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   2017| April-June  | Volume 12 | Issue 2  
    Online since April 28, 2017

 
 
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ORIGINAL ARTICLES
Effectiveness of vision therapy in school children with symptomatic convergence insufficiency
Jung Un Jang, Jung Yun Jang, Kim Tai-hyung, Hwang Woon Moon
April-June 2017, 12(2):187-192
DOI:10.4103/jovr.jovr_249_15  PMID:28540011
Purpose: To determine the effectiveness of vision therapy among Korean elementary school children with convergence insufficiency. Methods: A total of 235 elementary schoolchildren, 10.13 ± 2.45 years of age, were subjected to thorough eye examination including binocular vision testing. Of them, 32 individuals with symptomatic convergence insufficiency without strabismus, amblyopia, and ocular disease were chosen to receive vision therapy via brock string, barrel card, mirror stereoscope, prism goggles, and aperture rule for a duration of 8 weeks. Results: The results showed that most of the participants had severe problems in near point of convergence. After the vision therapy, the average near point of convergence improved by approximately 5.48 ± 0.96 cm in all participants. Moreover, vision therapy had an effect on increasing near positive fusional vergence and decreasing exophoria. Negative relative accommodation improved to 2.54 ± 0.51 and positive relative accommodation improved to −3.10 ± 1.08 diopters. After treatment, near phoria was 4.19 ± 1.66 and distance phoria was 1.61 ± 0.71 prism diopters. Conclusion: Among convergence insufficiency symptoms, the following improved in particular: near point of convergence, exophoria, and near positive fusional vergence. These findings suggest that vision therapy is very effective to recover from symptomatic convergence insufficiency.
  810 194 -
REVIEW ARTICLES
Contact lens-related complications: A review
Fateme Alipour, Saeed Khaheshi, Mahya Soleimanzadeh, Somayeh Heidarzadeh, Sepideh Heydarzadeh
April-June 2017, 12(2):193-204
DOI:10.4103/jovr.jovr_159_16  PMID:28540012
Contact lens-related problems are common and can result in severe sight-threatening complications or contact lens drop out if not addressed properly. We systematically reviewed the most important and the most common contact lens-related complications and their diagnosis, epidemiology, and management according to the literature published in the last 20 years.
  567 184 -
PERSPECTIVE
Toward the art of robotic-assisted vitreoretinal surgery
Amir Molaei, Ebrahim Abedloo, Marc D de Smet, Sare Safi, Milad Khorshidifar, Hamid Ahmadieh, Mohammad Azam Khosravi, Narsis Daftarian
April-June 2017, 12(2):212-218
DOI:10.4103/jovr.jovr_63_17  PMID:28540014
New technological progress in robotics has brought many beneficial clinical applications. Currently, computer integrated robotic surgery has gained clinical acceptance for several surgical procedures. Robotically assisted eye surgery is envisaged as a promising solution to overcome the shortcomings inherent to conventional surgical procedures as in vitreoretinal surgeries. Robotics by its high precision and fine mechanical control can improve dexterity, cancel tremor, and allow highly precise remote surgical capability, delicate vitreoretinal manipulation capabilities. Combined with magnified three-dimensional imaging of the surgical site, it can enhance surgical precision. Tele-manipulation can provide the ability for tele-surgery or haptic feedback of forces generated by the manipulation of intraocular tissues. It presents new solutions for some sight-threatening conditions such as retinal vein cannulation where, due to physiological limitations of the surgeon's hand, the procedure cannot be adequately performed. In this paper, we provide an overview of the research and advances in robotically assisted vitreoretinal eye surgery. Additionally the barriers to the integration of this method in the field of ocular surgery are summarized. Finally, we discuss the possible applications of the method in the area of vitreoretinal surgery.
