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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 1 | Issue 3
Page Nos. 389-611

Online since Friday, July 2, 2021

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EDITIORIAL  

CARE – The clinical case report checklist Highly accessed article p. 389
Santosh G Honavar
DOI:10.4103/ijo.IJO_1764_21  
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PHOTO ESSAY Top

Corneal ring infiltrate in fungal keratitis Highly accessed article p. 391
Manokamna Agarwal, Appakkudal R Anand, Meena Lakshmipathy
DOI:10.4103/ijo.IJO_2756_20  
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Multimodal imaging of autosomal recessive cornea plana associated with hard mature and polar cataract Highly accessed article p. 393
Vidya S Raja, Vijayalakshmi A Senthilkumar, Kavya Kondepati, Techi D Tara
DOI:10.4103/ijo.IJO_26_21  
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Atypical bilateral isolated coloboma of the lens with cataract in a young man Highly accessed article p. 395
C Tulasi Priya, Vivek Mahendra Singh, C Jagadesh Reddy
DOI:10.4103/ijo.IJO_3649_20  
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Developmental cataract with partial aniridia or optical iridectomy? – A diagnostic dilemma Highly accessed article p. 397
Madhu Shekhar, Priyanka Gusain, R Senthil Prasad, R Sankarananthan, Kamatchi Nagu
DOI:10.4103/ijo.IJO_3025_20  
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Lights, camera, action: Sparkling and twinkling X-mass tree cataract through the eyes of a Scheimpflug imaging and anterior segment optical coherence tomography Highly accessed article p. 399
Prasanna V Ramesh, Shruthy V Ramesh, Ramesh Rajasekaran, Meena K Ramesh
DOI:10.4103/ijo.IJO_266_21  
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Traumatic anterior dislocation of hypermature cataract: Management challenges p. 401
Ekta Singla, Suresh Kumar, Parul Ichhpujani, Parrina Sehgal
DOI:10.4103/ijo.IJO_2485_20  
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Pulp fiction of optic crack - The imperative irony of reloading a preloaded intraocular lens p. 402
Shruthy Vaishali Ramesh, Prasanna Venkatesh Ramesh, Ramesh Rajasekaran, Meena Kumari Ramesh
DOI:10.4103/ijo.IJO_2552_20  
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Primary calcification in a hydrophobic acrylic intraocular lens - A material analysis Highly accessed article p. 405
Harsha Bhattacharjee, Henal Javeri, Suklengmung Buragohain, Dipankar Das
DOI:10.4103/ijo.IJO_3431_20  
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Unilateral congenital ectropion uveae with advanced glaucoma in a child with neurofibromatosis 1 p. 407
Shilpa More, Vijayalakshmi A Senthilkumar, Sharmila Rajendrababu, Shanthi Radhakrishnan
DOI:10.4103/ijo.IJO_3535_20  
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Changing perspectives: Objective monitoring of corneal health in granulomatous uveitis by mapping the keratic precipitates through a Scheimpflug imaging system with calipers in inverse contrast p. 409
Prasanna V Ramesh, Shruthy V Ramesh, Meena K Ramesh, Ramesh Rajasekaran
DOI:10.4103/ijo.IJO_2871_20  
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Incontinentia pigmenti presenting as pseudoretinoblastoma p. 412
Samuel Martin, Ayan Chatterjee, Antonio Yaghy, Carol L Shields
DOI:10.4103/ijo.IJO_3158_20  
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Unilateral incomplete retinal vascularization due to congenital heart disease in a full-term newborn p. 414
Franco Benvenuto, Luis Diaz Gonzalez, María Celeste Mansilla, Adriana Fandiño
DOI:10.4103/ijo.IJO_3077_20  
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A curious case of macular edema in persistent fetal vasculature p. 416
Debdulal Chakraborty, Asmita Saha, Aditya Pradhan
DOI:10.4103/ijo.IJO_3223_20  
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Combined hamartoma of the retina and retinal pigment epithelium: Multimodal imaging to the rescue p. 418
Pooja Bansal, Taw Dipu, Meenakshi Thakar
DOI:10.4103/ijo.IJO_279_21  
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Unilateral isolated macular coloboma - A rare finding p. 420
Saswati Sen, Manmath K Das, Abhilash Chougule
DOI:10.4103/ijo.IJO_3709_20  
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Multimodal imaging in a case of posterior microphthalmos p. 422
Uday Tekchandani, Bruttendu Moharana, Ankur Singh, Ramandeep Singh
DOI:10.4103/ijo.IJO_3474_20  
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Resolution of cystoid macular edema in acute central retinal artery occlusion on swept-source and en-face optical coherence tomography p. 423
Abhishek Desai, Mihir Trivedi, Rushikesh Naigaonkar
DOI:10.4103/ijo.IJO_3036_20  
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Spectral domain optical coherence tomography imaging findings in a case of acute central retinal artery occlusion sparing the cilioretinal artery p. 425
Debmalya Das, Sujay Herekar, Rupak Roy, Kumar Saurabh
DOI:10.4103/ijo.IJO_3242_20  
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The bejewelled retinal fireworks of flecked retina syndrome: A multiplexed retinal imaging p. 427
Shruthy Vaishali Ramesh, Prasanna Venkatesh Ramesh, Meena Kumari Ramesh, Ramesh Rajasekaran, Anugraha Balamurugan
DOI:10.4103/ijo.IJO_2738_20  
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Bilateral optic disc coloboma in Joubert syndrome - A rare association p. 429
Iva R Kalita, Isha Gupta, Priya Sivakumar, K Veena
DOI:10.4103/ijo.IJO_2979_20  
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Multimodal imaging in partial optic nerve head avulsion p. 431
Manavi D Sindal, Bholesh Ratna, Annaji Rao Kota
DOI:10.4103/ijo.IJO_3132_20  
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Photic and postprandial amaurosis in Takayasu arteritis p. 433
J Anandhi, Thendral Velmurugan, Gitanjali Chellapandi
DOI:10.4103/ijo.IJO_3175_20  
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Eyelid lipoma – A rare entity p. 435
Upasna Ajmani, Karamjit Singh, Prempal Kaur, Rajesh Kumar, Shivani , Swati Setia
DOI:10.4103/ijo.IJO_2899_20  
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Management of congenital ectropion of bilateral upper and lower eyelids in Down's syndrome p. 437
G Seethapathy, Jitendra Jethani
DOI:10.4103/ijo.IJO_2902_20  
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Dermatitis passivata over eyebrow mimicking seborrheic keratosis: A peculiar complication following cataract surgery p. 439
Jaspriya Sandhu, Amandeep Singh, Sunil K Gupta, Palvi Singla
DOI:10.4103/ijo.IJO_2983_20  
