bluuebunny/crossref_metadata_2025 huggingface dataset:
Woke? Affect, Neoliberalism, Marginalised Identities and Consumer Culture
Authors: Kanai Akane , Gill Rosalind
Published: March 2021

Reading the current conjuncture is challenging. Alongside the exigencies of the current global pandemic, we live in a moment of resurgence of right-wing nationalism, populism, and a crisis of the left across the West. At the same time, we observe a different kind of political commonsense
emerging in consumer culture. From burger chains and oil companies to fast fashion, there is an increasing saturation of 'feel good' and 'positive' messages of female empowerment, LGBTIQ pride, racial and religious diversity and inclusion, and environmental awareness. In this article, we question
how radical politics – especially around gender, race and sexuality – is put to work in current moment as a response to crisis/ crises in this context of corporate 'wokeness'. We analyse the texture of woke capitalism – what it re-articulates and disarticulates – using
Stuart Hall's ideas of conjuncture but contribute an explicitly feminist perspective that notes the extent to which these ideological formations operate affectively. We draw on contemporary feminist work illustrating the affective operation of neoliberalism in the production of everyday
life and subjectivity. Going beyond a simple diagnosis of incorporation and recuperation of radical movements, we use the case study of woke capitalism to suggest the production of new affective movements structuring the ongoing obduracy of neoliberalism.
What We (Still) Need to Learn: Stuart Hall and the Struggle Against Racism
Authors: Rodman Gilbert B.
Published: March 2021

Forty years ago, in his seminal essay, 'The Whites of Their Eyes', Stuart Hall admonished the left for its – our – collective failure in figuring out how to fight back against racism effectively. Sadly, his criticism is no less valid today than it was then, and we still
have a lot to learn about how to defeat racism once and for all. We've known for more than a century that this thing we call 'race' isn't a scientifically valid phenomenon – and yet it continues to function perfectly well in the world as if it is one anyway. As Hall noted in a 2011 interview,
the mere act of unmasking essentialisms and deconstructing binaries doesn't stop them from 'roaring away' in the world, completely undisturbed by our analytic prowess. This essay takes stock of the current state of anti-racist struggles (at least in the US) and offers a critical analysis of
how and why our current efforts to combat racism continue to be so ineffective.
Leaving Academia: The Shifting Terrain of Higher Education
Authors: Segal Lynne
Published: March 2021

Leaving academia, this essay joins a steady chorus of reflection now thinking backwards over the last half century of extraordinary transformations in higher education. The industry is booming, more students than ever are entering universities, yet the academy is seen as increasingly
in crisis. Staff workloads keep mounting, student debt soaring, and staff and student anxieties alike are multiplying, even as government underfunding, imposed managerialism and commercialisation threaten to reduce the underlying logic of higher education to market principles. In this context
it is more urgent than ever to record the half century of struggle that opened up and enriched academic life, gradually ensuring the entry of hitherto excluded voices and topics into research and scholarship, especially in the humanities and social sciences. Drawing on my own involvement,
I recall some of these always-incomplete attempts to challenge the fault-lines of intellectual life in the academy, knowing that we need always to cherish the value of teaching, research and learning, simply for its own sake.
Ethnicity and Neonatal Lupus Erythematosus Manifestations Risk in a Large Multiethnic Cohort
Authors: Diaz Talia , Dominguez Daniela , Jaeggi Edgar , Knight Andrea M. , Laskin Carl A. , Ng Lawrence , Silverio Franklin , Silverman Earl D. , Hiraki Linda T.
Published: April 2021

Objective

To evaluate the association between ethnicity and neonatal lupus erythematosus (NLE), as well as specific NLE manifestations in a large multiethnic population.

Methods

We conducted a cohort study of the children (≤ 1 yr of age) seen in the NLE clinic at The Hospital for Sick Children (SickKids), between January 2011 and April 2019. The cohort was divided into European, non-European, and mixed European–non-European groups according to parent-reported child’s ethnicity (Canada Census categories). Outcomes were NLE and specific NLE manifestations (cardiac, cutaneous, cytopenias, transaminitis, and macrocephaly). The frequency of NLE and specific manifestations were compared between ethnic groups (Fisher exact test). We tested the association between ethnicity and (1) NLE risk, and (2) specific NLE manifestations with logistic regression models, including covariates for child’s sex, maternal rheumatic disease status during pregnancy, and maternal use of antimalarials during pregnancy (multiple comparisons threshold P < 0.008).

Results

We included 324 children born to 270 anti-Ro antibody–positive mothers. Median age at first visit was 1.8 (IQR 1.4–2.3) months, and median follow-up time was 12 (IQR 2–24) months. The majority was non-European (48%), with 34% European, and 18% mixed European–non-European. There was no significant association between non-European ethnicity (OR 1.18, 95% CI 0.71–1.94, P = 0.51), mixed European–non-European ethnicity (OR 1.13, 95% CI 0.59–2.16, P = 0.70), and NLE risk compared with European ethnicity. We also did not find an association between ethnicity and specific NLE manifestations in univariate or multivariable-adjusted models.

