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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 1 | Issue 1
Page Nos. 1-158

Online since Thursday, December 31, 2020

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EDITIORIAL  

The story is the thing - The birth of Indian Journal of Ophthalmology Case Reports Highly accessed article p. 1
Santosh G Honavar
DOI:10.4103/ijo.IJO_3810_20  
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GUEST EDITORIAL Top

Diamonds are forever… and so are case reports p. 2
Carol L Shields, Jerry A Shields
DOI:10.4103/ijo.IJO_3737_20  
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OPHTHALMIC IMAGES Top

Verrucous carcinoma: A rare variant of eyelid squamous cell carcinoma Highly accessed article p. 4
Tarjani V Dave, Sasi Pyda
DOI:10.4103/ijo.IJO_1600_20  
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Periocular cutaneous leishmaniasis p. 5
Md Shahid Alam, Sanhita Chatterjee
DOI:10.4103/ijo.IJO_1766_20  
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Beware of the bruise: Eyelid and periocular cutaneous angiosarcoma p. 6
Tarjani V Dave, Richa D Wagh, Dilip K Mishra
DOI:10.4103/ijo.IJO_1536_20  
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Congenital keratopellis p. 7
R Balamurugan, Parul Chawla Gupta, Sameer Sethi, Savleen Kaur, Jagat Ram
DOI:10.4103/ijo.IJO_1822_20  
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Pre-Descemet's corneal dystrophy p. 8
Alka Sonkeshri, Deepshikha Agrawal, Samrat Chatterjee, Sharad N Gomase
DOI:10.4103/ijo.IJO_2400_20  
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An interesting case of corneal burn following electrocution p. 9
Shweta Patro, Anushri Agrawal, KS Siddharthan
DOI:10.4103/ijo.IJO_1180_20  
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Intracameral fungal bridge p. 10
Mohamed Ibrahime Asif, Suman Lata, Shristi, Rahul Kumar Bafna, Rajesh Sinha
DOI:10.4103/ijo.IJO_646_20  
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Complete Schwalbe's ring in Axenfeld-Rieger anomaly p. 11
Sagarika Snehi, Gaurav Gupta, Deepika Dhingra, Sushmita Kaushik
DOI:10.4103/ijo.IJO_2268_20  
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Too close for comfort: Peters' anomaly type II p. 12
Samip Mehta, Bhaskar Srinivasan
DOI:10.4103/ijo.IJO_1785_20  
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Ota with Ito: An unusual concurrence Highly accessed article p. 13
Muthukrishnan Vallinayagam, Juhi Sahu, Anujeet Paul, Krishnagopal Srikanth
DOI:10.4103/ijo.IJO_2081_20  
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Posterior lenticonus (lentiglobus) in a 13-year-old child p. 14
Parul Jain, Ritu Arora
DOI:10.4103/ijo.IJO_1703_20  
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Anterior pyramidal polar cataract in an adult p. 15
Paul E G Nithila, Eliza Anthony, Aravind Haripriya
DOI:10.4103/ijo.IJO_2310_20  
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A rare case of lens neovascularization p. 16
Meghana Tanwar, Madhu Shekhar, Sabyasachi Chakrabarty
DOI:10.4103/ijo.IJO_1620_20  
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Piggyback intraocular lenses p. 17
Sharmila Rajendrababu, Chitaranjan Mishra
DOI:10.4103/ijo.IJO_1628_20  
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Vitreous cyst in a 13-year-old girl p. 18
Sashwanthi Mohan, Mohan Rajan
DOI:10.4103/ijo.IJO_1761_20  
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”Sunny-side up egg with red-sauce” appearance at macula p. 19
Gitanjli Sood, Ramanuj Samanta, Devesh Kumawat, Ajai Agrawal, Anupam Singh
DOI:10.4103/ijo.IJO_2128_20  
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Reversal of pseudocystic foveal cavitation in tamoxifen maculopathy captured on spectral-domain optical coherence tomography p. 20
Vinaya Felcida, Suman Pilli, Periyasamy Kumar, Dimitrios Kalogeropoulos
DOI:10.4103/ijo.IJO_1292_20  
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Hypertrophic sub-retinal scar in neovascular age related macular degeneration p. 21
Samendra Karkhur, Deepak Soni, Bhavana Sharma
DOI:10.4103/ijo.IJO_1908_20  
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Sea-fan neovascularisation in neglected proliferative diabetic retinopathy p. 22
Divya Agarwal, Atul Kumar
DOI:10.4103/ijo.IJO_2151_20  
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Infiltration of optic nerve head in acute lymphoblastic leukaemia presenting as an initial isolated site of relapse p. 23
