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   Table of Contents - Current issue
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April-June 2018
Volume 13 | Issue 2
Page Nos. 91-215

Online since Tuesday, April 10, 2018

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EDITORIAL  

Intravitreal injections: A historic background Highly accessed article p. 91
Gholam A Peyman
DOI:10.4103/jovr.jovr_54_18  PMID:29719634
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ORIGINAL ARTICLES Top

Mean posterior corneal power and astigmatism in normal versus keratoconic eyes Highly accessed article p. 93
Sepehr Feizi, Siamak Delfazayebaher, Mohammad Ali Javadi, Farid Karimian, Vahid Ownagh, Fatemeh Sadeghpour
DOI:10.4103/jovr.jovr_19_17  PMID:29719635
Purpose: To compare mean posterior corneal power and astigmatism in normal versus keratoconus affected eyes and determine the optimal cut-off points to maximize sensitivity and specificity in discriminating keratoconus from normal corneas. Methods: A total of 204 normal eyes and 142 keratoconus affected eyes were enrolled in this prospective comparative study. Mean posterior corneal power and astigmatism were measured using a dual Scheimpflug camera. Correlation coefficients were calculated to assess the relationship between the magnitudes of keratometric and posterior corneal astigmatism in the study groups. Receiver operating characteristic curves were used to compare the sensitivity and specificity of the measured parameters and to identify the optimal cut-off points for discriminating keratoconus from normal corneas. Results: The mean posterior corneal power was −6.29 ± 0.20 D in the normal group and −7.77 ± 0.87 D in the keratoconus group (P < 0.001). The mean magnitudes of the posterior corneal astigmatisms were −0.32 ± 0.15 D and −0.94 ± 0.39 D in the normal and keratoconus groups, respectively (P < 0.001). Significant correlations were found between the magnitudes of keratometric and posterior corneal astigmatism in the normal (r=−0.76, P < 0.001) and keratoconus (r=−0.72, P < 0.001) groups. The mean posterior corneal power and astigmatism were highly reliable characteristics that distinguished keratoconus from normal corneas (area under the curve, 0.99 and 0.95, respectively). The optimal cut-off points of mean posterior corneal power and astigmatism were −6.70 D and −0.54 D, respectively. Conclusion: Mean posterior corneal power and astigmatism measured using a Galilei analyzer camera might have potential in diagnosing keratoconus. The cut-off points provided can be used for keratoconus screening.
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Effect of cycloplegia on corneal biometrics and refractive state Highly accessed article p. 101
Abbas Bagheri, Mohadeseh Feizi, Aliakbar Shafii, Amir Faramarzi, Mehdi Tavakoli, Shahin Yazdani
DOI:10.4103/jovr.jovr_196_17  PMID:29719636
Purpose: To determine changes in refractive state and corneal parameters after cycloplegia with cyclopentolate hydrochloride 1% using a dual Scheimpflug imaging system. Methods: In this prospective cross-sectional study patients aged 10 to 40 years who were referred for optometric evaluation enrolled and underwent autorefraction and corneal imaging with the Galilei dual Scheimpflug system before and 30 minutes after twice instillation of medication. Changes in refraction and astigmatism were investigated. Corneal biometrics including anterior and posterior corneal curvatures, total corneal power and corneal pachymetry were compared before and after cycloplegia. Results: Two hundred and twelve eyes of 106 subjects with mean age of 28 ± 5 years including 201 myopic and 11 hyperopic eyes were evaluated. Mean spherical equivalent refractive error before cycloplegia was -3.4 ± 2.6 D. A mean hyperopic shift of 0.4 ± 0.5 D occurred after cycloplegia (P < 0.001). The astigmatism power did not significantly change (P = 0.8), however, 26.8% of eyes with significant astigmatism experienced a change of more than 5 degrees in the axis of astigmatism. Changes in posterior corneal curvature were scant but statistically significant (P = 0.001). Moreover, corneal thickness was slightly increased in the central and paracentral regions (P < 0.001 and P < 0.001, respectively). Conclusion: Cycloplegia causes a hyperopic shift and astigmatism axis changes, along with an increase in central and paracentral corneal thickness and change in posterior corneal curvature. The effects of cycloplegia on refraction and corneal biometrics should be considered before cataract and refractive surgeries.
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Histopathological parameters in pterygia and significant clinical correlations p. 110
Ahmed Mohamed Reda, Yasmine Maher Mohamed Shaaban, Somaia Ahmad Saad El-Din
DOI:10.4103/jovr.jovr_31_17  PMID:29719637
Purpose: To evaluate the clinical and histopathological parameters of pterygium to determine significant correlations between parameters that can affect management strategies. Methods: A total of 47 pterygia were clinically examined and excised for histopathological evaluation of epithelial and stromal changes. Some samples were immunostained with P53 (a protein of 53 kilodalton used as dysplastic epithelial marker), CD20 (CD/cluster of differentiation, are group of surface receptors providing targets for cellular immunophenotyping, CD20 as a B lymphocyte marker), CD 3 (as T lymphocyte marker) or vascular endothelial growth factor (VEGF/as vascular marker). Results: Most patients were male (59.6%). Cosmetic complaints (83%), grade II redness (61.7%), grade 2 extension (63.8), and associated astigmatism of <2.5 D (83%) were observed. Histopathological features included solar elastosis (100%), squamous hyperplasia (83%), increased stromal vascularity with hemorrhage (76.6%), and lymphocytic stromal infiltration, perivascular distribution, and mild epithelial lymphocytic exocytosis in 72.3%, 74.5%, and 70.2% of cases, respectively. Other changes included goblet cell hyperplasia (31.9%), prominent epithelial pigmentation (48.9%), and, most importantly, epithelial atypia (53.2%). Clinical redness was significantly correlated with vascularity, epithelial hyperplasia, and lymphocytic stromal infiltration; lymphocytic stromal infiltration was also significantly correlated with pterygium extension and with low astigmatism. Conclusion: The inflammatory response was mild in most cases and the density was not significantly correlated with any clinical parameter. Vascularity was related to clinical redness. Treatment with anti-VEGF may be beneficial, even for grade 1 pterygia that are not dominantly fibrotic.