Conclusion

In a large multiethnic cohort, there was no association between a child’s ethnicity and NLE risk or specific NLE manifestations.
NTRK-A narrative review
Authors: Batra Ullas , Nathany Shrinidhi , Sharma Mansi
Published: March 2021

Lung cancer diagnostics and therapeutics have witnessed a paradigm shift in the last decade because of the discovery of targetable biomarkers and rapid approvals of the corresponding targeted therapies. The prognosis of biomarker-driven tumors has improved, and hence, testing for the presence of targetable biomarkers is now a mandate according to both national and international recommendations. Apart from the common and canonical alterations in the epidermal growth factor receptor, anaplastic lymphoma kinase, and ROS1 genes, NTRK fusions, although rare, are gaining clinical importance as targetable alterations. With entrectinib and larotrectinib making their way into the phase III trials, a comprehensive knowledge about the biology, molecular diagnostic techniques, ongoing trials, and available drugs for NTRK-fusion-positive lung cancers is essential. Therefore, we performed a narrative review of the already published literature. The PubMed, Embase, and Scopus databases were searched using the keywords “biology of NTRK,” “TRK,” “NTRK” and “NSCLC.” A total of 32 relevant articles were reviewed. In this review, we have described the biology, signaling pathways, detection methods, and treatment for NTRK-fusion-positive cancers.
Synoptic reporting in lung cancers using Lung Cancer Reporting and Data System (LC-RADS)
Authors: Mahajan Abhishek
Published: March 2021

Words are the most important and sometimes the only medium of communication between a radiologist and a treating physician. The concept of structured reporting in radiology was well received in the face of growing concerns to overcome the limitations of unstructured reporting such as interobserver variations, errors in communication, and lack of standardization of reporting that primarily affect the patients who seek health care away from their diagnostic centers. With the introduction of synoptic reporting in radiology, it is now possible to standardize the reporting of diseases in a more comprehensive and less time-consuming manner, thus magnifying the impact of a radiological report in the further management of the disease under analysis. We aim to develop a standardized synoptic reporting template for lung cancers that would comprise and collate all the required computed tomography (CT) findings and demographic details of the patients. This will help the treating physicians and surgeons to plan the further course of disease management. It will also help to standardize the follow-up CT scans performed for the patients post any given treatment regimen with special reference to the likely complications caused by a particular treatment, such as radiation-related lung injury, immunotherapy-related toxicity, and surgical complications requiring urgent interventions.
Real-world data of second-line immunotherapy in metastatic clear cell renal cell carcinoma
Authors: Abbas Waseem , Aggarwal Anjali , Pankaj Promila , Jain Rachna
Published: March 2021

Background:

Targeted therapies have prolonged the survival of patients with metastatic renal cell carcinomas (RCC). However, the majority of patients with metastatic RCC develop treatment resistance and disease progression. The programmed cell death protein 1 inhibitors offer a new ray of hope for such patients.

Objectives:

The primary objective of this study was to evaluate the overall survival (OS) of patients with relapsed metastatic RCC treated with immunotherapy in the second-line setting. The secondary objectives were to assess the safety profile and objective response rate (ORR) for nivolumab.

Materials and Methods:

This retrospective study was conducted in the Department of Medical Oncology at the Max Institute of Cancer Care, a tertiary care center in Delhi, India. Patients with histologically proven stage IV RCC who had progressed on first-line tyrosine kinase inhibitors (TKIs) and treated with at least four cycles of nivolumab at our center between December 2015 and January 2019 were enrolled in the study. The OS, progression-free survival (PFS), immune-mediated adverse events (irAEs), and ORR were determined.

Results:

Out of 50 patients with metastatic RCC who progressed on first-line TKIs, 19 received immunotherapy with nivolumab. The median age of the patients was 62 years (range, 31–71 years); the male-to-female ratio was 2:1. The median follow-up time and duration of treatment were 11 months (range, 2–23) and 4.5 months (95% confidence interval [CI], 3.52–5.96), respectively, and 8 (42.1%) patients were alive at the time of analysis. The median OS was 13 months (95% CI, 10.4–15.5) from the start of nivolumab therapy, and the median PFS was 8 months (95% CI, not evaluable). The best response was progressive disease in 47.3%; the ORR was 26.3%. Grade 1/2 and grade 3/4 adverse events were observed in 68.4% and 10.5% of the patients, respectively. Adverse events of any grade were reported in 13 (68.6%) patients. Fatigue and hypothyroidism were the most frequently observed irAEs associated with nivolumab and occurred in 4 (21%) and 11 (57.8%) patients, respectively. Four (15.7%) patients developed grade 1 pruritus. No fatal toxicities were recorded.

Conclusion:

Nivolumab is efficacious and safe as a second-line treatment option for metastatic RCC in Indian patients.
Neuropsychological functioning in long-term survivors of pediatric acute lymphoblastic leukemia
Authors: Abraham Jisha , Veeraiah Surendran , Radhakrishnan Venkatraman
Published: March 2021

Background:

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Given the improvement in the survival of patients with ALL over the last few decades, the adverse effects of treatment and disease on survivors have become a major concern. Neuropsychological functioning has been reported to be affected in long-term survivors of ALL and can impact their quality of life.

Objective:

The objective of the study was to assess the neuropsychological functioning of long-term survivors of pediatric ALL.

Materials and Methods:

This prospective cross-sectional study was conducted at the Cancer Institute, Chennai, India, between March and August 2014. Pediatric patients with ALL who had survived at least 2 years after treatment and were in remission were included in the study. Various neuropsychological domains such as sustained attention, focused attention, verbal working memory, immediate memory, verbal learning, immediate recall, delayed recall, visuoconstructive ability, and visuomotor speed were assessed using age-appropriate tests. Data were analyzed using descriptive statistics and nonparametric tests such as the Mann–Whitney U and Kruskal–Wallis H-tests. P < 0.05 was considered statistically significant.