Harshit Vaidya, Vikas Khetan
DOI:10.4103/ijo.IJO_2023_20  
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PHOTO ESSAY Top

Facial dysmorphism – More than what meets the eyes p. 24
Aditi Mehta, Simar R Singh, Ramandeep S Virk
DOI:10.4103/ijo.IJO_880_20  
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An unusual case of recurrent eyelid cysticercosis p. 26
Isha K Patel, Divya U Caculo, Trupti M Solu, Shivani Acharya
DOI:10.4103/ijo.IJO_372_20  
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Tufted angioma of the eyelid – A rare entity p. 28
Debi Kundu, Subramanian Krishnakumar, Md Shahid Alam
DOI:10.4103/ijo.IJO_1571_20  
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Anterior segment optical coherence tomography characteristics of pseudopunctum in proximal canalicular blocks p. 30
Ruchi Goel, Priyanka Golhait, Samreen Khanam, Shweta Raghav, Sumit Kumar
DOI:10.4103/ijo.IJO_1594_20  
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Solitary limbal nodule in a child: An unusual presentation in pediatric vernal keratoconjunctivitis p. 32
Deepika Khurana, Anjali Chandrasekharan, Mamatha Angula, Kaustubh Mulay
DOI:10.4103/ijo.IJO_1695_20  
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Superior fornix mass with retained soft contact lens p. 34
Carl Benjamin Rebhun, Ann Q Tran, Irina Belinsky
DOI:10.4103/ijo.IJO_1819_20  
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Unusual “fish bone pattern” epitheliopathy p. 35
Mugundhan Rajarajan, Bhavatharini Muthukumar, Rajat Kapoor, Muralidhar Ramappa
DOI:10.4103/ijo.IJO_1461_20  
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Rapid Kayser-Fleischer ring following an embedded intracorneal copper foreign body p. 37
Ritu Arora, Jigyasa Sahu, Parul Jain, Shweta Viswanath
DOI:10.4103/ijo.IJO_1151_20  
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Intrastromal corneal epithelial cyst – When to intervene p. 39
Raj S Paul, Meena Lakshmipathy, Akila Ramkumar, J Karthick
DOI:10.4103/ijo.IJO_1568_20  
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A rare case of early neurotrophic keratitis following micropulse transscleral cyclophotocoagulation combined with phacoemulsification p. 41
Rahul Kumar Bafna, Namrata Sharma, Akshaya Balaji, Karthikeyan Mahalingam, Chandradevi Shanmugam, Kanagavalli Mahalingam
DOI:10.4103/ijo.IJO_1040_20  
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Caspofungin: Saviour in a case of recalcitrant fungal keratitis p. 43
Sujata Dwivedi, Shivaprakash M Rudramurthy
DOI:10.4103/ijo.IJO_13_20  
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Barbless fish hook injury to the cornea p. 44
Lakshmi Prasanna, Sowjanya Vuyyuru, Anahita Kate, Sushank A Bhalerao, Pratik Y Gogri
DOI:10.4103/ijo.IJO_1733_20  
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Assessment of anterior segment changes using multimodal imaging in a case of post-traumatic transient myopia p. 45
Ashok Kanakamedla, Simakurthy Sriram, Madhu Kumar, Anurag Shandil, Jayamadhury Gudimetla
DOI:10.4103/ijo.IJO_1088_20  
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Overcoming challenges of capsulotomy in anterior lenticonus: Femtosecond laser capsulotomy and Zepto precision pulse capsulotomy approach p. 48
Pratik Gogri, Tanvi Madia, Sushank Bhalerao
DOI:10.4103/ijo.IJO_1003_20  
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Morgagnian cataract and phacomorphic glaucoma p. 50
Vanita Pathak-Ray
DOI:10.4103/ijo.IJO_961_20  
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Goltz syndrome with congenital glaucoma: A new ophthalmologic manifestation p. 52
Gazella B Warjri, Vatsalya Venkatraman, Ramanjit Sihota, Viney Gupta, Shikha Gupta
DOI:10.4103/ijo.IJO_571_20  
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Wet age-related macular degeneration and choroidal effusion as a cause of angle closure p. 54
Christina Saekyung Lim, Prabhu Tonne, Subhanjan Mukherji
DOI:10.4103/ijo.IJO_151_20  
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Uveal effusion syndrome in achondroplasia p. 55
Suganeswari Ganesan, Pallavi Singh, Sudha Ganesh, Krishnakumar Subramanian, Muna Bhende
DOI:10.4103/ijo.IJO_1320_20  
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Association of Straatsma syndrome with persistent hyaloid vasculature p. 58
Janani Sreenivasan, Akila Ramkumar, Aditya Verma
DOI:10.4103/ijo.IJO_779_20  
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Scrub typhus associated acute macular neuroretinopathy p. 60
