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   2016| July-December  | Volume 24 | Issue 2  
    Online since December 9, 2016

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Reliability and utility of impression cytology in the diagnosis of dry eye
Fahad Abdullah Al Wadani, Rajshree Nambiar, Khalid M Abdul Wahhab, Tariq Al Asbali, Ajit Nambiar, Ata Ur Rahaman
July-December 2016, 24(2):51-56
Introduction: Dry eye disease is a multifactorial disease of the tears and ocular surface that can result in ocular discomfort and visual impairment. There are numerous tests to evaluate the ocular status in dry eye disease. Among the different tests for diagnosing dry eyes, Impression Cytology is considered a practical and minimally invasive investigation. Objective: The aim of this study was to characterize ocular surface symptoms typical of dry eyes, study pattern of dry eye in various systemic diseases, assess whether impression cytology samples could be used to define conjunctival surface changes and describe changes in conjunctival cells. We also aimed to compare the sensitivity of impression cytology with other diagnostic tests. Methods: A cross sectional study was conducted among 100 patients with symptoms of dry eye. After eliciting a complete history which included any systemic disease, occupation and drug intake these patients were subjected to various tests like Schirmers test, Tear Break Up Time (TBUT), Lissamine green staining and Conjunctival impression cytology. Results: All clinical tests have limited diagnostic value if performed individually, but impression cytology showed the highest sensitivity. Conclusion: It is recommended that impression cytology is an ideal method of investigating ocular surface disorders when diagnosis is not clinically obvious or when clinical diagnosis needs substantiation. It is recommended that major ophthalmic centers should develop and introduce this technique into routine clinical practice.
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The impact of cataract surgery on subjective visual functions and quality of life in patients with cataract in Northwestern Nigeria
Sadiq M Abdullahi, Mahmoud B Alhassan, Olufemi E Babalola
July-December 2016, 24(2):57-61
Purpose: To determine the impact of cataract surgery on visual functions (VFs) and quality of life (QoL) in patients with cataract at the National Eye Center, Kaduna. Methods: VFs and QoL questionnaires were administered to the patients preoperatively and 6 weeks postoperatively. Correlation was assessed among subjective VF, QoL, and visual acuity (VA). The preoperative and sixth-week postoperative VA, VF scores, and QoL scores were compared. A paired t-test was used for comparison between before and after surgery. Results: Two hundred and seventy-one patients were studied. The age range of the patients was 45 to 85 years with a mean age of 64.2 years (SD ± 6.51). There was significant improvement in overall VF and QoL following cataract surgery (P < 0.0001). Mean VF scores preoperatively and at 6 weeks postoperatively were 28.6 (SD ± 7.9) and 15.1 (SD ± 3.5), respectively. The overall mean QoL scores were 23.7 (SD ± 9.0.) preoperatively and 13.5 (SD ± 1.1) postoperatively. This difference was statistically significant P < 0.0001. Bilateral cataract surgery patients had greater gain in VF and QoL than those that had uniocular surgery. Conclusion: This study demonstrated that cataract surgery is effective in improving overall VF and vision-related QoL, which resulted in functional independence. The second eye surgery confers additional gains in terms of VF and QoL in patients with bilateral cataract.
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Pituitary adenoma misdiagnosed as glaucoma in an adult Nigerian male
Vivian B Osaguona, Valentina W Okeigbemen
July-December 2016, 24(2):92-94
We report a case of pathologic disc cupping in a 45-year-old Nigerian male with pituitary adenoma, which was misdiagnosed and treated as glaucoma with resultant bilateral blindness. Pathologic cupping of the disc is most commonly associated with glaucoma. However, the clinician needs to be aware that there are non-glaucomatous causes of pathologic disc cupping, some of which may be life-threatening.
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Visual outcomes after phacoemulsification with AcrySof toric intraocular lens implantation
Jaya Kaushik, Vaibhav K Jain, Jitendra K.S. Parihar, Piyush Chaturvedi, Vijay Mathur, Sanjay K Dhar
July-December 2016, 24(2):62-66
Introduction: To study the visual outcome of AcrySof toric intraocular lens (IOL) implantation in patients having cataract associated with astigmatism. Materials and Methods: In this prospective interventional case series, 30 eyes of 28 patients with preoperative astigmatism of 1.5–4.5 D cylinder underwent phacoemulsification with AcrySof toric IOL implantation. All patients were assessed on day 1, 1 week, 1 month, 2 months, and 3 months postoperatively. The outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, and degree of IOL rotation. Results: Mean UCVA improved significantly in study eyes (P < 0.05) at 3 months. The mean refractive astigmatism reduced from the preoperative value 3.05 ± 0.06 D to 0.208 ± 0.058 D (P = 0.001). The mean axis of rotation was 2.76 ± 1.88° in all eyes. Ninety percent of all eyes had mean axis of IOL rotation 10°. Only three eyes had mean axis of rotation 10° or more. Conclusion: AcrySof toric IOL implantation is an effective method to correct preoperative astigmatism in cataract patients.