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Topical olopatadine hydrochloride versus ketotifen fumarate for allergic conjunctivitis p. 119
Dharmistha Patel, N Sarala, Narendra Panduranga Datti
DOI:10.4103/jovr.jovr_85_17  PMID:29719638
Purpose: Allergic conjunctivitis (AC) is associated with itching, redness, tearing, pain, and burning sensation in the eyes. The inflammatory process is caused by the mechanism of immediate hypersensitivity due to direct contact with the allergen. This process triggers mast cells in the conjunctiva to activate and release mediators. The purpose of this study was to compare topical olopatadine and ketotifen in terms of effectiveness and safety for the management of AC. Methods: Patients clinically diagnosed with AC were randomized into two groups of 60 patients each and received either topical olopatadine HCl 0.1% or ketotifen fumarate 0.025%. They were followed up on the 4th, 15th, and 30th days to evaluate symptoms, signs, and quality of life (QOL) scoring. Results: There were a total of 120 patients (67 men and 53 women) with a mean age of 36.35 ± 11 years. Compared to baseline, scores of itching, tearing, redness, eyelid swelling, chemosis and papillae addition of all the individual scores mentioned above and QOL scores reduced significantly (P = 0.001) by the 4th and 15th days of olopatadine and ketotifen application. Compared with ketotifen, olopatadine significantly reduced itching, tearing, hyperemia, and total AC scores by the 4th day (P = 0.001) and conjunctival papillae by the 15th day (P = 0.001). Adverse reactions were reported in 10% and 18% of patients treated with olopatadine and ketotifen, respectively. Conclusion: Compared to ketotifen, olopatadine provided quicker relief of symptoms, and improved symptoms of AC and QOL, with fewer side effects.
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Retinal nerve fiber layer changes following primary retinal detachment repair with silicone oil tamponade and subsequent oil removal p. 124
Brijesh Takkar, Rajvardhan Azad, Neha Kamble, Shorya Azad
DOI:10.4103/jovr.jovr_134_16  PMID:29719639
Purpose: To evaluate the correlation between the retinal nerve fiber layer (RNFL), particularly the temporal RNFL (TRNFL), and visual outcomes following surgery for rhegmatogenous retinal detachment (RRD). Methods: This retrospective study was performed at a tertiary center; 32 patients underwent single and successful vitrectomy for total RRD using silicone oil as tamponade. Data were collected after oil removal. RNFL thickness and central foveal thickness (CFT) were measured using spectral domain optical coherence tomography. RNFL thickness and CFT of normal eyes were acquired as a control to calculate percentage changes in the affected eyes. The correlation between postoperative best-corrected visual acuity (BCVA) and TRNFL changes was the primary outcome measure. Results: Postoperative BCVA correlated negatively with retinal detachment (RD) duration (Pearson coefficient 0.56, P = 0.001) and percentage loss in TRNFL thickness (Pearson Coefficient 0.41, P = 0.02). The macula lost the maximum RNFL thickness (26%). The mean percentage loss of TRNFL was significantly higher in patients with postoperative BCVA <6/60 (42.63% vs. 24.06%, P = 0.009). Patients with postoperative BCVA <6/60 had a significantly longer mean RD duration (29 days) than those with postoperative BCVA >6/60 (17.5 days) (P = 0.026). Conclusion: When eyes with RRD are successfully repaired using silicone oil tamponade, the thickness of the RNFL decreases, particularly in the macula, and less macular neuronal loss is associated with better visual outcomes.
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Outcomes of light silicone oil tamponade for failed idiopathic macular hole surgery p. 130
M Hossein Nowroozzadeh, Hossein Ashraf, Mehdi Zadmehr, Mohsen Farvardin
DOI:10.4103/jovr.jovr_22_17  PMID:29719640
Purpose: To study the outcomes of redo macular hole surgery using light silicone oil tamponade. Methods: In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures. Results: Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open. Conclusions: Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes.
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Patterns of uveitis at a tertiary referral center in Northeastern Iran p. 138
Seyedeh Maryam Hosseini, Nasser Shoeibi, Raheleh Ebrahimi, Mehdi Ghasemi
DOI:10.4103/jovr.jovr_67_17  PMID:29719641
Purpose: To describe the demographic and clinical patterns of patients with uveitis referred to a tertiary center in northeastern Iran. Methods: This cross-sectional retrospective study included 235 patients with uveitis who had been referred to the uveitis clinic of Khatam-Al-Anbia eye hospital, affiliated to Mashhad University of Medical Sciences, from February 2013 to March 2014. Data regarding patient age, sex, anatomical location of the disease, and etiologic and clinical features were analyzed. Results: Mean patient age at the onset of uveitis was 35.75 ± 16.3 (range: 3–82) years. The ratio of females to males was 1.5 to 1. Sixty-four percent had bilateral involvement. The predominant type of inflammation was non-granulomatous (76%). Panuveitis (46.8%, 110 cases) was the most common form of uveitis followed by anterior (37%, 87 cases), intermediate (11.9%, 28 cases), and posterior uveitis (4.25%, 10 cases). The most common diagnoses were “idiopathic” in anterior and intermediate uveitis cases, toxoplasmosis in posterior uveitis group, and Behçet and Vogt-Koyanagi-Harada diseases in panuveitis cases. Overall, noninfectious causes (80.42%) of uveitis were more frequent than infectious causes (19.57%). The proportion of noninfectious uveitis was 82.75% in anterior uveitis, 78.18% in panuveitis, 92.85% in intermediate uveitis, and 50% in posterior uveitis. The most common associated systemic disease was Behçet disease. Conclusion: In contrast to most epidemiologic studies of uveitis, the clinical and etiologic patterns of uveitis were different in a tertiary referral center in northeastern Iran. Panuveitis was the most common clinical pattern in this study, and the most common associated systemic disease was Behçet disease.