Kiran Chandra, Simar Rajan Singh, Ramandeep Singh, Mohit Dogra
DOI:10.4103/ijo.IJO_1471_20  
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Anomalous aneurysmal vessel at the fovea p. 62
Raja Rami P Reddy, Anuj Sharma
DOI:10.4103/ijo.IJO_1747_20  
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Phacomatosis cesioflammea with bilateral diffuse choroidal hemangioma p. 64
B Shwetha, Pukhraj Rishi
DOI:10.4103/ijo.IJO_803_20  
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Single sitting multi-spot photodynamic therapy in management of large optic nerve head hemangioblastoma with macular edema p. 67
Avnindra Gupta, Ritesh Narula, Dinesh Talwar, Lalit Verma, Shraddha R Pawar
DOI:10.4103/ijo.IJO_900_20  
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Neuroretinitis: A rare presentation of optic disc melanocytoma p. 69
B Sripathi Kamath, Divya Shenoy, Jaison Velandy, Norman Mendonca
DOI:10.4103/ijo.IJO_867_20  
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Bilateral central retinal artery occlusion in a patient with diagnosed Takayasu's arteritis p. 71
Tejaswini Vukkadala, Akshaya Balaji, Shorya Vardhan Azad, Vinod Kumar
DOI:10.4103/ijo.IJO_868_20  
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High definition spectral domain: Optical coherence tomography image of caterpillar hair on the retina p. 72
Divya Mohanchandran Nair, VS Prakash, Gana Din
DOI:10.4103/ijo.IJO_681_20  
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Managing caterpillar hair induced posterior segment complications p. 73
Das Arnab, Saptorshi Majumdar, Santra Sourav
DOI:10.4103/ijo.IJO_860_20  
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Intravitreal Aflibercept in peripheral exudative hemorrhagic chorioretinopathy associated with large retinal pigment epithelial tear p. 75
Manpreet Brar, Mansi Sharma, S P S Grewal, Dilraj S Grewal, Mangat R Dogra
DOI:10.4103/ijo.IJO_584_20  
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Intraoperative optical coherence tomography (I-OCT)-guided identification of resolved sub-internal limiting membrane hemorrhage in leukemic retinopathy p. 77
Saurabh Verma, Shilpa Vishwanath, Shorya Vardhan Azad, Vinod Aggarwal
DOI:10.4103/ijo.IJO_1112_20  
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Third nerve palsy as an initial presentation of neurofibromatosis 2 p. 79
Deepanjali Arya, Sima Das
DOI:10.4103/ijo.IJO_332_20  
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CASE REPORTS Top

Reverse masquerade: Benign sebaceous tumors mimicking sebaceous gland carcinoma of the eyelid p. 80
Atanu Barh, Bipasha Mukherjee, Nisar Sonam Poonam, Subramanian Krishnakumar
DOI:10.4103/ijo.IJO_758_20  
Sebaceous lesions encompass a spectrum from benign lesions to disfiguring malignant lesions. Eyelid sebaceomas are extremely rare and only two definite cases are described in the English literature, whereas sebaceous adenomas occur in the eyelids more commonly and can be distinguished easily from sebaceous gland carcinoma by its clinical and histological appearance. We describe two cases of eyelid lesions that clinically resembled a possible malignant eyelid tumor. In both the cases, frozen section report was suggestive of a well-differentiated sebaceous gland carcinoma. However, histopathology examination of the permanent section was consistent with the diagnosis of sebaceoma and sebaceous adenoma respectively.
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Nevus of Ota with palatal involvement and Helicobacter pylori gastritis: A rare case report Highly accessed article p. 83
Dipankar Das, Prafulla Sarma, Kamal Chetri, Harsha Bhattacharjee, Saurabh Deshmukh, Nitu Kumari, Kunal Shinde
DOI:10.4103/ijo.IJO_585_20  
Congenital oculodermal melanocytosis is also known as Nevus of Ota, condition where blue nevus of skin and orbit are seen with ipsilateral nevus in conjunctiva and iris. They are often associated with glaucoma which can occur at any age. They can have melanocytosis and develop choroidal melanoma. We report a case of a middle-aged female with facial pigmentation and bilateral scleral, conjunctival, and iris nevus with an advanced glaucomatous change in both eyes and pigmentation of the palatal mucosa. Trabeculectomy with mitomycin-C application was done in the left eye. Gastrointestinal endoscopy by gastroenterologist showed gastritis and Helicobacter pylori infection.