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The clue lies in the details p. 441
Md Shahid Alam, Prabrisha Banerjee
DOI:10.4103/ijo.IJO_2851_20  
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OPHTHALMIC IMAGES Top

Concentric rings after femtosecond laser-assisted phacoemulsification with Descemet's membrane endothelial keratoplasty p. 443
Jose A Gegundez-Fernandez, Barbara Burgos-Blasco, David Diaz-Valle
DOI:10.4103/ijo.IJO_2847_20  
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Ocular findings associated with arthrogryposis multiplex congenita p. 444
Elizabeth Sasikala Anilkumar, Kalpana Narendran
DOI:10.4103/ijo.IJO_192_21  
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Fungal corneal ulcer: Through the eyes of a Scheimpflug camera p. 445
Shruthy V Ramesh, Prasanna V Ramesh, Meena K Ramesh, Ramesh Rajasekaran
DOI:10.4103/ijo.IJO_3140_20  
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Perforating injury of the cornea by bee sting p. 446
Sandeep Choudhary, Gaurav Gupta, Manu Saini
DOI:10.4103/ijo.IJO_219_21  
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Cilia incarnatum: A rare variant of an eyelash p. 447
Pratheeba D Nivean, Ramesh Dorairajan, Varshini Ramesh, Nivean Madhivanan
DOI:10.4103/ijo.IJO_240_21  
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Hypopyon in Calotropis toxicity p. 448
Venugopal Anitha, Meenakshi Ravindran
DOI:10.4103/ijo.IJO_358_21  
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Intracameral ‘Poké Ball' sign p. 449
Kushal Delhiwala, Rushik Patel, Bakulesh Khamar
DOI:10.4103/ijo.IJO_3370_20  
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Self-resolving cataract - “Lens feathering“ p. 450
Bholesh Ratna, Manavi D Sindal
DOI:10.4103/ijo.IJO_3485_20  
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A ‘galaxy'-like blue dot cataract p. 451
Surbhi Khurana, Parul C Gupta, Ranjan K Behera, Jagat Ram
DOI:10.4103/ijo.IJO_3803_20  
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Quadrantic lamellar lens opacity - Rule out Stickler! p. 452
Vanshaj Rai, Aditi Parab, Priya Sivakumar
DOI:10.4103/ijo.IJO_129_21  
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Distant direct ophthalmoscopy of lenticular coloboma explained p. 453
Sudarshan K Khokhar, Amber A Bhayana, Priyanka Prasad, Vimal Vashistha, Shorya V Azad
DOI:10.4103/ijo.IJO_3690_20  
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Persistent fetal vasculature with membranous cataract p. 454
Wu Xiang, Weirong Chen
DOI:10.4103/ijo.IJO_3677_20  
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Birefringence in ophthalmic lenses Highly accessed article p. 455
Neelima Manchikanti, Srikanth Maseedupalli
DOI:10.4103/ijo.IJO_2709_20  
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An after-after-cataract p. 456
Bharat Gurnani, Kirandeep Kaur, Poorani Rajendran
DOI:10.4103/ijo.IJO_3477_20  
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A novel sign for the endpoint of viscoaspiration - “Fluid gush disappearance” p. 457
Sudarshan K Khokhar, Amber A Bhayana, Aarush Deora, Priyanka Prasad
DOI:10.4103/ijo.IJO_3749_20  
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Capsular neovascularisation in uveitis p. 458
Harsha Bhattacharjee, Suklengmung Buragohain, Henal Javeri
DOI:10.4103/ijo.IJO_3625_20  
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Zonular laxity and pupillary block glaucoma in microspherophakia p. 459
Vijayalakshmi A Senthilkumar, Shilpa More
DOI:10.4103/ijo.IJO_3066_20  
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Sign of filtration in non-valved glaucoma drainage device p. 460
Premanand Chandran, Ganesh V Raman
DOI:10.4103/ijo.IJO_3218_20  
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Active vitreous hemorrhage on real-time video-angiography p. 461
Mumin Hocaoglu, Isil Sayman Muslubas, M Giray Ersoz, Serra Arf, Murat Karacorlu
DOI:10.4103/ijo.IJO_2897_20  
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Blue autofluorescence markers of reactivation of choroidal neovascularization in age-related macular degeneration p. 462
Sujay Herekar, Rupak Roy, Kumar Saurabh
DOI:10.4103/ijo.IJO_3101_20  
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Isolated retinal metastasis from non-small cell lung cancer p. 463
Philip P Storey, Basil K Williams Jr., Carol L Shields
DOI:10.4103/ijo.IJO_3195_20  
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Magnetic resonance imaging of simultaneous ipsilateral choroidal melanoma and orbital cavernous hemangioma p. 464
Leonardo Lando, Kanchan Sainani, Hatem Krema
DOI:10.4103/ijo.IJO_249_21  
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Developmental delay, vision impairment, and the “double-ring sign” p. 465
Vinodkumar M Kariyappa, Bhanudeep Singanamalla, Shweta Chaurasia, Priyanka Madaan, Lokesh Saini, Sameer Vyas
DOI:10.4103/ijo.IJO_475_21  
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CASE REPORTS Top

Unusual presentation of conjunctivo-palpebral dermoid Highly accessed article p. 466
Nibedita Das, Joyeeta Das
DOI:10.4103/ijo.IJO_3326_20  
A 10-year-old girl child presented with a chronic history of redness and itching in her right eye. Slit-lamp examination revealed two small reddish flat masses with few caterpillar hair-like structures in the lower palpebral tarsal conjunctiva simulating ophthalmia nodosa. However, histopathology of the excised mass showed a lesion composed of stratified squamous epithelium with hair follicles and adnexal tissues embedded in fibro collagenous substance compatible with dermoid choristoma. Different types of choristoma in bulbar conjunctiva, eyelid, and orbit have been mentioned in earlier literature. Palpebral conjunctival dermoid choristoma has been rarely described previously and the current case is a unique presentation of that entity.
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Drawstring temporary tarsorrhaphy with tarsal internal fixation for corneal protection p. 469
Maria Miura, Hidenaga Kobashi, Hualei Zhai, Joseph B Ciolino
DOI:10.4103/ijo.IJO_2091_20  
For a 47-year-old woman presented with a persistent corneal ulcer that was refractory to antibiotic drugs and amniotic transplantation, we performed both drawstring temporary tarsorrhaphy with tarsal internal fixation of the upper lid. Two weeks postoperatively the epithelial defect was resolved. The eyelid did not exhibit any complications such as trichiasis or skin necrosis. A drawstring temporary tarsorrhaphy with tarsal internal fixation was an effective treatment for the protection of the ocular surface and can be used to treat persistent corneal epithelial defects and exposure keratopathy.
