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fi rst sibling had a MESH (megalocornea, ectopia lentis, spherophakia, homocystinuria) association, but the second sibling did not have this association. The cases are presented because of the atypical ocular and systemic features with varying phenotypic presentations. Presence of abdominal hernia in children may be associated with collagen disorders and hence an ocular examination may be sought in view of development of glaucoma and ambyopia secondary to a subluxated lens.

other parasites that can cause periorbital pathology. The good example is the sparganosis.[5] The topic for further studies on periorbital dirofilariasis include (a) the diagnostic biomarker for help diagnosis, (b) host interaction to parasite and underlying contributing factors to infestation, (c) proper treatment and prevention of re-infestation.[5]

Somsri Wiwanitkit, Viroj Wiwanitkit1,2,3 Wiwanitkit House, Bangkhae, Bangkok, Thailand, 1 Faculty of Medicine, University of Nis, Serbia, 2 Hainan Medical University, China, 3 Joseph Ayobabalola University, Nigeria

Subashini Kaliaperumal, Praveen Kumar K, Bhuvaneshwari

Correspondence to: Dr. Somsri Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok, Thailand. E-mail: [email protected]

Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India Correspondence to: Dr. Subashini Kaliaperumal, 8A, Balaji Street, Tagore Nagar, Jeevanandapuram,

Pondicherry - 605 008, India. E-mail: [email protected]

References 1.

Spaeth GL, Barber GW. Homocystinuria- its ocular manifestations. J Pediatr Ophthalmol 1996;3:42-8.

2.

Lieberman TW, Podos SM, Hartstein J. Acute glaucoma, ectopia lentis and homocystinuria. Am J Ophthalmol 1966;61:252-5.

3.

Hubmacher D, Cirulis JT, Miao M, Keeley FW, Reinhardt DP. Functional consequences of homocysteinylation of the elastic fiber proteins fibrillin-1 and tropoelastin. J Biol Chem 2010;285:1188-98.

4.

5.

Mulvihill A, Yap S, O’Keefe M, Howard PM, Naughten ER. Ocular findings among patients with late-diagnosed or poorly controlled homocystinuria compared with a screened, well- controlled population. J AAPOS 2001;5:311-5. Ramsey MS, Daitz LD, Beaton JW. Lens fringe in homocystinuria. Arch Ophthalmol 1975;93:318. Access this article online Quick Response Code:

Website: www.ijo.in

Vol. 62 No. 1

References 1.

Gopinath TN, Lakshmi KP, Shaji PC, Rajalakshmi PC. Periorbital dirofilariasis-clinical and imaging findings: Live worm on ultrasound. Indian J Ophthalmol 2013;61:298-300.

2.

Kotigadde S, Ramesh SA, Medappa KT. Human dirofilariasis due to Dirofilaria repens in southern India. Trop Parasitol 2012;2:67-8.

3.

Garaffini T, Ducasse A, Jaussaud R, Strady A, Pinon JM. Human periorbital dirofilariasis. J Fr Ophtalmol 1996;19:55-7.

4.

Wiwanitkit V, Chongboonprasert C. Dirofilariasis repens. Chula Med J 2002;46:463-8.

5.

Ye H, Du Y, Liu G, Luo X, Yang H. Clinical features of 8 cases of orbital sparganosis in southern China. Can J Ophthalmol 2012;47:453-7. Access this article online Quick Response Code:

Website: www.ijo.in DOI: 10.4103/0301-4738.126191 PMID: ***

DOI: 10.4103/0301-4738.126190 PMID: ***

Periorbital dirofilariasis Dear Editor, The recent report of periorbital dirofilariasia is very interesting.[1] In a study by Gopinath et al. reported a case and discussed on the diagnostic procedure. A similar case was recently reported by Kotigadde et al.[2] Indeed, dirofilariasis is an accidental parasitosis in human beings. It can be seen as a soft tissue infection at any site. Focusing on periorbital filariasis, it usually presented as soft, cystic swelling lesion with associated tenderness.[2] Garaffini et al. noted that “residence in endemic areas (ex-USSR, Italy, Sri Lanka, Southeastern United States) should always be suspected in patients with this type of symptomatology.”[3] The confirmation is usually due to the histological examination.[4] In fact, there are also

Management of macular epiretinal membrane secondary to accidental globe perforation during retrobulbar anesthesia Dear Editor, We read with keen interest the article management of macular epiretinal membrane secondary to accidental globe perforation during retrobulbar anesthesia by Dhananjay Shukla describing the successful management of macular epiretinal membrane secondary to accidental globe perforation during retrobulbar anesthesia, but we have a few points and questions to make the article more pertinent.[1] In the era of phacoemulsification and instant visual rehabilitation, how is it that the patient complained of poor post-operative visual recovery 1 month after “successful” cataract surgery? What is the hospitals protocol for examining

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