Results:

Of the 51 participants, there were 30 male and 21 female survivors. Their median ages at diagnosis and assessment were 8.6 years and 18.3 years, respectively. Adult survivors (n = 31) were found to have deficits in immediate memory, verbal learning, immediate recall, visuoconstructive ability, and visuomotor speed. Adolescent survivors (n = 20) were found to have deficits in immediate memory and verbal working memory. Survivors aged 8 years or more at diagnosis had better focused attention and verbal working memory, while those diagnosed at age <8 years had better visuoconstructive ability. Those with longer survival had better verbal working memory.

Conclusions:

Long-term survivors of pediatric ALL experience deficits in various neuropsychological functions. Adult survivors have deficits in immediate memory, visuoconstructive ability, verbal learning, immediate recall, and visuomotor speed, whereas adolescent survivors have deficits in immediate memory and verbal working memory.
Assessment of COVID-19 severity using computed tomography imaging
Authors: Sharma Prerit Jugalkishor , Mahajan Abhishek , Rane Swapnil , Bhattacharjee Atanu
Published: March 2021

Computed tomography (CT) imaging has been reported to be a reliable tool for the evaluation of suspected cases and follow-up of confirmed cases of coronavirus disease 2019 (COVID-19). Despite the generation of a considerable amount of imaging data related to COVID-19, there is a need for an updated systematic review and meta-analysis pertaining to the questions of clinical significance. We aimed to analyze the correlation between abnormal chest CT findings and disease severity in patients with COVID-19. We searched for case series/studies published in the English language until March 24, 2020 that reported the clinical and chest CT imaging features of confirmed cases of COVID-19 in the PubMed database. A total of 208 studies were screened, and 71 were finally included in the meta-analysis. Study characteristics and relative risk (RR) estimates were extracted from each article and pooled using the random-effects meta-analysis model. There were a total of 6406 patients studied in a total of 71 studies; the male to female ratio was 1.08:1, and the mean age was 45.76 years; of these, 2057 patients from 14 studies were categorized into severe (24.3%) and mild (75.7%) disease groups. Imaging features that were more frequently noted in patients with severe disease than in those with mild disease included bilateral lung involvement (88.7% vs. 49.8%), scattered distribution (80.4% vs. 46.5%), multiple lobe involvement (95.7% vs. 59.6%), consolidation (88.3% vs. 60.3%), crazy-paving pattern (45.4% vs. 27.6%), air-bronchogram sign (29.7% vs. 15.1%), interlobular septal thickening (84.2% vs. 55.8%), and subpleural line (36.8% vs. 26.4%) differences between the two disease groups were statistically significant (P < 0.001). For 3778 patients in 29 studies, a significant pooled RR estimate was associated with abnormal chest CT findings in patients with COVID-19 (RR, 5.46%; 95% confidence interval [CI], 3.72%–8.04%; I
2 = 86%). Individual assessment of the CT features revealed that a significant pooled RR estimate was associated with pure ground-glass opacity (GGO) (RR, 1.63%; 95% CI, 1.12%–2.38%; I
2 = 79%), while lower pooled RR estimates were associated with CT features like crazy-paving pattern (RR, 1.37%; 95% CI, 1.10%–1.71%; I
2 = 60%), consolidation (RR, 0.47%; 95% CI, 0.32%–0.7%; I
2 = 83.5%), GGO with consolidation (RR, 0.73%; 95% CI, 0.52%–1.02%; I
2 = 75%), and air-bronchogram sign (RR, 0.58%; 95% CI, 0.36%–0.96%; I
2 = 94%). In conclusion, the number, location, extent, and type of radiological lesions are associated with COVID-19 progression and severity, suggesting the feasibility of using CT imaging in the assessment of disease severity in all age groups and efficient allocation of resources for patient management at the institutional level.
Recent updates in systemic therapy of breast cancer
Authors: Arora Shalabh , Gogia Ajay
Published: March 2021

Breast cancer is the most common malignancy and the leading cause of cancer-related deaths in women globally. Systemic therapy of breast cancer has evolved rapidly in the past few years. In this brief review, we aim to summarize the potentially practice-changing recent updates in the management of breast cancer. We searched the PubMed database for randomized clinical trials for breast cancer treatment conducted over the past 2 years. In addition, abstracts and results of studies reported at major oncology meetings were evaluated. A total of 95 randomized clinical trials were included to prepare this review. Multiple new therapeutic options for almost all subsets of breast cancer have emerged in the past 2 years. Most importantly, for hormone-receptor-positive breast cancer, addition of abemaciclib to endocrine therapy in the adjuvant setting and alpelisib for PIK3CA-mutant refractory advanced disease have been shown to improve the survival outcomes. Addition of pembrolizumab or atezolizumab to neoadjuvant chemotherapy has significantly increased the pathological complete response rate for early triple-negative breast cancer, while adjuvant metronomic capecitabine for 1 year has led to improved disease-free survival. Moreover, adjuvant adotrastuzumab emtansine fared better than trastuzumab in the management of residual disease after neoadjuvant treatment for human epidermal growth factor receptor 2 (HER2)-positive breast cancer, while tucatinib and neratinib have shown meaningfully improved progression-free survival in HER2-positive advanced disease, including patients with cranial nervous system involvement. Expanding access to these advances is soon expected to transform the way we treat breast cancers.
Impact of COVID-19 lockdown on patients with cancer in North Bihar, India
Authors: Singh Ravikant , Rai Chanda , Ishan Rohit
Published: March 2021

Background:

In India, the coronavirus disease-2019 (COVID-19) outbreak led to an extensive lockdown, leaving the other time-sensitive medical conditions, such as cancer unaddressed. Patients with cancer are extremely vulnerable to infections owing to their already immunocompromised status and the need for prolonged treatment.