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Overnight orthokeratology lens-related corneal endothelium deficiency in a 23-year-old woman: A case report p. 471
Zhang H Mei, Zhu Ying, Lin W Ping, Wei R Hua
DOI:10.4103/ijo.IJO_2133_20  
More children select OK lens to control myopia. Corneal endothelial cells (CECs) were used to assess the safety of OK lens. We reported a unique case of CECs deficiency in a high myopic woman who wore OK lens for 8 years. She followed up irregularly and did not replace the lens in time. The lenses were covered with thick protein membrane and scratches. Her endothelial cells density (ECD) dropped significantly. It remained at low level until 3-year follow-up. In conclusion, there is a great need for patient education regarding the potential risks involved with the increasing popularity of OK lenses.
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Platelet-rich plasma and fibrin glue for conjunctival autograft attachment in a recurrent neurotrophic sclero-conjunctival ulcer secondary to a chemical burn: A case report p. 474
Alba Gómez-Benlloch, Borja Salvador-Culla, María F de la Paz
DOI:10.4103/ijo.IJO_1175_20  
A patient with recurrent neurotrophic sclero-conjunctival ulcer secondary to chemical injury with sodium hydroxide underwent three failed amniotic membrane transplants and a resection of the keratinized tissue plus oral mucosal graft. Despite this intensive treatment, the ulcer did not close completely. Thus, a conjunctival autograft from the contralateral eye was performed, together with autologous platelet-rich plasma (PRP) and fibrin glue (FG) to attach the graft. One year later, the eye was quiet, with no signs of sclero-conjunctival ulcer. The mixture of PRP and FG appears to be capable of attaching a conjunctival autograft and promoting the healing of sclero-conjuctival ulcers.
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Medical device composed of amniotic membrane inhibits the rapid progression of acute calcareous degeneration caused by ocular graft-versus-host disease: Case report p. 476
Yu-Jung Wan, I-Hsin Ma, Huai-Wen Chang, Wei-Li Chen
DOI:10.4103/ijo.IJO_2540_20  
A 27-year-old man who underwent hematopoietic stem cell transplantation (HSCT) for the treatment of T-cell acute lymphoblastic leukemia presented with bilateral persistent corneal erosions. Acute calcareous deposition was later found in both eyes, and the ocular condition deteriorated rapidly. Active treatment with topical lubricants, topical anti-inflammatory agents, autologous serum, and punctal plug insertion were applied but in vain. Amniotic membrane (Prokera) was then applied in both eyes, and the corneal erosion and ocular inflammation improved rapidly. The intrastromal calcium deposition remained and did not progress.
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Crosslinking as a treatment option for lipid keratopathy p. 479
Esteban Santiago
DOI:10.4103/ijo.IJO_3487_20  
The purpose of this case report was to present a case of a patient treated with corneal collagen crosslinking for keratoconus with the secondary benefit of improvement of an established lipid keratopathy. After one session of crosslinking in both eyes, a marked regression of the lipid keratopathy in OS was observed in the 9th month follow-up visit. To the best of our knowledge, this is the first case report of lipid keratopathy improvement with crosslinking treatment. This can be another option when treating this condition in order to prevent visual loss and more invasive treatments.
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Successful visual rehabilitation with penetrating keratoplasty and doughnut amniotic membrane transplant for corneal scarring in advanced Mooren's ulcer p. 481
Aravind Roy, Rakhi D Cruz, Sowjanya Vuyyuru, Somasheila I Murthy
DOI:10.4103/ijo.IJO_203_21  
A 37-year-old one-eyed woman presented with a 3-month history of active Mooren's ulcer in her right eye. Conjunctival resection with tissue adhesive and bandage contact lens was performed thrice, despite which the eye progressed to total vascularized corneal scarring. After control of inflammation with systemic corticosteroids and immunomodulators, 10 months later she underwent penetrating keratoplasty with amniotic membrane transplant and tarsorrhaphy. At 2-year follow-up, the graft remained clear with no disease recurrence. This case highlights the modified surgical technique and the role of systemic immunosuppression while planning keratoplasty to achieve a successful outcome in end-stage Mooren's ulcer.
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A case series of donor tissue-transmitted keratitis and endophthalmitis following Descemet stripping automated endothelial keratoplasty: Management and outcomes p. 484
Ritika Mukhija, Vatika Jain, Saumya Yadav, Murugesan Vanathi, Radhika Tandon
DOI:10.4103/ijo.IJO_1637_20  
Donor-transmitted infection is one of the most dreaded complications after cornea transplant. We report four cases of fulminant graft infection with endophthalmitis following descemet stripping automated endothelial keratoplasty (DSAEK); all of these resulted from donor contamination by multidrug-resistant gram-negative bacteria (Pseudomonas in two cases, Proteus and Enterobacter in the other two). All donor corneas were retrieved in hospital premises, either ward or mortuary suggesting a possible nosocomial origin of these microorganisms. All four patients required surgical intervention for control of infection and had dismal clinical outcomes. Furthermore, in three cases, mate cornea also showed similar contamination, and additional two of these recipients also developed graft infection indicating an infection rate as high as 86%. This case series highlights an important issue of fulminant nosocomial donor cornea-related infections, possible despite standard precautions, with emergence of multidrug-resistant virulent pathogens. Adequate training of eye bank and health-care personnel and ensuing stringent protocols for retrieval and storage of corneas may help in reducing such sight-threatening adverse reactions and also consequent further ramifications.
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Ultrasound biomicroscopy findings and histopathological characteristics of anterior chamber cholesterolosis: A case report and literature review p. 489
Simran Mangwani-Mordani, Arturo Ramirez-Miranda, Gabriela del C Ruiz-Gonzalez, Lulu U Gurria, Enrique O Graue-Hernandez
DOI:10.4103/ijo.IJO_3105_20  
Anterior chamber cholesterolosis is an unusual finding, commonly caused by ocular trauma. Pathogenesis is still unknown; therefore, cases should be reported to determine correlations between past medical history and suggest probable etiologies. A 27-year-old male presented with normal vision in the right eye and no light perception in the left after suffering blunt ocular trauma. Ocular examination showed freely movable, highly refractile crystals forming a pseudohypopyon in the anterior chamber. B-scan ultrasonography revealed close funnel retinal detachment, ultrasound biomicroscopy showed cholesterol crystals in the anterior chamber and irideocorneal angle. Anterior chamber washout was performed, and aspirate indicated rhomboidal cholesterol crystals.
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Intra-lenticular metallic foreign bodies – A series of three cases p. 492
Richa Gupta, Abhishek Varshney
DOI:10.4103/ijo.IJO_3295_20  
Three consecutive cases presenting with intra-lenticular foreign bodies (ILFBs) were included in this series. ILFB retrieval with Kelman–McPherson forceps, along with cataract extraction and intraocular lens implantation in the bag was performed as a single-staged procedure for all under peri-operative systemic and topical steroids. Their visual recovery was excellent at 4 months with best-corrected visual acuity of 20/20, N6. Careful clinical and relevant radiological evaluation is paramount following penetrating ocular injury to rule out intraocular foreign body, especially ferrous, to avert the most visually debilitating sequelae of ocular siderosis. This series highlights a favourable outcome of ILFB removal with concurrent management of cataract.
