the needle had missed the disc by a few millimeters.
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Inadvertent globe penetration due to self-attempted eyeball tattooing p. 128
Bagavath Shalini, Arjun Velayudhan Nair, Mangala Periasamy, Karan Kumarswamy, Palmeera N J Dsouza
DOI:10.4103/ijo.IJO_1402_21  
Eyeball tattooing or scleral tattooing is a new form of body modification. A 27-year-old Indian male presented with defective vision in the left eye a day after self-attempted eyeball tattooing. The inadvertent penetration and ink injection led to the staining of the cornea, suspension of ink in the aqueous. The lens showed capsular staining and subsequent progression to the cataract. The posterior segment showed staining of vitreous with the red dye, retinal thickening at the macula. The optical coherence tomography showed inner retinal hyperreflectivity with retinal thickening. As these “Do it yourself” maneuvers are becoming trends influenced by social media, we report a case of self-attempted eyeball tattooing and its complications.
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Fine-needle aspiration biopsy along with vitrectomy in the diagnosis of primary intraocular lymphoma - An enhanced diagnostic approach p. 131
Vandana A Iyer, Pukhraj Rishi, Jyotirmay Biswas, Ekta Rishi
DOI:10.4103/ijo.IJO_932_21  
A 70-year-old lady presented with left eye subretinal mass, diagnosed as posterior uveitis previously. Fine-needle aspiration biopsy via transvitreal route proved to be a minimally invasive and effective diagnostic modality for sample collection with minimal complications and of high diagnostic potential.
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“Inert” cotton fibers – Gossypiboma in silicone oil-filled eyes: A case series p. 134
Rushik Patel, Kushal Delhiwala, Bakulesh Khamar
DOI:10.4103/ijo.IJO_902_21  
Retained cotton fibers (gossypiboma) are known following anterior segment surgeries. There is only one case report of pre retinal gossypiboma (retained cotton fibers; RCF) following pars plana vitrectomy (PPV) with silicone oil tamponade (SOI) for proliferative diabetic retinopathy. It was associated with dense exudation surrounding it. We report three cases (two retrolental and one preretinal) of inert RCF (gossypiboma), following PPV-SOI for rhegmatogenous retinal detachment.
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Analysis of microstructural changes in an X-linked juvenile retinoschisis patient harboring RS1 G668A mutation by en-face optical coherence tomography imaging p. 136
Chitaranjan Mishra, Roopam Duvesh, Susmita Chowdhury, Rupa Anjanamurthy, Naresh Babu Kannan, Kim Ramasamy, Periasamy Sundaresan
DOI:10.4103/ijo.IJO_1283_21  
Juvenile X-linked retinoschisis (JXLR) is an X-linked recessive retinal dystrophy caused by retinoschisin (RS1) gene mutations. The current study reports and describes the cumulative findings of en-face OCT for a 7-year-old JXLR patient harboring a hemizygous pathogenic RS1 mutation (c.G668A; p.Cys223Tyr), where residue 223 is vital for cellular adhesion. Fundoscopy showed cart-wheel appearance at macula. Further, en-face OCT revealed characteristic schitic lesions in the ganglion cell layer, inner plexiform layer, inner nuclear layer, and outer plexiform layer. Our report adds to the Indian RS1 mutation spectrum and casts insights into the schisis microstructure using en-face imaging.
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Macular hole associated retinal detachment with focal choroidal excavation in myelinated nerve fibre syndrome p. 140
Neha Goel
DOI:10.4103/ijo.IJO_702_21  
The Straatsma syndrome (STAS) consists of unilateral myelinated nerve fibers (MNF), high myopia, and amblyopia. This report describes a patient with total cataract and retinal detachment (RD) who underwent phacoemulsification with pars plana vitrectomy. Intraoperatively, a full-thickness macular hole (FTMH) and MNF were found. The internal limiting membrane peeling was carried out with a silicone oil tamponade. Postoperatively, the reduction in the extent of MNF was noted. The spectral-domain optical coherence tomography revealed type 1 closure of the FTMH with a focal choroidal excavation (FCE). To the best of our knowledge, this myriad of findings has not been reported in the STAS or in association with MNF.
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Multimodal imaging in a case of acute idiopathic maculopathy p. 142
Akshat Kothari, Manpreet Chugh, Kumar Saurabh, Rupak Roy
DOI:10.4103/ijo.IJO_2001_21  
Bacillary layer detachment (BLD) is an optical coherence tomography (OCT) finding depicting split within the inner segment of myoids. We present a case of acute idiopathic maculopathy in a young female who presented with sudden painless diminution of vision in the left eye without a prodromal viral illness. On the OCT splitting of ellipsoid and myoid zone of rod, inner segments were noted suggestive of BLD, whereas optical coherence tomography angiography showed flow void areas on choriocapillaris slab. BLD in acute idiopathic maculopathy occurs due to poor choroidal perfusion leading to stress and splitting of bacillary layer. However, once choroidal perfusion improves, BLD resolves and hence no treatment is required.
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Management of macular hole secondary to presumed chronic solar phototoxicity from sun-gazing p. 146
Dhananjay Shukla
DOI:10.4103/ijo.IJO_423_21  
A 70-year-old man presented with gradual visual decline in both eyes; the vision had become worse in the right eye recently. On fundus examination, the right eye was found to have a large macular hole; the left eye was unremarkable. The best-corrected visual acuity was 20/100 in the right eye and 20/63 in the left eye. Optical coherence tomography confirmed the macular hole in the right eye and revealed an unsuspected foveal atrophy with interruption of outer retinal bands in the left eye, suggestive of macular phototoxicity. Based on this evaluation, leading questions were asked, whereupon he admitted to a long-time morning ritual of sun-gazing. After vitrectomy with internal limiting membrane peeling in the right eye, the macular hole closed, and the best-corrected visual acuity improved to 20/40. A full-thickness macular hole presumably secondary to sun-gazing was successfully treated with significant visual improvement.