  393 109 -
REVIEW ARTICLES
Infantile periocular hemangioma
Mehdi Tavakoli, Saeid Yadegari, Mahnaz Mosallaei, Maryam Aletaha, Hossein Salour, Wendy W Lee
April-June 2017, 12(2):205-211
DOI:10.4103/jovr.jovr_66_17  PMID:28540013
Infantile periocular hemangiomas (IPH) are common benign vascular tumors that present early in childhood. They typically show a rapid nonlinear growth pattern a few weeks after birth during a proliferative phase, then continue with an involution phase and may result in serious ocular or systemic complications. Theses tumors may present in a range of small isolated lesions to multiple, diffuse involvements. Understanding the nature of the disease, the natural course, complications, indications for intervention, and treatment modalities would be helpful for ophthalmologists, who will likely be consulted for periocular cases. In this review, we present recent opinions about the pathogenesis, diagnosis, and treatment options for patients with IPH.
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ORIGINAL ARTICLES
VSX1 and SOD1 mutation screening in patients with keratoconus in the South of Iran
Mahmood Nejabat, Payam Naghash, Hassan Dastsooz, Sanaz Mohammadi, Mohsen Alipour, Majid Fardaei
April-June 2017, 12(2):135-140
DOI:10.4103/jovr.jovr_97_16  PMID:28540003
Purpose: To investigate mutations of visual system homeobox 1 (VSX1) and superoxide dismutase 1 (SOD1) in 20 patients with keratoconus in the south of Iran. Methods: Twenty patients with keratoconus who had a positive familial history were enrolled in this study and gave informed consent for DNA analysis. Genomic DNA was extracted from peripheral blood lymphocytes. Polymerase chain reaction (PCR) was carried out to amplify exon 2 of SOD1 and its exon-intron boundary for the detection of a seven-base deletion in intron 2 of SOD1, and also all five exons of VSX1 and their exon-intron boundaries. Amplified samples were then subjected to direct DNA sequencing. Results: Sequencing data were compared against reference sequences using NCBI basic local alignment search tool (BLAST), which revealed that our patients had no mutations in SOD1 and VSX1. Two single-nucleotide polymorphisms (SNPs), namely in VSX1(rs58752432 and rs59089167) were found in six patients. Conclusion: Mutations in VSX1 and SOD1 genes associated with keratoconus were not identified in our patients. Therefore, it will be necessary to investigate other chromosomal loci for potential causal mutations of keratoconus using next generation sequencing (NGS) methods in our population.
  358 112 -
EDITORIALS
Molecular imaging of subclinical diabetic retinopathy
Christoph Russmann, Mansoor M Amiji
April-June 2017, 12(2):129-131
DOI:10.4103/jovr.jovr_54_17  PMID:28540001
  354 102 -
MEWDS, common cold of the retina
Ali Tavallali, Lawrence A Yannuzzi
April-June 2017, 12(2):132-134
DOI:10.4103/jovr.jovr_241_16  PMID:28540002
  304 106 -
ORIGINAL ARTICLES
Molecular imaging of retinal endothelial injury in diabetic animals
Sonja Frimmel, Souska Zandi, Dawei Sun, Zhongyu Zhang, Alexander Schering, Mark I Melhorn, Shintaro Nakao, Ali Hafezi-Moghadam
April-June 2017, 12(2):175-182
DOI:10.4103/jovr.jovr_243_16  PMID:28540009
Purpose: Diabetic retinopathy is a leading cause of vision loss. There is a great need for early diagnosis prior to the occurrence of irreversible structural damages. Expression of endothelial adhesion molecules is observed before the onset of diabetic vascular damage; however, to date, these molecules cannot be visualized in vivo. Methods: To quantify the expression of endothelial surface molecules, we generated imaging probes that bind to ICAM-1. The α-ICAM-1 probes were characterized via flow cytometry under microfluidic conditions. Probes were systemically injected into normal and diabetic rats, and their adhesion in the retinal microvessels was visualized via confocal scanning laser ophthalmoscopy. Histology was performed to validate in vivo imaging results. Vascular pathologies were visualized using trypsin-digested retinal preparations. Results: The α-ICAM-1 probes showed significantly higher adhesion to retinal microvessels in diabetic rats than in normal controls (P < 0.01), whereas binding of control probes did not differ between the two groups. Western blotting results showed higher ICAM-1 expression in retinas of T1D animals than in normal controls. Retinal endothelial ICAM-1 expression was observed via molecular imaging before markers of structural damage, such as pericyte ghosts and acellular capillaries. Conclusion: Results indicate that molecular imaging can be used to detect subtle changes in the diabetic retina prior to the occurrence of irreversible pathology. Thus, ICAM-1 could serve as a diagnostic target in patients with diabetes. This study provides a proof of principle for non-invasive subclinical diagnosis in experimental diabetic retinopathy. Further development of this technology could improve management of diabetic complications.
