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   Table of Contents - Current issue
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July-December 2020
Volume 12 | Issue 2
Page Nos. 35-56

Online since Tuesday, March 9, 2021

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REVIEW ARTICLE  

Updates on management of pellucid marginal degeneration: Topographic patterns, differential diagnosis, and surgical options p. 35
Amr Mounir
DOI:10.4103/sjopthal.sjopthal_20_20  
Pellucid marginal degeneration (PMD) is a rare ectatic corneal disease involving the inferior part of the cornea. It is difficult to differentiate between keratoconus (KCN) and PMD by slit lamp, especially in the detection of early and subclinical stages of the diseases. Corneal topography is the main diagnostic tool of PMD with characteristic diagnostic patterns “crab-claw” or “butterfly.” PMD could be mistaken as KCN, keratoglobus, and other peripheral thinning conditions such as Terrien marginal degeneration and Mooren's ulcer. Spectacles, soft and rigid gas permeable contact lens are the main visual correcting method in early stage of the disease. Different surgical techniques are available for PMD management; however, none of them were found to be effective, so further studies will be needed in the future.
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ORIGINAL ARTICLES Top

Eye care in the intensive care unit for COVID-19 patients p. 43
Hany Mahmoud, Ahmed Hamody
DOI:10.4103/sjopthal.sjopthal_17_20  
Purpose: To assess eye manifestations and ensure the importance of eye care for COVID-19 patients in the intensive care unit, they need regular ophthalmological examination and follow-up. Patients and Methods: In this case series study, 43 patients' (86) eyes with COVID-19 were included in the study. The ocular history was taken from hospital-registered data. They were ophthalmologically examined using a portable slit lamp or by a by-side examination (diffuse illumination), and the anterior segment was evaluated. Schirmer's test was done for all patients to assess dryness. A Tono-Pen™ Tonometer was used in all cases to measure intraocular pressure with full infection control measures. Results: Sixteen (18.6) per cent of eyes were affected either by dryness due to exposure, infection (mucopurulent conjunctivitis), and subconjunctival hemorrhage with no apparent vision affection, and two were on antiglaucoma medications before the infection and advised to continue their medication. Conclusion: Eye care is mandatory for patients in ICU with COVID-19.
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Corneal endothelial density: An indicator for primary glaucoma progression p. 46
Aditya Kailas Khadamkar, Shubha Nagpal
DOI:10.4103/sjopthal.sjopthal_5_20  
Purpose: Glaucoma is a progressive optic neuropathy causing death of retinal ganglion cells and their axons resulting in visual morbidity. This study was aimed to evaluate the impact of primary glaucoma on retinal nerve fiber layer (RNFL) thickness and corneal endothelial damage and to establish any correlation between these two. Materials and Methods: A total of 104 patients (179 eyes) diagnosed as primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and normotensive glaucoma (NTG) were included in this study. Secondary glaucoma, postviral infection, ocular trauma, ocular surgery, and diabetes mellitus were criteria for exclusion. Average retinal nerve fiber layer (AvRNFL) thickness and endothelial cell count (cell density [CD]) were measured. Statistical analysis was done using Spearman's correlation coefficient. Results: The AvRNFL thickness in POAG (n = 120) was 83.83, PACG (n = 46) was 81.45, and Normotensive (NTG) (n = 13) was 71.07 μ. The mean CD values were 2416.68 cells/mm2, 2622.543 cells/mm2, and 2482.69 cells/mm2, respectively. A significant positive correlation between these two values was observed in POAG (P = 0.004) but not seen in PACG or NTG. Conclusion: Corneal endothelium loss may be an indicator of disease progression and RNFL thinning in patients of POAG. Routine specular microscopy evaluation of these patients can be helpful, and low endothelial counts indicate RNFL damage.
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CASE REPORTS Top

Pilomatrixoma of the left upper eyelid p. 51
Pragati Garg, Akansha Sharma
DOI:10.4103/sjopthal.sjopthal_15_19  
To report an uncommon presentation of pilomatrixoma. We report a 72-year-old male attending the ophthalmology outpatient department of a tertiary care center of North India with a painless growth just above his left upper lid at the lateral end of the left eyebrow. He underwent radiological imaging, histopathological examination, and thorough ocular examination which were suggestive of a pilomatrixoma. Pilomatricoma, histologically, is characterized by a mass made up of basaloid cells in the periphery, ghost cells in the central part and calcification, and sometimes ossification. The ghost cells represent necrotic areas of previously vital basaloid cells. The calcification and ossification areas appear progressively in necrotic areas. Ghost cells are pathognomonic of pilomatricoma.
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An unusual case of periocular necrotizing fasciitis: A rare but fatal complication p. 54
Aakanksha Sharma, Eathi Tuli, Gaurav Sharma, Neha Mohammed
DOI:10.4103/sjopthal.sjopthal_14_20  
Necrotizing fasciitis is the infection of the superficial fascia. Periocular necrotizing fasciitis is rare because of rich vascular supply of face as compared to the other parts of the body. In most of the cases, Group A beta-hemolytic streptococci are reported. Even a trivial injury to the eyelid can lead to necrotizing fasciitis. In this case report, a patient presented with fulminant periocular necrotizing fasciitis which was managed with intravenous antibiotics and surgical debridement. Reconstructive plastic surgery was required for the remaining tissue defect and cicatricial ectropion of the lower eyelid.
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