51
|
Mohamed A, Peguda R, Ramappa M, Ali MJ, Chaurasia S. Corneal endothelium in xeroderma pigmentosum: clinical specular microscopy study. Br J Ophthalmol 2015; 100:750-3. [DOI: 10.1136/bjophthalmol-2015-307079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 09/07/2015] [Indexed: 11/03/2022]
|
52
|
Ramappa M, Chaurasia S, Chakrabarti S, Kaur I. Congenital corneal anesthesia. J AAPOS 2014; 18:427-32. [PMID: 25439301 DOI: 10.1016/j.jaapos.2014.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 05/13/2014] [Accepted: 05/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To report the various clinical presentations of congenital corneal anesthesia. METHODS The medical records of children diagnosed with congenital corneal anesthesia between January 2006 and June 2012 at the L.V. Prasad Eye Institute, Hyderabad, India, were retrospectively reviewed for demographics and clinical characteristics. RESULTS A total of 40 patients (29 males) were included. Median age at presentation was 12 months (interquartile range, 6-60 months). Bilateral involvement was noted in 28 cases (70%). Generalized pain insensitivity with anhidrosis was documented in 10 cases (25%). The spectrum of corneal lesions included geographic epithelial defects (32 eyes), sterile ulcers (15 eyes), sterile ulcers with hypopyon (11 eyes), secondary bacterial keratitis (2 eyes), superficial/ deep corneal vascularisation (5 eyes). Generalized anesthesia with self-mutilating behavior was recognized in 10 cases. In all cases, sterile corneal ulcers resolved on average 30 days after permanent 2/3-width paramedian tarsorrhapy. One eye progressed to the stage of anterior staphyloma and subsequently underwent auto evisceration. Four eyes that underwent keratoplasty for visual rehabilitation had poor outcomes. CONCLUSIONS Accurate diagnosis, recognition of risk factors, and thorough neurological assessment is important for lessening long-term sequelae of congenital corneal anesthesia. Judicious use of tear substitutes and expedited tarsorrhaphy is crucial to restoration of useful vision in these children.
Collapse
|
53
|
Mohamed A, Chaurasia S, Ramappa M, Sangwan VS, Jalali S. Lenticular changes in congenital iridolenticular choroidal coloboma. Am J Ophthalmol 2014; 158:827-830.e2. [PMID: 24997235 DOI: 10.1016/j.ajo.2014.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/26/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the lenticular changes associated with congenital iridolenticular choroidal coloboma. DESIGN Retrospective, observational case series. METHODS setting: Tertiary eye care center in south India. study population: Total of 145 eyes of 98 patients. observation procedure: Medical records of all patients with the diagnosis of congenital iridolenticular choroidal coloboma between January 2011 and December 2012 were reviewed retrospectively for demographic profile, extent of coloboma, and associated lenticular changes. RESULTS Median age of patients at the time of initial visit was 23 years (interquartile range, 13-38 years). The male-to-female ratio was ∼ 1:1. Forty-eight percent had bilateral involvement. Lens showed cataract changes in 68 eyes (48.9%). The most common type of cataract was nuclear sclerosis, which was noted in 51% of cases. A distinct type of cataract, called "coloboma cataract" (characterized by linear opacity in the region of the coloboma), was observed in 29% of cases. Other associated findings were phacodonesis in 3 eyes, dislocation in 3 eyes, and subluxation in 5 eyes. Disc and/or macular involvement in 57 eyes (39.3%) did not influence the type or density of cataract (P > .05). CONCLUSIONS Congenital iridolenticular choroidal coloboma is associated with early cataractous changes. The most common type of cataract is nuclear sclerosis. The type and density of cataract do not seem to be related to the extent of the choroidal coloboma. We suggest a distinct description with the nomenclature "coloboma cataract" to be considered in the clinical grading of cataracts in patients with this condition.