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A rare case of Haberland syndrome p. 85
Mohamed I Asif, Siddhi Goel, Mrinalini A Yadav, Vipul Singh, Prafulla K Maharana
DOI:10.4103/ijo.IJO_1786_20  
A 10-month-old male child presented with a mass lesion in the left eye which was present since birth as noted by the parents. It was non-progressive. He also had left eye upper eyelid coloboma and a single nodular lesion on the left zygomaticotemporal region along with multiple nodular lesions on the scalp with non-scarring alopecia. A pediatric consultation was sought for systemic associations and a diagnosis of Haberland syndrome was made. Surgical debulking of the ocular lesion was done along with optical correction and amblyopia therapy for visual rehabilitation.
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Femtosecond laser-assisted intrastromal MyoRing implantation for correction of irregular astigmatism after penetrating keratoplasty and high myopia p. 88
Pozdeyeva Nadezhda Aleksandrovna, Sinitsyn Maksim Vladimirovich
DOI:10.4103/ijo.IJO_1053_20  
MyoRing was implanted using a femtosecond laser to correct a high irregular corneal astigmatism after penetrating keratoplasty and high myopia. Femtosecond laser-assisted intrastromal MyoRing implantation allows to increase its sphericity, regularity and at the same time to correct high myopia. The creation of an additional “framework” in the corneal transplant by the MyoRing increased its biomechanical properties and prevented regression of the obtained refractive result. Femtosecond laser-assisted intrastromal MyoRing implantation allows to correct irregular astigmatism after penetrating keratoplasty and high myopia.
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A case of old total Descemet membrane detachment due to ophthalmic viscosurgical device with clear cornea: Microscope-integrated intraoperative optical coherence tomography-guided drainage p. 91
Nidhi Kalra, Mohamed Ibrahime Asif, Jatinder S Bhalla, Rahul K Bafna, Rajesh Sinha
DOI:10.4103/ijo.IJO_1740_20  
We report a case of a large bullous descemet membrane detachment (DMD) following inadvertent injection of ophthalmic viscoelastic device in the supradescemetic space. A 27 years old male with juvenile open-angle glaucoma underwent trabeculectomy in the right eye followed by anterior chamber reformation. He developed DMD for which intracameral gas injection failed twice. He presented with complaints of blurring of images in that eye. Examination revealed a bullous DMD without any corneal edema, confirmed by anterior segment optical coherence tomography (ASOCT). Microscope-integrated intraoperative OCT (mi-OCT) guided drainage with intracameral gas injection was done following which the detachment settled completely.
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Microbial keratitis due to infection with Citrobacter freundii: A rare entity p. 93
R Balamurugan, Parul Chawla Gupta, R Raghulnadhan, Archana Angrup, Bhavana Yadav, Jagat Ram
DOI:10.4103/ijo.IJO_664_20  
We report a unique case of Citrobacter freundii keratitis in a 35-year-old male presented with a paracentral corneal ulcer secondary to injury with a tile particle. Clinically, it seemed like a fungal ulcer. However, the bacterial culture was positive for Citrobacter freundii, which responded to topical amikacin and ceftazidime. Citrobacter freundii is a facultative anaerobic gram-negative bacterium belonging to the family of Enterobacteriaceae being associated with external eye infections; while this is another report of it being associated with microbial keratitis.
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Unusual case of corneo-scleral melt treated with scleral patch graft in a patient of Porphyria Cutanea Tarda p. 95
Sweety G Tiple, Umang Mathur, Sima Das, Arpan Gandhi
DOI:10.4103/ijo.IJO_1516_20  
Porphyria cutanea tarda (PCT) is the most common form of Porphyria, which is a group of metabolic disorders of haem biosynthesis characterized by the involvement of the skin, eyes, and neuro-visceral tissue. Although scleral thinning in the interpalpebral area is a well-documented feature, severe corneal involvement is rarely described. We, herein report a young male who presented with bilateral scleral thinning in the interpalpebral area and an anterior staphyloma in the right eye. Systemic examination was suggestive of PCT. We report the first case of PCT in literature successfully treated with autologous scleral patch graft.
