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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft
Correspondence Address :
Supriya Adinath Pokle,
Resident, Department of Ophthalmology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune-411018, Maharashtra, India.
E-mail: supriya.pokle8@gmail.com
Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation.
Blurred vision, Corneal opacity, Peripheral ulcerative keratitis, Photophobia
A 50-year-old female patient presented to the ophthalmology department with complaints of blurred vision, irritation, watering, and photophobia in both eyes for one year. The symptoms worsened in the Right Eye (RE) over the past 15 days, leading her to seek care at a private hospital where she was diagnosed with corneal melting and perforation para-centrally in the RE, and corneal thinning with an ulcer defect inferiorly in the Left Eye (LE). She underwent corneal perforation suturing in the RE before coming to the current facility. Her medical history revealed that she had been a known case of Rheumatoid Arthritis (RA) for 20 years and had been on irregular medical treatment. No other systemic illnesses were present.
Upon examination, the vision in the Right Eye (RE) was counting fingers at half a foot, with accurate Perception of Rays (PR) in all quadrants. In the Left Eye (LE), the vision was 6/60. Matting of eyelashes was observed in both eyes with sticky discharge. The slit lamp examination of the RE revealed a Bandage contact lens in place, normal conjunctiva, and three interrupted sutures on the cornea, located paracentrally between 6 and 7 O’clock, approximately 3 mm away from the inferior limbus (Table/Fig 1). Descemet’s membrane folds were present in a radiating pattern from the suture site, and corneal indentation was noted at the suture site. The anterior chamber was shallow at the periphery and collapsed at the suture site, with a small air bubble located superiorly covering less than 1/3 of the anterior chamber. Iris chafing was noted at 11-12 O’clock, and the pupil was hazily visible (Table/Fig 1). The fundus could not be visualised in the RE. Examination of the LE revealed 6/60 vision, normal conjunctiva, and a corneal ulcer defect measuring 3×5 mm, involving half of the stromal thickness between 5 and 8 O’clock, approximately 3 mm away from the limbus (Table/Fig 2). The anterior chamber and iris were within normal limits in the LE, and the fundus was hazily visible but within normal limits (Table/Fig 2).
All routine laboratory investigations were conducted, revealing a haemoglobin level of 11.2 gm/dL and a Total WBC count of 11200/cmm, slightly higher than the normal range of 4000-10000/cmm. The Rheumatoid factor, analysed using the latex advanced turbidimetric assay method with an EM 200 fully automated biochemistry analyser, was elevated at 124.6 IU/mL, compared to the normal range of 0-18 IU/mL.
Following the examination, the sutured corneal perforation in the Right Eye (RE) due to RA was surgically treated with corneal patch graft repair under local anaesthesia to preserve and restore the corneal tectonic integrity. Three loosely interrupted sutures were cut using Vannas scissors. The borders of the perforation were evenly trimmed with Vannas scissors. A 4-0 trephine was utilised to harvest a donor corneal tissue, and the patch graft tissue was obtained. The graft tissue was sutured at the perforation site with eight interrupted sutures using 10-0 Ethicon suture. The patient was instructed to use artificial tears eye drops six times a day in both eyes and Gatiquine-P eye drops topically six times a day, with a tapering schedule (6 times-4 times-3 times-2 times-1 time-Stop). Additionally, the patient was prescribed oral tablet Prednisolone 40 mg with a weekly tapering schedule (40 mg-30 mg-20 mg-10 mg-Stop). For systemic disease control, Methotrexate 7.5 mg tablets were initiated once daily for twice a week (every Saturday and Sunday) and continued. The corneal ulcer defect and thinning in the Left Eye (LE) were managed with artificial tears eye drops six times a day and antibiotic drops administered twice daily for one month.
On the fifth post-operative day, the patch graft in the Right Eye (RE) remained in place with all eight interrupted sutures intact. Mild oedema was observed at the graft-host junction, the anterior chamber was well formed, and the vision in the RE was 3/60. Perception of Rays (PR) was accurate in all quadrants. In the Left Eye (LE), the vision had improved to 6/36. Corneal thinning, involving one-fourth of the stromal thickness, measured 2×2 mm inferiorly from 5-7 O’clock, approximately 3-4 mm away from the limbus.