Collapse
|
54
|
Ramappa M, Wilson ME, Rogers RC, Trivedi RH. Brittle cornea syndrome: a case report and comparison with Ehlers Danlos syndrome. J AAPOS 2014; 18:509-11. [PMID: 25266838 DOI: 10.1016/j.jaapos.2014.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 06/10/2014] [Accepted: 06/14/2014] [Indexed: 11/26/2022]
Abstract
We report a 6-week-old white boy of nonconsanguineous parents who presented with bluish scleral discoloration, thin corneas, and progressive high myopia. A diagnosis of brittle cornea syndrome was confirmed by molecular analysis and prompt measures were taken to manage the condition. Long-term follow-up of children diagnosed with brittle cornea syndrome is important to minimize the risks of corneal rupture and for detecting late-onset systemic conditions.
Collapse
|
55
|
Mohamed A, Chaurasia S, Murthy SI, Ramappa M, Vaddavalli PK, Taneja M, Garg P, Chinta S, Basu S, Rathi VM, Sangwan VS. Endothelial Keratoplasty: A Review of Indications at a Tertiary Eye Care Centre in South India. Asia Pac J Ophthalmol (Phila) 2014; 3:207-10. [PMID: 26107758 DOI: 10.1097/apo.0b013e3182a75304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objective of this study was to review the indications for endothelial keratoplasty (EK) performed at a tertiary eye care center in South India between January 2007 and December 2011. DESIGN This was a hospital-based, cross-sectional study. METHODS A retrospective analysis of the indications of EK surgeries between January 2007 and December 2011 was done using the Corneal Tissue Utilization Register available with the Ramayamma International Eye Bank, L. V. Prasad Eye Institute, Hyderabad, India. Additional data such as age, sex, and socioeconomic status of the transplant recipients were obtained from the Medical Records Department, L. V. Prasad Eye Institute. RESULTS Data were available for 1048 EK surgeries performed on 978 patients. The number of EK surgeries increased from 40 in 2007 to 232 in 2011. The median age of the patients was 58 years (range, 5 months to 92 years) with a male-female ratio of 1.5:1. The clinical indications for EK were pseudophakic corneal edema (47.9%), failed prior penetrating keratoplasty (20.0%), Fuchs endothelial corneal dystrophy (10.8%), aphakic corneal edema (6.0%), failed prior EK (4.3%), congenital hereditary endothelial dystrophy (1.8%), Descemet membrane detachment/tear (1.6%), iridocorneal endothelial syndrome (1.4%), and corneal edema due to other reasons (6.2%). CONCLUSIONS The most common indication for EK was pseudophakic corneal edema, followed by post-penetrating keratoplasty graft failure and Fuchs endothelial corneal dystrophy.
Collapse
|
56
|
Sonarkhan S, Ramappa M, Chaurasia S, Mulay K. Bilateral anterior lenticonus in a case of Alport syndrome: a clinical and histopathological correlation after successful clear lens extraction. BMJ Case Rep 2014; 2014:bcr-2013-202036. [PMID: 24969069 DOI: 10.1136/bcr-2013-202036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 29-year-old woman presented with symptoms of gradual, progressive, painless diminution of vision in both eyes for past 8-10 years. On examination, uncorrected visual acuity was 20/60 in the right eye and 20/126 in the left eye. Anterior segment examination was essentially normal except for a conical protrusion in the pupillary axis of the anterior lens capsule with a clear underlying lens. During surgery, central protruded fragile lens capsule was meticulously handled to create well-centered continuous curvilinear capsulorhexis by using paediatric rhexis forceps. Histopathology of excised capsule showed markedly thinned lens capsule with normal epithelium. Electron microscopy of the anterior lens capsule showed multiple linear and irregular zones of dehiscence. Few of these had fibrillar, irregular electron-dense material and vacuoles; and adjacent cells were irregular suggestive of Alport syndrome. Postoperative course was uneventful and visual acuity improved to 20/20 unaided. Clear lens extraction is an effective means of rehabilitating visually symptomatic anterior lenticonus of Alport syndrome.
