Indian Journal of Ophthalmology

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ISSN / EISSN : 0301-4738 / 1998-3689
Published by: Medknow (10.4103)
Total articles ≅ 8,959
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, SantoshGopi Krishna Gadde, Akhila Sridharan, Nikithareddy Gurram, B Poornachandra, Nivedhitha Govindasamy
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_1289_21

Abstract:
Purpose: To compare multicolor imaging (MCI) with Optos color fundus photography (OCFP) for the evaluation of morphology and extent of preretinal membranes in diabetic tractional retinal detachments (TRD). Methods: In this retrospective study, 30 eyes with diabetic TRDs were imaged using the MCI feature of the Heidelberg Spectralis Spectral-domain optical coherence tomography (SD-OCT) and color photo using the Optos Daytona ultra-widefield fundus camera. Two investigators independently graded and determined the agreeability between the two modalities with respect to the extent of the TRD and preretinal membranes on the SD-OCT B-scan images. Results: The MCI provided better visualization of the attachments and traction points of the posterior hyaloid face and preretinal membranes and is comparable to the SD-OCT B-scan images. The inter-rater agreeability rates for OCFP had a Kappa (κ) value of 0.37, while the MCI had a κ value of 0.46. When comparing between images of different wavelengths, grading using infrared reflectance (IR) had a poor agreement (−0.04 ± 0.04) while green reflectance (GR) (0.46 ± 0.32) and blue reflectance (BR) (0.53 ± 0.19) had a moderate agreement. The composite MCI and GR images also had comparatively higher intraclass coefficient when compared to the OCFP (0.25 [−0.09–0.55]) and IR (−0.03 [−0.39–0.34]) images. Conclusion: MCI is more sensitive for determining the extent of TRDs and for the detection of secondary membranes when compared to OCFP, thus, aiding in better surgical planning.
Manpreet Singh, Aditi Mehta, Manpreet Kaur, Pankaj Gupta
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_2710_21

Namrata Sharma, Tushar Agarwal, JeewanS Titiyal, RasikB Vajpayee, Prakhyat Roop
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_150_22

Abstract:
Background : This video shows the dreaded complication of expulsive suprachoroidal haemorrhage in a penetrating keratoplasty . It teaches the various measures that help in preventing and managing the challenge peri-operatively. Purpose: This video is intended to sensitize the corneal surgeons about this rare complication using real-time surgical video and prepare them to face this challenge by demonstrating the preventive and mitigating strategies. Synopsis: A patient who was suitably taken up for an autokeratoplasty had expulsive choroidal haemorrhage in the non-seeing eye. This complication was managed using glycerin-preserved donor corneal button. Further, the video discusses various pre-operative and intra-operative optimizations to avoid such a complication and mitigate the damage caused by it, should it ever happen during a surgery. Highlights: Expulsive choroidal haemorrhage can be a traumatizing event and one must be mentally prepared to manage it. Pre-operative high-risk factors should always be managed and intra-operative maneuvers performed to prevent the complication, as shown in the video. Video link: https://youtu.be/s_ImBugPELw
Mehul Shah, Shreya Shah, Pradeep Chandane, Sakshi Makhloga, Deeksha Thorat, Meera Sanghani
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_1651_21

Abstract:
Purpose: Marfan syndrome (MFS) is a genetic disorder associated with considerable morbidity and mortality. Presently, well-documented information on this condition is not available in India. Methods: In this retrospective cohort study, we recruited patients with clinically diagnosed MFS who presented to the outpatient department using revised Ghent nosology. We retrieved complete ophthalmic information, including vision, anterior and posterior segments, exported from electronic medical records, and relevant investigations, surgical details, and follow-up data were obtained in a specific, pretested format. Results: Our cohort consisted of 86 eyes of 43 patients and had a male preponderance. The prevalence was 20.5 per 100,000 individuals. The mean age of the patients was 23.9 years. All eyes were treated either optically with refraction or surgically using lensectomy and vitrectomy with suture supported scleral fixated intraocular lens (IOL), which significantly affected the visual outcome (P = 0.000). Conclusion: Although considered a rare disease, MFS is commonly found in the ophthalmological setting. Refraction and surgery (lensectomy with scleral fixated IOL) may improve the vision significantly.
, Nimitha Najeeb, Arino John, Vn Anima
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_1389_21

