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Delhi Journal of Ophthalmology Delhi Journal of Ophthalmology Delhi Journal of Ophthalmology Delhi Journal of Ophthalmology Editor Rohit Saxena Managing Editor Rajesh Sinha Editorial Committee Editorial Board Parijat Chandra Jitendra Jithani Rajvardhan Azad Vimla Menon Rasik B Vajpayee Tushar Agarwal M.Vanathi Atul Kumar Pradeep Sharma Rajinder Khanna Shibal Bhartiya Prakash Chand Agarwal Ashok K Grover V P Gupta Harbans Lal Munish Dhawan Swati Phuljhele Mahipal S Sachdev S. Bharti Amit Khosla B Ghosh Harinder Sethi Reena Sharma Lalit Verma Ashok Garg Kirti Singh Raghav Gupta Varun Gogia Sharad Lakhotia P K Pandey B P Guliani Ashish Kakkar Sashwat Ray P V Chaddha Ramanjit Sihota S P Garg Rachana Meel Saptorshi Majumdar Dinesh Talwar Divender Sood Arun Baweja Digvijay Singh Shraddha Puranik K P S Malik Rishi Mohan Sanjay Mishra Tanuj Dada Namrata Sharma Tarun Sharma General Information Delhi Journal of Ophthalmology (DJO), once called Visiscan, is a quarterly journal brought out by the Delhi Ophthalmological Society. The journal aims at providing a platform to its readers for free exchange of ideas and information in accordance with the rules laid out for such publication. The DJO aims to become an easily readable referenced journal which will provide the specialists with up to date data and the residents with articles providing expert opinions supported with references. Contribution Methodology Author/Authors must have made significant contribution in carrying out the work and it should be original. It should be accompanied by a letter of transmittal.The article can be sent by email to the Editor or a hard copy posted. Articles receive will be sent to reviewers whose comment will be emailed to the author(s) within 4-6 weeks. The identity of the authors and the reviewers will not be revealed to each other by the editorial team. Detailed instructions to the contributors and for advertisement are included at the end of the journal. Editorial Process The DJO has Dr Rohit Saxena as its Editor who is assisted by a team of renowned ophthalmologists and an illustrous editorial board. The reviewers,who are leaders in their respective fields, form the back bone of the journal by setting standards for the published work. Disclaimer The journal does not take any responsibility for the articles published in the journal unless it is explicitly stated so. The views expressed in the articles and editorials are of the authors and do not in any way reflect the policy of the Delhi Journal of Ophthalmology. The journal does not endorse or guarantee the quality or efficacy of any product or service mentioned or advertised in the journal issues. Advertisements carried in this journal are expected to conform to internationally accepted medical, ethical and business standards. Editorial Office Dr Rohit Saxena, Room No. 479, Dr R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi-110029 Ph +91-011-26593182, Email : [email protected] Published by Dr Rohit Saxena, Editor DJO, on behalf of Delhi Ophthalmological Society, Delhi Editorial Assistant Varun Kumar Vol. 21, No. 3, January-March, 2011 DJO 1 Delhi Journal of Ophthalmology Contents Editorial 3. Where the mind is without fear Dr. Rohit Saxena Major Review 4. Endophthalmitis Shivani Pahuja, Ritesh Narula 9. The Operation Theatre : Basic Architecture Sapna, Saptorshi Majumdar, Pradeep Venkatesh 15. Upshoot And Downshoot In Duane’s Retraction Syndrome Suma Ganesh 19. Marcus Gunn Jaw-Winking Phenomenon : A Review Dewang Angmo, Mandeep S. Bajaj, Neelam Pushker, Supriyo Ghose 23. Review of doses of important drugs in ophthalmology Yogesh Bhadange, Bhavin Shah , Brijesh Takkar, Rajesh Sinha Preferred Practice Pattern 28. Systematic Approach to a Case of Disc Pallor Digvijay Singh, Rohit Saxena, Pradeep Sharma, Vimla Menon Case Reports 33. Bilateral Mooren’s Ulcer with perforation and Iris prolapse Uday Gajiwala, Jyotsom Ganatra, Rajesh Patel, Parin Shah, Rohan Chariwala 38. Acute Onset Myopia and Angle Closure Glaucoma after Topiramate Administration Nidhi Verma, Ashok Kumar Instrument Scan 40. Understanding your Direct Ophthalmoscope Digvijay Singh, Rohit Saxena, Pradeep Sharma, Vimla Menon Original Article 45. Study of Colour Blindness in Tibetan Population Navjot Kaur, Avinash Kumar, Gurinder Kaur, Jasjeet Kaur Dhillon, K.D.Singh 48. Manual Sutureless Small Incision Technique for Exchange of dislocated Posterior Chamber IOL Lakshminarayana Pasumala Instructions to Authors DJO Vol. 21, No. 3, January-March, 2011 2 Delhi Journal of Ophthalmology Editorial Where the mind is without fear The relevance of Rabindranath Tagore’s poem for today’s ophthalmologist. WHERE the mind is without fear and the head is held high (in OPD’s, rounds, OT’s) Where knowledge is free (conferences, symposiums, internet) Where the world