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Contralateral autologous corneal transplantation in an human immunodeficiency virus-positive patient with multiple failed grafts: A challenging experience p. 98
Sudhakar Potti, Aparna N Nayak
DOI:10.4103/ijo.IJO_1227_20  
A 61-year-old human immunodeficiency virus (HIV)-positive female patient, planned for a repeat penetrating keratoplasty in the left eye after two failed grafts, also had an absolute right eye and a clear cornea with healthy endothelium (CD4-2445 cells/mm2) with no perception of light. Due to an unexpected damage to the only optical grade tissue that occurred during surgery, consent was taken from the patient to perform an autokeratoplasty from the contralateral blind eye and was successfully performed on the left eye with visual potential. The blind eye received a therapeutic grade donor tissue.
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Novel approach of autologous simple limbal epithelial transplantation (autoSLET) in eyes with acute unilateral severe ocular chemical injury p. 100
Rajat Jain, Neha Mohan, Sayan Basu
DOI:10.4103/ijo.IJO_1083_20  
A 19-year-old boy was presented 4 days after left eye acute chuna injury grade 4 (Dua). BCVA was finger counting 1 m, limbal ischemia, ground glass cornea, and corneal epithelial defect involving adjacent conjunctiva. Autologous contralateral simple limbal epithelial transplantation (SLET) was performed. Complete ocular surface epithelization was noted at day 21. At 8-months follow-up, there was a stable ocular surface with 20/20p BCVA. AutoSLET achieves rapid epithelialization in severe chemical injuries thereby preventing adverse effects of delayed epithelial healing avoiding the need for visual rehabilitative procedures later. Larger case series with longer follow-up is required.
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Ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis among patients admitted to a medical college hospital: A case series p. 103
Shadin Khadeeja, Rashmi Shambhu, Anupama Bappal, Shama Sharief
DOI:10.4103/ijo.IJO_1294_20  
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare blistering diseases of the skin and mucous membranes with ocular involvement. This is a retrospective analysis of patients with SJS and TEN admitted in a medical college hospital from June 2016 to May 2019. Six among 21 patients had ocular involvement. Five patients with mild grade of ocular involvement were managed with conservative treatment. One patient with TEN and bilateral severe grade involvement underwent bedside application of amniotic membrane. Performing this technique can become challenging. Hence, we look forward towards the inventions of easier variations of the technique.
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A complicated case of symblepharon managed with Goretex p. 106
Anitha Venugopal, Meenakshi Ravindran
DOI:10.4103/ijo.IJO_963_20  
The objective of this study was to report a complicated case of chemical injury with symblepharon, LSCD, and pseudo pterygium managed successfully with ePTFE (Goretex) a novel method of treatment to prevent recurrence of symblepharon. A 10-year-old girl presented to us with progressive symblepharon and pseudopterygium encroaching the visual axis leading to defective vision, strabismus amblyopia, and motility restriction. The challenge, in this case, was the recurrence of symblepharon and fleshy growth. Goretex is a biocompatible and inert material. Along with Amniotic membrane transplantation (AMT), it creates a strong mechanical barrier between tenons, sclera, and tarsus. Thereby it prevents the recurrence of symblepharon, Goretex is a novel treatment approach that is simple and effective in preventing symblepharon.
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Pigmentary glaucoma associated with anterior megalophthalmos p. 108
Magdalena Popiela, Divya Mathews
DOI:10.4103/ijo.IJO_1988_20  
We present a case of anterior megalophthalmos associated with secondary pigmentary glaucoma in the right eye, with other factors contributing to his raised intraocular pressure (IOP). The mechanism of glaucoma was multifactorial – pigment dispersion syndrome, abnormal angle architecture, IOP rises post pars plana vitrectomy with gas, postcataract extraction, element of steroid response. He underwent successful viscocanalostomy to control his IOP. To the best of our knowledge, there is no previous literature publication on viscocanalostomy as a surgical management of glaucoma in an eye with anterior megalophthalmos.
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A rare case of phacomatosis pigmento vascularis with glaucoma in an Indian child: Management with review of literature p. 111
Chintan Shah, Pradhnya Sen, Richa Jain, Devindra Sood, Amit Mohan, Elesh Jain
DOI:10.4103/ijo.IJO_1816_20  
We present a rare case of phacomatosis pigmentovascularis in a 6-year-old child. The child had one functioning eye with severe glaucoma at presentation. We managed the case with primary Ahmed glaucoma valve implantation followed by two needling attempts. After 3 years of follow-up, the intraocular pressure was well maintained with the addition of two antiglaucoma medications.