Collapse
|
57
|
Sati A, Ramappa M, Chaurasia S, Prasad SM. Deep anterior lamellar keratoplasty in case of Hurler-Scheie syndrome. BMJ Case Rep 2014; 2014:bcr-2013-202730. [PMID: 24706723 DOI: 10.1136/bcr-2013-202730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-year-old boy with Hurler-Scheie syndrome (H/S syndrome) reported with reduced vision in both the eyes for past few years. Deep anterior lamellar keratoplasty (DALK) was performed for visual rehabilitation in his left eye. During surgery, the predescemet's plane was reached by meticulously dissecting the lamellar fibres using a manual technique. Histopathology of the dissected cornea showed the presence of numerous alcian blue positive deposits corroborating with the diagnosis of mucopolysaccharidosis (MPS). Postoperative course was uneventful. One year following surgery, the graft was clear and had a visual acuity of 20/50 with +1.00 170° - 0.75 refractive correction. Endothelial cell count, as measured by non-contact specular microscopy, was 2473.4 cells/mm(2). This case report highlights the application of DALK in a case of MPS-related corneal stromal opacification.
Collapse
|
58
|
Chaurasia S, Mulay K, Ramappa M, Sangwan V, Murthy S, Nair R, Vemuganti G. Reply: To PMID 24211864. Am J Ophthalmol 2014; 157:917-8. [PMID: 24630210 DOI: 10.1016/j.ajo.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 11/18/2022]
|
59
|
Chaurasia S, Murthy S, Ramappa M, Mohamed A, Garg P. Outcomes of Descemet's stripping endothelial keratoplasty in eyes with failed therapeutic penetrating keratoplasty. Acta Ophthalmol 2014; 92:167-70. [PMID: 23387367 DOI: 10.1111/aos.12033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the results of Descemet's stripping endothelial keratoplasty (DSEK) for failed therapeutic penetrating keratoplasty (PK). METHODS Twenty-seven eyes of 27 patients undergoing DSEK for failed therapeutic PK were analysed. RESULTS The mean age of the patients was 36 ± 13.9 years (range: 14-70 years). The median size of the therapeutic graft was 10 mm (inter-quartile range; IQR 9.5-11 mm). Descemet's membrane stripping was performed in all eyes. Graft clarity was achieved in 20/27 eyes. Six eyes had primary graft failure, and one had interface keratitis in the early postoperative period. In all eyes with primary graft failure, there was progressive stromal vascularization, which led to haziness in the graft. Late postoperative complications were rejection in four eyes, infection in two eyes, secondary graft failure in one eye and vortex keratopathy in one eye. Graft size was found to be a significant risk factor for graft rejection in this series. At the last follow-up visit, the best-corrected visual acuity was ≥20/40 in 5/27 eyes (18.5%), 20/60-20/40 in 12/27 eyes (44.4%), 20/100-20/60 in 3/27 eyes (1.5%) and ≤20/200 in 7/27 eyes (25.9%). CONCLUSIONS Considering the limited success of repeat PK in failed large therapeutic keratoplasty, DSEK is a viable option for visual rehabilitation in these eyes, however; visual acuity may be limited due to sub-epithelial/stromal or interface scarring.