has not been broken up into fragments By narrow domestic walls (zones, institutions vs individual, govt. v/s pvt.) Where words come out from the depth of truth (in free paper sessions, articles) Where tireless striving stretches its arms towards perfection (in our work) Where the clear stream of reason has not lost its way (Duke Elder, Kanski…) Into the dreary desert sand of dead habit (routine of OPD-rounds-OT) Where the mind is led forward by thee (God who gave us the opportunity to give sight) Into ever-widening thought and action (think and reach beyond routine clinical work) Into that heaven of freedom, my Father, let my country (us ophthalmologist) awake. Dear friends, The relevance of the above poem is timeless and for everyone whichever occupation we may be pursuing. It is just a reminder that we must get out of our routine and think towards becoming better and more accomplished in our work and our duty of serving the patients for which we are here. Let us resolve to give our best towards the care of our patients…. The result of course is always out of our hands. This is the penultimate issue of the Delhi Journal of Ophthalmology with yours truly as the Editor and I must accept that despite the challenges of bringing out the journal regularly with a content that is somewhat accurate, interesting and scientifically sound, my period as editor has been most enjoyable and fulfilling. Dr. Rohit Saxena The Delhi journal of Ophthalmology is now indexed at Index Copernicus. The editorial board is involved in the task of getting the journal indexed in other sites as well as improving the quality of articles and their presentation. This is only possible with the support of each and every DOS member. In addition to the present heads, the DJO also publishes original research including thesis work of residents. We also welcome to article comments and advise on how to improve the DJO. Any DOS member who has not received the previous four issues please contact DOS Secretariat [email protected], [email protected] or Editor, DJO editordjo@gmail. com. Some copies have come back due to incorrect addresses, so members are requested to please provide correct addresses and contact details to DOS Secretariat. Vol. 21, No. 3, January-March, 2011 DJO 3 Delhi Journal of Ophthalmology Major Review Endophthalmitis Shivani Pahuja1, Ritesh Narula2 1 Guru Nanak Eye Centre, 2 Shroff Charity Eye Hospital. Endophthalmitis is an inflammation of the internal layers of material, infectious keratitis or as a complication of suture the eye resulting from intraocular colonization of infectious removal. These patients are also at risk of infections due to agents and manifesting with an exudation into vitreous cavity. prolonged corticosteroid use following surgery. Though the word endophthalmitis means any inflammation of the internal ocular spaces but in clinical practice it is usually Endophthalmitis as a complication of vitreoretinal surgery is taken to mean inflammation secondary to intraocular infection. relatively uncommon. Scleral buckle infection usually appears Endophthalmitis can be divided into two main types based between the second and seventh day of surgery, and, presents as on the mode of infection as: Exogenous and Endogenous severe lid oedema with conjunctival chemosis associated with (ie, metastatic). Exogenous endophthalmitis results from severe ocular pain and headache. Intraocular inflammation direct inoculation as a complication of ocular surgery, foreign may develop associated with media haziness, subretinal bodies, blunt or penetrating ocular trauma. Endogenous exudation and localised exudative retinal detachment. In endophthalmitis [1] results from the hematogenous spread of delayed subacute cases fistula and granuloma form, resulting organisms from a distant source of infection (eg, endocarditis). in exposure of the buckle. Diabetes and prolonged duration Endogenous endophthalmitis is quite rare. Various studies have of surgery have been identified as specific risk factors in this reported incidence varying from 2% to 15%. In endogenous setting. Incidence of endophthalmitis following pars plana endophthalmitis, blood-borne organisms permeate the blood- vitrectomy has been reported as low as 0.051%. ocular barrier either by direct invasion (septic emboli) or by changes in vascular endothelium caused by substrates released The risk factors are different for isolated and cluster during infection. Destruction of intraocular tissues may be due endophthalmitis. Patient factors play a predominant role in to direct invasion by the organism and/or from inflammatory isolated postoperative endophthalmitis. Patients own bacterial mediators of the immune response. Due to increase in the flora may gain entry at the time of surgery and thus increasing spread
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