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   Table of Contents - Current issue
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July-September 2018
Volume 13 | Issue 3
Page Nos. 217-371

Online since Thursday, July 12, 2018

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EDITORIAL  

Electroretinography and rhegmatogenous retinal detachment p. 217
Mohammad Mehdi Parvaresh
DOI:10.4103/jovr.jovr_145_18  PMID:30090174
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ORIGINAL ARTICLES Top

Lacrimal gland changes on orbital imaging after glaucoma drainage implant surgery p. 219
Sarah M Jacobs, Raghu C Mudumbai, AJ Amadi
DOI:10.4103/jovr.jovr_200_17  PMID:30090175
Purpose: This study evaluates the radiographic appearance of lacrimal gland tissue after placement of a glaucoma drainage implant (GDI) to characterize the impact of the device on the gland's imaging patterns. Methods: We performed retrospective chart review of departmental records at two urban academic medical centers, which were systematically searched using procedure codes to identify adult glaucoma patients who underwent unilateral superotemporal GDI from January 1995 to December 2015. Radiology records were cross-checked to identify the subset of patients who underwent postoperative orbital CT or MRI. Chart review collected data on glaucoma diagnosis, management, examination findings, and clinical complaints. Imaging studies were reviewed for orbital changes using qualitative assessment of the radiographic appearances and computer-guided calculations to quantify asymmetries. Results: A review of all eye operations in the inclusion period identified 315 patients with GDI, 13 of whom were eligible for inclusion. Elapsed time from device placement to imaging averaged 41.9 months, and the average clinical follow-up was 56.4 months. Radiographic lacrimal gland changes were appreciable in 69% (9 of 13) of patients, most commonly with posterior displacement and flattening of the gland (7 of 13). ImageJ analysis revealed significantly smaller lacrimal glands in orbits with GDI (P = 0.04). No clear correlation was found between gland changes and clinical dry eye symptoms. Conclusion: GDI placement was associated with radiographically-appreciable lacrimal gland changes in two-thirds of patients, with changes occurring in a predictable pattern of lacrimal gland flattening, posteriorization, and volume loss. Radiographic changes correlated with clinical symptoms in few patients.
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Visual field changes in professional wind versus non-wind musical instrument players in the Philadelphia orchestra p. 224
Shuai-Chun Lin, Cindy X Zheng, Michael Waisbourd, Jeanne Molineaux, Lichuan Zeng, Tingting Zhan, Kamran Rahmatnejad, Arthur Resende, Anand V Mantravadi, Lisa A Hark, Marlene R Moster, Joseph I Markoff, George L Spaeth, L Jay Katz
DOI:10.4103/jovr.jovr_155_17  PMID:30090176
Purpose: We compare the prevalence of glaucoma in professional wind versus non-wind instrument players in the Philadelphia Orchestra. Visual field changes in individuals with glaucoma and glaucoma suspects were evaluated, and the results were correlated with cumulative practice time. Methods: In this cross-sectional, observational study, fifty-one Philadelphia Orchestra musicians were enrolled and categorized as wind or non-wind instrument players. All study participants underwent screening fundus photography. Participants with optic discs suspicious for glaucoma underwent further evaluation, including standard automated visual field perimetry and a comprehensive eye examination by a glaucoma specialist. Results: Of the 51 musicians enrolled, 9 of the 21 wind instrument players (43%) and 8 of the 30 non-wind instrument players (27%) were suspected of developing glaucoma in at least one eye (P = 0.25), with examinations performed on 12 of the 17 returning musicians (71%) for further confirmation. Wind instrument players exhibited significantly higher Octopus visual field mean defect scores (1.08 ± 1.5 dB) than non-wind instrument players (−0.43 ± 0.7 dB; P < 0.001). There was a significant association between cumulative hours playing wind instruments and visual field mean defect (P < 0.001). Conclusion: Among members of the Philadelphia Orchestra, the difference in prevalence of glaucoma suspicious optic discs between wind and non-wind instrument players was not significant. The clinical significance of the greater visual field mean defect found in wind instrument players, and the association between the degree of visual field mean defect and the cumulative practice-time of playing wind instruments, needs further investigation.