Objectives:

We aimed to study the impact of the COVID-19 lockdown on the utilization of health-care services by patients with cancer in the Muzaffarpur district of North Bihar, India.

Materials and Methods:

This descriptive, cross-sectional study was conducted at a preventive oncology clinic in the Muzaffarpur district of North Bihar in India. All consecutive patients registered in the population-based cancer registry of Muzaffarpur were telephonically contacted between April 15, 2020, and May 7, 2020, during the first phase of the nationwide lockdown. The patients were asked questions related to their disease, treatment status, and impact of the lockdown on their treatment. Detailed responses were recorded and analyzed.

Results:

The study comprised 210 patients of which majority were women (62.9%) and aged more than 40 years (77.1%). A total of 162 (77%) patients were found to be affected by the lockdown, of which 137 (65.4%) missed their scheduled visits, 1 (0.5%) missed surgery, 1 (0.5%) missed chemotherapy, and 24 (11.4%) could not get the prescribed drugs. Most patients who missed their scheduled appointments were aged more than 60 years, women, inhabitants of rural areas, with multiple comorbidities, or belonged to the lower middle-income economic strata. About 70% of the patients faced transportation issues, and 55% experienced financial problems during the lockdown.

Conclusion:

The lockdown led to difficulties in accessing cancer care in almost 80% of the patients with cancer. This suggests the need for strategic planning of health-care services for patients with cancer during the current pandemic, by means of telemedicine consultation, home-based palliative care services, and ensuring the availibility of essential cancer drugs.
Cancer-related fatigue and its impact on quality of life in patients with central nervous system tumors
Authors: Singh Gunjesh Kumar , Varghese Litty , Menon Nandini , Dale Ochin , Patil Vijay M.
Published: March 2021

Background:

Cancer-related fatigue (CRF) has a high prevalence in individuals with cancer, especially in those with central nervous system (CNS) tumors, and impacts the quality of life (QOL). However, there are limited data on CRF in Indian patients with CNS tumors.

Objective:

We aimed to estimate the CRF scores in patients with CNS tumors.

Materials and Methods:

This cross-sectional study was conducted in the Department of Medical Oncology of the Tata Memorial Hospital in Mumbai, India, between May 2019 and August 2019. Patients with CNS tumors aged ≥18 years, who presented to the Neuro-Oncology Disease Management Group, were enrolled in the study. The Functional Assessment of Chronic Illness Therapy Fatigue Scale was used to collect data related to well-being and fatigue. Data were captured in a single visit. Descriptive statistics and multiple regression analyses were performed to identify the factors associated with a high fatigue score.

Results:

There were 100 patients in our cohort with a median age of 40 (range, 18–64) years. The median fatigue score was 36. The median physical well-being, social well-being, emotional well-being, functional well-being, and Functional Assessment of Cancer Therapy-General (FACT-G) scores were 19, 19.9, 18, 17, and 72, respectively. There was a significant correlation between the fatigue score and the various subscales of FACT-G (P < 0.0001). The associated risk factors for CRF were age (P = 0.021), poor Eastern Cooperative Oncology Group-Performance Status (ECOG PS) (2–3) (P < 0.0001), general category based on the payment ability of the patient (P = 0.004), ongoing treatment status (P = 0.0003), and the presence of recurrent disease (P = 0.001).

Conclusion:

CRF is common in patients with CNS tumors and impacts all aspect of the QOL. It is affected by age, ECOG PS, payment ability, treatment status, and disease recurrence status.
Algorithm to choose the appropriate test for comparison between two groups
Authors: Dessai Sampada B. , Patil Vijay M.
Published: March 2021

The current manuscript describes the method of selection of statistical tests for comparing two groups. In this article, we discuss the factors on which the selection of tests depends and provide an algorithm for the selection of the inferential statistical test.
Temporal hemi-transposition of a split medial rectus muscle
Authors: Kothari Mihir , Solanki Meghna , Sugathan Susha
Published: March 2021

A 9-year-old boy with complete lateral rectus palsy, following the treatment for his embryonal rhabdomyosarcoma of the right lateral rectus muscle, underwent temporal hemi-transposition of lower 2/3rd of medial rectus muscle beneath the inferior rectus muscle. Satisfactory alignment and resolution of diplopia was achieved postoperatively. He developed staphylococcal scleromalacia after surgery that was successfully managed with scleral patch graft, oral and topical antibiotics, and steroids.
Choroidal effusion with neurosensory detachment after medial transposition of Y-split lateral rectus in third nerve palsy
Authors: Yadav Neha , Sharma Pradeep , Panwar Vikash , Shakrawal Jyoti , Azad Shorya Vardhan
Published: March 2021

Transposition of lateral rectus to medial rectus, though an alluring and effective method in managing complete third nerve palsy, is not without its complications. We report a rare but known complication of choroidal effusion with neurosensory detachment after medial transposition of Y split lateral rectus, in a case of posttraumatic complete third nerve palsy with aberrant regeneration. This led to a severe drop in visual acuity which did not resolve spontaneously and was managed by release of the scleral suture and topical, intravenous, and oral steroids subsequently leading to its complete resolution and restoration of visual acuity.
Bilateral mucocele in a patient with Robinow syndrome
Authors: Usta Gulsah , Karaca Umut , Okur Erdogan , Okur Nazan , Konukcu Onur , Ozkaya Dilek
Published: March 2021