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Anterior chamber depth change following cataract surgery in pseudoexfoliation syndrome; a preliminary study
Mohammad Reza Fallah Tafti, Hossein Abdollah Beiki, S Farzad Mohammadi, Golshan Latifi, Elham Ashrafi, Zahra Fallah Tafti
April-June 2017, 12(2):165-169
DOI:10.4103/jovr.jovr_81_15  PMID:28540007
Purpose: To assess the pseudophakic anterior chamber depth (PP-ACD) or effective lens position (ELP) change after cataract surgery in patients with pseudoexfoliation syndrome (PEX). Methods: Consecutive eyes with PEX and cataract underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). Eyes with severe PEX and with axial length (AL) greater than 24 mm or less than 22 mm were not included. Eyes with capsular complication or unstable bags that needed capsular tension ring insertion were excluded. The SRK-II formula was applied to calculate IOL power for postoperative emmetropia. PP-ACD or ELP was measured using anterior segment optical coherence tomography. Data obtained at one and six months post operation were evaluated during analysis. Results: Twenty-six eyes of 26 subjects (mean age: 72 years; range: 60–84 years) were studied. PP-ACD was deepened (mean change: 0.08 mm) and a concurrent hyperopic shift (0.3 D) was observed postoperatively between month 1 and month 6 (P values ≤0.002). PP-ACD and postoperative refraction changes were correlated with age and AL (P values <0.025), respectively. Increased hyperopic shift and PP-ACD deepening in eyes with posterior capsule opacification (PCO) was noted postoperatively at six months, but the difference was not statistically significant (P values = 0.15 and 0.2, respectively). Conclusion: After cataract surgery in eyes with PEX syndrome, a significant backward movement of the IOL occurs postoperatively in the first six months, which is associated with a concurrent small hyperopic shift.
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Post-photorefractive keratectomy pain and corneal sub-basal nerve density
Masoumeh Mohebbi, Amin Rafat-Nejad, Seyed-Farzad Mohammadi, Kosar Asna-Ashari, Maryam Kasiri, Saeed Heidari-Keshel, Farshad Askarizadeh
April-June 2017, 12(2):151-155
DOI:10.4103/jovr.jovr_100_16  PMID:28540005
Purpose: The perceived and reported pain of patients receiving photorefractive keratectomy (PRK) widely varies. We assessed the potential role of the subbasal nerve plexus density as a predictor of postoperative pain level. Consecutive patients scheduled to undergo PRK at the Refractive Surgery Clinic of Farabi Eye Hospital, Tehran, were approached. Methods: Forty-nine myopic left eyes from 49 patients who consented to undergo scanning slit confocal microscopy assessments preoperatively were included. ImageJ (1.48v) was used to measure the captured subbasal nerve length. Postoperative pain intensity was assessed by the Visual Analog Scale (VAS) (score range: 0 for no pain to 10 for the maximum possible) on the next day of surgery. Results: The mean age of the patients was 27.55 (range: 19–40) years. The median reported pain level was 5. Approximately 32.7% of the subjects reported a pain score of 6 or higher. Mean nerve density was 19.54 (range: 14.34–24.73) mm/mm2. Nerve density was not correlated with the reported intensity of pain (P = 0.172). However, pain was correlated with the reported ocular discomfort, i.e., a pooled index of foreign body sensation, photophobia, burning sensation, and tearing (P < 0.001), and also with the pooled index of ocular inflammatory signs (conjunctival injection and eyelid edema) (P = 0.027). Conclusion: Crude density of corneal nerves may not be a good predictor of post-PRK pain while wearing bandage contact lenses. The predominant pain mechanism appears to be of an inflammatory nature (not nociceptive or neuropathic).