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Mini-vitrectomy; a simple solution to a serious condition p. 231
Mohammad Pakravan, Hamed Esfandiari, Nassim Amouhashemi, Amir Veisi, Pooya Torkian, Shahin Yazdani
DOI:10.4103/jovr.jovr_192_17  PMID:30090177
Purpose: To evaluate the safety and efficacy of clear corneal approach irido-zonulo-hyaloido-vitrectomy, which we named “mini-vitrectomy,” in the management of pseudophakic aqueous misdirection. Methods: In this retrospective, non-comparative interventional case series, 24 eyes with diagnosis of pseudophakic aqueous misdirection were enrolled. Medical therapy with cycloplegics and laser therapy, including posterior capsulotomy and hyaloidotomy, was not effective in the management of the condition. The eyes underwent mini-vitrectomy, a simple technique in which iridotomy, zonulectomy, hyaloidectomy, and limited anterior vitrectomy were performed via a clear cornea incision. The main outcome measure was reformation of the anterior chamber, which was evaluated at day 1 and months 1, 3, 6, and 12. Results: The mean age of patients was 75.3 ± 11.3 years (range, 47 to 90), and 13 (54.2%) patients were women. Anterior chamber was deep in 22 patients (91.7%) at the last follow-up visit. The mean intraocular pressure (IOP) was 30.31 ± 1.9 mm Hg at presentation on 2.67 ± 1.09 glaucoma medications. IOP decreased significantly to 14.5 ± 4.6 mm Hg at 12-month follow-up. (P = 0.001). The number of glaucoma medications at final visit was 2.2 ± 0.9 (P = 0.21). Conclusion: Mini-vitrectomy is a simple, safe, and effective procedure in the management of pseudophakic aqueous misdirection, and it can be adopted by all ophthalmologists who are involved in glaucoma management and are not comfortable with the pars plana vitrectomy approach.
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Subthreshold continuous wave autofluorescence-controlled laser treatment of chronic central serous chorioretinopathy p. 236
Hossein Ashraf, Mansooreh Jamshidian, Mohammad Reza Khalili, Mousa Zare, Anis Shamsi
DOI:10.4103/jovr.jovr_9_17  PMID:30090178
Purpose: To investigate the therapeutic effect of clinically invisible subthreshold continuous wave autofluorescence-controlled laser treatment on visual acuity and macular status of patients with chronic central serous chorioretinopathy (CSCR). Methods: In this prospective case series, patients with clinical and fluorescein angiographic (FA) findings of CSCR and chronic visual loss (>6 months) were included. Complete ocular examination, FA, and optical coherence tomography (OCT) tests were performed. Each eye was subjected to a direct laser treatment of leakage points by 532 nm continuous wave low energy laser pulses, which were kept invisible by reducing the power to 70% of the threshold test spot. Considering the lack of visible effect on the retinal pigment epithelium (RPE), the laser effect was monitored by pre- and post -treatment infrared and autofluorescence images. Results: A total of 20 patients were included in this study, of whom 12 patients (9 male and 3 female patients) with an average age of 38 years had complete follow-up (Average: 3.5 months). The mean preoperative visual acuity was 20/80, which improved to 20/40 at the final visit. The mean preoperative central macular thickness (CMT) was 330 μm and the average final CMT in the last OCT test was 188 μm (P = 0.001). Conclusion: Subthreshold continuous wave autofluorescence-controlled laser treatment may be a good treatment for chronic CSCR to avoid the risks of retinal damage by clinically suprathreshold laser therapy.
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Preoperative electrophysiological characterization of patients with primary macula-involving rhegmatogenous retinal detachment p. 241
Jonathan B Lin, Julia Sein, Gregory P Van Stavern, Rajendra S Apte
DOI:10.4103/jovr.jovr_161_17  PMID:30090179
Purpose: To determine 1) which components of retinal function are impaired after rhegmatogenous retinal detachment, 2) which outer retinal pathways (rod- or cone-driven) are more severely affected, and 3) whether there is concomitant inner retinal dysfunction. Methods: We conducted a prospective observational study in a large academic institution. We performed preoperative electroretinography on eight patients to assess outer and inner retinal function. In all cases, a comparison between the eye with the detached retina and the control fellow eye was made. Results: Eyes with a detached retina had significantly lower a-wave and b-wave amplitudes with respect to both rod- and cone-dominated testing parameters (P < 0.05) and reduced 30 Hz flicker responses compared to fellow eyes (P < 0.05); the effect size was similar for all significantly reduced parameters (r~0.6). There were no significant differences between eyes with detached retinas and control fellow eyes with respect to b/a-wave ratios, a-wave latencies, or b-wave latencies. Conclusion: Patients with rhegmatogenous retinal detachment have preoperative outer retinal dysfunction equally affecting both rod- and cone-driven pathways, and they have minimal inner retinal dysfunction.