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A novel presentation of atypical bilateral Chandler syndrome with an insight into management p. 114
Karthikeyan Mahalingam, Monika Yadav, Venkatesh Nathiya, Dewang Angmo
DOI:10.4103/ijo.IJO_1045_20  
We report an atypical presentation of bilateral Chandler's syndrome with secondary angle-closure glaucoma. Right eye (RE) AS-OCT showed higher lens vault. Left eye (LE) had decompensated cornea. Intraocular pressure (IOP) in RE was 18–20 mm Hg on four topical glaucoma medications. RE cup-disk-ratio was 0.8–0.9:1. Specular and confocal microscopy aided in diagnosis. As trabeculectomy had poor prognosis (due to increased lens vault), RE phacoemulsification was done in the first stage. Postoperatively IOP in the RE was 14 mm Hg on topical glaucoma medications at 3 months follow-up. Parameters like corneal status, lens vault and IOP control must be taken into account before planning for filtering surgery.
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Fractured blood stained steroid implant p. 117
Brijesh Takkar, Anushri Prakash Godbole
DOI:10.4103/ijo.IJO_1200_20  
The usual biodegradation of the sustained release steroid implant does not involve fractures. The case presented in this report was noted to have vitreous haemorrhage staining a steroid implant injected for management of diabetic retinopathy. The implant gradually thinned in the areas adjacent to the haemorrhage, to eventually fracture into 2 pieces. Fracture of the implant is an uncommon event and may be a cause of concern as it can potentially alter the pharmacokinetics/dynamics of the drug.
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Dapsone maculopathy p. 119
Juan Carlos Gutiérrez-Hernández, Gabriel Rodríguez-Vargas
DOI:10.4103/ijo.IJO_771_20  
We report the case of a 43-year-old lady with intentional dapsone overdose 26 years ago. Multimodal imaging revealed macular ischemia as the cause for visual loss, while choriocapillaries remained intact.
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Stellate nonhereditary idiopathic foveomacular retinoschisis treated as cystoid macular edema p. 121
Brijesh Takkar, Mihika Dube, Prakhar Goyal, Ashwini Singh, Sunita Sabarwal
DOI:10.4103/ijo.IJO_1569_20  
Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR) is a rare eye disease, hitherto unreported in Indians. We report a case of SNIFR in an Indian female wrongly treated as cystoid macular edema (CME). Differentiation between chronic CME and foveoschisis is paramount while dealing with rare diseases like SNIFR.
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Active concurrent central serous chorioretinopathy and pachychoroid neovasculopathy managed with combination therapy of photodynamic therapy and anti-vascular endothelial growth factor agent p. 123
Barun Garg, Isha Gupta, Sugandha Goel, Deepak Senger, Kumar Saurabh, Rupak Roy
DOI:10.4103/ijo.IJO_836_20  
Pachychoroid disease spectrum includes central serous chorioretinopathy (CSR) and pachychoroid neovasculopathy (PNV). Pachychoroid phenotype is characterized by choroidal hyperpermeability, dilated choroidal vessels (pachyvessels), and focal or diffuse increase in choroidal thickness. Newer imaging modalities have aided in the diagnosis of choroidal diseases. Herein, we present a case of active concurrent CSR with PNV in a middle-aged patient with successful treatment by photodynamic therapy and intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab) injection.
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A new phenotype of Kartagener's syndrome: An interesting case report p. 127
Kalpana Badami Nagaraj, Kavitha L Tumbadi, B Ravi, YD Shilpa, G Bhavna, BC Hemalatha
DOI:10.4103/ijo.IJO_1645_20  
Kartagener's syndrome (KS) is Primary Ciliary Dyskinesia, autosomal recessive disorder characterised by triad of situs inversus of viscera, sinusitis, bronchiectasis due to ciliary dysfunction. Primary ciliary dyskinesia - retinitis pigmentosa syndrome is an X-linked ciliary dysfunction of respiratory epithelium and photoreceptors of retina leading to ocular disorders associated with chronic bronchiectasis, sinusitis and. sensorineural hearing loss. Here we present one such case of Kartagener's syndrome with Retinitis Pigmentosa (RP) which was also associated with Retinal Detachment (RD) in short stature individual reported for the first time, to the best of our knowledge which could be a new phenotypic presentation in Primary Ciliary Dyskinesia.
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Optical coherence tomography angiography of epiretinal neovascularization in a case of macular telangiectasia type 2 and coexistent proliferative diabetic retinopathy p. 130
Rania G Estawro, Abdallah K Hassouna
DOI:10.4103/ijo.IJO_1641_20  
Epiretinal neovascularization (ERN) is a novel optical coherence tomography angiography (OCTA) finding, which has been recently described in association with macular telangiectasia type 2 (MacTel 2). To our knowledge, this is the first documentation of ERN and coexistent proliferative diabetic retinopathy (PDR), which could be clinically confused with diabetic foveal neovascularization. OCTA is a useful tool to evaluate ERN and differentiate it from diabetic foveal neovascularization.