At the one-month follow-up, the patient’s vision in the RE had improved to 6/60, with the ability to count fingers at half a foot. PR was accurate pre-procedure, and a nebular opacity was noted in the patch graft. The vision in the LE was 6/36, and the corneal melt and thinning had healed, leaving a macular corneal opacity measuring 2-3×4 mm para-centrally and inferiorly from 5 to 8 O’clock.
During the three-month follow-up, the vision in the RE was 6/60, and a leucomatous corneal opacity was observed on the patch graft (Table/Fig 3). In the LE, the vision remained at 6/36 with a macular corneal opacity measuring 3×5 mm para-centrally and inferiorly from 5 to 8 O’clock (Table/Fig 4). The patient continued using artificial tears in both eyes and taking Methotrexate 7.5 mg once daily, twice a week.
Peripheral Ulcerative Keratitis (PUK) is a rare and serious complication of RA. In nearly 50% of cases, PUK is bilateral and typically occurs in the advanced stages of RA (1). The mechanism of corneal melting involves the deposition of immune complexes in the peripheral cornea, leading to the occlusion of episcleral and conjunctival capillaries, followed by cytokine release and recruitment of inflammatory cells. In the context of RA, ulceration more commonly affects the peripheral cornea compared to the central cornea (2).
For the management of corneal perforations, surgical procedures such as conjunctival flaps, keratoplasty, amniotic membrane grafts, cyanoacrylate glue, or corneal transplants, along with medical therapy involving immuno-suppressants, steroids, and antibiotics, are performed, with favourable outcomes (3),(4). Shivanna Y et al., demonstrated the surgical technique of patch graft for a case of corneal melt with iris prolapse, resulting in improved vision for the patient (5), similar to the present case. Alternatively, Cyanoacrylate 2Tissue Adhesive (CTA) supported by Intracorneal Scleral Patch (ICSP) has also been used in managing RA-related corneal perforations (4). Livny E et al., managed three cases similar to the present study using corneo-limbal covering grafts (6). Awan MA and Ramaesh K utilised Superior Forniceal Advancement Conjunctival Pedicle (SFACP) among their patients to manage RA-associated corneal perforations (7).
While the present case did not involve any other co-morbidities, Shivanna Y et al., reported a case with type 2 diabetes mellitus that was untreated and had PUK in the eye that underwent cataract surgery (5). Corneal melting following cataract surgery in RA patients has also been reported in studies from Mexico, Spain, and Greece [8-10]. At the time of diagnosis, the patient in the current study had no known predisposing factors, such as radiation treatment, which could increase the risk of neurotrophic keratopathy, severe dry eye disease, or infection. In contrast, Dervenis P et al., reported a history of eyelid radiation before corneal melting occurred, and Livny E et al., reported cases with a past history of penetrating keratoplasty (6),(8).
The visual acuity of the patient in this study improved following the graft, with 6/60 in the RE and 6/36 in the LE. Previous studies have reported varying visual outcomes ranging from finger counting to 6/60 (6),(7),(8), although the follow-up periods differed. Singh G et al., reported a case of corneal melt in RA complicated by a superimposed MRSA infection, which was treated with a combination of antibiotics and anterior lamellar keratoplasty before initiating the immunosuppressive regimen (11).
Corneal patch graft repair helped maintain the tectonic support and integrity of the cornea, leading to an improvement in vision for the RA patient with a complications of corneal melt and perforation. Along with restarting immunosuppressive therapy for RA, the procedure proved effective in enhancing outcomes with minimal complications.
DOI: 10.7860/JCDR/2024/68873.19364
Date of Submission: Dec 06, 2023
Date of Peer Review: Feb 10, 2024
Date of Acceptance: Mar 02, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 08, 2023
• Manual Googling: Feb 26, 2024
• iThenticate Software: Feb 29, 2024 (8%)
ETYMOLOGY: Author Origin
EMENDATIONS: 5
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
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- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com