Collapse
|
60
|
Chaurasia S, Mulay K, Ramappa M, Sangwan V, Murthy S, Nair R, Vemuganti G. Corneal changes in xeroderma pigmentosum: a clinicopathologic report. Am J Ophthalmol 2014; 157:495-500.e2. [PMID: 24211864 DOI: 10.1016/j.ajo.2013.10.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 10/24/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the clinicopathologic features of corneal involvement in patients with xeroderma pigmentosum. DESIGN Retrospective review of corneal histopathology. METHODS Thirteen corneal specimens of 11 patients with xeroderma pigmentosum who underwent keratoplasty (lamellar/full-thickness) for corneal involvement were studied. Five-micrometer-thick sections were made from all the samples and stained using hematoxylin-eosin and periodic acid-Schiff stains. A light microscopic examination was performed to study the histopathologic changes. RESULTS The corneal findings on clinical examination were haze, scarring, vascularization, stromal edema, pigment clumps on endothelial surface, and corneal thinning. The histopathologic evaluation revealed changes in all layers of cornea. Epithelial changes seen were intraepithelial edema, fibrosis, epithelial downgrowths, and pannus formation. The Bowman membrane was fragmented or absent. Stroma was characterized by alteration in the lamellar pattern, scarring, edema, loss of keratocytic nuclei, and calcification. The Descemet membrane was thickened to a variable extent in most specimens and there was marked loss of endothelial cells in all. CONCLUSION Most histologic features are consistent with the previous few reports. The remarkable finding in all corneal specimens was a moderate to severe degree of loss of the endothelial cells. This noteworthy finding supports the ultraviolet (UV) radiation-induced endothelial cell damage in these patients. This has an important clinical implication when planning for anterior lamellar keratoplasty, as endothelial cell density may be subnormal in these patients.
Collapse
|
61
|
Singh B, Mohamed A, Chaurasia S, Ramappa M, Mandal AK, Jalali S, Sangwan VS. Clinical manifestations of congenital aniridia. J Pediatr Ophthalmol Strabismus 2014; 51:59-62. [PMID: 24369682 DOI: 10.3928/01913913-20131223-01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 10/10/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the various clinical manifestations associated with congenital aniridia in an Indian population. METHODS In this retrospective, consecutive, observational case series, all patients with the diagnosis of congenital aniridia seen at the institute from January 2005 to December 2010 were reviewed. In all patients, the demographic profile, visual acuity, and associated systemic and ocular manifestations were studied. RESULTS The study included 262 eyes of 131 patients with congenital aniridia. Median patient age at the time of initial visit was 8 years (range: 1 day to 73 years). Most cases were sporadic and none of the patients had parents afflicted with aniridia. The most common anterior segment abnormality identified was lenticular changes. Cataract was the predominant lens finding, observed in 93 of 231 (40.3%) phakic eyes. Other lens abnormalities were subluxation, coloboma, posterior lenticonus, and microspherophakia. Corneal involvement of varying degrees was seen in 157 of 262 (59.9%) eyes, glaucoma was identified in 95 of 262 (36.3%) eyes, and foveal hypoplasia could be assessed in 230 of 262 (87.7%) eyes. Median age when glaucoma and cataract were noted was 7 and 14 years, respectively. None of the patients had Wilm's tumor. CONCLUSIONS Congenital aniridia was commonly associated with classically described ocular features. However, systemic associations were characteristically absent in this population. Notably, cataract and glaucoma were seen at an early age. This warrants a careful evaluation and periodic follow-up in these patients for timely identification and appropriate management.
Collapse
|
62
|
Chaurasia S, Ramappa M, Sangwan V. Cataract surgery after Descemet stripping endothelial keratoplasty. Indian J Ophthalmol 2013. [PMID: 23202404 PMCID: PMC3545142 DOI: 10.4103/0301-4738.103803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Management of endothelial dysfunction in phakic patients is sometimes a dilemma for corneal surgeons. Phakic patients with visually significant cataract and endothelial dysfunction are preferably managed by performing combined cataract surgery with endothelial keratoplasty. However, combined surgery may be deferred in eyes with early incipient cataract, younger age and where anterior chamber is poorly visualized. As cataract formation may be accelerated after endothelial keratoplasty, these eyes may need cataract surgery subsequently. Surgical intervention in eyes with endothelial keratoplasty is of concern as this may affect the graft adversely and threaten graft survival. In this report, we describe the intraoperative surgical details and postoperative clinical course of a patient who underwent phacoemulsification with intraocular lens implantation after Descemet stripping automated endothelial keratoplasty (DSAEK).
