Presenting Symptoms Are Associated with Uveal Melanoma-Related Death
Maria Fili, Stefan Seregard, Gustav Stålhammar
Read MoreThe science and philosophy of manuscript rejection
Ali, Mohammad Javed
Read MoreA three-time Pulitzer Prize winner and American Poet, Carl Sandburg (1878–1967) summarized one of his experiences as follows:
“I wrote poems in my corner of the Brooks Street station. I sent them to two editors who rejected them right off. I read those letters of rejection years later, and I agreed with those editors”.
Manuscript rejection is a dreaded fear that most authors anticipate and is an experience that every researcher faces.[123] Rejection is an integral part of a scientific career.[43456] It is common knowledge that reputed journals reject manuscripts in higher numbers than the numbers accepted. Some studies have shown that as many as 62% of the published manuscripts were initially rejected.[7] Hence, it is essential to reflect on the causes of rejection, its significance in the scientific process, and how we can minimize it. The fundamental need of Science is to keep its knowledge secure and maintain its role as a powerful tool in understanding nature. The peer-review process is a critical step in fulfilling such an objective. Surveys have shown that the peer-review process helped 91% of the respondents to improve their manuscripts.[18] A researcher, therefore, gathers enough evidence to satisfy the peer-reviewers and skeptical competitors. While all may not be satisfied, a critical majority needs to endorse the work to have the desired impact. The mandate of the present editorial is to discuss the common causes of manuscript rejection, measures to deal with them, and present a simple checklist to minimize manuscript rejections. These are by no means an exhaustive list, but the intention is to present the literature trends and the editor’s experience and perspectives…….. FULL TEXT
Journal : IJO
Ref : Manuscript Publication
Do it yourself non-contact eyelid eversion: I-Verter
Tagare, Shivraj; Nair, Megha; Gosalia, Hirika; Venkatesh, Rengaraj; Vedachalam, Rajesh; Singh, Harsh Vardhan
Read MoreDear Editor,
In this era of the COVID-19 pandemic, there is a potential risk of transmission of viral infections during lid eversion due to the exposure of ocular fluids such as tears and conjunctival secretions following contact between the examiner’s finger and the patient’s bare ocular surface.[12] Lid eversion in deep sockets, madarosis, and pediatric patients are some of the other challenges faced. Alternate methods using paper clips[3] and wire speculum[4] have been described in the past but none reduce the risk of transmission of the infection. The principle of lid eversion consists of a combination of two forces—pulling force by fingers on the eyelashes [Fig. 1a] and a pushing force by fingers on the upper tarsus [Fig. 1b]. Adopting this, a simple tool which made no direct contact with the ocular surface was made using two materials: (a) Double-sided tape and (b) Ice cream stick. An ice cream stick was cut at one end with dimensions of 3.5 cm × 6 mm to which one side of the double-sided tape of dimensions 3.5 cm × 5 mm was stuck [Fig. 2a]. The other side of the tape adheres to the skin of the upper eyelid overlying the upper tarsus. The adherence of the double tape creates the pulling force on the upper eyelid and the rotational motion along the axis of the ice cream stick creates the pushing force on the tarsus just over its upper border everting the eyelid. It can be used to examine the upper tarsal conjunctiva, superior fornix and lid swellings, foreign body removal, saline wash in chemical injury, etc. [Fig. 2b and Video 1]. Double eversion can also be attempted [Fig. 2c]. Paramedical staff can also evert the upper eyelid while the doctor examines the patients [Fig. 2d]. Thus, I-Verter is a safe, universal, easily disposable, and economical DIY device for lid eversion with a minimum risk of infection.
https://journals.lww.com/ijo/Fulltext/2021/07000/Do_it_yourself_non_contact_eyelid_eversion_.83.aspx
Journal : IJO
Prevention of mucormycosis in COVID-19 – the need of the hour
Ish, Pranav; Ish, Somya
Read MoreDear Editor,
There has been an increased realization of rhino-orbito-cerebral mucormycosis (ROCM) in coronavirus disease 2019 (COVID-19) and post-COVID-19 patients in the past few weeks. The editorial published recently in this journal[1] is a consolidated review of the diagnosis, staging, and management of ROCM for the awareness of the medical fraternity. However, there are certain issues regarding the prevention of ROCM that need further evidence before recommending at the national level.