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OCT based macular thickness in a normal Indian pediatric population p. 144
Bharti Nigam, Pragati Garg, Lubna Ahmad, Ritika Mullick
DOI:10.4103/jovr.jovr_51_17  PMID:29719642
Purpose: Cirrus optical coherence tomography (OCT) provides high resolution cross-sectional images of the retina, vitreous humor, and optic nerve head with an axial resolution of 5 μm and a reproducibility of 1.6 μm. An integrated normative database is available only for adult subjects ≥18 years of age; the normal reference ranges of the macular thicknesses of pediatric subjects are not available. The purpose of this study was to determine the normal reference range of macular thickness of pediatric. Methods: A total of 340 eyes of 170 children 5-17 years of age were recruited for this study. Participants received a full ophthalmic examination including a vision assessment, cycloplegic refraction, fundus examination, intraocular pressure measurement, assessment of ocular motility, and alignment. Macular thickness measurements were obtained through dilated pupils using Cirrus HD-OCT. Results: The mean macular thickness was 114.88 ± 14.74 in the right eye and 113.99 ± 15.62 in the left eye (P = 0.589). On further evaluation, macular thickness was highest in the inner macula, followed by the outer macula and central fovea (P < 0.001). Conclusion: The normative data of macular thickness in pediatric subjects 5-17 years of age will help diagnose macular disorders.
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Quantitative analysis of macular thickness following open globe injury in subjects with clear media and no retinal damage p. 149
Farshad Ostadian, Fereydoun Farrahi, Maryam Hajizadeh
DOI:10.4103/jovr.jovr_25_18  PMID:29719643
Purpose: To evaluate the change in macular thickness after open globe injury (OGI) in patients with clear media and without retinal damage using optical coherence tomography (OCT). Methods: In this longitudinal observational pilot study, 17 patients with clear media and without retinal damage who underwent repair of OGI for corneal, corneoscleral, or scleral laceration were studied. In addition to routine follow-up, all patients were examined at the first and third postoperative months and best corrected visual acuity (BCVA), slit-lamp examination, applanation tonometry, dilated fundus examinations, and macular OCT scans were documented. Results: In all patients, no signs of macular edema, macular thickening, cystic changes, or other signs of cystoid macular edema were present in OCT images and examinations. The Early Treatment Diabetic Retinopathy Study map indicated that there were no significant differences in macular thickness between the first and third months in all patients (P > 0.05). There was no significant relationship between macular thickness and uveal or vitreous prolapse and the size or site of laceration (P > 0.05). BCVA in the first and third months also showed no significant change (P > 0.05). There were no cases of intraocular pressure increase in any of the patients. Conclusion: Macular thickness had no significant change following OGI repair in eyes with clear media and without retinal damage; thus, it seems that OGI of this extent and its surgical repair have no effect on macular thickness.
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Contrast sensitivity abnormalities in deaf individuals p. 153
Masoud Khorrami-Nejad, Javad Heravian, Farshad Askarizadeh, Davood Sobhani-Rad
DOI:10.4103/jovr.jovr_218_16  PMID:29719644
Purpose: Hearing impaired children are heavily dependent on their sense of vision to develop efficient communication skills; any contrast sensitivity defect can negatively impact their lives because they are not able to use auditory stimuli to recognize probable dangers in the world around them. The purpose of this study was to determine the contrast sensitivity abnormalities in deaf individuals. Methods: In this cross-sectional study, contrast sensitivity of 15- to 20-year-old high-school boys with hearing disability from Tehran, Iran were evaluated. Sixty-four eyes were tested for contrast sensitivity and refractive error. All subjects had an intelligence quotient (IQ) >70. We investigated their contrast sensitivity with Vector vision CVS-1000 in 4 different spatial frequencies. Results: Profound hearing loss was noted in 50% of the subjects. The frequency of contrast sensitivity abnormalities in 4 different spatial frequencies varied between 51.6% and 65.6%. The largest abnormalities were recorded at 18 cycles per degree. Only 12.5% of deaf students had corrected distance visual acuity (CDVA) greater than zero (in LogMAR). The abnormalities in contrast sensitivity showed no correlation with the type or severity of hearing loss. Conclusion: Hearing impaired boys are at a greater risk for contrast sensitivity abnormalities than boys with normal hearing. The larger frequency of contrast sensitivity abnormalities in high spatial frequencies than in other frequencies may demonstrate greater defects in the central visual system compared with the periphery in individuals with hearing loss.
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CLINICAL PRACTICE GUIDELINES Top