Collapse
|
63
|
Ramappa M, Bhalekar S, Chaurasia S, Mulay K, Trivedi RH, Wilson ME. Presumed allograft stromal rejection after deep anterior lamellar keratoplasty in a boy presenting with interface fluid syndrome. J AAPOS 2013; 17:554-7. [PMID: 24160982 DOI: 10.1016/j.jaapos.2013.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 06/06/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
Selective anterior lamellar corneal replacement procedures have resulted in fewer allograft rejections compared with penetrating keratoplasty. Deep anterior lamellar keratoplasty offers several advantages over conventional penetrating keratoplasty, significantly reducing the lifetime endothelial rejection. We report the case of a child with a presumed immune-mediated stromal rejection after deep anterior lamellar keratoplasty who presented with interface fluid, confirmed by optical coherence tomography, that subsequently resolved after prompt topical steroid treatment.
Collapse
|
64
|
Chaurasia S, Ramappa M, Murthy SI, Vemuganti GK, Fernandes M, Sharma S, Sangwan V. Chronic conjunctivitis due to Mycobacterium tuberculosis. Int Ophthalmol 2013; 34:655-60. [DOI: 10.1007/s10792-013-9839-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/25/2013] [Indexed: 11/28/2022]
|
65
|
Sejpal K, Ali MH, Maddileti S, Basu S, Ramappa M, Kekunnaya R, Vemuganti GK, Sangwan VS. Cultivated Limbal Epithelial Transplantation in Children With Ocular Surface Burns. JAMA Ophthalmol 2013; 131:731-6. [DOI: 10.1001/jamaophthalmol.2013.2308] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
66
|
Ashar JN, Ramappa M, Vaddavalli PK. Paired-eye comparison of Descemet's stripping endothelial keratoplasty and penetrating keratoplasty in children with congenital hereditary endothelial dystrophy. Br J Ophthalmol 2013; 97:1247-9. [DOI: 10.1136/bjophthalmol-2012-302602] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
67
|
Ashar JN, Pahuja S, Ramappa M, Vaddavalli PK, Chaurasia S, Garg P. Deep anterior lamellar keratoplasty in children. Am J Ophthalmol 2013; 155:570-574.e1. [PMID: 23218688 DOI: 10.1016/j.ajo.2012.09.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/21/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children. DESIGN Retrospective interventional case series. METHODS setting: Institutional, L.V. Prasad Eye Institute, a tertiary care center in south India. study population and intervention: All children less than 16 years of age undergoing DALK from January 2003 to January 2011. main outcome measure: Visual outcome and complications. RESULTS Twenty-six eyes of 26 children (13 male and 13 female) with a mean age of 7.82 ± 4.64 years underwent DALK for keratoconus (8), microbial keratitis (6), corneal scar (6), corneal keloid (3), chemical injury with limbal stem cell deficiency (2), and dermoid (1). Big bubble was achieved in 5 eyes, while manual dissection was done in 21. Follow-up ranged from 1 week to 7.3 years. Seventeen patients with a minimal follow-up of 6 months were evaluated for visual outcomes. Final vision varied from counting fingers to 20/20 (mean sphere 2.32 diopters, mean cylinder -2.5 diopters). Complications encountered were suture-related graft infiltrate (3), graft dehiscence (3), and Descemet membrane detachment (2). CONCLUSIONS DALK is a feasible option in children with stromal corneal pathology. It offers advantages in the form of lower risk of graft rejection. However, the risk of complications such as suture-related infections and graft dehiscence persists even in these cases.