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Fish-shaped anterior capsular rupture with anterior subcapsular cataract following blunt trauma in a young man: Case report p. 495
Nikunj Tank, Shivani Dixit, Purvi Bhagat
DOI:10.4103/ijo.IJO_2938_20  
A 20-year-old man presented with a history of blunt trauma by a rubber ball to his right eye. His visual acuity in the affected eye was 20/120 for distance and N36 for near. The lens showed anterior capsule tear with anterior subcapsular cataract, which did not progress to maturation even after 1 month. Following initial conservative management, phacoemulsification with a three-piece monofocal intraocular lens (IOL) implantation was performed and best-corrected visual acuity (BCVA) of 20/20 was achieved. This represents one of the few cases of blunt trauma presenting as an isolated anterior capsule rupture and anterior subcapsular cataract without mature cataract formation.
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Misplaced and invisible intraocular lens p. 497
Madhusmita Behera, Subrata Mandal, Pankaj Rupauliha
DOI:10.4103/ijo.IJO_3131_20  
Traumatic dislocation of foldable posterior chamber intraocular lens (PCIOL) is very rare and an emergency condition. Again, intra-operative dislocation of foldable PCIOL is very rare. We are reporting a case of inadvertent intraoperative suprachoroidal dislocation of foldable PCIOL without any retinal detachment, irido-dialysis, zonular dialysis, or vitreous loss.
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Trifocal toric intraocular lens implantation for cataract in a young patient with congenital nystagmus p. 499
Purendra Bhasin, Aashish Dhage
DOI:10.4103/ijo.IJO_3288_20  
We report a case of Trifocal Toric IOL implantation in a patient having cataract with congenital nystagmus. A detailed ocular assessment for pre- and postoperative uniocular and binocular visual acuity, nystagmus characteristics, abnormal head posture, fundus examination, IOP measurement, and biometry was carried out. Preoperative visual acuity was 6/12p and 6/18p in right and left eye, respectively, with binocular visual acuity of 6/12p. Postoperative visual acuity was 6/12 in right and 6/9 in the left eye, respectively. Binocular visual acuity was 6/9 for far and N6 at 40 cm for near after implantation of a trifocal toric IOL. No change in nystagmus characteristics was observed.
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Escitalopram-induced bilateral secondary angle-closure with uncommon associations p. 501
Rajwinder Kaur, Ekta Gupta, Anupriya Aggarwal
DOI:10.4103/ijo.IJO_2925_20  
Acute angle closure is a rare complication in patients receiving antidepressant treatment. We report two uncommon associations of acute-onset myopia with internal limiting membrane folds and soft exudates following the use of escitalopram. A 28-year-old woman, with no prior history of glasses, taking escitalopram for depression, presented with decreased vision. On examination, she was found to have myopic shift in both eyes and intraocular pressure of 38 mm Hg and 40 mm Hg in the right and left eye, respectively. She had closed angles on gonioscopy; anterior displacement of the iris-lens diaphragm on B-scan and undilated fundus examination revealed soft exudates and inner limiting membrane folds at the macula in both eyes. It is highly important that clinicians be made aware of the risk factors associated with drug-induced secondary acute angle closure with an antidepressant. History taking plays a significant role play in view of any hepatic and renal dysfunction.
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Unilateral acute secondary angle-closure glaucoma in active thyroid eye disease p. 503
Vijayalakshmi A Senthilkumar, Chinmayee Pradhan, Sindhu Dosapati, R Krishnadas
DOI:10.4103/ijo.IJO_3260_20  
Thyroid eye disease (TED) is the most common and disfiguring orbital disease in adults. This complex condition is characterized by autoimmune-mediated inflammation of the orbital soft tissues, extraocular muscles, and eyelids. Majority of those with TED have autoimmune hyperthyroidism (Graves disease), but rarely patients can have hypothyroidism or normal thyroid function. Association of TED with open-angle glaucoma has been reported widely, whereas its association with angle-closure glaucoma has been sparsely reported as case reports. We report two instances of secondary angle-closure glaucoma (SACG) in patients with active TED, with focus on clinical presentation, diagnostic challenges, and presumed mechanisms of angle closure.
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Familial exudative vitreoretinopathy presenting as bilateral secondary angle-closure p. 506
Gaurav Gupta, Raghulnadhan Ramanadhane, Deepika Dhingra, Surinder Singh Pandav, Sushmita Kaushik, Faisal Thattaruthody, Mohit Dogra
DOI:10.4103/ijo.IJO_2109_20  
A 24-year-old man presented with sudden-onset bilateral simultaneous angle closure with intraocular pressure (IOP) of 30 and 52 mm Hg in the right and left eye, respectively. Ultrasound biomicroscopy detected the presence of bilateral supraciliary fluid, whereas fundus appearance was suggestive of familial exudative vitreoretinopathy (FEVR). He was managed with cycloplegics, topical steroids, and anti-glaucoma medications (AGM) followed by cryotherapy to peripheral leaking retinal vessels of both eyes, once IOP was controlled and supraciliary fluid resolved. Any patient with bilateral simultaneous angle closure must alert one to look beyond the diagnosis of primary angle closure and search for secondary causes.
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Dangerous and deadly phenytoin-induced idiosyncratic mydriatic reaction in an epileptic patient precipitating a bilateral acute angle-closure attack p. 509
Prasanna Venkatesh Ramesh, Shruthy Vaishali Ramesh, Ramesh Rajasekaran, Meena Kumari Ramesh
DOI:10.4103/ijo.IJO_2862_20  
A 52-year-old woman presented with acute bilateral ocular pain, headache and vomiting. Examination revealed bilateral circum-corneal congestion, 360° closed angles with a shallow chamber and sluggish mid-dilated pupil. Intraocular pressure was 40 and 42 mm Hg in OD and OS respectively. On vigilant history taking, patient revealed administration of Phenytoin for her epileptic event recently. The suspected drug was stopped and the symptoms reversed. YAG PI was performed, visual acuity improved to 20/20 with reduction of intraocular pressures to normal. This case highlights the risk of developing bilateral acute angle-closure attack after Phenytoin administration.