We report the case of a 23-year-old man with Robinow syndrome (RS) and bilateral epiphora due to nasolacrimal duct obstruction associated with bilateral mucoceles. The patient underwent endoscopic dacryocystorhinostomy (DCR) on the right and endoscopic revision DCR on the left, an anterior ethmoidectomy, and a septoplasty. Subsequently, he was disease-free at his 3-month follow-up. Like patients with midface anomalies, patients with RS frequently have lacrimal system pathologies. Since early recognition of this type of midface anomaly can minimize morbidity by facilitating optimal surgical therapy, we recommend a thorough ocular evaluation of patients with RS.
A rare case of infectious crystalline keratopathy caused by Burkholderia cepacia
Authors: Khanna Vaibhav , Christy Josephine , Jayarajan Aruna P , Chhabra Kanika , Mishra Kapil
Published: March 2021

We report a unique case of infectious crystalline keratopathy (ICK) caused by Burkholderia cepacia in a 47-year-old patient with history of multiple penetrating keratoplasties (PKPs). Slit-lamp examination revealed a white nonsuppurative needle-like branching anterior stromal infiltrate. Microscopic examination of the Gram-stained smear showed gram-negative bacilli. Cultures revealed Burkholderia cepacia, which was multidrug resistant and sensitive to piperacillin/tazobactam. Based on antibiotic sensitivity report, patient was started fortified piperacillin-tazobactam (0.32%) eye drop on an hourly basis. After 8 weeks of aggressive therapy, the infiltrate resolved with subsequent corneal scarring and vascularization. To our knowledge, this is the first reported case of Burkholderia-related ICK. ICK, first described by Gorovoy et al.[1] in 1983, is an indolent keratitis with characteristic needle-like branching opacities in the absence of corneal or anterior segment inflammation.[2] The presence of an immunocompromised corneal state, such as chronic topical steroid use post PKP, is a known risk factor for the development of ICK. Other risk factors include surgical procedures such as lamellar keratoplasty, corneal cross-linking, laser-assisted in situ keratomileusis, pterygium excision, and trabeculectomy with 5- FU. Topical anaesthetic abuse as a risk factor has also been described.[3] Burkholderia is a group of Gram-negative bacteria, composed of at least 20 different species. We describe a case of Burkholderia keratitis presenting as ICK in a patient who underwent multiple PKPs and a history of long-term topical steroid therapy.
Bilateral corneal haze and unilateral glaucoma in a preterm infant with congenital erosive vesicular disease – A case report
Authors: Mohan Monisha , Shetty Shashikant
Published: March 2021

We report a rare ocular presentation of bilateral corneal haze and unilateral glaucoma in a 33-week old preterm infant diagnosed to have congenital erosive and vesicular dermatosis.
A case of peripapillary pachychoroid syndrome treated with anti-vascular endothelial growth factor injections
Authors: Sen Parveen , Sreenivasan Janani , Maitra Puja
Published: March 2021

Peripapillary pachychoroid syndrome (PPS) is a novel variant in the pachychoroid disease spectrum in which pachychoroid features are more prominent around the optic nerve head and are associated with intraretinal and/or subretinal fluid. The choroidal thickness in PPS is characterized by its atypical distribution with nasal macular choroid being thicker than the temporal counterpart. There are a few case reports of PPS in the literature that describe the morphological features of PPS but the management protocols are yet to be established. We hereby describe the clinical course of a 54-year-old gentleman who came to us with complaints of a gradual decrease in vision. On basis of multimodal imaging, a diagnosis of PPS was made. Since the patient was symptomatic, he was treated with intravitreal aflibercept which showed a favorable anatomical and functional outcome.
Multimodal imaging in a case of macular vortex vein varix
Authors: Bhatia Priyavrat , Kohli Gaurav Mohan , Shenoy Pratik , Sen Alok
Published: March 2021

Variceal dilations of vortex vein are not uncommon in eyes with high myopia. However, its occurrence in emmetropic eyes and posterior location has rarely been reported. We report a case of 55-year-old man who presented with a reddish orange sub-retinal lesion at the macula with subtle pulsation and collapse on pressure indentation. The lesion appeared hyerfluorescent on early frames of FFA with persistent silhouette in the late frames. ICGA showed dilated and tortuous vascular complex with hyperfluorescence in the mid phase without any evidence of late leakage. On SD–OCT the lesion appeared as a hypo-reflective sinusoidal space extending from the Hallers layer to the choriocapillary bed with distortion of the overlying RPE. The En-face Angio-OCT imaging was suggestive of a flow void sinusoidal tract with internal septa. The clinical features and collaborative findings on multimodal imaging were suggestive of variceal dilatation of the vortex vein ampulla.
Retinal arteriolar calcification and ischemic retinopathy in a patient with chronic kidney disease
Authors: Mishra Chitaranjan , Kannan Naresh B , Chakrabarti Anirban , Kumar Mahesh , Ramasamy Kim
Published: March 2021