Collapse
|
68
|
Ashar JN, Ramappa M, Chaurasia S. Endothelial keratoplasty without Descemet's stripping in congenital hereditary endothelial dystrophy. J AAPOS 2013; 17:22-4. [PMID: 23352381 DOI: 10.1016/j.jaapos.2012.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 07/24/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare outcomes of non-Descemet's stripping endothelial keratoplasty (nDSEK) with Descemet's stripping endothelial keratoplasty (DSEK) for the surgical management of congenital hereditary endothelial dystrophy (CHED). METHODS Patients with CHED who were treated with DSEK or nDSEK were analyzed and compared with respect to graft adhesion, graft clarity, visual acuity, refraction, and complications. RESULTS A total of 6 patients were included in the series. Of these, 3 (mean age, 5.6 ± 1.52 years; 1 male) underwent DSEK and 3 (mean age, 5.6 ± 0.57 years; 2 males) nDSEK. Preoperative best-corrected visual acuity of patients who underwent DSEK was 1.3 logMAR units compared with 1.13 logMAR units for nDSEK patients. There were no intraoperative complications. During the early postoperative period, 1 patient who had n DSEK had lenticule detachment and was successfully managed by repeat air injection. The average time for resolution of graft edema was 30 days. The postoperative best-corrected visual acuity was 0.13 ± 0 .10 in DSEK patients and 0.13 ± 0 .10 in nDSEK patients (P = 1). Mean refraction was comparable in both groups of patients. CONCLUSIONS The outcomes of nDSEK were similar to DSEK in CHED in this small series. The specific advantage of nDSEK is the decreased surgical time and intraocular tissue manipulation.
Collapse
|
69
|
Chaurasia S, Ramappa M, Garg P, Murthy SI, Senthil S, Sangwan VS. Endothelial keratoplasty in the management of irido-corneal endothelial syndrome. Eye (Lond) 2013; 27:564-6. [PMID: 23348727 DOI: 10.1038/eye.2012.298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the results of endothelial keratoplasty (EK) in the management of irido-corneal endothelial (ICE) syndrome. DESIGN Retrospective, consecutive, interventional case series. METHODS Eight eyes of seven patients underwent EK for corneal edema owing to ICE syndrome. Simultaneous cataract surgery was performed in five eyes. The charts were reviewed for demographics, clinical findings, and outcomes after EK. RESULTS Mean age was 50.4 years (range 35-59 years). Mean follow-up was 12.5 months (range 6-24 months). Corneal clarity was restored in all eyes and was maintained till the last follow-up. Four patients had acute rise in the intraocular pressure in the post-operative period, which was well controlled on medical treatment. One patient who was non-compliant with medications and regular follow-up advice had progression of glaucomatous disc changes and visual field loss. The best-corrected visual acuity ranged from 20/50-20/30. CONCLUSIONS EK is a viable option in ICE syndrome. Adequate control of glaucoma is the paramount factor in maintaining good visual acuity in these eyes.
Collapse
|
70
|
Ummar S, Tibrewal S, Ramappa M, Kekunnaya RA. Atropine for treatment of myopia. Ophthalmology 2012. [PMID: 23207035 DOI: 10.1016/j.ophtha.2012.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
71
|
Sati A, Ramappa M, Sharma N, Chaurasia S, Vemuganti GK, Kannabiran C, Garg P. Bilateral granular dystrophy: A clinicopathogenetic correlation after alcohol assisted debridement with phototherapeutic keratectomy. Med J Armed Forces India 2012; 71:S1-4. [PMID: 26265796 DOI: 10.1016/j.mjafi.2012.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 08/12/2012] [Indexed: 10/27/2022] Open
|
72
|
Majji AB, Ramappa M, Murthy S, Balne P, Nalamada S, Garudadri C, Mathai A, Gopinathan U, Garg P. Author reply. Ophthalmology 2012. [DOI: 10.1016/j.ophtha.2012.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
73
|