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Role of autofluorescence in Siegrist streaks p. 133
Anamika Patel, Bhavik Panchal, Avinash Pathengay
DOI:10.4103/ijo.IJO_645_20  
A 41-year-old female presented to us with blurred vision in both eyes for the past 3 months. She was a known hypertensive and was treated for malignant hypertension in the past. She was diagnosed as hypertensive retinopathy with choroidopathy. Multiple hypopigmented linear streaks (Siegrist streaks) within the arcade and in the form of islands outside the arcades were noted. Fundus autofluorescence was performed to understand and classify the appearance and resolution of these streaks. Herein, we report the role of autofluorescence in describing Siegrist streaks secondary to hypertensive choroidopathy.
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Gossypiboma of the eye p. 135
Madhu Kumar, Simakurthy Sriram, Ashok Kanakamedla, Jayamadhury Gudimetla, Anurag Shandil, Manit Agrawal
DOI:10.4103/ijo.IJO_1566_20  
A 50-year-old male patient with proliferative diabetic retinopathy with vitreous hemorrhage underwent vitrectomy with oil tamponade. At 1 week post-operative visit, we noticed a retained cotton fiber with adjacent exudation. Patient was started on oral steroids with a subsequent clearing of exudation within 2 weeks. Inadvertent foreign body implantation after an intraocular surgery occurs more frequently than expected. To date, there is no published report of retained cotton fiber in the vitreous cavity. We present a rare case of pre-retinal retained cotton fiber post-vitrectomy with resultant inflammation and its clinical course.
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Bilateral non-arteritic anterior ischemic optic neuropathy with idiopathic intracranial hypertension secondary to attempted abortion related hemorrhage: A rare case report p. 137
Amit Kumar Deb, Gaurav Ghag, Pratik Gera, Nirupama Kasturi, Sandip Sarkar
DOI:10.4103/ijo.IJO_383_20  
We report a unique case of bilateral non-arteritic anterior ischemic optic neuropathy with co-existing idiopathic intracranial hypertension (IIH) in a young female following severe blood loss from abortion. At presentation, she had bilateral gross diminution of vision (hand movements and light perception in right & left eyes respectively) and bilateral pallid disc edema. Lumbar puncture and brain imaging were suggestive of IIH. Temporal association of vision loss with acute blood loss as well as fluorescein angiography were suggestive of bilateral NAION. Patient was treated with intravenous (IV) mannitol, IV methylprednisolone followed by oral steroids, oral acetazolamide, repeat lumbar punctures, and blood transfusion. Vision in right eye improved to 20/40 & left eye 20/500 at sixth month. Multidisciplinary approach is, thus, needed in management of such a case.
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Treatment of 0.01% atropine eye drops induced convergence excess esotropia and rebound myopia managed with 1% atropine eye drops p. 140
Shairin Jahan, Mihir Kothari, Meghna Solanki
DOI:10.4103/ijo.IJO_581_20  
We report a case of progressive childhood myopia who developed rebound myopia and convergence excess esotropia after switching from 1% atropine eye drops to 0.01% atropine eye drops. The esotropia recovered and myopia progression was arrested after stopping 0.01% atropine drops and resuming 1% atropine eye drops.
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Restrictive strabismus in-patient with congenital third nerve palsy p. 142
Rajesh Subhash Joshi, Divya Harshawardhan Jain, Vidya P Hiremath
DOI:10.4103/ijo.IJO_1010_20  
In this study, we describe a case of restrictive exotropia in a 10-year-old female with amblyopia. The diagnosis of the accessory muscle was established through the magnetic resonance imaging (MRI) of the brain and orbit. A patient with restriction of all ocular movements in conjunction with enophthalmos of one eye or both eyes or the retraction of the eyeball should be suspected for an accessory ocular muscle and should be investigated accordingly.
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Large-angle hypertropia managed by modified Nishida's procedure p. 145
Sowmya Raveendra Murthy, Prerana Tripathi
DOI:10.4103/ijo.IJO_380_20  
Treating vertical squints especially large-angle hypertropia caused by inferior rectus palsy is a challenge. Superior rectus recession in presence of positive forced duction tests is the first step in surgical management. Following this, full tendon transposition of horizontal recti inferiorly (Inverse Knapp's procedure) is the standard procedure of choice. Modified Nishida's procedure has been described to treat vertical deviations like MED and inferior rectus aplasia. We describe a case of large-angle hypertropia treated by Modified Nishida's procedure.