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Early macular changes after phacoemulsification in eyes with high myopia p. 249
Hossein Ashraf, Samaneh Koohestani, M Hossein Nowroozzadeh
DOI:10.4103/jovr.jovr_69_17  PMID:30090180
Purpose: To evaluate macular changes after cataract surgery in eyes with high myopia. Methods: This prospective cohort enrolled patients with high myopia (axial length ≥26 mm) who underwent phacoemulsification with intraocular lens implantation. Spectral-domain optical coherence tomography (OCT) scans were obtained at baseline and 2 and 6 months after the operation. Postoperative macular changes on OCT scans were regarded as the main outcome measure. Results: Thirty-four eyes of 31 patients with high myopia were included (age, 60 ± 10 years [mean ± SD]); of these, 14 patients (45.2%) were male. The mean axial length was 27.8 ± 1.5 mm. Epiretinal membrane (one eye, 2.9%), lamellar hole (one eye, 2.9%), myopic foveoschisis (2 eyes, 5.9%), and vitreomacular traction associated with foveoschisis (one eye, 2.9%) were notable findings at baseline examination; no eye showed cystoid macular edema (CME) at this time. At the 2-month examination, three eyes (8.8%) developed CME. At the 6-month follow-up, one eye with CME at 2 months improved, and a new case of CME (5.6%) was detected. The characteristics of epiretinal membrane, lamellar hole, vitreomacular traction, and foveoschisis did not change at the 2- and 6-month examinations and no new cases occurred. Conclusion: Uncomplicated phacoemulsification had no significant effect on the prevalence or characteristics of pre-existing macular abnormalities in eyes with high myopia up to 6 months of follow-up. The incidence of CME 2 months after uncomplicated cataract surgery in eyes with high myopia was about 9%.
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Visual and anatomical outcomes of pars plana vitrectomy for dropped nucleus after phacoemulsification p. 253
Ali Lashgari, Majid Kabiri, Alireza Ramezani, Morteza Entezari, Saeed Karimi, Sajad Kakaei, Mehdi Yaseri, Homayoun Nikkhah
DOI:10.4103/jovr.jovr_156_17  PMID:30090181
Purpose: To determine the prognostic factors and visual and anatomic outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE). Methods: The records of patients with complicated PE who underwent PPV to remove posteriorly dislocated nucleus fragments from January 2011 to December 2014 were retrospectively reviewed. Results: Of 43 patients, 36 patients (36 eyes) were included with mean age of 73 ± 9.5 years and mean follow-up duration of 23.8 ± 15.3 (range 4–53) months. The mean interval between cataract surgery and PPV was 11.5 ± 9.6 (range 1–45) days. The pre-PPV mean best-corrected visual acuity (VA) was 1.04 ± 0.24 logMAR, which improved to 0.46 ± 0.18 logMAR (P < 0.001). Pre-PPV VA ≥20/200 was significantly associated with good final VA ≥20/40 (P = 0.002). Implantation of intraocular lens (IOL) at the time of complicated PE and complicated course after PPV were significantly associated with poor visual outcome of <20/40 (P = 0.041 and P < 0.001, respectively). However, the timing of PPV, route of nucleus removal, and final IOL status were not significantly associated with the visual outcome. The most frequent causes of poor visual outcome were optic atrophy, cystoid and/or diabetic macular edema, history of rhegmatogenous retinal detachment, and pre-existing eye disease (age-related macular degeneration). Conclusion: PPV for dropped nucleus was associated with improved VA. Better pre-PPV VA was associated with good visual outcome, while inserting IOL at the time of complicated PE, and complicated course after PPV were associated with poor visual outcome.