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Hypotonous malignant glaucoma following glaucoma drainage device implantation p. 512
Suresh Kumar, Ekta Singla, Parul Ichhpujani, Obaidur Rehman
DOI:10.4103/ijo.IJO_2545_20  
Malignant glaucoma also known as “aqueous misdirection” is a frightening complication post glaucoma surgery. The usual presentation is with high intraocular pressure with flat anterior chamber both centrally and peripherally. The management option includes pharmacotherapy, laser and pars plana vitrectomy(PPV). We describe a case of malignant glaucoma which presented one day after the surgery with low intraocular pressure. The patient was managed by anterior vitrectomy via paracentesis with anterior vitrectomy settings by glaucoma surgeon.
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A curious case of unilateral buphthalmos: Angle-closure glaucoma secondary to uveitis in a newborn p. 515
Sushma Tejwani, Vijna Kamath, Nimisha Sharma
DOI:10.4103/ijo.IJO_2990_20  
Unilateral secondary angle-closure glaucoma due to uveitis is a rare presentation in a neonate. While the congenital pupillary membranes present predominantly with iris and pupillary changes, glaucoma being a late presentation in a milder form. We report an unusual presentation of a few weeks old baby, having unilateral buphthalmos, normal iris, flat anterior chamber, and elevated intraocular pressure with a pupillary membrane, causing secondary angle-closure glaucoma. There was indirect evidence of maternal infection during the antenatal period with raised IgG titers. The case was managed with anterior chamber reformation, iridectomy along with membranectomy, and did not require trabeculectomy.
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Bilateral buphthalmos associated with neonatal-onset ectropion uveae, microspherophakia and pigment dispersion p. 517
Vijayalakshmi A Senthilkumar, R Krishnadas, A Ravichandar
DOI:10.4103/ijo.IJO_3739_20  
Childhood glaucoma is a potentially blinding disease and poses crucial challenges in both diagnosis and management. We report a rare case of secondary glaucoma associated with nonacquired ocular anomalies in a 3-month infant with a family history of pigmentary glaucoma (PG) in two generations presenting as bilateral buphthalmos associated with ectropion uveae, microspherophakia, and high myopia. The child was successfully managed by combined trabeculotomy and MMC-augmented trabeculectomy with stabilized IOP at 12 months follow-up.
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Bilateral acute iris transillumination in a young woman p. 520
Neethu Mohan, Prasanna Venkataraman, Nithila EG Paul
DOI:10.4103/ijo.IJO_2668_20  
Bilateral acute depigmentation of iris and bilateral acute iris transillumination are entities characterized by acute onset of pigment dispersion in the anterior chamber, discoloration of the iris stroma, pigment deposition in the anterior chamber angle, and elevation of intraocular pressure. A 39-year-old woman presented with acute onset pain and redness in both eyes. On examination, both eyes showed clear cornea, deep anterior chamber, and profound pigment dispersion and raised intraocular pressure with no signs of anterior uveitis. Ocular hypertension was refractory to medical therapy necessitating. Prompt differentiation of this condition from uveitis is crucial to avoid prolonged unwarranted steroid therapy.
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New-onset anterior uveitis in two patients on ustekinumab for inflammatory bowel disease p. 522
Gabrielle Fridman, Kara C LaMattina
DOI:10.4103/ijo.IJO_3248_20  
This report presents the first published cases of new-onset uveitis in patients on ustekinumab therapy. We present two patients with inflammatory bowel disease who developed anterior uveitis while on ustekinumab 90 mg every 8 weeks. Both patients achieved quiescence of their uveitis and improved control of their systemic disease with increased dose frequency of ustekinumab at every 4 weeks. Further investigation is warranted to determine if a true association exists.
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Intermediate uveitis: A rare diagnosis of brucellosis in eastern India p. 524
Krishnapada Baidya, Bratatee Roy, Sneha Jain
DOI:10.4103/ijo.IJO_3024_20  
Brucellosis is endemic to India but remains highly underdiagnosed. We report an unusual case of intermediate uveitis with Brucella etiology (BE). A 45-year old female from eastern India complains of diminution of vision and floaters in both eyes (BE), worsening over the last 6 months. Previously, she received on and off oral steroids for 2 years. Her BCVA in right eye (RE) was 20/160 and left eye (LE) was 20/200. She had old keratic precipitates, posterior subcapsular cataract, and vitritis in BE. On ELISA, she was positive for Brucella IgM antibodies. Subsequently, oral antibiotics improved her vision. Ocular involvement in brucellosis, can cause severe vision-threatening complications. An early diagnosis of brucellosis can thus save sight.
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Massive serous macular detachment after an uneventful combined trabeculotomy with trabeculectomy in two cases of Sturge-Weber syndrome resolved with oral propranolol p. 526
Mohit P Gajbhiye, Sirisha Senthil
DOI:10.4103/ijo.IJO_3022_20  
Managing glaucoma in Sturge-Weber syndrome (SWS) is refractory needing surgery, which is often associated with serious complications. We report massive serous macular detachment in two patients with SWS following uneventful combined trabeculotomy with trabeculectomy (CTT). Two children with SWS and choroidal haemangioma underwent CTT with all pre-, peri- and postoperative precautions. Few days postoperatively, a large serous macular detachment was noted with a significant drop in vision. They were treated with oral propranolol (2 mg/Kg bodyweight with pediatricians' monitoring for 6-weeks) which helped in complete resolution of subretinal fluid in 1-month with good improvement in visual acuity and well-controlled IOP.
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Recurrent central serous chorioretinopathy in a surgically closed traumatic macular hole p. 529
Manoj Soman, KR Sheera, Unnikrishnan Nair
DOI:10.4103/ijo.IJO_2853_20  
A 36-year-old gentleman with history of central serous chorioretinopathy (CSCR) developed full thickness macular hole in the right eye with recurrence of CSCR 2 weeks after blunt trauma to his right eye. Vitrectomy resulted in complete closure of the macular hole and resolution of the subretinal fluid. Post macular hole surgery he developed two episodes of CSCR recurrence with no reopening of the hole. This report hypothesises the possible mechanisms underlying this unusual association and explains how a surgically manipulated macular tissue could endure significant submacular fluid accumulation.
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Structural and functional recovery of macular atrophy following acute traumatic maculopathy p. 532
Duncan Lyons, Brett Drury
DOI:10.4103/ijo.IJO_1651_20  
This case report describes a rare case of spontaneous structural and functional recovery of macular atrophy following acute traumatic maculopathy. A 53-year-old man suffered a blunt left-eye injury. Initial optical coherence tomography showed evidence of macular hole formation. Over the following month, macular atrophy developed, with left best-corrected visual acuity ranging from 6/24 to 6/18. Following 14 months, the atrophy spontaneously resolved – correlating with left visual acuity improving to 6/6. Although the outcome from severe traumatic maculopathy and subsequent macular atrophy is almost uniformly considered to be poor, this rare case demonstrates that spontaneous recovery may still occur.