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Torsipulsion, a useful diagnostic sign in lateral medullary infarction: A report of three cases p. 148
R Muralidhar, N Vidhya, D Ramamurthy
DOI:10.4103/ijo.IJO_64_20  
A number of ocular motility disturbances such as skew deviation, saccadic/smooth pursuit abnormalities, Horner's syndrome, and nystagmus have been reported in lateral medullary infarction. We report 3 patients who had torsipulsion as the main ocular movement abnormality directly attributable to lateral medullary infarction. Patients 1 and 2 had a clockwise torsional movement that was diagnosed on slit lamp. The movement was elicited on asking the patients to make a horizontal saccade. Both patients were noted to have dorsolateral medullary infarction on MRI of the brain. Neither patient had symptoms directly attributable to torsipulsion. Patient No. 3 was referred for non-resolving left 6th nerve palsy. He had infarcts in the left pons, cerebellum and dorsolateral medulla. Torsipulsion was the only ocular motility disorder caused by medullary infarction. Different pathways in the dorsolateral medulla have been implicated in the various ocular motility and neurological abnormalities seen in lateral medullary syndrome. It is possible that sparing of some and involvement of others could result in varied clinical presentations reported in literature. It is important for the ophthalmologist to be aware of torsipulsion as a diagnostic sign of lateral medullary infarction.
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Craniosynostosis, osteopetrosis, and Arnold-Chiari malformation type 1 – Ophthalmic manifestations: A rare case report p. 151
Vivekanand Uttamrao Warkad, Danish Alam, Debasmita Majhi, Bharat Panigrahy
DOI:10.4103/ijo.IJO_1408_20  
We report an interesting rare case of a child with a constellation of craniosynostosis (CS), osteopetrosis (OP), and Arnold-Chiari malformation type 1 (ACM1), presenting with developmental delay and progressive vision loss since infancy with normal intellect. The ophthalmic examination revealed bilateral advanced visual loss, bilateral proptosis, optic atrophy, and large angle esotropia in primary gaze. A systemic examination revealed facial dysmorphism, abnormal shape of the head, malunion fracture of the right arm, and scoliosis. Neuroimaging revealed features suggestive of CS, OP, and ACM-1. Neurosurgical consultation was sought, and the ventriculoperitoneal shunt was advised.
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Usefulness of mitochondrial deoxyribonucleic acid barcoding in identification of Chrysomya bezziana ophthalmomyasis: A case report p. 154
Meghana Tanwar, Sabyasachi Chakrabarty, Gunja Chowdhury, Usha Kim, Paramasivan Rajaiah
DOI:10.4103/ijo.IJO_1758_20  
We report a case of ophthalmomyiasis profunda with a complete destruction of ocular tissues in an old diabetic lady who presented with sudden onset of bleeding from a progressively increasing, painless swelling in her left eye since two weeks. She was primarily treated with Ivermectin, paraffin dressing, manual removal of maggots, and then total exenteration. Deoxyribonucleic acid (DNA) barcoding analysis supported by DNA sequencing accurately identified the species as Chrysomya bezziana based on the mitochondrial cytochrome c oxidase 1 gene. This case report demonstrates the usefulness of DNA barcoding, complementing the conventional identification methods, in accurate identification of maggots of ophthalmic significance.
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Eosinophilic mucin chronic rhinosinusitis with orbital involvement: management strategies based on clinical presentation p. 156
Archana A Nair, Andrea A Tooley, Fang Zhou, Seth Lieberman, Payal Patel, Irina Belinsky
DOI:10.4103/ijo.IJO_313_20  
Allergic fungal sinusitis (AFS) and eosinophilic mucin chronic rhinosinusitis (EMCRS) are subtypes of a chronic rhinosinusitis with eosinophilia that have different diagnostic criteria but are phenotypically similar. Ophthalmic complications may be the presenting symptoms. Treatment of ophthalmic complications is typically directed at reducing the inflammatory burden in the sinuses and rarely requires direct surgical intervention. However, atypical cases with associated subperiosteal abscess may necessitate orbital surgery. The authors present 2 cases of EMCRS with orbital involvement – one that responded to the traditional treatment of oral corticosteroids and functional endoscopic sinus surgery (FESS), and the other requiring surgical drainage of a subperiosteal abscess in order to describe the management strategies based on clinical presentation.
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