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Lamellar hole-associated epiretinal proliferation closing an ectopic macular hole p. 149
Manoj Soman, Asmita Indurkar, Ashwin Mohan, Unnikrishnan Nair
DOI:10.4103/ijo.IJO_3468_20  
The aim of this study was to describe a case where lamellar hole–associated epiretinal proliferation developed into an ectopic macular hole and eventually led to the closure of the defect. This is a retrospective case review of a 61-year-old patient with documented spectral-domain optical coherence tomography (Spectralis, Heidelberg, Germany) follow-up of 3 years, which shows the presence of epiretinal proliferation closing an iatrogenic ectopic lamellar hole developed after a failed macular hole surgery.
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Non-neoplastic autoimmune retinopathy – A rare disorder in unusual age group p. 152
Srinivas Gowda, Mansur A Khan, Anjali Maheshwari, S Mohan
DOI:10.4103/ijo.IJO_3573_20  
Nonparaneoplastic autoimmune retinopathy (npAIR) is a subtype in the spectrum of autoimmune retinopathy (AIR) disorders. Diagnosis is a challenging task due to its rare incidence, lack of epidemiological data, no accepted standardized diagnostic criteria, nonavailability of testing facilities, and economic factors. As per available data, npAIR is more common (60%) in females above 50 years, but in our case, it presented in a relatively young lady of 32 years. We report a rare disorder with diagnostic challenges presenting in an unusual age group.
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Combined branch retinal vein and branch retinal artery occlusion in atrial septal defect p. 155
Zhiqin Zuo, Zhihua Shen, Xiaoqing Zhou
DOI:10.4103/ijo.IJO_476_21  
A 30-year-old male patient presented with branch retinal artery occlusion and branch retinal vein occlusion in his right eye. The patient had a history of atrial septal defect (ASD). A cardiology consultation was sought, and the patient was admitted for closure of moderate-grade ASD. Subsequently, his retinal hemorrhage showed improvement. Patients with branch retinal artery occlusion and branch retinal vein occlusion affecting the same retinal quadrant should be examined for heart issues to rule out an atrial septal defect.
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Three branches involvement in retinal vein occlusion p. 159
Fatemeh Abdi, Parya Abdolalizadeh, Amin Zand, Arzhang Gordiz, Mahsa Sardarinia, Tahmineh Motevasseli
DOI:10.4103/ijo.IJO_1457_21  
Two patients presented with sudden painless unilateral blurry vision. The first patient was a 57-year-old female, and the second was a 71-year-old male. The medical history of the first patient was significant for diabetes mellitus and systemic hypertension. Funduscopy of both revealed an unusual form of RVO, occlusion of three main veins of the retina, with concomitant intraretinal hemorrhages, and macular edema. An extensive ischemic retina was found in the fluorescein angiography of the second patient. Retinal vein occlusion can present as three main veins occlusion in some patients due to rare anatomic variation.
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Bilateral Mycobacterium abscessus chronic endophthalmitis presenting as retinitis in a human immunodeficiency virus positive young male – A case report p. 162
Keerti Mukesh, Dhwani Shah, Krishna R Murthy, Kalpana Babu
DOI:10.4103/ijo.IJO_1826_21  
We report an interesting case of chronic endophthalmitis presenting as bilateral retinitis with chronic granulomatous inflammation due to Mycobacterium abscessus in a 17-year-old human immunodeficiency virus (HIV)-positive young male. The diagnosis was made on the basis of cytopathology, culture, and genomic sequencing on the vitreous biopsy. The treatment included antitubercular therapy, intravenous meropenem, and intravitreal amikacin injections. At the end of 6 months, the retinitis resolved well and best-corrected visual acuity (BCVA) was 6/9 both eyes (OU). Though endophthalmitis due to M. abscessus has been described in the literature, bilateral retinitis is rare and is being described in this case report.
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A case of atypical peripheral intraocular cysticercosis: Diagnosed by ultra-wide fundus fluorescein angiography combined with intraocular fluid detection p. 165
Xinlei Hao, Man Yuan, Liugui Chen, Wei Jin, Anhuai Yang
DOI:10.4103/ijo.IJO_1295_21  
Intraocular cysticercosis results from the larval of the pork tapeworm, Taenia solium. Diagnosis has traditionally been based on fundus dilation examination, B ultrasonography, and optical coherence tomography. We describe herein a rare case of atypical peripheral intraocular cysticercosis in the calcification stage, which was diagnosed with the help of ultrawide fundus fluorescein angiography and intraocular fluid detection. A relatively conservative surgical plan was performed without removing cyst.
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Bilateral multifocal congenital simple hamartoma of the retinal pigment epithelium p. 168
Roshni Mohan, Divya Yadav, Sourabh Prasad Behera
DOI:10.4103/ijo.IJO_1858_21  
Congenital simple hamartomas of the RPE are benign, solitary, stationary, well-demarcated lesions seen in the retina. They are usually characterized by their pigmentation, superficial or deep involvement of the retinal layers and abrupt margins, and convex tenting of the surface. They have been recently studied extensively using SD-OCT and OCT-angiography. We have described a case of bilateral multiple congenital simple hamartomas of the RPE and their imaging characteristics.
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A rare case of bilateral retinoblastoma metastasizing into the forearm p. 170
Manoj Soman, Sameer Iqbal, Jayasree Katoor, Nitya Puthiyedath, Jay U Sheth, Unnikrishnan Nair
DOI:10.4103/ijo.IJO_658_21  
We present a case of an 8-year-old boy who had undergone chemotherapy with transpupillary thermotherapy for bilateral retinoblastoma (RB) at the age of 6 months. The patient had left forearm pain at the present visit. Bilateral ocular examination did not reveal any signs of RB reactivation. However, bone scan with technetium 99m-methyl diphosphonate (99mTc–MDP) and magnetic resonance imaging (MRI) showed the presence of metastasis in the proximal end of the ulnar bone, which was confirmed on bone marrow biopsy. Based on PCR study and molecular analysis, Ewing's sarcoma was ruled out and the patient was confirmed to have metastatic RB. Subsequently, he underwent chemotherapy along with wide excision of left proximal ulna + extracorporeal radiation therapy (ECRT) + plate reconstruction. At 15-month follow-up, the patient was stable with absence of recurrence of RB. This case highlights the need for long-term follow-up of patients with RB and the need for timely detection and management of metastasis.