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Foveal avascular zone and vessel density in healthy subjects: An optical coherence tomography angiography study p. 260
Khalil Ghasemi Falavarjani, Hamideh Shenazandi, Dariush Naseri, Pasha Anvari, Pegah Kazemi, Farzaneh Aghamohammadi, Feras Alissmail, Sayyed Amirpooya Alemzadeh
DOI:10.4103/jovr.jovr_173_17  PMID:30090182
Purpose: To report the normal characteristics and correlations of the foveal microvascular networks using optical coherence tomography angiography (OCTA) in a healthy Iranian population. Methods: Enface 3x3 OCTA images were obtained using the RTVue Avanti spectral-domain optical coherence tomography with AngioVue software (Optovue, Fremont, CA, USA). Foveal avascular zone (FAZ) area, central foveal point thickness and inner retinal thickness at the foveal center and the vascular density of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) in the fovea were recorded. Results: Seventy normal eyes of 70 subjects (range, 9 to 71 years) were studied. Mean FAZ area was 0.32 ± 0.11 (range, 0.13-0.67) mm2 in SCP and 0.50 ± 0.13 (range, 0.19-0.94) mm2 in DCP. Mean SCP vessel density was 29.6 ± 4.7 (range, 16.3-40.3) % in the fovea. Mean DCP vessel density was 27.0 ± 5.9 (range, 15.0-45.2) % in the fovea. The FAZ area at SCP level was negatively correlated to the central subfield thickness (P < 0.001). The FAZ area at DCP level correlated negatively to the central subfield thickness and was significantly associated to age (both P < 0.001). The foveal SCP vessel density significantly correlated with foveal thickness and the foveal DCP vessel density correlated significantly with central foveal subfield thickness and was inversely related to age (all P < 0.05). Conclusion: In this study, central foveal subfield thickness was a major determinant of the FAZ size and foveal vessel density. Age was a determinant for FAZ area and whole image vessel density in DCP.
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Analysis of VSX1 variations in Brazilian subjects with keratoconus p. 266
Dulceria Costa da Silva, Bianca Nery Benevides Gadelha, Alex Felipe Barbosa Feitosa, Rafaela Gomes da Silva, Tarsila Livia Paz e Albuquerque, Débora Christina Pereira Fernandes Santos, Diego Nery Benevides Gadelha, Bruno Luiz Fonseca Schamber-Reis
DOI:10.4103/jovr.jovr_116_17  PMID:30090183
Purpose: To screen visual system homeobox 1 (VSX1) gene in Brazilian subjects affected with keratoconus (KCN). Methods: Seventy-three patients with KCN and 106 healthy controls were enrolled in this study. Patients were diagnosed with KCN based on eye examination and corneal topographic features according to Rabinowitz's criteria (K > 47.2, I-S > 1.4 and KISA > 100%). DNA from blood samples was extracted from donors, and the exons and exon-intron boundaries of VSX1 were sequenced. The potential impact of the identified amino acid changes was assessed with Poly-Phen2, SIFT, and PMUT analysis tools. Genotyping was confirmed by RLFP technique, which was also applied to genotype non-affected individuals. Results: We found three non-synonymous substitutions (L68H, R131S, and D105E) in VSX1 exon 1, with L68H mutation as a novel variation in this gene. In silico analysis indicated that all variations found were predicted to be probably damaging to VSX1 structure and function. Examination of R131S and L68H variations segregating in one family suggested a strong effect of these variations in increasing disease severity in the proband, which presented bilateral KCN leading to corneal grafting before the age of sixteen. We found a novel synonymous substitution (P79P) and two previously described exonic polymorphisms, with unknown roles in VSX1 pathogenesis. Conclusion:VSX1 polymorphisms found in the Brazilian population support a genetic component in KCN pathogenesis. L68H is a novel mutation, and the phenotypic data suggest that this mutation might enhance disease severity when combined with other polymorphisms. However, further investigations are needed.
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Trichostatin a restores expression of adherens and tight junction proteins during transforming growth factor β-mediated epithelial-to-mesenchymal transition p. 274
Darshini A Ganatra, Abhay R Vasavada, Nair G Vidya, Devarshi U Gajjar, Sankaranarayanan Rajkumar
DOI:10.4103/jovr.jovr_110_17  PMID:30090184
Purpose: Adherens junctions and polarity markers play an important role in maintaining epithelial phenotype but get altered during the epithelial-mesenchymal transition (EMT). Alterations of these markers during EMT of lens epithelial cell (LEC) can lead to vision compromising conditions. The aim of this study was to examine if Trichostatin-A (TSA), a histone deacetylase inhibitor, can prevent EMT by restoring the adherens junction complex in LEC. Methods: Fetal human lens epithelial cell line (FHL124) was used. Cells were treated with 10 ng/ml TGF-β2 in the presence or absence of TSA. Real time-PCR and western blotting were carried out for HDAC1, HDAC2, CDH1 (E-cad), TJP1 ( ZO-1) and CTNNB1 (β-cat). Level of histone acetylation was analyzed by western blotting. Chromatin Immunoprecipitation was carried out to study the level of acetylated histone H4 and HDAC2 at the promoter regions of CDH1, TJP1, and CTNNB1. E-cad, ZO-1, and β-cat were localized using immunofluorescence. Kruskal-Wallis test was used for statistical analysis. Results: TSA down-regulated HDAC1 and HDAC2 and led to an increase in global acetylation. The mRNA and protein levels of E-cad, ZO-1, and β-cat decreased during EMT but were up-regulated by TSA treatment. TSA also helped in stabilizing these proteins at cell-cell junctions during EMT. TSA decreases association of HDAC2 at the promoter regions of adherens junction genes while increasing histone H4 acetylation status. Conclusion: TSA increases histone acetylation and restores the adherens junction complex in LECs. TSA helps in preventing EMT and thus shows potential against lens fibrosis and vision compromising conditions.