Abstract:
Purpose: To determine the magnitude and direction of association of anxiety and depression and the quality of life (QoL) in persons with glaucoma. Methods: This prospective cross-sectional study in conducted in a tertiary eye center in north Kerala included glaucoma patients and normal subjects aged 40–80 years. The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), Glaucoma Quality of Life (GQOL), and glaucoma evaluation were performed for all participants. One-way analysis of variance was used for statistical analysis. Results: The study included 148 subjects with glaucoma and 150 subjects without glaucoma. The prevalence of depression (35.81%) and anxiety (25.0%) was significantly higher in glaucoma patients. In a multivariate regression model, PHQ-9 (adjusted OR: 2.39, 95% CI: 1.31–4.38, P< 0.001), GAD-7 (adjusted OR: 2.06, 95% CI: 1.01–4.19, P = 0.01) and GQOL (coefficient: 6.92, 95% CI: 4.52–9.31, P = < 0.001) was significantly associated with glaucoma. The GAD-7 score was significantly higher (P = 0.02) in PACG compared to POAG in moderate and severe anxiety. ADL scores (one-way ANOVA, P = 0.001) and GQOL scores (one-way ANOVA, P< 0.001) were significantly associated with vision impairment and blindness. Conclusion: Depression and anxiety are common in glaucoma patients, indicating the need for screening protocols using PHQ and GAD scales to identify persons at risk. The lack of ophthalmic risk factors associated with depression and anxiety emphasizes the importance of psychological evaluation and combined management with a psychiatrist in glaucoma management.
, Vd Sweta, R Sandhya
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_684_21

Abstract:
Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow-up. The post-T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre-existing glaucoma and lost to follow-up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post-injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post-T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post-IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field.
MahipalS Sachdev, Avnindra Gupta, Hemlata Gupta, GitanshaShreyas Sachdev, Raghav Malik, Ritika Sachdev
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_1636_21

Abstract:
We propose a technique for combined femto laser-assisted cataract surgery (FLACS) and limited vitrectomy from the pars-plana site for optimization of surgical results in subluxated cataracts. FLACS creates a free-floating, customised capsulotomy, minimizes stress on compromised zonules, and prechops the nucleus, effectively reducing the ultrasonic power as well as the forces required to chop the nucleus. The area of zonular dehiscence creates a direct communication between the irrigation fluid and the anterior vitreous, leading to its hydration. Trans-limbal vitrectomy creates a continuum between the liquefied vitreous and the main wound, leading to further vitreous loss, and exaggeration of the zonular weakness, while pars-plana vitrectomy avoids this by cutting the liquefied vitreous, near its attachment, thereby preventing further hydration and causing lesser stress to the zonules. A combination of these procedures, along with a capsule support device, gives favorable surgical outcomes in moderate to severe subluxations.
, Pratima Vishwakarma, Savitri Sharma, Joveeta Jospeh, Sanchita Mitra, Ashik Mohamed
Published: 1 January 2022
Indian Journal of Ophthalmology, Volume 70; https://doi.org/10.4103/ijo.ijo_1880_21

Abstract:
Purpose: To assess the sensitivity of potassium hydroxide and calcofluor white (KOH+CFW) mount in the diagnosis of Pythium keratitis and concordance among microbiologists. Methods: Three microbiologists evaluated the microscopic images of KOH + CFW mounts of confirmed cases of Pythium and fungal keratitis seen between January 2019 and February 2021. The filaments were compared using specific differentiating features. The sensitivity and specificity of KOH + CFW in diagnosing Pythium infection were evaluated along with concordance among the microbiologists. Results: Sixty consecutive cases with confirmed growth of fungus or Pythium insidiosum (n = 29) were evaluated. The sensitivity of KOH + CFW in the correct identification of Pythium filaments ranged from 79.3% to 96.5% among three microbiologists. There was good interobserver (k = 0.76–0.90) and intraobserver (k = 0.70–0.97) agreements among three microbiologists. The differentiating findings (P< 0.0001) suggestive of Pythium filaments were the absence of septae in 23 (79.3%) and collapsed walls in 22 (75.9%) cases. Conclusion: KOH + CFW has good sensitivity and specificity in the diagnosis of Pythium keratitis with good interobserver and intraobserver concordance.
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