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   Table of Contents - Current issue
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January-June 2018
Volume 10 | Issue 1
Page Nos. 1-38

Online since Tuesday, September 4, 2018

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REVIEW ARTICLE  

Myopia: Etiology, epidemiology, and management strategy p. 1
Yazan Sultan Gammoh
DOI:10.4103/sjopthal.sjopthal_15_18  
Myopia, once seen as a simple refractive error where the image is focused in front of the retina, is now considered as an epidemic with projected estimates of half the world population becoming myopic by the year 2050. It has been shown that the prevalence of myopia is highest in Asian countries, while evidence in the Western world shows an increase in the prevalence of myopia, with a financial burden leading to uncorrected refractive errors including myopia being a major cause of avoidable vision impairment. Although no definite single cause of myopia has been proven, both hereditary factors and near work play a role in the development and progression of myopia. Inaccuracy of accommodation at near and hyperopic defocus at the periphery of the retina have been investigated as possible causes of myopia development, with research on animals providing an insight into the development of myopia in humans. Optical, pharmacological, and corneal reshaping strategies have been developed to control myopia progression with variable results. While undercorrection of myopes and correction with single vision lenses have not been proven to be effective in myopia management, other methods such as orthokeratology and use of atropine are showing evidence of controlling the progression of myopia.
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ORIGINAL ARTICLES Top