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Changes in choroidal perfusion after orbital decompression surgery for Graves' ophthalmopathy
Narieman Nik, Amelia Fong, Marianna Derdzakyan, Chrysavgi Adamopoulou, Adam Sise, Aziz Khanifar, Reginald Sanders
April-June 2017, 12(2):183-186
DOI:10.4103/jovr.jovr_165_16  PMID:28540010
Purpose: To assess choroidal perfusion before and after orbital decompression surgery in patients with Graves' ophthalmopathy. Methods: In this interventional case series, surgical decompression for optic nerve compromise was performed on four eyes of three patients with Graves' disease. Complete ophthalmic examination including visual acuity, color vision, and intraocular pressure assessment were done pre- and postoperatively. High-speed indocyanine green angiography was performed prior to surgery and was repeated one year after surgery. Results: In all three patients, choroidal perfusion defects were noted pre-operatively in the eyes with the compressive optic neuropathy. At 1 year after orbital decompression surgery, the defects improved or completely resolved. Improved visual acuity and color perception, as well as decreased intraocular pressure, were also noted postoperatively. Conclusion: Patients with Graves' orbitopathy may have abnormal choroidal perfusion even in the absence of optic neuropathy. Orbital decompression may improve choroidal circulation in these patients.
  212 73 -
The association of central corneal thickness with ocular and general parameters in a community setting: The Yazd eye study
Reza Soleimanizad, Mohammad Hosein Nowroozzadeh, Hossein Ziaei, Mohammad Pakravan, Mehdi Yaseri, Marzieh Katibeh
April-June 2017, 12(2):141-150
DOI:10.4103/jovr.jovr_111_15  PMID:28540004
Purpose: To assess central corneal thickness (CCT) and its associations in an adult Iranian population. Methods: This was a population-based cross-sectional study of adults aged 40–80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. Results: The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 μm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 μm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P= 0.025, respectively), and hyperopia (P = 0.009). Conclusion: In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475–613 μm or with interocular asymmetry greater than 33 μm (6%) should prompt evaluation for potential ocular disorders.
  202 72 -
Predictors of successful laser capsulotomy for significant posterior capsule opacification after phacoemulsification
Brijesh Takkar, Parijat Chandra, Shreyas Temkar, Ashutosh Kumar Singh, Indrish Bhatia
April-June 2017, 12(2):170-174
DOI:10.4103/jovr.jovr_244_15  PMID:28540008
Purpose: This study aimed to determine the reasons behind the failure of laser capsulotomy (LC) performed for significant posterior capsular opacification (PCO). Methods: Eighty-eight eyes of 88 patients referred for LC at a tertiary care center were retrospectively analyzed. The data recorded included the cause of cataract, visual acuity, duration of PCO, location of PCO, intraocular lens (IOL) position, IOL type, and lens capsule status. These data were later analyzed for determining the requirement of high pulse energy during LC and the success rate of primary LC. Results: The mean age of the participants was 55.77 ± 18.60 years with 58 (65.9%) male patients. The mean duration between cataract and LC surgeries was 45.58 ± 37.33 months. Senile (n=58), uveitic (n=12), post-pars plana vitrectomy (PPV) (n=12), and traumatic (n=6) cataracts were the common causes. Late-presenting PCO, trauma, uveitis, sulcus placement of IOLs, irregular capsulorhexis shape, and polymethyl methacrylate (PMMA) IOLs were significantly associated with unsuccessful LC and/or higher pulse energy settings during LC. Conclusion: Significant PCO is often associated with cataract caused by uveitis or trauma, and after PPV. PCO associated with trauma, sulcus placement of IOLs, and PMMA IOLs may need multiple LCs.