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Disappearance of choroidal nevi pigmentation following nivolumab treatment p. 175
Kleopas-Gerasimos Chatzicharalampous, Konstantinos Barakos, Dimitrios Papantoniou, Antheia Kissopoulou
DOI:10.4103/ijo.IJO_724_21  
A 64-year-old caucasian male, with a left eye choroidal nevus, was diagnosed with a nodular cutaneous melanoma of the head, which was radically excised. He experienced a metastatic relapse in the lungs, which was treated for 2 years with nivolumab, an immune checkpoint inhibitor of the programmed cell death 1 (PD-1) receptor. The patient has had annual follow-ups of his choroidal nevus. At the control 2 years follow-up after the start of nivolumab, the nevus unexpectedly disappeared. To our knowledge, this is the second reported case in the literature of choroidal nevus disappearance associated with PD-1 treatment and the first-ever reported case in Sweden.
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A rare presentation of vasculotoxic and neurotoxic ophthalmic manifestations of snakebite p. 177
Shafeeqa G Khader, Harish Sivagnanam
DOI:10.4103/ijo.IJO_630_21  
Every year, a substantial number of snakebite cases are reported worldwide, more so from tropical countries. Although the fatality rate is quite low, it is nonetheless considered a medical emergency in view of the possible hematological, neurological, cardiac, and renal complications. The snake venom injected into the body contains a multitude of compounds that are responsible for their multisystem involvement. However, ocular complications following a snakebite are seldom reported in the literature. Our case report deals with the occurrence of transient central retinal artery occlusion and toxic neuritis soon after a snakebite.
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Ivabradine-induced photosensitivity and phosphenes: Case report p. 179
Nikunj K Bhatt, Aniruddha Phadke, Sourabh D Patwardhan, Nidhi S Patwardhan
DOI:10.4103/ijo.IJO_1606_21  
Ivabradine is a novel antianginal drug that acts by reducing the heart rate of the patient by acting on hyperpolarization-activated cyclic nucleotide–gated ion channels. Here, we report a case of a 39-year-old female who was taking ivabradine for the prevention of heart failure due to dilated cardiomyopathy and was noticing an increased photosensitivity and phosphenes after 1 year of treatment. The side effects of the medication were serious enough to affect the quality of the life of the patient. The patient became asymptomatic after stopping the medication.
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The optic disc neovascularization paradox p. 181
Daraius Shroff, Sandeep Kumar, Priyanka Gupta, Charu Gupta
DOI:10.4103/ijo.IJO_1270_21  
A 65-year-old man with recurrent vitreous hemorrhage, after vitrectomy for proliferative diabetic retinopathy (PDR), was referred to us for further management. He was treated with an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection. Six weeks after the injection, the hemorrhage cleared. At this stage, multimodal imaging including fundus fluorescein angiography (FFA) and swept-source optical coherence tomography angiography (SS-OCTA) was done to determine the source of the vitreous hemorrhage. Surprisingly, while there was no leakage on FFA, the neovascularization (NV) was beautifully captured on SS-OCTA.
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Progressive optic neuropathy secondary to JAK2 mutation-positive myeloproliferative neoplasm p. 183
Swetha Komma, Selvakumar Ambika, Veena Olma Noronha, Deepak Arjundas
DOI:10.4103/ijo.IJO_768_21  
We describe a 25-year-old male presenting with chronic papilledema due to cerebral venous sinus thrombosis (CVST) and was found to have a myeloproliferative disorder with JAK2 mutation. All measures to salvage vision were unfruitful from transverse sinus stenting, thecoperitoneal shunt to optic nerve sheath fenestration. This case illustrates the importance of screening for JAK2 mutation in patients with CVST and abnormal blood counts.
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COMMENTARY Top

Commentary: Progressive optic neuropathy secondary to JAK 2 mutation positive myeloproliferative neoplasm p. 186
Jawahar L Goyal, Shalini Singh
DOI:10.4103/ijo.IJO_2367_21  
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CASE REPORTS Top

Inadvertent antihypertensive double dosing with concurrent Tadalafil use - A double whammy on the optic nerve! p. 188
Samuel A Minaker, Arun N E Sundaram
DOI:10.4103/ijo.IJO_760_21  
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common acute unilateral optic neuropathy in adults over the age of 50. Nocturnal hypotension has been hypothesized as the potential cause of NAION. Phosphodiesterase type 5 inhibitor (PDE5I) has been a known cause of NAION. We report an interesting case of NAION that was triggered by inadvertent double dosing of antihypertensive medication and concurrent use of a PDE5I.
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Papilledema associated unilateral juxtafoveal choroidal neovascularization in a patient of intracranial chondrosarcoma p. 190
Ramanuj Samanta, Gitanjli Sood, Devesh Kumawat, Neeraj Saraswat, Ajai Agrawal, Arnab Garai
DOI:10.4103/ijo.IJO_860_21  
Skull base chondrosarcomas are rare intracranial neoplasms. Although peripapillary choroidal neovascularization (CNV) has infrequently been noted in papilledema secondary to other pathologies, juxtafoveal CNV following intracranial chondrosarcomas have never been reported earlier. We report a case of a 50-year-old lady with operated intracranial chondrosarcoma who presented with progressive diminution of vision in the right eye. Detailed ophthalmic evaluation and ancillary investigations confirmed the diagnosis of papilledema associated juxtafoveal CNV in the right eye, and she received two intravitreal bevacizumab injections with guarded outcome. We have also described the probable differentials of the current case and highlighted the need for a high index of suspicion among neurologists as well as ophthalmologists for this rare but vision-threatening complication.