Prevalence of refractive errors in Al Bahar Alahmar province in Sudan p. 8
Galal Mohamed Ismail, Atif Babeker Mohamed Ali, Athar Bashir Hassan Dalil
DOI:10.4103/sjopthal.sjopthal_26_17  
Purpose: The study was carried out to investigate the prevalence of refractive errors in al Bahar Alahmar province in Sudan. The aim was to identify the prevalence in the province and to help in improving the health strategic plans in the area as well as reviewing the eye care services provided in the region. Materials and Methods: Eye testing had been executed on 790 patients with ages ranged between 10 and 59 years and means of 41.7 standard deviation ± 10.1. All patients tested for distance vision using (tumbling E chart) and near vision using (tumbling E chart). The battery kept simple at the beginning of the test; however, noncycloplegic objective refraction followed using a streak retinoscope to refract and prescribe the required optical correction. Results: Decreased in vision was more common in the age group of (40–49) years old, right eye (RE); 38% and left eye (LE); 34% (χ2 = 20.83/df = 20/P = 0.04). Spectacles could improve the vision to 6/6 from 45.8% (unaided) in RE to 91.5% aided and from 44.4% to 90.6% for LE. The prevalence of refractive error was 37.1% for the total; of which 19.6% hypermetropia, 6.6%, myopia and 10.9% astigmatism, respectively. The prevalence of hypermetropia increased in those age (40–49) RE; 38% and LE; 39.4% with highly association with age (χ2 = 58.41/df = 12/probability P = 0.001). Myopia found in the age group (50–59) years old RE; 40.4% and LE; 37.8%, but without any significant association between myopia and age (χ2 = 46.28/df = 12/P = 0.74). In examination site, 66.8% of the ametropes were not wearing correction, but 12.4% wearing distance correction, 15.1% using near correction, and 5.7% wearing distance and near correction. Conclusion: Hypermetropia was the most common type of refractive errors. Refractive errors affect a sizable portion of these three towns, a substantial number of uncorrected refractive errors individuals were waiting for help. Thus, awareness and services must be dramatically improved to meet the needs.
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Effect of subconjunctival antivascular endothelial growth factor on corneal neovascularization after penetrating keratoplasty p. 14
Deeksha Lochab, Renu Dhasmana, Neeti Gupta
DOI:10.4103/sjopthal.sjopthal_11_18  
Purpose: To evaluate the effect of subconjunctival anti-VEGF on corneal neovascularisation post penetrating keratoplasty. Methods: A total of 31 eyes of 31 patients with corneal neovascularisation post penetrating keratoplasty were subjected to 2.5 mg/0.1 ml of subconjunctival bevacizumab in each quadrant of neovascularisation. We evaluated the regression of corneal neovascularisation after subconjunctival bevacizumab at 1 week, 4 weeks and 6 weeks and the incidence of complications and subjective complaints related to the treatment was also noted. Results: This was an experimental study, conducted from September 2015 to September 2016. A total of 31 patients with corneal neovascularisation post penetrating keratoplasty were included in the study, out of which 27(87.1%) were males and 4(12.9%) were females. 90.3% of patients had neovascularisation in all 4 quadrants, 6.5% had neovascularisation in 2 quadrants and only 3.2% had neovascularisation in only 1 quadrant. All patients who were subjected to subconjunctival bevcizumab, the regression of neovascularisation at 1 week, 4 weeks and 6 weeks was noted and there was a significant decrease in neovascularisation in central segments 1.97 ± 3.72 as compared to pre 5.13 ±7.12(p=0.001) and also in peripheral segments at 6 weeks 29.90 ± 15.73 as compared to pre bevacizumab 44.32 ± 17.97(p<0.001). Conclusion: The use of subconjunctival bevacizumab seems to be an effective and safe method in the treatment of corneal neovascularisation.
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Knowledge, awareness and practice of CVS in digital device users p. 18
Shweta Chauhan, Renu Dhasmana, Anuradha Raj
DOI:10.4103/sjopthal.sjopthal_3_18  
Aim: The aim was to study the knowledge, awareness, and practice of computer vision syndrome (CVS) in digital device users. Materials and Methods: This was an observational study conducted on 504 healthy students of a medical college. The students underwent an interview in the form of a preset questionnaire. Results: The present study comprised a total of 188 (37.3%) males and 316 (62.7%) females with the mean age of 21.98 ± 4.61 years. Awareness about CVS was poor, i.e., only 32% had ever heard of the term CVS of which around 65% could correctly define it. It was noted that more than half of the participants resorted to incorrect methods for relief of ocular symptoms. Social media was the largest source of information (15.1%). The association of age with awareness, knowledge with respect to definition, blink rate, and source of information was highly significant (P = 0.003, 0.001, 0.001, and 0.01, respectively). The association of profession of the participant with knowledge about blink rate and practice of taking a break was found to be highly significant (P = 0.002 and 0.01, respectively). Awareness about the blink rate and practice of closing eyes was significantly associated with the sex of the participant (P = 0.03 and 0.01, respectively). Conclusion: This study shows that the younger generation has significant knowledge about CVS, but there is a gap in practice. A program studying and addressing the barriers to practice needs to be developed for younger generation.
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Evaluation of risk factors and treatment outcome of microbial keratitis in a tertiary eye center p. 25
Simanta Khadka, Meenu Chaudhary, Madhu Thapa
DOI:10.4103/sjopthal.sjopthal_5_18  
Purpose: To evaluate the risk factors and treatment outcome of microbial keratitis in a tertiary eye care centre. Methods: A hospital based prospective study in clinically diagnosed cases with microbial keratitis were enrolled. Corneal scrapes taken and subjected to direct microscopy and culture. Empirical treatment initiated following smear report and definitive treatment commenced after culture and sensitivity report. Patients were followed up for 3 months. Treatment outcome was assessed on the basis of signs of healing, scar formation, necessity of surgical intervention and severe complications. Results: A total of 95 patients were included. Microbial keratitis was common in the age group of 51-60 years with male preponderance. It was common in people involved in agricultural works, and frequent during the agricultural season of monsoon and spring. Among the predisposing factors, history of ocular trauma with vegetative matter is common. Majority presented before 14 days of onset of symptoms and also had history of prior treatment. Organisms were identified under direct microscopy in (38.9%) of cases and isolated in (51.6%) in culture medium. Streptococcus pneumoniae (22.1%) and Aspergillus (7.3%) were the most common bacterial and fungal isolate respectively. In vitro antibiotic sensitivity demonstrated bacteria were most sensitive to ofloxacin. A total of (75.8%) patients achieved complete healing whereas (10.5%) required surgical intervention. Conclusion: Early presentation, medication compliance and timely intervention can lead to good clinical and visual outcome in patients with microbial keratitis.
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Associations between dry eye symptoms with tear film stability, volume, and osmolarity in a sample of young adults in Kuala Lumpur p. 32
Mohamad Hanif Hajar-Maidin, Bariah Mohd-Ali, Asmah Ahmad, Zainora Mohammed, Jamaluddin Mohamed
DOI:10.4103/sjopthal.sjopthal_14_18  
Context: Dry eyes (DE) are common ocular problems and any abnormalities in tear film are a concern to eye care practitioners. However, the association between DE symptoms with clinical tests is controversial. Aim:This study aims to investigate the associations between DE symptoms with tear film stability, volume, and osmolarity in a sample of young adults living in Kuala Lumpur. Methodology: A total of 107 healthy young adults, 35 males and 72 females participated in this study with a mean age of 23.06 ± 2.63 years. DE symptoms were screened using McMonnies DE questionnaire (MDEQ); tear stability was evaluated using tear break-up time test (TBUT); tear volume was measured using phenol red thread test (PRT); and tear osmolarity was measured with micro osmometer. The MDEQ score classified 36 subjects as having DE and 71 as non-DE (NDE). Results: Mean score for DE was 16.49 ± 1.74 and 7.23 ± 3.09 for NDE. Mean TBUT for DE and NDE was 4.76 ± 1.58 s and 5.69 ± 1.61 s, respectively. Mean PRT was 7.97 ± 5.60 mm for DE and 12.59 ± 5.70 mm for NDE. Mean tear osmolarity for DE and NDE was 322.42 ± 36.94 Osm/L and 286.35 ± 21.31Osm/L accordingly. Analysis using independent t-test showed a significant difference in TBUT and osmolarity between two groups (P < 0.05). Mann–Whitney sum rank test shown that there were significant differences in PRT measurement between two group (P = 0.00). Significant correlations were noted between MDEQ score with tear osmolarity (r = 0.42, n = 107, P = 0.00), PRT (r = −0.36, n = 107, P = 0.00) and TBUT (r = −0.28, n = 107, P = 0.00). Conclusion: This study demonstrated that significant associations between DE symptoms with TBUT, PRT, and tear osmolarity. MDEQ should be considered by eye care practitioners to confirm the diagnosis of dry eye.
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CASE REPORT Top

A rare case of circumscribed choroidal hemangioma in sturge–weber syndrome p. 37
Ankita Anil Patil, Anamika Agrawal, Anjali D Nicholson
DOI:10.4103/sjopthal.sjopthal_2_18  
A 13-year-old female presented with acute-onset pain and redness in the left eye with a history of poor vision in that eye. On examination, a port-wine stain was present involving the ipsilateral eyelids, and the vision in the affected eye was no perception of light with elevated intraocular pressure and indirect ophthalmoscopy showing total retinal detachment. Ultrasonography B-scan showed a dome-shaped lesion with smooth contours and high irregular internal reflectivity and total retinal detachment suggestive of a circumscribed choroidal hemangioma. The patient was treated symptomatically for pain and elevated intraocular pressure. Neurology and oncology opinion was sought for systemic evaluation and radiotherapy.
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