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Epidemiological study and treatment outcome of primary ocular and adnexal malignancies in a rural Indian tertiary eye care center
Somen Misra, Kunal Patil, Neeta Misra, Aayush Tandon
July-December 2016, 24(2):67-70
Purpose: Malignancies of the eye and adnexa are rare, and account for only 0.2–0.8% of all human malignancies. Although specific tumor related studies are reported in the literature, a study of all the ocular malignancies are very few, and to the best of our knowledge, none from a rural population. The purpose of this study was to examine the prevalence and treatment outcomes of primary ocular malignancies in rural India. Materials and Methods: A retrospective analysis of 92 histopathologically proven primary ocular and adnexal malignancies encountered at Pravara Rural Medical College, Loni, over a period of 20 years (July 1994–June 2014) was undertaken. Patients of all age groups were included. Results: Squamous cell carcinoma was found to be the most common primary ocular malignancy. A bimodal peak was observed in the age distribution, one during the first decade due to retinoblastoma and the second in the fifth decade due the other malignancies. Squamous cell carcinoma was the most common malignancy with 38.04%, followed by retinoblastoma 25%. A combined approach of surgery, chemotherapy and radiotherapy was used to save life, salvage the eye and possibly maintain useful vision. Reconstruction of the orbital and periorbital region was also done wherever possible. Conclusion: Retinoblastoma was the most common malignancy in the first decade of life. Squamous cell carcinoma was the most common malignancy overall. The presence of HIV in cases of squamous cell carcinoma, especially among young patients, should be kept in mind. The outcome of management is better, with possible cure, if diagnosis is made early and proper surgery along with other adjuvant measures are undertaken.
  4,049 402 1
Fish hook injury of eyelid: An unusual case
Samarth Mishra, Jagadish P Rout, Pramod K Sharma, Bhavna Govindaraj, Bidisha Mahapatra
July-December 2016, 24(2):76-79
Fishing is a common pastime as well as an important source of daily income for people around the world, be it a developed or a developing nation. It can be associated with unusual ocular injuries. Here, we report a case of a young man who presented with a fishhook injury into his right lateral half of upper eyelid piercing through the fornix. To the best of our knowledge, this is the first reported case of fishhook injury from this part of the world and only a few have been published in the literature till date. This case report aims at familiarizing the reader with this uncommon and atypical injury and its better management.
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Pattern of ocular pathologies diagnosed with B-scan ultrasonography in a hospital in rural India
Surekha V Bangal, Akshay J Bhandari, Fuzail Siddhiqui
July-December 2016, 24(2):71-75
Context: B-scan ultrasonography (USG) plays a key role as a valuable diagnostic imaging device in the field of ophthalmology. Aim: To study the pattern of ocular pathologies defined by B-scan USG in rural hospital. Settings and Design: Hospital-based prospective observational study. Materials and Methods: Hospital-based prospective observational study conducted over a period of 2 years. A total of 100 patients were included. Statistical Analysis Used: Chi-square test. Results: In this study of 100 cases, majority of the cases (57%) were above 40 years of age. There were 54 (54%) male patients and 46 (46%) female patients. The most commonly observed indication for ophthalmic B-scan USG was ocular trauma leading to cataract formation in 45 cases. Conclusion: B-scan USG stands as an excellent, reliable, and cost-effective noninvasive radiological diagnostic modality for proper evaluation of a variety of ocular disorders in both clear and opaque media.
  4,042 341 1
A case report of traumatic dislocation of eyeball
Deepak Choudhury, Pramod Kumar Sharma
July-December 2016, 24(2):89-91
Complete dislocation of an intact globe into the maxillary sinus after an extensive blowout fracture is a rare occurrence. We report a case of pure blowout fracture of the floor of the orbit with intact orbital margins due to trauma resulting in complete dislocation of the globe into the maxillary sinus in a 42-year-old male. On ocular examination, the right eyeball was found to be absent from the orbit. Computerized tomography scan with contrast showed: (1) pure orbital blowout fracture; (2) intact eyeball in the right maxillary sinus; and (3) optic nerve seemed to be intact. Surgical exploration of the right maxillary sinus through Caldwell-Luc approach revealed a circular fracture which was just the size of the globe in the middle of the inferior orbital wall. The orbital contents were also found to be dislocated completely into the right maxillary sinus. The dislocated globe was repositioned into the orbit and the orbital floor fracture repaired with bone graft taken from iliac crest. The visual acuity in the right eye after the repositioning was no light perception. We are reporting this case because it is a rare condition and the various operative challenges.
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Management of perforated mooren's ulcer with a rotational scleral autograft in Abuja
Olufemi Emmanuel Babalola
July-December 2016, 24(2):80-83
Mooren's ulcer is a fairly common peripheral corneal melting disease in Nigeria. Cases presenting late with perforation and uveal prolapse are a serious challenge to management, particularly in a setting where corneal grafting is not routinely practiced. To describe the management of perforated Mooren's ulcer using scleral rotational autograft. A case of bilateral Mooren's ulcer with corneal melting and uveal prolapse in the left eye (LE) involving 1½ h was managed with a scleral rotational autograft at the Rachel Eye Center, Abuja. The patient was a 75-year-old female retiree with concomitant rheumatoid arthritis involving the knee and metacarpophalangeal joints. Following a 360° peritomy and cryotherapy in both eyes, a partial thickness scleral hinged autograft was developed and rotated over the uveal prolapse and corneal defect whereupon, it was fastened with interrupted 10/0 nylon sutures and secured with a bandage soft contact lens. The integrity of the globe was maintained for over 6 months with the scleral flap which became largely transparent from the 13th day after the surgery. The anterior chamber went flat temporarily, but this was reversed with firm pad over a contact lens. This technique is recommended as at least a stopgap before the availability of corneal grafts.
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Ocular injuries: Another example of the heavy prize of terrorism
Funmilayo Jane Oyediji, Ojo Perpetua Odugbo, George Amaechi Obikili
July-December 2016, 24(2):84-88
Injuries to the face and ocular structures could occur at the war front not only to the enemies, but also to unsuspecting friends of the security agents. We report here a case of ocular injury involving an air force personnel (lance corporal) who was mistakenly hit on the face by the back blast of a rocket-propelled grenade shot by a colleague without prior warning resulting in varying degrees of ocular injuries.
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