A 58-year-female with a history of chronic kidney disease presented with defective vision in both the eyes (BE). Her vision was 20/120 in the right eye (RE) and 20/200 in the left eye (LE). Fundus evaluation revealed retinal arteriolar calcification, neovascularization of the disc (NVD), and drusen at the posterior pole in BE. Optical coherence tomography (OCT) images passing through the retinal arterioles indicated hyper reflective structures with back shadowing suggestive of intravascular calcification. En-face OCT angiography images over the optic discs were suggestive of NVD in BE. Blood investigation revealed elevated levels of phosphate and the product of calcium and phosphate levels. The patient was treated with pan-retinal photocoagulation in BE. However, the visual outcome was poor.
Facial palsy as an atypical presenting sign of cortical venous thrombosis
Authors: Akkayasamy Kowsalya , Jayaprakash Anju Ajitha , Narayanamoorthy Jayasri , Kumar Mahesh
Published: March 2021

A 39-year-old woman presented with inability to close left eye for 1 day and headache for 1 week. Neurologist evaluation revealed left lower motor neuron facial palsy and was treated for migraine with facial palsy. On developing nausea and vomiting, fundus examination showed papilledema and magnetic resonance imaging (MRI) with magnetic resonance venogram (MRV) revealed cortical venous thrombosis. Blood investigations revealed microcytic hypochromic anemia. She recovered completely by 6 months after anticoagulant therapy, hematinics, and anti-edema medications. This rare presentation of facial palsy in CVT highlights the need for early fundus examination and imaging with MRV to prevent morbidity and mortality.
Empty vessel in central retinal artery occlusion
Authors: Kanakamedla Ashok , Shandil Anurag , Simakurthy Sriram , Konana Vinaya K , Gudimetla Jayamadhury , Kumar R Madhu
Published: March 2021

A 16-year-old female presented with a sudden onset painless diminution of vision in the right eye. Fundus examination showed retinal whitening at the posterior pole with a cherry red appearance of fovea suggestive of CRAO. Swept-source Optical coherence tomography (SS-OCT) showed increased thickness, hyperreflective inner retina, and an empty vessel. Optical coherence tomography angiography (OCT-A) confirmed the absence of perfusion in the vessel. After intervention, reperfusion in the vessel was appreciated both on SS-OCT and OCT-A. We report a novel finding of detection of empty vessels on SS-OCT in a case of central retinal artery occlusion (CRAO).
Inclusion conjunctival cyst after infected buckle removal
Authors: Agarwal Isha , Sreenivasan Janani , Attiku Yamini , Rishi Ekta , Rishi Pukhraj
Published: March 2021

This case report describes the unique presentation of post buckle infection, inclusion conjunctival cyst. A 17-year-old male presented with pain, redness and a mass lesion in the left eye status post an infected scleral buckle removal. Surgical exploration revealed retained sutures and the capsule presumed to be formed around the buckle. After removal of both, patient was asymptomatic with stable BCVA and fundus findings. Surgical management includes not just the removal of the buckle material, but also the buckle sutures and the capsule formed around the episcleral buckle implant to completely remove the foci of infection and inflammation.
Rapidly progressing granulomatous retinochoroiditis with vasculitis
Authors: Agarwal Aniruddha , Sharma Suryaprakash , Kumar Aman , Marchese Alessandro , Sehgal Shobha , Singh Manpreet , Gupta Nalini , Sharma Aman , Gupta Amod , Agarwal Anita , Gupta Vishali
Published: March 2021

A 36-year-old male suffered a traumatic open globe injury to his right eye resulting in phthisis. One year later, he developed a sudden progressive decrease in vision in the fellow (left) eye. Examination revealed arteriolar attenuation, multifocal deep subretinal infiltration, retinal edema, and necrosis. The patient underwent diagnostic vitrectomy in the left eye, and diagnostic enucleation of the phthisical right eye after suboptimal response to intravenous corticosteroid, antiviral, and antibiotic therapy. Detailed immuno-histopathological evaluation revealed extensive retinal disorganization with photoreceptor loss, perivascular infiltration, Dalen-Fuchs nodules, and granulomatous inflammation with central necrosis and melanin pigment, suggestive of a rare variant of sympathetic ophthalmia.
Retinal cavernous haemangioma in an infant with aggressive posterior retinopathy of prematurity
Authors: Singh Simar Rajan , Arora Atul , Jain Sahil , Dogra Mohit , Dogra Mangat Ram , Katoch Deeksha
Published: March 2021

A 2-month-old premature infant (37 weeks post-menstrual age) was referred for persistent pre-retinal bleed following laser treatment for retinopathy of prematurity. Detailed examination revealed a reddish purple, raised, lobulated lesion at the junction of the vascularised retina and laser scars. Typical clinical findings along with fluorescein angiography helped establish the diagnosis of retinal cavernous haemangioma. This report describes the youngest reported case of retinal cavernous haemangioma in a premature child.
Acquired postganglionic cholinergic dysautonomia – A rare clinical entity
Authors: Kakkitampara Meena Chembil , Mohan Madhukar , Raju Anju Sivadasa
Published: March 2021

Acute dysautonomia or dysfunction of the autonomic nervous system is characterized by severe postganglionic sympathetic and parasympathetic dysfunction, with a relative or complete sparing of motor and sensory function. Acquired cholinergic dysautonomia, a very rare condition of failure of the parasympathetic system leads to complete bilateral internal ophthalmoplegia, impaired secretion of tears, and may present with visual symptoms. Herein, we report a rare case of acute cholinergic dysautonomia in an 11-year-old girl.
Spontaneous closure of macular hole with conversion to type 2 choroidal neovascular membrane in a case of Vogt Koyanagi Harada disease
Authors: Vaidya Harshit , George Amala , Sen Parveen
Published: March 2021