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Can there be smoke without fire? Optical coherence tomography angiography has the answer p. 535
Thoguluva P Vignesh, Piyush Kohli, Jayant Kumar, Philip J Rosenfeld, Kim Ramasamy
DOI:10.4103/ijo.IJO_2654_20  
Macular edema is typically seen on optical coherence tomography (OCT) as fluid-filled cystic alterations that cause increased retinal thickness. The increased OCT reflectivity within these intraretinal spaces in the outer avascular retina can exhibit flow-like properties when imaged using OCT angiography (OCTA). The motion signal arising from within these intraretinal cavities corresponds to a feature of exudation known as suspended scattering particles in motion (SSPiM). We present multimodal imaging of a patient with SSPiM who underwent partial resolution of this OCTA finding.
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Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to laser pointer injury in a child p. 538
Pilar Llavero-Valero, María José Morillo-Sánchez, Borja Domínguez-Serrano, Antonio José Gómez-Escobar, Estanislao Gutiérrez-Sánchez, Enrique Rodríguez de la Rúa Franch
DOI:10.4103/ijo.IJO_2835_20  
Laser pointers are readily available and are often labeled as toys. A 12-year-old girl was brought to the emergency department complaining of a central scotoma in the right eye after being exposed to a laser pointer. Fundus examination revealed severe maculopathy in both eyes. Optical coherence tomography angiography and fundus angiography examinations revealed choroidal neovascularization in the area of the laser injury in the right eye. One intravitreal anti-VEGF injection was administered in the right eye, resulting in good clinical and structural responses. Intravitreal anti-VEGF may be effective for improving visual outcomes in laser pointer-induced maculopathy complicated with choroidal neovascularization.
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Primary exudative retinal detachment in stage 4b retinopathy of prematurity managed nonsurgically – A case report p. 542
Vishal R Dedhia, Jitendra Jethani
DOI:10.4103/ijo.IJO_1752_20  
Preterm baby born at 30 weeks of gestation presented at 3 weeks with zone 1 stage 3 retinopathy of prematurity (ROP) with plus disease in the right eye and zone 1 stage 4b ROP with plus disease in the left eye. We report this rare primary presentation of exudative retinal detachment in ROP in the left eye managed by concurrent laser photocoagulation and intravitreal injection anti-VEGF. ROP regressed completely in 6 weeks. The right eye was managed similarly. Stage 4b ROP usually requires surgical intervention. We report this rare presentation managed nonsurgically with good prognosis.
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Multimodal imaging of infantile nephropathic cystinosis p. 545
Krishna K Roy, P Sen, M Lakshmipathy, Raj S Paul
DOI:10.4103/ijo.IJO_1977_20  
Cystinosis is a lysosomal storage disorder characterized by cystine crystal accumulation in different parts of body including the eyes. The purpose of this article was to describe different ophthalmological abnormalities in cystinosis using multimodal imaging. A 5-year-old girl with cystinosis was assessed clinically and with slit-lamp photography (SLP), anterior segment-OCT (AS-OCT), in vivo confocal microscopy (IVCM), fundus photography, swept-source optical coherence tomography (SS-OCT), and fundus autofluorescence. Based on all findings, she was diagnosed with ocular cystinosis. Corneal crystals were better visualized by IVCM than AS-OCT or SLP. Retinal crystal were well delineated by OCT.
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Intravitreal triamcinolone in the treatment of serous retinal detachment secondary to choroidal osteoma without choroidal neovascularization: A case report p. 548
Fang-Yi Chiu, Lee-Jen Chen, Wei-Chun Chan, Shawn Tsai
DOI:10.4103/ijo.IJO_3259_20  
Choroidal osteoma (CO) is a rare, benign, ossifying tumor of the choroid usually seen in otherwise healthy eyes. Vision impairment in CO is mainly attributed to serous retinal detachment (SRD) with or without choroidal neovascularization (CNV) and subfoveal tumor decalcification. We report a 54-year-old man with CO-related SRD without concomitant CNV in his right eye. The subretinal fluid was refractory to intravitreal aflibercept injections. Intravitreal injections of triamcinolone acetonide (IVTA) were performed and resulted in significant fluid resolution and remarkable visual improvement. This is the first reported case in the literature demonstrating the efficacy of IVTA in CO-related SRD.
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A rare association of phakomatosis p. 551
Dharmeswari Thangaraju, Priya Sivakumar
DOI:10.4103/ijo.IJO_2563_20  
Simultaneous occurrence of neurofibromatosis and tuberous sclerosis is very rare. A 55-year-old hypertensive man was referred for ophthalmic evaluation. On examination, Lisch nodules were seen over the iris in both the eyes with fundus showing bilateral temporal pallor. Magnetic resonance imaging (MRI) brain was done to rule out optic pathway gliomas. MRI brain was negative for gliomas but showed subependymal nodules in the ventricles, a feature of Tuberous sclerosis. A screening computed tomography (CT) abdomen showed multiple angiomyolipoma in the kidney, which confirmed the diagnosis. It is important to be aware of this rare co-existence so that a devastating consequence can be prevented.
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Acute endophthalmitis caused by Ochrobactrum anthropi following cataract surgery in an immunocompetent patient – A case report p. 554
Adwaita Nag, Aditya Verma, AR Anand
DOI:10.4103/ijo.IJO_3080_20  
A 54-year-old man developed left eye inflammation three days after cataract surgery and was diagnosed with endophthalmitis. Aqueous culture revealed Ochrobactrum anthropi resistant to vancomycin and cephalosporin. Systemic and intravitreal ciprofloxacin injections caused only transient improvement and eventually, pars plana vitrectomy was done. There was complete resolution, good visual recovery, and no recurrence. O.anthropi is an uncommon organism with a characteristic resistance to empirical antibiotics and usually causes chronic infection in immunocompromised. We report a rare case of acute endophthalmitis in an immunocompetent patient. To the best of our knowledge, this is the first report of O. anthropi endophthalmitis from India.
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Postoperative endophthalmitis by Scedosporium apiospermum – A case report p. 557
Manisha Agarwal, Ankit Garg, Julie Pegu, Shalini Singh, Shalin Shah, Arpan Gandhi
DOI:10.4103/ijo.IJO_2970_20  
A male patient underwent an uneventful cataract surgery. He developed fungal postoperative endophthalmitis by Scedosporium apiospermum species. This fungus is a common cause of endogenous endophthalmitis in immunocompromised patients with poor visual outcomes. We report this case to share our experience of managing fulminant postoperative endophthalmitis with an iris fungal ball in an immunocompetent patient caused by S. apiospermum.