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Assessment of horizontal inequity in eye care utilization in the Iranian middle-aged population p. 284
Maedeh Raznahan, Mohammad Hassan Emamian, Hassan Hashemi, Hojjat Zeraati, Akbar Fotouhi
DOI:10.4103/jovr.jovr_221_17  PMID:30090185
Purpose: The present study was designed to determine the extent that horizontal inequity was realized regarding eye care utilization in a middle-aged population as well as factors affecting this equity. Methods: Data were obtained from a population-based study (Shahroud Eye Cohort Study) in 2009 that included 5190 participants from 40 to 64 years of age. Horizontal inequity was determined based on the following variables: (i) economic status, (ii) eye care service needs, (iii) non-need variables, and (iv) eye care utilization (visiting an ophthalmologist or optometrist). Decomposition analysis of the concentration index based on a nonlinear model and indirect standardization was used to ascertain the contribution of each factor in inequity of eye care utilization. Results: After adjusting for need variables, the results of our study demonstrated that horizontal inequity in eye care utilization in a middle-aged Iranian population remained positive and significant (horizontal inequity: 0.19; 95% confidence interval: 0.17–0.23) indicating that use of services was focused among participants with a better financial situation. Furthermore, decomposition analysis demonstrated that educational level and economic status had the greatest contribution (54.1% and 41.1%, respectively) in comparison to other variables. Conclusion: This study demonstrated that horizontal inequity exists in eye care utilization among the middle-aged Iranian population.
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The Shiraz pediatric eye study; a population based survey of school age children: Rationale, design and baseline characteristics p. 293
Mohammad Reza Talebnejad, Mohammad Hossein Nowroozzadeh, Hamideh Mahdaviazad, Mohammad Reza Khalili, Masoumeh Beygom Masoumpour, Maryam Keshtkar, Elham Mohammadi, Zahra Tajbakhsh
DOI:10.4103/jovr.jovr_246_17  PMID:30090186
Purpose: To describe the rationale, study design, methodology, and baseline characteristics of the Shiraz Pediatric Eye Study, a population-based survey of schoolchildren in Shiraz, Iran. Methods: This population-based study included schoolchildren aged 6–12 years from all four educational districts of Shiraz who were recruited in years 2015–2016. Stratified random sampling was used to select 2400 participants from all districts. Data were recorded from a detailed interview and ocular evaluation of each eligible student. The eye examination comprised uncorrected and best corrected visual acuity measurement, refraction, external eye examination (including specific strabismus and lid evaluation tests), slit lamp biomicroscopy, intraocular pressure measurement, the Ishihara color vision test, and stereoacuity. Exophthalmometry, optical biometry, and optical coherence tomography were performed for a randomly selected subset of children. General characteristics and socioeconomic variables were also recorded to assess risk factors. Results: From a total of 2400 selected students, 2001 (83.3%) participated in the study. The mean age of the students was 9.1 ± 1.6 years, and 59.7% were girls. Most children had at least one parent with a diploma or less than diploma (63.5%), and 2.2% had illiterate parents. Conclusion: This study is expected to provide accurate estimates of the prevalence of visual impairments and their related determinants in Shiraz. In addition, it will identify children who should be targeted by blindness prevention programs.