  196 69 -
CASE REPORTS
Trichoblastoma of the upper eyelid
Bahram Eshraghi, Hamid Riazi-Esfahani, Ramon Katoozpour, Pasha Anvari, Mehdi Mortazavi, Fahaimeh Asadi Amoli
April-June 2017, 12(2):219-221
DOI:10.4103/2008-322X.205378  PMID:28540015
Purpose: To describe a case of trichoblsatoma on the eyelid. Case Report: A 45-year-old woman presented with a recurring mass on her upper right eyelid. Histopathological examination revealed well-circumscribed tissue composed of an aggregation of basaloid cells. Immunohistochemistry showed positive staining for CD34 and CD10. The patient underwent total excision of the recurrent mass. Conclusion: Although rare, trichoblastoma should be considered in differential diagnosis of skin masses of the eyelids.
  208 56 -
Congenital double elevator palsy with sensory exotropia: A unique surgical management
RC Nagpal, Anuradha Raj, Amit Maitreya
April-June 2017, 12(2):222-224
DOI:10.4103/2008-322X.205380  PMID:28540016
Purpose: To report a unique surgical approach for congenital double elevator palsy with sensory exotropia. Case Report: A 7-year-old boy with congenital double elevator palsy and sensory exotropia was managed surgically by Callahan's procedure with recession and resection of the horizontal recti for exotropia without inferior rectus recession, followed by frontalis sling surgery for congenital ptosis. Conclusions: Favourable surgical outcome was achieved without any complication.
  193 63 -
SURGICAL TECHNIQUE
Minimally invasive surgery for the removal of posterior intraocular foreign bodies
Jesus Hernan Gonzalez-Cortes, Yunuen Bages-Rousselon, Jesus Emiliano Gonzalez-Cantu, Jesus Mohamed-Hamsho
April-June 2017, 12(2):236-240
DOI:10.4103/jovr.jovr_109_16  PMID:28540021
This is a prospective clinical assay that included six patients who were diagnosed with penetrating corneal injury, traumatic cataract, and posterior segment intraocular foreign body (IOFB). Following anterior segment repair and extraction of traumatic cataract by clear cornea phacoemulsification, a standard 25-gauge transconjunctival pars plana vitrectomy was performed to find and release the IOFB. With active suction using a 25-gauge silicone tipped cannula, the foreign body was retrieved and safely placed in the anterior chamber. After stabilization of the anterior chamber with viscoelastic injection, IOFB extraction through the main phaco incision was easily performed, followed by placement of an intraocular lens. Of the six patients, 66.6% showed a significant improvement of visual acuity. No complications associated directly with the surgical procedure occurred. Our surgical technique is a safe alternative for handling and removing a posterior IOFB. There was no need for a scleral incision.
  181 70 -
ORIGINAL ARTICLES
Office-based relaxing incision procedure for correction of astigmatism after deep anterior lamellar keratoplasty
Mohammad Ali Javadi, Sepehr Feizi, Firooz Mirbabaee, Yousef Fekri
April-June 2017, 12(2):156-164
DOI:10.4103/jovr.jovr_24_16  PMID:28540006
Purpose: To report the outcomes of a simple and effective office-based procedure for the correction of astigmatism after deep anterior lamellar keratoplasty (DALK). Methods: This study enrolled 24 consecutive keratoconic eyes that developed an intolerable amount of graft astigmatism after DALK. The location and extension of steep semi-meridians were determined using corneal topography. Office-based relaxing incision procedures were performed at the slit-lamp biomicroscope using a 27-gauge needle. Relaxing incisions were made at the donor-recipient interface on one side of the steepest meridian with an arc length of 45° to 60° and an initial depth of approximately 70–80% of the corneal thickness. Topography was performed after 30–40 minutes and the initial incision was enhanced in depth and length. If an acceptable amount of astigmatism was not achieved, another incision was created at the opposite semi-meridian during the same session. Results: Mean follow-up period was 13.1 ± 7.4 months. Mean preoperative best spectacle corrected visual acuity was 0.26 ± 0.14 logMAR, increasing to 0.22 ± 0.09 logMAR after the procedure (P = 0.20). Mean spherical equivalent refractive error increased from − 4.64 ± 3.06 diopters (D) preoperatively to −6.06 ± 3.15 D postoperatively (P = 0.01). Mean keratometric astigmatism was reduced by 2.95 ± 3.43 D and 5.16 ± 2.97 D measured using subtraction and vector analysis methods, respectively (P < 0.001). Microperforation occurred in one eye, which spontaneously improved with no sequelae. Conclusion: Office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after DALK. This approach effectively decreases the need for the more costly alternative in the operating room.