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Compression optic and oculomotor neuropathy caused by misdiagnosed sphenoid sinus mucocele p. 193
Jie Zhang, De Lan, Yiguang Hong, Xuemei Wei
DOI:10.4103/ijo.IJO_573_21  
We herein describe the case of a 60-year-old man who complained of headache and inability to open his left eye. Four years ago, he was admitted to a hospital because of the loss of vision in his left eye. Without adequate radiological examination, he was misdiagnosed with ischemic optical neuropathy and treated with glucocorticoid and neurotrophic drugs, but his vision did not improve. After sphenoidostomy under local anesthesia in time, his headache disappeared and his left eye could be opened immediately. We herein report this case to emphasize the relationship between the optic and oculomotor neuropathy and paranasal sinus disease.
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Bilateral internuclear ophthalmoplegia developing as a manifestation of dengue fever and treatment by modified Nishida procedure: A case report and review of the literature p. 195
Neelam Pawar, Meenakshi Ravindran, S Padmavathy, Sabyasachi Chakrabarty, Anurag Gandhi
DOI:10.4103/ijo.IJO_1669_21  
Typical causes of internuclear ophthalmoplegia (INO) include demyelinating conditions, with inflammation, infection, and trauma being less common causes. Diplopia associated with INO severely impacts the patient's quality of life. Orthoptic treatment usually fails; therefore, appropriate surgical treatment should be considered. We report the unique case of a 25-year man with bilateral INO developing as a manifestation of dengue fever-related encephalitis and its successful treatment by modified Nishida procedure.
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Cerebral visual impairment secondary to chikungunya encephalitis – A case report p. 198
Sandra C Ganesh, Cinnam Shailaja, Vanathi Narayanasamy, G Dayananda Sagar, Amrutha Sindhu, Shilpa G Rao, Robert House, Linda Lawrence
DOI:10.4103/ijo.IJO_754_21  
Cerebral visual impairment is a significant cause of visual impairment in children in developing countries. It has varied etiologies. In this report, we describe the evaluation and management of a 1-year-old child with visual impairment due to neonatal chikungunya encephalitis.
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Modified split tendon nasal transposition of lateral rectus muscle in third nerve palsy p. 201
Sowmya Raveendra Murthy
DOI:10.4103/ijo.IJO_1790_21  
Complete third nerve palsy presents with large-angle exotropia and hypotropia in varying degrees, posing a challenge for surgical correction. Nasal transposition of lateral rectus, either full tendon or split tendon or in its adjustable and enhanced modifications, have shown to correct exotropia in third nerve palsy. We present a further modification of split tendon nasal transposition of lateral rectus to correct the large vertical deviation in complete third nerve palsy.
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A case of adult-onset cyclic esotropia combined with hypotropia p. 204
Yueping Li, Wei Zhang
DOI:10.4103/ijo.IJO_877_21  
A 39-year-old woman presented with 48 hours periodic esotropia and hypotropia after vitreoretinal surgery for retinal detachment and then loss of vision in the left eye. The ocular motility revealed the limitation of supraduction and abduction of the left eye on strabismic days and full duction on good days. After strabismic surgery only for correcting esotropia, the patient changed to hypotropia on the previous strabismic days and exotropia on the previous good days alternatively in a 48-hour period. Its pathogenesis is still unknown. We supposed the patient had similar neurological mechanisms as ocular neuromyotonia and secondary cyclic oculomotor palsy.
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Aftermath in Traboulsi syndrome: A case report p. 207
Venugopal Anitha, Ramakrishnan Rangappa, Meenakshi Ravindran, Mohideen A Kader
DOI:10.4103/ijo.IJO_647_21  
To report a long-term (15 years) follow-up of a patient with a rare congenital ophthalmological disorder known as Traboulsi syndrome. It is characterized by ectopia lentis, congenital blebs, and facial dysmorphism. A 25-year-old female was identified with Traboulsi syndrome based on the typical facial, ocular features, and literature evidence. Serial anterior segment optical coherence tomography (ASOCT) and ultrasound biomicroscopy (UBM) were done to document the anterior segment. This case report discusses the clinical aspects of the syndrome such as its long-term sequelae, complications, and management outcomes.
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Clinical and genetic aspects of a child with monilethrix and visual rehabilitation p. 211
Monisha Mohan, Shashikant Shetty, Vijayalakshmi Perumalsamy, C Prakash, Periasamy Sundaresan
DOI:10.4103/ijo.IJO_542_21  
Monilethrix is a rare genodermatosis, presented to us with predominant ocular manifestations. The affected proband was typically characterized by severe photophobia, defective vision, and hypotrichosis with brittle and stubby hair. Here, we report a rare case of a 9-year-old male child who has been affected by monilethrix with severe ocular complications including blepharitis, madarosis, and corneal pannus with lamellar cataract. The child has undergone cataract surgery and visual rehabilitation was provided with low-vision devices.
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Trichilemmal cyst of eyelid: A case report and review of literature p. 214
Kavya M Bejjanki, Dilip K Mishra, Anasua G Kapoor
DOI:10.4103/ijo.IJO_783_21  
Trichilemmal cyst is a rare benign tumor of the skin, with distinct keratinisation and a predilection for the scalp. In the eyelid, these benign hair follicle lesions clinically mimic chalazion and recurrences occur with incomplete removal of cyst wall. To the best of authors' knowledge, only 7 cases of eyelid trichilemmal cysts have been described in English literature. Herein, we report a case of a 56-year-old lady with a nodule on the upper eyelid, with typical clinical features and characteristic histopathological findings aiding the diagnosis of trichilemmal cyst. Complete resection was performed to prevent recurrence. The authors also reviewed the cases of eyelid trichilemmal cyst reported in literature to highlight the demography, clinical features, and management of this rare eyelid tumor.