Prevention of ROCM in the COVID-19 era needs judicious use of steroids (both dose and duration), control of comorbidities (especially diabetes), and maintaining hygiene and cleanliness. The use of drugs such as posaconazole for prophylaxis is currently not recommended in the Indian guidelines for COVID-19.[2] Even the international guidelines recommend posaconazole prophylaxis only for patients with neutropenia and in graft-versus-host disease, that too with moderate strength.[3] The editorial discusses the role of posaconazole in high-risk cases of COVID-19. These high-risk factors mentioned include 3 weeks of oxygen, steroids, mechanical ventilation, or comorbidities with immunosuppression. The rationale of these suggestions requires clinical evidence of reduced incidence of ROCM before advocating the same. Posaconazole is an expensive drug with limited availability in India. This will create a huge subset of the population in India affected by the current wave for posaconazole prophylaxis. A reasonable suggestion can be vigilant screening for ROCM in all such patients for early diagnosis and appropriate therapy.
The classification into possible, probable, and proven ROCM has been aptly discussed. Although every attempt must be made to make a proven diagnosis, initiating antifungal therapy even in probable cases has a favorable risk–benefit ratio. When it is recommended by the author to clinically follow up with endoscopy and radiology without any antifungal drugs in possible ROCM,[1] it makes the concept of drug therapy for prophylaxis redundant.
There are multiple therapies that are being used for severe COVID-19, including many immunosuppressants (tofacitinib, baricitinib, bevacizumab, and itolizumab), although only tocilizumab is mentioned in the national guidelines as an off-label therapy in India. Thus, they can be possible risk factors and must also be judiciously used with strict clinical monitoring, and ideally only in a trial mode setting.[4]
The war with COVID-19 has rendered huge morbidity and mortality. ROCM is adding fuel to this fire and spreading across the country. Appropriate clinical practices, judicious use of drugs, early diagnosis, and early treatment are the most important strategies in the current times.
Journal : IJO
Ref : COVID-19 Mucormycosis Orbit Rhino-orbito-cerebral mucormycosis
COVID-19, steroids, and mucormycosis: What an ophthalmologist should know
Tandon, Abhishek; Pandey, Latika
Read MoreDear Editor,
The landmark RECOVERY (Randomised Evaluation of COVID-19 Therapy)[1] trial published in June 2020 has served as a license to use steroids in patients with COVID-19 (coronavirus disease 2019). However, the benefit was specifically shown with low-dose, short-duration dexamethasone in moderate to severe illness, a point we certainly seemed to have missed. The use of high doses of corticosteroids and anti-IL-6-directed strategies in patients has led to a flare-up of secondary bacterial and fungal infections, mucormycosis being an important one of them.
With the blatant misuse of steroids, new cases of mucormycosis are coming into light every day, and as such it becomes important for a treating ophthalmologist to familiarize themselves with the disease, aiding in early diagnosis, a point that cannot be emphasized enough. Delay in recognizing the early symptoms and signs could prove cataclysmic in a disease that already has such a high mortality rate. Sarkar et al.[2] reported that four of their 10 patients expired within 1 of the diagnosis, five patients had irreversible vision loss, and only one patient had both ocular and systemic favorable outcomes. Eyelid swelling, black discoloration, ptosis, proptosis, restricted eye movement, eschar or black discharge in the nasal or oral cavity, and cranial nerve involvement are ominous signs[3] that should raise alarms in a post-COVID-19 patient.
Mucormycosis has a significant impact on the patient’s standard of living and therefore a high clinical suspicion, early diagnosis, and prompt treatment are key to alleviate the patient’s misery and ameliorate recovery. There is no biomarker for mucormycosis, and hence a negative galactomannan and beta-d-glucan are useful pointers only to rule out other mold infections. Rapid diagnostic methods include KOH (potassium hydroxide) mount, calcofluor stain, and biopsy. Because mucor is difficult to culture, biopsy is the mainstay of diagnosis. Treatment principles include antifungal agents, surgical debridement, and reversal of underlying predisposing factors. Amphotericin B has been the standard of treatment for invasive mucormycosis, but in cases of renal impairment, posaconazole or isavuconazole become useful alternatives.[4]
Journal : IJO
Endoscopic transnasal drainage for orbital implantation cyst after orbital wall reconstruction
Wu, Ende; Sun, Jiaying; Zhou, Guangming; Wu, Wencan
Read MoreAn implantation cyst after orbital wall reconstruction may present as a late complication, which can cause local pain, proptosis, diplopia, and vision impairment. Previous surgical strategies prefer transconjunctival or subtarsal approach for cyst drainage, a similar approach to orbital wall reconstruction. These strategies may have risk of secondary infection. Herein, we propose an endoscopic transnasal surgical approach, through which the removal of implant and cyst drainage can be performed conveniently. The residual, medial single-layer cyst wall is generally strong enough to support the orbital soft tissues without the need for a new implant. We believe this surgical approach can simplify the procedure, reduce the complications, and prevent cyst recurrence.