Macular hole in uveitic pathologies is a rare entity. Spontaneous closure of macular hole with conversion to a type 2 choroidal neovascular membrane has been reported even more sparsely. We present an interesting case of a 51-year-old woman with convalescent stage of Vogt-Koyanagi-Harada disease of 20 years duration, who developed a macular hole along with reactivation of the disease. Immunosuppressive therapy was started to control the ocular inflammation, while the macular hole was observed. One and half years later, there was a repeat episode of inflammation when she presented with a decline in vision in the same eye with a choroidal neovascular complex and spontaneous closure of the macular hole. She received two intravitreal injections of ranibizumab biosimilar under systemic immunosuppressive cover. The CNV was stable and the macular hole remained closed over a 6-month drug free interval from the last injection. This is the first report of spontaneous closure of a macular hole with a concurrent neovascular membrane in a case of VKH.
A rare case of Staphylococcus caprae keratitis with endophthalmitis after phacoemulsification surgery
Authors: Parmar Gautam , Borde Prashant , Meena Ashok Kumar , Gupta Varun A
Published: March 2021

Staphylococcus caprae is a catalase-positive and coagulase-negative organism that has been implicated in many systemic human infections but rarely in ocular infections. We present a rare case of S. caprae keratitis after phacoemulsification surgery. A 63-year-old male presented with the complaints of pain, redness in OS for 3 days following a phacoemulsification surgery. Cornea had an epithelial defect with a ring-shaped deep infiltrate. Temporary keratoprosthesis-associated pars plana vitrectomy was done followed by penetrating keratoplasty. Staphylococcus caprae was identified in culture. This case report points out to the pathogenic potential of S. caprae in keratitis in immunocompetent patient.
Congenital abducens-oculomotor dysinnervation
Authors: Pandey Pramod K. , Sachdeva Neha , Saraf Priya , Choudhury Rupak B. , Yadav Vidula , Kishore Divya
Published: March 2021

In a boy aged 6 years left unilateral congenital ptosis with medial rectus-levator palpebrae superioris (MR-LPS) synkinesis; the coexisting hitherto unreported likely lateral rectus-superior rectus (LR-SR) dysinnervation is reported. Ocular movements were full and cover test did not reveal any ocular misalignment. Such a presentation can only arise from two concurrent dysinnervations: first one between inferior and superior divisions of third nerve and second one between third and sixth cranial nerve. The dysinnervation may conform to a forme-fruste TUBB3 (Tubulin, Beta 3 Class III Gene) pathogenic variant phenotype and may be classed as a novel congenital cranial dysinnervation disorder (CCDD).
Management of hypotony induced by transscleral diode cyclophotocoagulation in failed Ahmed glaucoma valve surgery
Authors: Pathak-Ray Vanita , Badduri Anusha , Gulati Isha
Published: March 2021

Valved Glaucoma Drainage Devices like Ahmed Glaucoma Valve (AGV) are prone to bleb encapsulation around the endplate with subsequent uncontrolled intraocular pressure. Aqueous suppression may or may not lead to resolution and the valve may eventually fail. We report the management in a series of 3 eyes of 3 patients who had failed AGV surgery and after receiving transscleral diode cyclophotocoagulation (TSCPC) treatment, presented with hypotony and decreased vision.
Anterior segment optical coherence tomography aided delineation of metallic intraocular foreign body
Authors: Vuyyuru Sowjanya , Bhalerao Sushank A , Gogri Pratik Y , Reddy Phanindhara , Mallipudi Rajavardhan
Published: March 2021

Penetrating ocular injury is an important cause of loss of vision and may be associated with the presence of intraocular foreign body (IOFB). Missed IOFB may present with non-specific clinical features which may delay accurate diagnosis and proper management. We are presenting a case of unusual retained intraocular foreign body in a 38-year-old woman which emphasizes the need of careful review of patient's traumatic history and need of investigation like anterior segment optical coherence tomography (ASOCT) in diagnosis, localization of foreign body and follow-up after foreign body removal.
Metastatic orbital carcinoid tumors masquerading as “hot” orbit
Authors: Mukherjee Bipasha , Podury Soumya , Vijay Vathsalya , Krishnakumar Subramanian , Alam Md Shahid
Published: March 2021

We report two patients presenting with acute orbital inflammation as an unusual manifestation of metastatic carcinoid tumors. Neuroimaging revealed rim enhancing lesions mimicking orbital abscesses in both. Histopathology confirmed the diagnosis of metastatic neuroendocrine tumors with primary in the gastrointestinal tract. Atypical presentation of orbital metastases with inflammatory signs of a “hot” orbit is usually misdiagnosed. The clinical features of inflammation may result from the spontaneous release of inflammatory mediators intrinsic to neuroendocrine tumors. In elderly patients with bilateral, multiple extraocular muscle involvement, or acute-onset proptosis with inflammatory signs should alert the clinician to the rare possibility of metastatic neuroendocrine carcinoma.
Modified Nishida's procedure in management of unilateral isolated inferior rectus aplasia - A case report
Authors: Ramkumar Akila V , Agarkar Sumita , Mailankody Swathi
Published: March 2021