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A rare presentation of neonatal retrobulbar orbital abscess secondary to acute dacryocystitis p. 217
Harshdeep S Gabba, Gaurav Garg, Rukmendra P S Warkade, Abhishek Agarwal, Ayush Mehta, Rajul Agarwal
DOI:10.4103/ijo.IJO_1210_21  
Clinical presentation of a neonate with acute dacryocystitis may vary considerably. A retrobulbar orbital abscess secondary to pediatric acute dacryocystitis is extremely rare. Currently, the treatment of choice is a surgical intervention in view of the life-threatening condition. Our short report shows a 28-day-old neonate with bilateral pediatric acute dacryocystitis, preseptal cellulitis, and retrobulbar orbital abscess in the right eye. Radiological examination of the orbit showed bilateral lacrimal sac mucocele and intra-orbital large abscess in the right eye. A trial of medical management in the form of microbial culture and sensitivity-proven intravenous antibiotics were given because of parents' hesitancy toward surgical intervention. The neonate had a successful anatomic and functional outcome.
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A case of tuberculous dacryoadenitis with review of literature p. 220
Sumeet Lahane, Sheetal Munde, Ramanna Chalvadi, Dhananjay Prajapati, Ragini Parekh, Tatyarao Lahane
DOI:10.4103/ijo.IJO_919_21  
Lacrimal gland inflammation is commonly due to viral infection, autoimmune, and idiopathic inflammatory disease. Orbital and adnexal tuberculosis (OTB) is a rare entity even in the TB endemic country of India. TB dacryoadenitis is one of the presentations in the OTB spectrum, with less than 25 cases in the literature. We report the case of a 14-year-old female primarily presented with unilateral dacryoadenitis and cold abscess at the lower lumbar region. Biopsy of lacrimal gland confirmed on histopathology as tuberculosis. Systemic investigation revealed pulmonary and extrapulmonary TB. She was treated with systemic category I anti-tubercular treatment resulting in complete regression of disease.
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Mirror, mirror in the orbit: Reflections from a singular orbital foreign body p. 223
Kamalpreet Likhari
DOI:10.4103/ijo.IJO_2530_20  
A 23-year-old lady was working at her sewing machine when she was struck in the left eye by something, probably a piece from a hand mirror, which her children were playing with. She presented with a hard object palpable just above and behind her left upper lid. CT scan revealed a large foreign body, which was subsequently surgically removed. The need for extreme caution as well as the surgical plan and procedure for removing such brittle and hazardous objects from the orbit are discussed in this report.
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Severe effects of accidental orbital trauma by a less venomous fish Siganus rivulatus p. 225
Hatice D Ilhan, Tülay Cagatay, Yusuf Ayaz, Mustafa Ünal
DOI:10.4103/ijo.IJO_3372_20  
A 51-year-old male was injured by the fish, Siganus rivulatus, while swimming in the Mediterranean waters of Antalya, Turkey. The injury was caused when a spine of the fish's dorsal fin penetrated in the left lower eyelid superior to the inferior orbital rim, causing his left eye to experience sudden vision loss, total medial gaze restriction, and pupil dilation. A foreign body detected on orbital computed tomography was extracted with orbitotomy. The patient received methylprednisolone and antibiotic for 7 days, then medication was tapered. Final visual acuity reached 20/32 in the left eye, but pupil dilation did not improve. To the best of our knowledge, this is the first reported case of orbital trauma secondary to a Siganus rivulatus strike. In this report, we describe the treatment that the patient underwent for this injury and his subsequent recovery.
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Lateral and superior orbital wall autodecompression in a patient with thyroid eye disease p. 227
Behzad Khademi, Elham Sadeghi
DOI:10.4103/ijo.IJO_3540_20  
Orbital autodecompression was reported previously in thyroid eye disease (TED). The reports principally focused on spontaneous orbital wall fractures or medial and inferior orbital wall expansion. This report introduces a 66-year-old man, a known case of TED with distinctive signs of lateral and superior orbital wall autodecompression on preoperative imaging.
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A rare case of bilateral superior ophthalmic vein thrombosis presenting simultaneously with central retinal vein occlusion and cerebral venous sinus thrombosis p. 229
Pradeep K Panigrahi, Swati Samant, Srikant K Dhar
DOI:10.4103/ijo.IJO_1780_21  
A 57-year-old female presented with redness in both eyes and headache for 1-month duration. The clinical examination showed bilateral episcleral vessels congestion and central retinal vein occlusion. Optical coherence tomography scans were normal in both eyes. Radiological examination revealed bilateral superior ophthalmic vein thrombosis and venous sinus thrombosis involving the left terminal sigmoid sinus. The serum homocysteine level was elevated. The patient was treated with anticoagulants and vitamin B12 supplements. Three months following the initial presentation, there was a reduction in the episcleral vessel congestion and retinal hemorrhages. The magnetic resonance venography at the end of 3 months showed a partially recanalized left jugular bulb with chronic thrombosis of the left terminal sigmoid sinus.
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A rare case of nontraumatic bilateral carotid cavernous fistula Barrow type D – A case report p. 232
Labdhi Shah, Maheshkumar Shanmugam, Harshit Shah, Akkayasamy Kowsalya, Jayasri K Narayanamoorthy
DOI:10.4103/ijo.IJO_1562_21  
Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the normal carotid arterial system. We are presenting a very rare case of spontaneous nontraumatic bilateral Barrow type D CCF. A 41-year-old patient presented to our tertiary eye care center with a history of long-standing bilateral congested eyes. On imaging, the patient was diagnosed with spontaneous bilateral Barrow type D CCF. The patient improved significantly by treatment with carotid decompression exercises. It is recommended to consider the diagnosis of bilateral CCFs as a differential diagnosis in patients with long-standing history of congested eyes nonresponsive to conventional topical treatment.