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Positive syphilis serology in a case of endogenous candida endophthalmitis posing a diagnostic dilemma p. 561
Amruta More, Alok Sen, Gaurav Kohli, Pratik Shenoy, Amod Gupta
DOI:10.4103/ijo.IJO_2674_20  
Endogenous candida endophthalmitis (ECE) being a rare entity can often be misdiagnosed particularly in a seropositive debilitated patient. Ocular syphilis may have protean clinical manifestations and may be difficult to diagnose in absence of typical clinical manifestations. A high index of suspicion based on the clinical picture and imaging features may aid in differentiating these clinical entities. We report a case of ECE in a diabetic patient with a positive syphilis serology, the co-existence of which posed a diagnostic dilemma. We discuss the pragmatic approach and management for such a perplexing scenario.
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COMMENTARY Top

Commentary: A curious case of double dilemma p. 564
Bala Murugan Sivaraman, Eliza Anthony
DOI:10.4103/ijo.IJO_259_21  
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CASE REPORTS Top

Bilateral congenital rubella retinopathy in monochorionic monoamniotic twins: A case report p. 566
Suklengmung Buragohain, Dipankar Das, Nilutparna Deori, Hemlata Deka, Damaris Magdalene, Anubhi Paharia
DOI:10.4103/ijo.IJO_3356_20  
Congenital rubella syndrome in twins is rare, and when present, there is a variable effect on the fetuses depending on unknown factors. The available literature on CRS in twins is very limited with only a few reported cases. We report a rare case of a pair of monochorionic monoamniotic twins who were diagnosed as having bilateral congenital rubella retinopathy in both eyes.
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Subthreshold micropulse laser treating residual macular subretinal fluid after rhegmatogenous retinal detachment surgery: A case report p. 568
Khaled El Matri, Yousra Falfoul, Nibrass Chaker, Ahmed Chebil, Rim Bouraoui, Leila El Matri
DOI:10.4103/ijo.IJO_2728_20  
We report the effect of micropulse laser (MPL) treating a case of residual subretinal fluid (SRF) after rhegmatogenous retinal detachment (RRD) surgery. A 38-year-old male patient presenting with residual SRF 6 months following RRD surgery. Initial central macular thickness (CMT) was 243 μm. A 3 × 3 MPL macular grid was performed with moderate reduction of SRF (CMT = 191 μm). Five months following second MPL session, we noted a complete resolution of SRF (CMT = 98 μm) and fundus autofluorescence did not show any laser scare. Micropulse laser might represent a new non-invasive efficient treatment for residual SRF after RDD surgery. MPL effect seemed to be delayed and close follow-up was necessary.
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Scleral rupture during micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachment - A case report p. 571
Rohini Grover, Abhishek Varshney, Supreet Juneja
DOI:10.4103/ijo.IJO_2722_20  
Scleral rupture during 23-gauge pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment, without known predisposing factors, is a rare but catastrophic complication. Scleral rupture in our patient developed in superotemporal quadrant corresponding to the area of chorioretinal atrophy in retina. Prompt suturing of scleral rupture, usage of perfluoro-N-octane (PFO) as short-term endo-tamponade, and removal of epiretinal membrane (ERM) under silicone oil (SO) were the major contributing factors leading to successful outcome. High index of suspicion should be kept for any chorioretinal atrophic patches and sclera corresponding to these areas should be carefully examined for any pathosis.
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Persistent fetal vasculature with microphakia, lacrimal drainage disorder, and congenital ptosis: An unusual presentation p. 574
Surbhi Khurana, Parul C Gupta, Jagat Ram
DOI:10.4103/ijo.IJO_3254_20  
Persistent fetal vasculature (PFV) is a rare congenital ocular anomaly, characterized by failure of regression of embryonal hyaloid vasculature and is known to cause a broad range of anomalies. We report a 3-month old female infant with PFV, congenital nasolacrimal duct obstruction, and congenital ptosis in the left eye. At the time of lens aspiration, microphakia was seen after dilatation with a Malyugin ring. The child underwent uneventful lens aspiration, primary posterior capsulotomy, and anterior vitrectomy. All these features point towards role of abnormal embryological development in PFV. The meticulous surgical technique is essential to prevent intraoperative and postoperative complications in these patients.
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True muscle transplantation surgery for large angle exotropia: A case series p. 577
Sonali Rao, Atulyakruti Gupta
DOI:10.4103/ijo.IJO_3308_20  
Managing large-angle exotropia (>70 PD) can be challenging with the various techniques available. In this case series, we present “True Muscle Transplantation"––a simple technique––to manage large-angle sensory exotropia as a possible alternative. Seven patients (four women and three men) of mean age 39.71 ± 17.38 years with sensory large-angle exotropia (>70 PD) underwent proposed surgery after detailed preoperative workup. The stump resected from MR was transplanted to LR and recessed. The mean preoperative deviation of 77.14 ± 4.52 PD base-in reduced to mean postoperative angle of 4.71 ± 4.42 PD at 6 months with good ocular alignment, no lateral incommittance, and no limitation of ductions in all patients. Stable results were maintained beyond 6 months. True Muscle Transplantation, therefore, has the potential of being a possible alternative.
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A case of cyclical Brown's syndrome p. 580
Snehal Ganatra, Shashikant Shetty, Meeralakshmi Prajna, Neha Chauhan, P Vijayalakshmi
DOI:10.4103/ijo.IJO_2365_20  
A 5-year-old girl presented with limitation of elevation in adduction in her left eye. She had history of intermittent deviation in the left eye for the past 2 months. Parents gave a characteristic history that she had an obvious deviation when she woke up in the morning and resolved as the day progressed. Neuroimaging and ocular examination was unremarkable. Only one such case of intermittent Brown's syndrome has been reported in the past in a patient with history of maxillary sinusitis. Herein, we present a case that shows a unique presentation of an intermittent heterotropia without any systemic associations.
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Botulinum toxin: A surgery-sparing strategy for cyclic esotropia p. 582
Sandra C Ganesh, DS Srushti, Kalpana Narendran
DOI:10.4103/ijo.IJO_2896_20  
Cyclic esotropia is associated with alternating periods of esotropia and orthotropia within a defined cycle, occurring typically in pre-school children. Therapeutic options include surgery which is based on strabismic day angle, or injection of botulinum toxin into the medial rectus muscle. The latter is a simpler, less invasive, and potentially surgery sparing option causing a temporary drug-induced muscle paresis and providing enough opportunity to regain the fusion potential. We report one such case of childhood cyclic esotropia treated with injection botulinum toxin.
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A rare case of racemose ocular myocysticercosis masquerading as exotropic Duane's retraction syndrome p. 585
Sumit Monga, Puneet Jain, Geeta Sethi
DOI:10.4103/ijo.IJO_3138_20  
A 13-year-old girl presented with recent onset diplopia. At presentation, she had an ocular motility deficit resembling left eye exotropic-Duane's retraction syndrome. On imaging, her left eye lateral rectus was grossly swollen, with the presence of an elongated cystic lesion in its belly. The latter was a rare presentation of racemose cysticercosis, an uncommon variant of neurocysticercosis, hitherto unreported in an extraocular muscle. The child was medically managed with oral steroids and albendazole. There was a partial resolution of ocular motility deficit and complete regression of the intramuscular cysticercus lesion.