https://journals.lww.com/ijo/Fulltext/2021/07000/Endoscopic_transnasal_drainage_for_orbital.65.aspx
Journal : IJO
Subjective outcome and quality of life following external dacryocystorhinostomy
Dani, Koshal; Yadalla, Dayakar; Joy, Anupama; Wu, Annie M; R, Jayagayathri
Read MorePurpose:
To assess the patient reported outcome and quality of life in post external dacryocystorhinostomy operated patients.
Methods:
A prospective questionnaire based study was carried out on 112 patients diagnosed with chronic dacryocystitis who underwent external dacryocystorhinostomy in the department of Orbit and Oculoplasty at a tertiary eye hospital in South India.
Results:
We included 112 cases in our study. Mean (SD) of the age of patients was 48.03 (12.79) years and ranged from 7 to 72 years of age. 44 (39.3%) patients were males and 68 (60.7%) were females. All cases had subjective symptoms of tearing, pain and swelling at baseline which were relieved by post-operative 3 in all cases. The mean (SD) best corrected visual acuity was 0.28 (0.39) at baseline and 0.25 (0.37) at postoperative 3 (p < 0.001). All four parameters studied in the GBI questionnaire – total mean GBI (32.22 vs 48.86, P < 0.001), general subscale (31.21 vs 44.08, P < 0.001), social health (46.28 vs 61.01, P < 0.001), physical outcome (22.17 vs 55.80, P = 0.0001) scores showed significant improvement from 1 vs 3 months post DCR.
Conclusion:
The GBI questionnaire is an effective tool for assessing patients’ quality of life following DCR. External DCR can not only produce a successful anatomical outcome but also bring about a measurable improvement in subjective symptoms and quality of life among patients with symptomatic NLDO.
COMMENTARY:
Ali, Mohammad Javed
Lacrimal drainage disorders have complex physical, functional, and psychosocial impacts on the patient’s quality of life. Hence, the evaluation of posttreatment outcomes should extend far beyond the routine anatomical and functional success. Several quality-of-life questionnaires or scoring systems with numerous parameters have been used and validated for lacrimal disorders. They include Glasgow Benefit Inventory (GBI), the nasolacrimal duct obstruction symptom score (NLDO-SS), lacrimal symptom questionnaire (Lac-Q), ocular surface diseased index (OSDI), and the visual function questionnaire (VFQ-25).[1]
Journal : IJO
Assessing the results of anophthalmic prostheses
Vardizer, Yoav; Sobeh, Tamer; Prat, Daphna Landau; Simon, Guy J Ben; Tomkins-Netzer, Oren
Read MorePurpose:
Anophthalmic sockets cause disfigurement that may result in emotional and social distress. The choice of procedure and implant is based upon the surgeon’s experience. There remains no standardization of cosmetic result. We sought to identify quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and to determine correlations between self-reported and third-party assessment of cosmetic success.
Methods:
This was a prospective observational study, which included 107 adult patients (50.1% female; age 53.08 ± 18.64 years, range 18–89) with acquired anophthalmia following prosthesis fitting. Patients completed a self-assessment questionnaire on self-perception of body image and ocular properties. Three independent examiners assessed cosmetic score. Assessed variables included prosthesis movement, eyelid symmetry, prosthesis stability, and socket fullness.
Results:
The general cosmetic result was 8.1 ± 2.19 (on a predetermined scale of 1–10) as perceived by the patients and 7.2 ± 0.19 by the examiners. Interexaminer correlation was high for all variables (P < 0.05). A good cosmetic result was correlated with prosthesis movement (P = 0.02), eyelid symmetry (P = 0.001), and prosthesis stability (P = 0.01). Factors that correlated with a good cosmetic result on multivariate analysis were prosthesis movement (odds ratio [OR] 4.95, P = 0.004), eyelid symmetry (OR 4.51, P = 0.006), and socket fullness (OR 3.56, P = 0.005). No correlation was observed between patients’ perceptions of the overall cosmetic result and those of the examiners.
Conclusion:
The cosmetic result of prosthesis use among anophthalmic patients is generally good, as perceived by both patients and examiners. Good eyelid position and symmetry, orbital fullness, and prosthesis motility were associated with a better cosmetic result.