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Impact of vision therapy on eye-hand coordination skills in students with visual impairment p. 301
Javad Heravian Shandiz, Abbas Riazi, Abbas Azimi Khorasani, Negareh Yazdani, Maryam Torab Mostaedi, Behrooz Zohourian
DOI:10.4103/jovr.jovr_103_17  PMID:30090187
Purpose: To evaluate the enhancing effects of vision therapy on eye–hand coordination skills in students with visual impairments. Methods: Thirty-five visually impaired patients who underwent vision therapy comprised the treatment group, and 35 patients with impaired vision who received no treatment comprised the control group. Full ophthalmic examinations were performed, including biomicroscopy, retinoscopy, and assessments of subjective refraction and visual acuity. Eye–hand coordination was evaluated using the Frostig test. Vision therapy in the treatment group was performed using the Bernell–Marsden ball, perceptual-motor pen, random blink test, and random shape assessment. Results: Data were analyzed for the 35 visually impaired patients and 35 control participants. The mean age was 11.51 ± 3.5 and 11.09 ± 3.1 years in the treatment and control groups, respectively. Female participants comprised 80% of the treatment group and 57% of the control group. Before treatment, the mean scores on the Frostig test were 22.74 ± 4.32 and 21.60 ± 4.10 in the treatment and control groups, respectively, and after treatment, the mean Frostig test scores were 24.69 ± 3.99 and 21.89 ± 3.92, respectively. Statistically significant intergroup differences were found in eye–hand coordination (P < 0.05). No significant intergroup differences were noted in the distance and near visual acuity values. Conclusion: The results demonstrated that vision therapy could significantly improve eye–hand coordination, but no enhancement was found in near or distance visual acuity.
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Comparison of three vision therapy approaches for convergence insufficiency p. 307
Maryam Aletaha, Farideh Daneshvar, Mahnaz Mosallaei, Abbas Bagheri, Mohammad Reza Khalili
DOI:10.4103/jovr.jovr_99_17  PMID:30090188
Purpose: We compared the effectiveness of three active vision therapy approaches for convergence insufficiency (CI). Methods: This randomized clinical trial included patients meeting the eligibility criteria and with symptomatic CI, who were allocated into three groups. In the home-based vision orthoptic therapy (HBVOT) group, patients performed the pencil push-up procedure 15 min/day for 5 days/week. In the office-based vision orthoptic therapy (OBVOT) group, patients underwent 60-min orthoptic therapy using a major amblyoscope twice weekly with additional home orthoptic therapy. In the augmented office-based vision orthoptic therapy (AOBVOT) group, patients performed orthoptic exercises using 3-diopter over-minus lenses and a base-out prism in addition to major amblyoscope therapy, and additional home reinforcement was prescribed during the same time period. Results: All 84 subjects (mean age, 26.8 ± 8.3 years) showed a statistically significant improvement in near exophoria, positive fusional vergence (PFV) at near, near point of convergence (NPC), stereoacuity, and Convergence Insufficiency Symptom Survey (CISS) scores at follow-up. Exophoria decreased by 64%, 68%, and 85% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.2). PFV increased by 68%, 100%, and 100% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P < 0.001). NPC decreased (improved) by 86%, 89%, and 96% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.4). The CISS scores decreased by 75%, 96%, and 100% in the HBVOT, OBVOT, and AOBVOT groups, respectively (P = 0.003). Conclusion: Our results showed that in adults with CI, the augmented office-based orthoptic treatment was relatively more effective than the other treatments.
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REVIEW ARTICLES Top

Optical coherence tomography angiography in eyes with retinal vein occlusion p. 315
Grace Tsai, Touka Banaee, Felipe F Conti, Rishi P Singh
DOI:10.4103/jovr.jovr_264_17  PMID:30090189
Optical coherence angiography (OCTA) is a noninvasive technique that has been introduced in recent years to detect ophthalmological pathology. The growing usage of OCTA to detect retinal abnormalities can be attributed to its advantages over the reference-standard fluorescein angiography (FA), although both of these techniques can be used in association. OCTA's advantages include its dye independency, its ability to produce depth-resolved images of retinal and choroidal vessels that yield images of different vascular layers of the retina, and the better delineation of the foveal avascular zone. OCTA's disadvantages include the lack of normalized patient data, artefactual projection issues, and its inability to detect low-flow lesions or pathologic conditions. Different OCTA platforms use unique algorithms to detect microvasculature, which are implemented in both spectral-domain (SD) and swept-source (SS) OCT machines. Microvascular changes in retinal vein occlusions (RVOs) are visible in both the superficial and deep capillary networks of the retina in OCTA. These visualizations include a decrease in foveal and parafoveal vascular densities, non-perfusion areas, capillary engorgement and telangiectasias, vascular tortuosity, microaneurysms, disruption of the foveal perivascular plexus, and formation of collateral vessels. The restricted field of view and inability to show leakage are important limitations associated with the use of OCTA in RVO cases. In this article, we present a brief overview of OCTA and a review of the changes detectable in different slabs by OCTA in RVO cases published in PubMed and Embase.