  195 52 -
CASE REPORTS
Endogenous endophthalmitis after severe burn: A case report
Seyedeh Maryam Hosseini, Ali Ahmadabadi, Seyed Hassan Tavousi, Majid Khadem Rezaiyan
April-June 2017, 12(2):228-231
DOI:10.4103/jovr.jovr_144_15  PMID:28540018
Purpose: This report describes a rare ocular complication in a burned patient. Case Report: A 12-year-old girl was admitted to our burn center because of full thickness burn of 46% of her total body surface area. On the 23rd day of her stay, she complained of pain and decreased visual acuity in the right eye. Examination of this eye revealed panuveitis, dense vitritis, and a large chorioretinal abscess in the macular area; her best corrected visual acuity (BCVA) in this eye was hand motion. The left eye was completely normal. A smear and culture of the vitreous biopsy revealed the presence of Candida albicans. With a diagnosis of endogenous endophthalmitis due to fungal infection, the patient was treated with systemic fluconazole, intravitreal injection of Amphotericin B, and pars plana deep vitrectomy. After 6 months, the patient's final ocular examination revealed BCVA of counting fingers at two meters, a large macular scar, and quiescence of the intraocular infection. Conclusion: Burn patients treated with broad-spectrum antibiotics are at risk of candidemia and its complications, including endogenous endophthalmitis. Early diagnosis of endogenous endophthalmitis in high risk patients could prevent visual loss.
  181 61 -
Cluster headache associated with secondary unilateral blepharospasm: A case report and review of the literature
Abbas Bagheri, Minoo Mohammadi, Ghader Harooni, Keyvan Khosravifard, Mohadeseh Feizi, Shahin Yazdani
April-June 2017, 12(2):225-227
DOI:10.4103/jovr.jovr_158_15  PMID:28540017
Purpose: Cluster headache is one of the most serious types of headache that is accompanied by autonomic parasympathetic symptoms. Its association with hemifacial spasm in the same side had been rarely reported. The aim of this report is describing a case with this association and treatment strategies. Case Report: Here we report a 37-year-old female with cluster headache associated with secondary unilateral blepharospasm that was successfully treated with combination therapy including botulinum toxin injection. Conclusion: Hemifacial spasm associated with cluster headache needs special attention and can be treated successfully.
  194 40 -
LETTERS
Outcomes of cataract surgery in children with Down syndrome
Murtaza Saifee, Lingkun Kong, Kimberly Guo Yen
April-June 2017, 12(2):243-244
DOI:10.4103/jovr.jovr_212_16  PMID:28540023
  166 58 -
Bilateral serous macular elevation associated with lupus protein-losing enteropathy
Angela Hiu Yan Wong, Stephen Tak Lun Li, Chi Kin Ho, Po Fat Yiu
April-June 2017, 12(2):245-246
DOI:10.4103/jovr.jovr_117_16  PMID:28540024
  162 42 -
NEWS
Rose bengal-green light for collagen cross-linking
Mehran Zarei-Ghanavati
April-June 2017, 12(2):241-242
DOI:10.4103/jovr.jovr_70_17  PMID:28540022
  134 59 -
PHOTO ESSAY
Ultrawide field imaging in uveitic non-dilating pupils
Koushik Tripathy, Rohan Chawla, Pradeep Venkatesh, Yog Raj Sharma, Rajpal Vohra
April-June 2017, 12(2):232-233
DOI:10.4103/2008-322X.205360  PMID:28540019
  139 53 -
Ring in the eye
Parul Chawla Gupta, Jagat Ram
April-June 2017, 12(2):234-235
DOI:10.4103/jovr.jovr_257_15  PMID:28540020
  133 52 -
ERRATUM
Clinical practice guidelines for prevention, diagnosis and management of early and delayed-onset ocular injuries due to mustard gas exposure

April-June 2017, 12(2):247-247
DOI:10.4103/2008-322X.205383  PMID:28540025
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