Intravitreal injection of anti-vascular endothelial growth factor agents for ocular vascular diseases: Clinical practice guideline p. 158
Homayoun Nikkhah, Saeed Karimi, Hamid Ahmadieh, Mohsen Azarmina, Majid Abrishami, Hossein Ahoor, Yousef Alizadeh, Hasan Behboudi, Narsis Daftarian, Mohammad Hossein Dehghan, Morteza Entezari, Fereydoun Farrahi, Heshmatollah Ghanbari, Khalil Ghasemi Falavarjani, Mohammad Ali Javadi, Reza Karkhaneh, Siamak Moradian, Masoud Reza Manaviat, Morsal Mehryar, Ramin Nourinia, Mohammad Mehdi Parvaresh, Alireza Ramezani, Alireza Ragati Haghi, Mohammad Riazi-Esfahani, Masoud Soheilian, Mohsen Shahsavari, Hossein-Ali Shahriari, Zhale Rajavi, Sare Safi, Armin Shirvani, Saeed Rahmani, Hamideh Sabbaghi, Mojgan Pakbin, Bahareh Kheiri, Hossein Ziaei
DOI:10.4103/jovr.jovr_50_18  PMID:29719645
Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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REVIEW ARTICLES Top

Intraocular pressure fluctuation: Is it important? p. 170
Ji Hyun Kim, Joseph Caprioli
DOI:10.4103/jovr.jovr_35_18  PMID:29719646
Elevated intraocular pressure (IOP) is a major risk factor for the development and progression of glaucoma. Previous prospective, randomized, long-term studies have demonstrated the strength of IOP reduction in slowing the progression of disease. It is well known that IOP is not a fixed value but fluctuates considerably over time. Although there have been some studies on IOP fluctuation and the progression of glaucoma, whether IOP fluctuation is an independent risk factor for glaucomatous damage and disease progression remains controversial. In this article, we reviewed the definition of IOP fluctuation, and both the evidence and the speculation for and against the effect of IOP fluctuation on glaucoma progression. Although conclusions seem to vary from study to study, we considered that different studies examined different groups of patients, at different stages of disease, and at different IOP levels. Our conclusion is that these apparently disparate results are not conflicting, but rather can be viewed as complementary. In clinical care, we recommend the consideration of IOP “modulation” rather than just IOP “reduction” when glaucoma patients are treated. Quality-based IOP control may be more effective than quantity-based IOP reduction to prevent or retard disease progression.
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Common orbital infections ~ State of the art ~ Part I p. 175
Shirin Hamed-Azzam, Islam AlHashash, Daniel Briscoe, Geoffrey E Rose, David H Verity
DOI:10.4103/jovr.jovr_199_17  PMID:29719647
Infections of the orbit and periorbita are relatively frequent, and can cause significant local and systemic morbidity. Loss of vision occurs in more than 10% of patients, and systemic sequelae can include meningitis, intracranial abscess, and death. Numerous organisms infect the orbit, but the most common are bacteria. There are many methods through which orbital infections occur, with infection from the neighboring ethmoid sinuses the most likely cause for all age groups. Prompt management is essential in suspected orbital cellulitis, and involves urgent intravenous antibiotics, rehydration, and treatment of any co-existent underlying systemic disease, e.g., diabetes, renal failure. This review summarizes the common infectious processes of the orbit in both pediatric and adult groups. We review pathophysiology, symptoms, signs, and treatment for infectious orbital processes.
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Rare orbital infections ~ State of the art ~ Part II p. 183
Shirin Hamed-Azzam, Islam AlHashash, Daniel Briscoe, Geoffrey E Rose, David H Verity
DOI:10.4103/jovr.jovr_202_17  PMID:29719648
Infections of the orbit and periorbita are relatively frequent. Identifying unusual organisms is crucial because they can cause severe local and systemic morbidity, despite their rarity. Opportunistic infections of the orbit should be considered mainly in debilitated or immunocompromised patients. The key to successful management includes a high index of suspicion, prompt diagnosis, and addressing the underlying systemic disease. This review summarizes unusual infectious processes of the orbit, including mycobacterial, fungal, and parasitic infections, as well as their pathophysiology, symptoms, signs, and treatment.
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CASE REPORTS Top