COMMENTARY:
Dave, Tarjani V
An ideal outcome of anophthalmic socket surgery depends on the volumetric outcome in terms of the superior sulcus deformity and the enophthalmos with prosthesis along with an excellent socket surface area that avoids lagophthalmos and allows for a well-retained prosthesis.[1] Another factor that needs to be looked at is the presence of any eyelid abnormalities such as ptosis, lower eyelid retraction, and entropion that are commonly seen in anophthalmic sockets. The incidence of new-onset ptosis is close to 40% in patients with anophthalmos.[2] It is also known that anophthalmic levator function is greater with an increased anterior projection of the implant and prosthesis.[2] This makes it important for us to understand the concept of making scleral flaps during evisceration and ideal sizing of implants to achieve a symmetric fullness of the superior sulcus and avoid anophthalmic ptosis.[3] Along with this, one of the most important factors that is sub-optimally addressed is the cosmetic outcome of the prosthesis itself.[4] This puts an emphasis on the development of a metric to assess the aesthetic outcome of an anophthalmic socket incorporating all of these factors.
The article details quantifiable anatomical features and functional properties related to a successful cosmetic result in patients with ocular prosthesis and determine correlations between selfreported and thirdparty assessment of cosmetic success. The authors detail that the professional examiners associated good cosmetic results with the ability of the prosthesis to move in comparison to the contralateral eye, eyelid symmetry, and socket fullness. In contrast, the patients mostly rated their own cosmetic result as good according to the eyelid symmetry and prosthesis stability. The only parameter that correlated well between the patients and the examiners was sufficient conjunctival surface.
When compared to this series, data from Indian patients[1] suggest that motility of the prosthesis forms one of the most important factors that patients are concerned about while undergoing socket surgery and fabrication of a prosthetic eye. This could partly be because the mean age of the patients undergoing socket surgery in India is roughly two decades younger than what is published in this article. This also brings out the need for socket surgery to be refined both in terms of technique and technology to match the patients’ expectations. While implantation of a 20 mm implant serves to give an excellent superior sulcus fullness in Asian Indian eyes, this cannot be achieved without incorporating surgical techniques such as 2 and 4 scleral flaps. Technological advances in manufacturing implants that might help increase motility without the need for pegging or a second procedure are the need of the hour.
Journal : IJO
Ten-year outcomes of uveal melanoma based on The Cancer Genome Atlas (TCGA) classification in 1001 cases
Shields, Carol L; Mayro, Eileen L; Bas, Zeynep; Dockery, Philip W; Yaghy, Antonio; Lally, Sara E; Ganguly, Arupa; Shields, Jerry A
Read MorePurpose:
To understand the prognostic value of The Cancer Genome Atlas (TCGA) for uveal melanoma metastasis, using a simplified 4-category classification, based on tumor DNA.
Methods:
A retrospective cohort study of 1001 eyes with uveal melanoma at a single center, categorized according to TCGA as Group A, B, C, or D (by fine-needle aspiration biopsy for DNA analysis), and treated with standard methods, was studied for melanoma-related metastasis at 5 and 10 years.
Results:
Of 1001 eyes with uveal melanoma, the TCGA categories included Group A (n = 486, 49%), B (n = 141, 14%), C (n = 260, 26%), and D (n = 114, 11%). By comparison, increasing category (A vs. B vs. C vs. D) was associated with features of older age at presentation (56.8 vs. 52.8 vs. 61.1 vs. 63.5 years, P < 0.001), less often visual acuity of 20/20–20/50 (80% vs. 67% vs. 70% vs. 65%, P = 0.001), tumor location further from the optic disc (P < 0.001) and foveola (P < 0.001), and greater median tumor basal diameter (10.0 vs. 13.0 vs. 14.0 vs. 16.0 mm, P < 0.001) and tumor thickness (3.5 vs. 5.2 vs. 6.0 vs. 7.1 mm, P < 0.001). The Kaplan–Meier (5-year/10-year) rate of metastasis was 4%/6% for Group A, 12%/20% for Group B, 33%/49% for Group C, and 60%/not available for Group D.
Conclusion:
A simplified 4-category classification of uveal melanoma using TCGA, based on tumor DNA, is highly predictive of risk for metastatic disease.
Journal : IJO
Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1
Sen, Mrittika………
Read MorePurpose:
COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India’s second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.
Methods:
This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.
Results:
Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).
Conclusion:
Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
Journal : IJO
Ref : Amphoteracin B COVID-19 Orbit Orbital Exenteration Rhino-orbito-cerebral mucormycosis