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Eye health information systems in selected countries p. 333
Nasim Hashemi, Hamid Moghaddasi, Reza Rabiei, Farkhondeh Asadi, Azadeh Farahi
DOI:10.4103/jovr.jovr_149_17  PMID:30090190
One of the important factors for achieving “Vision 2020” targets is the availability and accessibility of eye health information systems. This study aimed to describe eye health information systems in selected countries. The status of eye health information systems in Australia, the United States, and England was reviewed. Data were gathered from the PubMed, Scopus, and ScienceDirect databases. The main key terms used included, but were not limited to “National Action plan”, “Eye Health Information System”, “Database”, and “Registery”. Also, the websites of the World Health Organization, the International Agency for the Prevention of Blindness, and Departments of Health in the selected countries were accessed. Fifty documents and articles of 170 retrieved references related to the research goals were used in this study. In all three countries, the issue of eye health is considered to be a national health priority. Concerning data gathering, the most common point in these countries was data gathered directly (health information systems, eye registries) and indirectly (studies, projects, and surveillance systems) by the organizations that participated in eye health programs. Producing accessible, timely, and highly quality information about eye health is one of the most important goals in the formation of eye health information systems in the selected countries, which facilitates achievement of the goals of the “Vision 2020: The Right to Sight” initiative.
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PERSPECTIVE Top

A historical perspective on treatment of Fuchs' endothelial dystrophy: We have come a long way p. 339
Majid Moshirfar, Yanning Ding, Tirth J Shah
DOI:10.4103/jovr.jovr_94_18  PMID:30090191
Fuchs' endothelial corneal dystrophy is a hereditary and progressive vision-threatening disease with a high prevalence in our adult population. In the past two decades, endothelial transplantation has dramatically changed the way we treat these patients. Back then, our limited surgical techniques often resulted in less than ideal outcomes. It was unimaginable for our patients to achieve near perfect visual acuity in such a short span of time. Over the years, we have tenaciously refined our surgical techniques to vastly improve patient outcomes, and with the recent advent of Rho-kinase inhibitors, we may even consider delivering a simple injection to our patients in the future. Our purpose is to take a historical perspective on how far we have come in treating this disorder and how rapidly this field will continue to evolve.
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CASE REPORTS Top

“Mouse Sign” on optical coherence tomography of detached endothelial graft indicates graft inversion p. 344
Dhivya Ashok Kumar, Shana Sood, Amar Agarwal
DOI:10.4103/jovr.jovr_1_17  PMID:30090192
Purpose: To report the mouse-like configuration of detached endothelial keratoplasty graft observed on optical coherence tomographic imaging after pre-Descemet's endothelial keratoplasty (PDEK). Case Report: Three eyes of 3 patients who underwent PDEK and had graft detachment in the initial postoperative period of <2 weeks were examined. Fourier domain optical coherence tomography was performed in all eyes. All 3 patients had partial graft detachment with the detached region involving the central and inferior cornea. One end of the graft formed a thick convex scroll detaching outward, downward, and upward, and the other end was attached to the edematous cornea forming the 'mouse' configuration. The graft was inverted, and rebubbling failed in all 3 eyes. Graft exchange was required. Conclusion: Mouse sign in OCT imaging indicates the possibility of an inverted graft and predicts unsuccessful rebubbling. Graft exchange is required in such eyes.
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Severe cutaneous reaction to latanoprost eye drops p. 348
Ivan Yeu Ming Yip, Akash Raj
DOI:10.4103/jovr.jovr_248_16  PMID:30090193
Purpose: Latanoprost is known to have several ocular side effects, including redness of the eyelids, lengthening of the eyelashes, an increase in iris pigmentation, and dryness of the eyes that causes discomfort. There are also several rarer systemic side effects reported in the literature, including chest pain. Case Report: Here we report a rare case of a patient who developed a cutaneous blistering rash on both eyelids, both sides of the neck, and the dorsum of both hands after direct contact with latanoprost eye drops. The lesions cleared following withdrawal of the eye drops. Conclusion: Topical latanoprost can cause severe blistering of the skin that could undermine a patient's confidence in the treating medical team. Reporting of an adverse effect is difficult when a generic topical medication is used.