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Orbital cellulitis complicated by central retinal artery occlusion with sparing of cilioretinal artery: A case report and review p. 235
Gaurav Garg, Narendra Patidar, Vinit Dahiya
DOI:10.4103/ijo.IJO_740_21  
Orbital cellulitis (OC) with an incidence of 0.1 per 100,000 is a sight and life-threatening emergency with a dreadful potential to cause orbital apex syndrome and central retinal artery occlusion (CRAO). In the era of modern antibiotics, visual loss in the case of isolated OC has significantly reduced. But in the event of the added complication of orbital apex syndrome and CRAO, the visual prognosis decreases markedly. A 24-year-old Asian Indian male presented with left eye staphylococcal OC complicated by orbital apex syndrome and CRAO with cilioretinal artery sparing following nasal folliculitis and upper lid preseptal cellulitis. He was promptly treated with culture-sensitive antibiotics, lateral canthotomy, and cantholysis. On follow-up, his vision improved from hand movements to 20/40 with the resolution of inflammation, proptosis, and ophthalmoplegia. To conclude, promptness in diagnosis, treatment, and presence of foveal-sparing CRAO may improve the prognosis of OC.
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An aggressive orbital mass in a young patient p. 240
Sonia Phulke, Chai Teck CHOO, Anita Chan
DOI:10.4103/ijo.IJO_50_21  
Undifferentiated pleomorphic sarcoma (UPS), earlier known as malignant fibrous histiocytoma, is a rare entity in the orbit. Here, we report a case of UPS in a 34-year male, who presented as rapidly progressive unilateral proptosis with no history of any other systemic diseases. The tumor was removed surgically, followed by adjuvant chemotherapy and radiotherapy. After one year follow-up, the patient had not shown any orbital recurrence but had lung and gastrointestinal metastasis. UPS is rare, but because of its aggressive behavior, it should be included in the differential diagnosis of orbital tumors.
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Early ipsilateral orbital metastasis of choroidal melanoma without evidence of hepatic metastasis: Case report p. 243
Ever Ernesto Caso Rodriguez, Jordan Isenberg, Aline Sutil, Melina Morales, Renato Sant'ana, Rubens Belfort
DOI:10.4103/ijo.IJO_657_21  
Uveal melanoma is the most common primary intraocular cancer in adults. The liver is the most common site of metastasis. Ipsilateral orbital metastasis without radiological and clinical evidence of liver metastasis is extremely rare. We present a 77-year-old patient with choroidal melanoma in his right eye who was treated with enucleation and 9 months later presented ipsilateral orbital metastasis without radiological and clinical evidence of metastatic liver lesions. After the diagnosis of orbital metastasis, he underwent exenteration and radiotherapy and the patient developed lung, liver, and subcutaneous metastases in the following months. Early detection of uveal melanoma and especially when the tumor is small, can save lives since no treatment has proven to significantly alter mortality when there is metastatic disease.
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Use of volumetric analysis in the management of recurrent dermis fat graft hypertrophy p. 246
Shebin Salim, Olma V Noronha, Bipasha Mukherjee
DOI:10.4103/ijo.IJO_585_21  
Autologous dermis fat graft is an option commonly used for volume replacement in congenital anophthalmic sockets. Hypertrophy of the graft is a very rare complication that can be managed by debulking the graft. Volumetric analysis by computed tomography or magnetic resonance imaging helps in calculating the amount of fat to be excised while debulking. We report a case of recurrent dermis fat graft hypertrophy managed by debulking with the aid of volumetric analysis. The patient underwent dermis fat grafting at the age of 1, followed by graft hypertrophy at the age of 2 years and recurrent hypertrophy at the age of 6 years. Debulking was done with the aid of volumetric analysis when hypertrophy recurred. The patient is doing well with a stable cosmesis at the last follow-up after 1 year.
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PHOTO ESSAY Top

Spontaneous regression of progressive epithelial ingrowth following femto laser-assisted in situ keratomelusis p. 249
Josephine S Christy, Bharat Gurnani, Divya Manohar
DOI:10.4103/ijo.IJO_569_21  
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Surgical approach of congenital sclerocorneal cyst: A case report and literature review p. 251
Pey Yih Ng, Sujaya Singh, U-Teng Chan, Fazliana Ismail, Shamala Retnasabapathy
DOI:10.4103/ijo.IJO_1513_21  
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Imaging for fungal kerato-uveitis p. 253
Pratima Rajendra Vishwakarma, Bhupesh Bagga, Savitri Sharma
DOI:10.4103/ijo.IJO_1384_21  
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Acanthamoeba sclerokeratitis: Infection or inflammation? p. 255
Himabindu Alluri, Tanvi Soni, Sujata Das
DOI:10.4103/ijo.IJO_1360_21  
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Accelerated photoactivated chromophore for infectious keratitis-collagen cross-linking in deep mycotic keratitis p. 257
Surbhi Khurana, Parul Chawla Gupta, Amit Gupta, Suryaprakash Sharma, Jagat Ram
DOI:10.4103/ijo.IJO_998_21  
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Tissue remodelling in end stage Mooren's ulcer p. 259
Uma Y Thigale, Aravind Roy
DOI:10.4103/ijo.IJO_1480_21  
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Post-traumatic isolated host bed dehiscence with an intact limbal sparing lamellar keratoplasty graft-host junction: A rare case report p. 261
Mona Bhargava, Aditi Ghosh Dastidar, Saket Benurwar, Raj Shekhar Paul, Varsha Govardhan Bhambhani
DOI:10.4103/ijo.IJO_879_21  