A case of post encephalitic optic neuritis: Clinical spectrum, differential diagnosis and management p. 191
Ravinder Kumar, Abhishek Bhargava, Gagan Jaiswal, Viral R Soni, Bhoomika Katbamna, Arpit Vashisht
DOI:10.4103/jovr.jovr_136_16  PMID:29719649
Purpose: Most cases of optic neuritis are idiopathic or are associated with multiple sclerosis. We present a case in which a young female developed post-infectious left optic neuritis following herpes simplex encephalitis (HSE). Case Report: A 24-year-old female presented with a severe headache, fever, and malaise of a one-week duration. Viral encephalitis was diagnosed and treated; intravenous acyclovir (750 mg every 8 h) was administered for 14 days. The patient improved clinically and was prescribed oral valacyclovir (1,000 mg, three times daily) for an additional 3 months as an outpatient. The patient presented again four weeks after the initial admission with left periocular pain and other typical manifestations of optic neuritis. We diagnosed post-infectious left optic neuritis following viral encephalitis. Corticosteroid therapy with 250 mg intravenous methylprednisolone every 6 hours was initiated and the patient showed rapid significant recovery. Conclusion: This case report highlights the patient's clinical course and includes a brief history of the systemic effects of HSE, as well as the pathophysiology, management, and differential diagnosis of post-encephalitic optic neuritis. We suggest that clinicians should routinely perform an ophthalmologic examination during the follow-up visits of such patients.
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Intraocular lens calcification: Clinico-pathological report of two cases and literature review p. 195
Mansour Rahimi, Ali Azimi, Masoud Hosseinzadeh
DOI:10.4103/jovr.jovr_36_16  PMID:29719650
Purpose: We report the clinicopathological features and surgical outcomes of two cases of intraocular lens (IOL) calcification along with a review of the current literature. Case Report: The first patient was a 53-year-old woman with diabetes mellitus (type 2) who underwent phacoemulsification with posterior chamber IOL insertion (PCIOL), and pars plana vitrectomy. Significant clouding of the IOL was first noted after 1.5 years, and the IOL was replaced with an Artisan lens. The second patient was a 22-year-old woman with Vogt-Koyanagi-Harada syndrome; she underwent a lensectomy, PCIOL, and pars plana vitrectomy. IOL opacification was first noted 4.5 years after the initial surgery and the IOL was extracted. Conclusion: The calcification of each IOL was confirmed by a pathologist. Further studies are required to determine the primary causes and mechanisms of the calcification of biomaterials including IOLs.
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Combined tenonplasty and scleral graft for refractory Pseudomonas scleritis following pterygium removal with mitomycin C application p. 200
Heidar Siatiri, Nima Mirzaee-Rad, Shruti Aggarwal, Ahmad Kheirkhah
DOI:10.4103/jovr.jovr_122_16  PMID:29719651
Purpose: To report a surgical approach combining scleral patch graft and tenonplasty for successful management of refractory Pseudomonas scleritis following pterygium removal with mitomycin C application. Case Report: A 75-year-old diabetic woman with a history of prior pterygium excision and mitomycin C application developed infectious necrotizing scleritis caused by Pseudomonas aeruginosa. Owing to progression of scleritis despite medical management, the patient underwent surgery. Intraoperatively, extensive scleral ischemia was noted. Therefore, debridement of the necrotic tissue, scleral graft, tenonplasty to bring blood vessels to the ischemic sclera, and amniotic membrane transplantation were performed. Postoperatively, no signs of ischemia or recurrence of infection were observed. During 6 months of follow-up, the patient achieved complete restoration of the globe integrity with a non-inflamed ocular surface. Conclusion: Through restoration of blood supply to the ischemic sclera, tenonplasty is an effective adjunctive procedure in addition to conventional scleral patch graft for the treatment of refractory Pseudomonas scleritis associated with ischemia.
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Simultaneous unilateral presentation of three different ocular manifestations of granulomatosis with polyangiitis p. 203
Ali Salehi, Farzan Kianersi, Heshmatollah Ghanbari, Zahra Dastborhan, Ebrahim Gerami, Elnaz Pirmoazzen
DOI:10.4103/jovr.jovr_123_16  PMID:29719652
Purpose: To report the simultaneous presentation of three ocular manifestations of granulomatosis with polyangiitis in one eye. Case Report: A 42-year-old man with a confirmed diagnosis of granulomatosis with polyangiitis was referred to the emergency room with sudden blurred vision. Eye examination showed hyperemic conjunctiva due to necrotizing scleritis in the superior nasal quadrant of the left eye, a mass in the left superior lid, as well as central retinal artery occlusion in the same eye. Conclusion: This case suggests that unilateral eye involvement may be a manifestation of underlying granulomatosis with polyangiitis.
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PHOTO ESSAYS Top