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Growth retardation-alopecia-pseudoanodontia-optic atrophy (GAPO) syndrome: A rare cause of optic atrophy of optic atrophy p. 588
Aditya Sethi, Sahebaan S Sethi
DOI:10.4103/ijo.IJO_3344_20  
This case reports on a 21/2-year-old male child with GAPO syndrome, a rare autosomal recessive condition characterized by growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O). Since Anderson and Pindborg in 1947 first described this syndrome, close to 30 individuals have been reported with this diagnosis. Often a history of consanguinity is noted, as in our case, in this rare autosomal recessive condition. The phenotype of this condition, initially thought to be a result of ectodermal dysplasia, can be attributed to the accumulation of extracellular connective tissue matrix and its progressive character must be pointed out. The clinical findings, ophthalmological features that include optic atrophy, glaucoma, are reviewed and discussed.
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Transient bilateral disc edema with spontaneous resolution following spine surgery: A rare case report p. 591
Pradeep K Panigrahi
DOI:10.4103/ijo.IJO_145_21  
A 49-year-old man presented with flashes and transient obscuration of vision in both eyes 1 week after spine surgery for disc prolapse. Best-corrected visual acuity was 20/20 in both eyes. Fundoscopy showed bilateral disc edema. All investigations were normal. There was spontaneous resolution of bilateral disc edema 2 months following presentation.
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The diagnostic challenge of ptosis and diplopia: Cavernous sinus syndrome as the sole sign of unknown pancreatic cancer p. 593
Nurhan K Tutar, Sami Omerhoca, Nilufer Kale
DOI:10.4103/ijo.IJO_140_21  
Cavernous sinus syndrome (CSS) is a rare condition that presents with clinical signs and symptoms due to the involvement of the cranial nerves (CN) III, IV, VI, V1, and V2. Various causes such as vascular, inflammatory, infectious, or neoplastic pathologies are involved in the etiology. CSS is rarely the first sign of cancer. In this report, we would like to describe a unique patient who manifested with CSS in which the etiological factor behind the clinic was a metastatic pancreatic adenocarcinoma previously unknown.
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Bilateral external ophthalmoplegia due to uremia in Goodpasture syndrome: A case report p. 596
Niranjan K Pehere, Aulakh Simranjeet, Megha S Uppin
DOI:10.4103/ijo.IJO_2727_20  
Several ophthalmic manifestations have been reported in patients with uremia due to chronic kidney disease (CKD). These include chronic sore eyes, ischemic optic neuropathy, and retinal detachment. In this case report, we discuss a patient of Goodpasture syndrome undergoing hemodialysis for CKD who presented with a complaint of diplopia. The patient had bilateral near-total external ophthalmoplegia, which initially progressed and remained constant at the last follow-up. The patient was neurologically stable with normal neuroimaging; however, his serum creatinine and blood urea levels remained persistently elevated despite regular hemodialysis. After considering several differential diagnoses, we finally arrived at a diagnosis of bilateral external ophthalmoplegia secondary to uremia and propose potential mechanisms for its pathogenesis.
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Orbital foreign body in a child presenting with cardiogenic shock p. 599
Thangjam A Singh, Benjamin Nongrum, Prasanta K Goswami, Renjano N Okhyopvui
DOI:10.4103/ijo.IJO_2795_20  
Orbital foreign bodies can have a variety of presentations like restriction of extraocular movement and orbital cellulitis. A child sustained injury to the right eye with a piece of wood. He had features of cellulitis but no signs of septicemia. The noncontrast computed tomography showed a hyperdense structure suggestive of a large foreign body located in the retro-orbital area upto the apex of the orbit. He presented with shock which was consistent with cardiogenic shock, probably secondary to oculocardiac reflex, as evident by the presence of bradycardia, systemic hypotension and low SpO2. On removal of the foreign body, the vitals improved.
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A rare orbital cyst due to traumatic lens dislocation p. 602
Anan Wang, Qihua Xu, Yaohua Wang, Wanlu Qiu, Hongfei Liao
DOI:10.4103/ijo.IJO_3241_20  
Lens dislocation into the subconjunctival or subtenon's space is a rare but known complication of blunt eye trauma. However, lens dislocation into the orbital space has never been reported. Here, we describe a case of orbital cyst caused by traumatic lens dislocation. A 55-year-old man complained of persistent orbital edema and pain in the right eye after ocular evisceration and orbital implant surgery for severe scleral rupture. Computed tomography showed increased soft-tissue density in the infero-temporal orbital space. An orbitotomy and histological examination confirmed that the mass in the orbit was a cyst that formed from the dislocated lens.
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Paraneoplastic orbital myositis in a patient with natural killer/T-cell lymphoma p. 605
Areum Jeong, Min Kyoung Kim, Joon Hyuk Choi, Won Jae Kim
DOI:10.4103/ijo.IJO_2850_20  
Paraneoplastic orbital myositis can occur in patients with natural killer/T-cell lymphoma (NKTL). A discrepancy between ocular motility examinations and imaging findings may suggest paraneoplastic orbital myositis in patients with malignancy. Extraocular muscle biopsy should be performed for definite diagnosis and appropriate treatment, especially in patients with atypical clinical manifestations.
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Acute orbital presentation in an activated B-cell subtype, diffuse large B-cell lymphoma: clinicoradiological, histopathological and immunohistochemical correlation p. 608
Devjyoti Tripathy, Anuradha Pradhan, Ruchi Mittal
DOI:10.4103/ijo.IJO_2773_20  
Non-Hodgkin's lymphoma is the most common ocular adnexal neoplasm in adults. Involvement of the ocular adnexae can be primary in origin or secondary resulting from systemic disease. We report a 66-year-old male patient with an acute onset of orbital lymphoma with several atypical clinicoradiological features in the absence of any clinical signs of systemic disease at presentation. A histopathological diagnosis of diffuse large B-cell lymphoma was made and immunophenotyping revealed it to be an activated B-cell (ABC) subtype with a “non-double-expressor” phenotype. Rapid progression of disease was noted and resulted in a poor outcome. Clinicoradiological, histopathological, and immunohistochemical correlation is critical for accurate diagnosis in such situations. Additional immunophenotyping to delineate the subtype of DLBCL may have an important role in decision-making regarding the choice of treatment, and may contribute to the prognostication of disease outcome.
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COMMENTARY Top

Commentary: Bilateral occlusive retinal vasculitis in ulcerative colitis p. 611
Padmamalini Mahendradas, Ankush Kawali, Srinivasan Sanjay, Bhujang K Shetty
DOI:10.4103/ijo.IJO_3801_20  
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