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Descemet's stripping endothelial keratoplasty in corneal epithelial hyperplasia with endothelial decompensation p. 263
Prateek Gujar, Radhika Natarajan
DOI:10.4103/ijo.IJO_1149_21  
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Absent pupillary aperture p. 265
Mousumi Banerjee, Kumar Bhawesh, Shorya V Azad
DOI:10.4103/ijo.IJO_1547_21  
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Posterior polar cataract with an occult posterior capsular rent: A rare catch p. 267
Tina Damani, Dhaivat Shah, Ravin Punamia, Shirali Gokharu
DOI:10.4103/ijo.IJO_804_21  
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Traumatic cataract with iris cyst - A combined approach p. 269
Monica Budhwani, Sudhakhar Potti
DOI:10.4103/ijo.IJO_1260_21  
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Direct slit-lamp view of angle of anterior chamber in superior corneal ectasia p. 271
Arjun Velayudhan Nair, Mangala Periasamy, Revathi Rajaraman
DOI:10.4103/ijo.IJO_1366_21  
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Montage image of fundus nearly upto the ora serrata with the help of an android mobile p. 273
Chhaya Bharti
DOI:10.4103/ijo.IJO_2008_21  
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Fundus imaging of ora serrata with an android mobile without any additional attachments p. 275
Chhaya Bharti
DOI:10.4103/ijo.IJO_578_21  
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An insight on Bergmeister's Papillae p. 277
Prateek Jain, Anshuman Pattnaik, Pooja Shinde
DOI:10.4103/ijo.IJO_849_21  
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Paracentral acute middle maculopathy in a patient with sickle cell trait p. 279
Peng Yong Sim, Elizabeth Yang
DOI:10.4103/ijo.IJO_1577_21  
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"Teardrop on a hat" sign in a case of vitreomacular traction: Explaining the vector forces on optical coherence tomography imaging p. 281
Harshit Vaidya, Jitendra Suthar
DOI:10.4103/ijo.IJO_830_21  
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Iridolenticular coloboma with butterfly shaped chorioretinal coloboma p. 283
Ekta Gupta, Rajwinder Kaur, Balbir Khan, Anupriya
DOI:10.4103/ijo.IJO_1846_21  
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Pigmented mobile vitreous cyst with cystoid macular edema in retinitis pigmentosa - A quirky association p. 285
Rushik Patel, Kushal Delhiwala, Bakulesh Khamar, Parth Rana
DOI:10.4103/ijo.IJO_847_21  
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Tale of a choroidal tuberculoma: Bacillary layer detachment at presentation and late choroidal neovascularization p. 287
Syed Mohideen Abdul Khadar, Jahnara Jaffar, Vinit Shah, Akruti Gunderia
DOI:10.4103/ijo.IJO_1425_21  
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Bacillary layer detachment and its spontaneous resolution in central retinal vein occlusion p. 290
Raj S Hirawat, Nagesha C Krishnappa, Rashi T Sawal, Pratyusha Ganne
DOI:10.4103/ijo.IJO_1623_21  
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Chimney leak in proliferative diabetic retinopathy p. 292
Nikitha Gurram Reddy, Ramesh Venkatesh, Sameeksha Agrawal, Pranjal Mishra, Jay Chhablani
DOI:10.4103/ijo.IJO_1139_21  
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Celebrations with party poppers turning into ocular nightmares: Case series p. 294
Sathya T Ravilla, S Ashok Vardhan
DOI:10.4103/ijo.IJO_202_21  
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Sebaceous mantleoma: A rare benign neoplasm p. 296
Jayagayathri Rajagopalan, Anupama Joy, Dayakar Yadalla
DOI:10.4103/ijo.IJO_2568_20  
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Bilateral plasmacytoma of extraocular muscles presenting with orbital inflammation p. 298
Vijitha S Vempuluru, Anasua G Kapoor, Dilip K Mishra, Swathi Kaliki
DOI:10.4103/ijo.IJO_195_21  
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OPHTHALMIC IMAGES Top

Bird's view of the human eye p. 300
Julie Pegu, Shayana Bhumbla, Surbhi Arora, Saptarshi Mukherjee
DOI:10.4103/ijo.IJO_1783_21  
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Sub-bulbar conjunctival “sago-pearls” p. 301
Kushal Delhiwala, Rushik Patel, Bakulesh Khamar
DOI:10.4103/ijo.IJO_1552_21  
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High astigmatism in young female: Not always a keratoconus p. 302
Aditya Ghorpade, Anitha Venugopal
DOI:10.4103/ijo.IJO_697_21  
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Flappergasted! p. 303
Anuja K Desai, Parin Mehta
DOI:10.4103/ijo.IJO_1749_21  
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Iris stromal cyst: With a fluid debris level p. 304
PC Ranjith
DOI:10.4103/ijo.IJO_2451_20  
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Stellate cataract and bilateral ptosis in Steinert myotonic dystrophy p. 305
Gonzalo García de Oteyza, Kristian A Vázquez-Romo, Ana M García-Albisua
DOI:10.4103/ijo.IJO_1938_21  
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Star suture lenticular opacity p. 306
Rinal Pandit, Dhaivat Shah
DOI:10.4103/ijo.IJO_888_21  
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True exfoliation of the lens capsule - Floating membrane in the eye p. 307
Aparna Rao
DOI:10.4103/ijo.IJO_1614_21  
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“Zorbing ball” cataract p. 308
Amber A Bhayana, Sikshya Moharana, Priyanka Prasad, Rohan Ranjan
DOI:10.4103/ijo.IJO_2191_21  
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Broken rossette cataract p. 309
D Bala Sarasawathy, Kalpana Narendran
DOI:10.4103/ijo.IJO_1787_21  
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Ruptured posterior lens capsule with clear crystalline lens p. 310
Utsab Pan, Romana Fazal, Diptesh Das
DOI:10.4103/ijo.IJO_1984_21  
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Traumatic posterior capsular blowout p. 311