Scheimpflug-based optical densitometry for assessment of corneal opacity: An objective method to monitor interstitial keratitis p. 207
Alireza Peyman, Mohsen Pourazizi
DOI:10.4103/jovr.jovr_96_17  PMID:29719653
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Successful management of proliferative diabetic retinopathy and multiple choroidal tubercles in a patient with miliary tuberculosis p. 210
Rohan Chawla, Pradeep Venkatesh, Koushik Tripathy, Sunil Chaudhary, SK Sharma
DOI:10.4103/jovr.jovr_203_16  PMID:29719654
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LETTERS Top

VSX1 and SOD1 mutation screening in patients with keratoconus p. 212
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jovr.jovr_135_17  PMID:29719655
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Author's reply p. 213
Mahmood Nejabat, Payam Naghash, Hassan Dastsooz, Sanaz Mohammadi, Mohsen Alipour, Majid Fardaei
DOI:10.4103/jovr.jovr_52_18  PMID:29719656
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ERRATUM Top

Erratum: Distribution of different sized ocular surface vessels in diabetics and normal individuals p. 214

DOI:10.4103/2008-322X.229638  PMID:29722367
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Erratum: Review of static approaches to surgical correction of presbyopia p. 215

DOI:10.4103/2008-322X.229639  PMID:29722364
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