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Ophthalmic artery occlusion following facial sclerosing therapy p. 351
Alireza Dehghani, Leila Rezaei, Heshmatollah Ghanbari, Kobra Nasrollahi, Mehdi Tavakoli
DOI:10.4103/jovr.jovr_29_16  PMID:30090194
Purpose: To describe a case of ophthalmic artery occlusion and complete ophthalmoplegia after intralesional injection of a sclerosing agent into a subcutaneous hemangioma on the forehead. Case Report: A 16-year-old girl underwent direct injection of 3 mL of sodium tetradecyl sulfate (Fibrovein) emulsion 1% (10 mg/mL) with a 23-gauge needle into a subcutaneous hemangioma on the forehead. Immediately after the injection, she developed sudden loss of vision and lid swelling of the left eye. Her visual acuity in the left eye became no light perception. Her left eye also developed a dilated pupil, ptosis, and complete external ophthalmoplegia. Funduscopy of the left eye revealed signs of central retinal artery occlusion. Magnetic resonance imaging of the orbit showed thickening of the medial and lateral rectus muscles of the left eye. Magnetic resonance venography of the brain was normal with no evidence of cavernous venous thrombosis. After 3 months, her ptosis and ophthalmoplegia resolved but her visual acuity remained no light perception. Conclusion: Persistent total visual loss should be kept in mind as a disastrous complication of sclerosing therapy in a patient with facial hemangioma.
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Regression of giant olfactory groove meningioma and complete visual acuity recovery after discontinuation of cyproterone acetate p. 355
Anne Laure Bernat, Sophie Bonnin, Moujahed Labidi, Nouman Aldahak, Damien Bresson, Schahrazed Bouazza, Sebastien Froelich
DOI:10.4103/jovr.jovr_21_17  PMID:30090195
Purpose: To report on the medical management of meningioma with compression of the optic chiasm associated with the use of cyproterone acetate (CA). Case Report: A 65-year-old woman who was being treated with CA presented with a recent decrease in visual function, leading to discovery of a giant olfactory groove meningioma with compression of the optic chiasm. CA was discontinued immediately, and her visual function improved dramatically. At 13 months, in addition to a significant improvement in visual and neurocognitive symptoms, the tumor volume was reduced by 50%. Conclusion: In meningiomas associated with CA, treatment cessation may result in prompt improvement in symptoms and a reduction in tumor volume, even if the tumor is large and causing neurologic impairments.
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PHOTO ESSAYS Top

Artistic iris: A case of congenital sectoral heterochromia iridis p. 359
Mandeep Tomar, Richa Dhiman, Gaurav Sharma, Nishita Yadav
DOI:10.4103/jovr.jovr_91_17  PMID:30090196
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Ocular myiasis Highly accessed article p. 361
Parul Chawla Gupta, Jagat Ram, TT Faisal, Aniruddha Agarwal, Sumeeta Khurana, Amber Prasad
DOI:10.4103/2008-322X.158891  PMID:30090197
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Giant atypical macular hole after vitrectomy for needle perforation p. 363
Bruno Fortaleza de Aquino Ferreira, Aline Lemos Barros Martins, Pedro Carlos Carricondo
DOI:10.4103/jovr.jovr_100_17  PMID:30090198
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LETTERS Top

Corneal thickness measurement after hyperopic photorefractive keratectomy p. 365
Maddalena De Bernardo, Nicola Rosa
DOI:10.4103/jovr.jovr_217_17  PMID:30090199
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Author's reply p. 366
Mahmoud Jabbarvand, Farshad Askarizadeh, Mohamad Reza Sedaghat, Hadi Ghadimi, Bahram Khosravi, Mohammad Aghazadeh Amiri, Foroozan Narooie-Noori
DOI:10.4103/jovr.jovr_97_18  PMID:30090200
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Traumatic macular retinoschisis p. 368
Koushik Tripathy
DOI:10.4103/jovr.jovr_46_17  PMID:30090201
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Author's reply p. 370
Mohammad Hossein Jabbarpoor Bonyadi
DOI:10.4103/jovr.jovr_96_18  PMID:30090202
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