Inferior rectus aplasia is a rare cause of apparent inferior rectus palsy presenting as upward deviation of eye since birth. An ideal procedure to manage these cases should correct the deviation in primary gaze and improve motility of the eye. It has been managed in the past by full or partial tendon transplantation of horizontal recti muscles which poses a risk of anterior segment ischemia and is usually done in a staged manner. We report a case of inferior rectus aplasia confirmed preoperatively by imaging and successfully managed by a no split, no tenotomy method done in a single stage.
Pseudo orbital apex disorders
Authors: Dutta Paromita , Kumar Prateek , Nagpal Vaibhav , Anand Kamlesh , Hariani Avani , Krishnan Ashish
Published: March 2021

Multiple cranial nerve palsies are clinical conundrums that can be solved by determining zones of the proximity of the affected nerves. The affliction of two or more contiguous neuroanatomic structures helps in the localization of the causative lesion. However, there are certain caveats to this method of estimation when it may not be applicable such as in cases of multifocal or diffuse pathologies and large mass lesions. Orbital apex disorders refer to the clinical spectrum arising from lesions in the orbital apex, superior orbital fissure, and cavernous sinus. Besides, large neoplasms in the middle cranial fossa too may have a similar presentation. It is essential to consider the possibility of false localizing signs, as is highlighted in our two case reports, both of which initially appeared to be caused by orbital apex region lesions.
Overcorrection after modified Nishida's procedure and medial rectus recession for sixth nerve palsy reversed by cutting one transposition suture
Authors: Rajamani Muralidhar , Dandapani Ramamurthy
Published: March 2021

A number of vertical rectus transposition procedures have been described for nonresolving complete sixth nerve palsy. Overcorrections following transposition procedures may be treated by reversing/adjusting the transposition or advancing the medial rectus (if previously recessed). Undercorrections require transposing an additional vertical rectus or recessing the medial rectus. Of the many available transposition procedures for sixth nerve palsy, Nishida's procedure offers the advantage of not having to disinsert the vertical recti and sparing the ciliary circulation. There are no reports on management of overcorrections following this procedure to the best of our knowledge. We report a patient with complete sixth nerve palsy, who developed a consecutive exotropia and anterior segment ischemia after Nishida's transposition with medial rectus recession. He was successfully treated by cutting the transposition suture on superior rectus.
Nocardia keratitis following corneal cross linking for keratoconus
Authors: Gujar Prateek , Budhwani Monica
Published: March 2021

We report a case of Nocardia keratitis following corneal cross-linking for progressive keratoconus. A 26-year-old otherwise healthy woman underwent crosslinking for keratoconus in her left eye. She presented with corneal infiltrates with a wreath-like pattern, on the seventh postoperative day. Gram's and acid-fast staining revealed Nocardia. She was managed with topical fortified amikacin 2.5% eye drops. The keratitis resolved to leave dense vascularization which was managed with topical prednisolone 1% eye drops.
Exudative retinal detachment in treatment naïve aggressive posterior retinopathy of prematurity
Authors: Mohideen Syed K A , Jaffar Jahnara , Halder Utpal , Shetty Adheesh P
Published: March 2021

We report the first case of bilateral exudative retinal detachment in treatment naïve zone one aggressive posterior retinopathy of prematurity. Exudative detachments in retinopathy of prematurity have been reported in literature following laser photocoagulation or cryotherapy. But exudative detachment as an initial presentation in APROP is rather rare. The abnormality in our case was noticed at the second visit. A 20-day-old infant (born at 32 weeks of gestation) was diagnosed to have APROP. He was advised intravitreal bevacizumab injection (0.625 mg) in both eyes. Two days later when the infant was brought in for injection, he was found to have bilateral exudative retinal detachments almost reaching the posterior pole. We administered the intravitreal injections of bevacizumab in both eyes and the baby was followed up at regular intervals. Review at 1-month post-injection revealed resolution of detachments.
Double trouble - Fungal keratitis with concomitant presumed herpes simplex virus keratouveitis
Authors: Kanhere Minal D , Madduri Bhagyasree , Mohan Nitin , Fernandes Merle
Published: March 2021

A gentleman with microbiological proven fungal keratitis developed pigmented keratic precipitates with increased anterior chamber reaction on antifungals. Presumed HSV iritis was suspected. Topical steroids were contraindicated. Complete resolution was observed with oral Acyclovir and anti-fungal therapy. A year later acute granulomatous anterior uveitis occurred which responded to topical steroids but progressed to corneal melt with perforation. Following penetrating keratoplasty, he has a clear graft and 20/80 vision. Concomitant HSV iritis with active fungal keratitis is extremely rare. This management dilemma necessitated only oral Acyclovir while continuing anti-fungal therapy while avoiding steroids for HSV kerato-uveitis.
Radius–Maumenee syndrome
Authors: El Alami Fatine , El Ouafi Aziz , Bouassel Anass , Iferkhass Said , Laktaoui Abdelkader
Published: March 2021

Radius–Maumenee syndrome (SRM) is an idiopathic uncommon disorder that occurs with a dilation of the episcleral vessels and an increase in intraocular pressure (IOP). Most cases of dilated episcleral vessels can be attributed to carotid-cavernous-sinus fistula, cavernous sinus thrombosis, dural arteriovenous shunt, superior vena cava syndrome, Sturge–Weber syndrome, or Obstructive orbital lesions. There are rare cases without an underlying cause. It is a syndrome that constitutes a diagnostic and therapeutic challenge. The aim of our work was to report a case of Radius–Maumenee syndrome and to describe the diagnostic procedure for this relatively rare condition.