Himanshi Singh, Surbhi Khurana, Parul C Gupta, Ranjan K Behera, Jagat Ram
DOI:10.4103/ijo.IJO_1160_21  
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Iatrogenic lens pseudo-coloboma following trabeculectomy p. 312
Amber Amar Bhayana, Priyanka Prasad, Vaibhav Namdev, Akshat Sharma, Tanuj Dada, Sudarshan Khokhar
DOI:10.4103/ijo.IJO_2057_21  
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Lenticular indentation due to vitreous incarceration following open globe injury p. 313
Amber A Bhayana, Saima A Mazumder, Priyanka Prasad, Akshat Sharma, Sudarshan K Khokhar, Anita Gupta
DOI:10.4103/ijo.IJO_2074_21  
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Total closure of anterior chamber angle due to crystalline lens dislocation observed by anterior segment optical coherence tomography p. 314
Yu Ichioka, Masayuki Akimoto
DOI:10.4103/ijo.IJO_1449_21  
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Cobweb in the eye: Pseudophakia in microspherophakia p. 315
Rohit Rao, Charudutt Kalamkar, Amrita Mukherjee, Jayesh Patil, Aarti Jain
DOI:10.4103/ijo.IJO_1041_21  
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Intraocular lens bag-Cionni complex dislocated in anterior chamber p. 316
Neiwete Lomi, Amber A Bhayana, Saima A Mazumder, Nimmy Raj, Priyanka Prasad, Sudarshan K Khokhar, Radhika Tandon
DOI:10.4103/ijo.IJO_984_21  
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A novel technique to measure intraocular lens decentration using ultrasound biomicroscopy p. 317
Sudarshan K Khokhar, Amber A Bhayana
DOI:10.4103/ijo.IJO_1607_21  
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Blue bleb – Post-phacoemulsification retained trypan blue dye in an old bleb p. 318
Kunal Mandlik, Shivraj Tagare, Swati Upadhyaya, Devika Bhattacharya
DOI:10.4103/ijo.IJO_1113_21  
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Optic disc neovascularization in panuveitis and the role of optical coherence tomography angiography in diagnosis and follow-up p. 319
Laura Such-Irusta, Raquel Burggraaf-Sánchez de las Matas, Julián Zarco-Bosquet
DOI:10.4103/ijo.IJO_3809_20  
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Non-invasive multimodal imaging in a case of choroidal macrovessel p. 320
Rajesh Ramanjulu, Surendra Pal, Devashish Dubey, Mahesh Shanmugam
DOI:10.4103/ijo.IJO_1512_21  
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Minion aborted chorioretinal coloboma: A comprehensive multimodal imaging canvas p. 321
Prasanna V Ramesh, Shruthy V Ramesh, K Aji, Anugraha Balamurugan, Meena K Ramesh, Ramesh Rajasekaran
DOI:10.4103/ijo.IJO_1843_21  
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Two pits, coloboma and a hole p. 322
Mohammed Sabir, Abhidnya Surve, Vinod Kumar
DOI:10.4103/ijo.IJO_1072_21  
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Diagnostic utility of the optical coherence tomography ganglion cell complex in diagnosing Leber's hereditary optic neuropathy masquerading as functional vision loss p. 323
Arjun Balachandar, Arun N E Sundaram
DOI:10.4103/ijo.IJO_544_21  
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Witnessing the spectacle/eye goggles in the eye: An investigative optical coherence tomography analysis of macula in advanced diabetic eye disease p. 324
Prasanna Venkatesh Ramesh, Shruthy Vaishali Ramesh, Prajnya Ray, K Aji, Anugraha Balamurugan, Meena Kumari Ramesh, Ramesh Rajasekaran
DOI:10.4103/ijo.IJO_889_21  
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Nd:YAG membranotomy to disperse trapped oil p. 325
Amber A Bhayana, Priyanka Prasad
DOI:10.4103/ijo.IJO_2204_21  
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“Staphyle” like hyperoleon p. 326
Amber A Bhayana, Shorya V Azad, Priyanka Prasad, Shivani Joshi, Naintara Chouhan, Sudarshan K Khokhar
DOI:10.4103/ijo.IJO_1162_21  
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Bilateral Purtscher retinopathy in a child p. 327
Amit K Deb, Pratima Chavan, Sandip Sarkar, Tanmay Gokhale, Ninan Jacob
DOI:10.4103/ijo.IJO_1040_21  
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Choroidal neovascular membrane associated with subretinal dead filarial-like worm p. 328
Debdulal Chakraborty, Aditya Verma, Dipankar Das, Jyotirmay Biswas
DOI:10.4103/ijo.IJO_1193_21  
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Multimodal imaging of Bietti's retinal dystrophy p. 329
Sashwanthi Mohan, Namitha Mohan, Sujatha Mohan
DOI:10.4103/ijo.IJO_1010_21  
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Retinopathy of prematurity laser through posteriorly dislocated crystalline lens p. 330
Amber A Bhayana, Priyanka Prasad, Shorya V Azad, Poonam Sheoran
DOI:10.4103/ijo.IJO_2034_21  
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Intraoperative sub-internal limiting membrane migration of triamcinolone particles p. 331
Naresh Babu, Piyush Kohli, Kim Ramasamy
DOI:10.4103/ijo.IJO_1427_21  
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Piggyback optic disc p. 332
Aditi Parab, Priya Sivakumar, Harsh Vardhan Singh
DOI:10.4103/ijo.IJO_1306_21  
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Bilateral medial rectus aplasia with atypical morning glory anomaly p. 333
Shweta Chaurasia, Jaspreet Sukhija, Manu Saini
DOI:10.4103/ijo.IJO_1736_21  
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Molluscum contagiosum as seen by fluorescein stain p. 334
Dipankar Das, Saurabh Deshmukh, Harsha Bhattacharjee, Brenda Latsaheb, Palak Chirania, Apurba Deka
DOI:10.4103/ijo.IJO_1615_21  
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Infantile-onset myasthenia: Is it always congenital? p. 335
Vinit Banga, Bhanudeep Singanamalla, Lokesh Saini
DOI:10.4103/ijo.IJO_632_21  
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Evisceration - Not an epilogue! p. 336
Venugopal Anitha, Meenakshi Ravindran, V Maneksha
DOI:10.4103/ijo.IJO_1890_21  
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