Ramappa M, Pehere NK, Murthy SI, Chaurasia S, Rao HL, Sangwan VS. Rotational autokeratoplasty in pediatric patients for nonprogressive paracentral corneal scars. Ophthalmology 2012; 119:2458-62. [PMID: 23009890 DOI: 10.1016/j.ophtha.2012.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/19/2012] [Accepted: 06/27/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report the outcomes of ipsilateral rotational autokeratoplasty (RAK) for nonprogressive paracentral corneal opacities in children <16 years of age. DESIGN Retrospective, consecutive, interventional case series. PARTICIPANTS Thirty-three eyes of 33 children aged <16 years undergoing RAK for nonprogressive paracentral scars. METHODS Medical records were retrospectively reviewed for the primary etiology of corneal opacity, time of onset, duration of opacity, preoperative visual acuity, formula used for calculation of trephine size, size of the trephine used, and duration of follow-up. Any intraoperative and early and late postoperative complications were noted for all patients. Postoperative visual acuity and astigmatism were noted. Visual acuity was converted to logarithm of the minimum angle of resolution units for analysis. MAIN OUTCOME MEASURES Primary outcome was postoperative visual acuity. Graft clarity and complications were analyzed as secondary outcomes. RESULTS The mean age at surgery was 7.2 ± 3 .9 months. The mean follow-up duration was 27 ± 37 months. The commonest etiology of corneal opacity was trauma (62.5%), followed by resolved microbial keratitis (21.9%). Postoperative visual acuity (1.25 ± 0.84) was significantly better (P<0.001) than preoperative visual acuity (2.05 ± 0.96). The mean astigmatism at last visit was 4.04 ± 2.21 diopters. Postoperative visual acuity was better in older children (β = -0.01; P = 0.03) and had a shorter delay in presentation (β = 0.02; P = 0.05). At the last follow-up, the graft was clear in 27 cases (81.25%). The cumulative probability of graft survival was 85% at 2 years and 65% at 5 years. Complications included wound leak in 4 eyes, secondary glaucoma in 2 eyes, graft infiltrate and traumatic dehiscence in 1 eye each. CONCLUSIONS Rotational is a autokeratoplasty viable alternative surgical option to allogenic keratoplasty. Graft survival at 2 years seems to be better than allogenic keratoplasty. Younger age and delay in presentation contribute to poorer visual outcomes after surgery. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Collapse
|
74
|
Majji AB, Ramappa M, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A, Gopinathan U, Garg P. Author reply. Ophthalmology 2012. [DOI: 10.1016/j.ophtha.2012.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
75
|
Chaurasia S, Ramappa M, Sangwan VS. Clinical outcomes of non-Descemet stripping automated endothelial keratoplasty. Int Ophthalmol 2012; 32:571-5. [DOI: 10.1007/s10792-012-9615-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/16/2012] [Indexed: 11/30/2022]
|
76
|
Chaurasia S, Ramappa M, Rao HL, Bansal P. Descemet's stripping automated endothelial keratoplasty. Ophthalmology 2012; 119:1498-9; author reply 1499. [PMID: 22749091 DOI: 10.1016/j.ophtha.2012.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022] Open
|
77
|
Monga S, Ramappa M, Kekunnaya R, Chaurasia S, Rao H. Intraocular lenses in children. Ophthalmology 2012; 119:1503-4;author reply 1504-5. [PMID: 22749102 DOI: 10.1016/j.ophtha.2012.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/06/2012] [Indexed: 11/16/2022] Open
|
78
|
Chaurasia S, Ramappa M, Garg P. Outcomes of air descemetopexy for Descemet membrane detachment after cataract surgery. J Cataract Refract Surg 2012; 38:1134-9. [DOI: 10.1016/j.jcrs.2012.01.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/19/2012] [Accepted: 01/21/2012] [Indexed: 11/17/2022]
|
79
|
Puranik C, Chaurasia S, Ramappa M, Sangwan V, Balasubramanian D. Corneal chalcosis following blast injury. Br J Ophthalmol 2012; 96:762. [DOI: 10.1136/bjophthalmol-2011-300794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
80
|
Ramappa M, Ashar J, Vaddavalli PK, Chaurasia S, Murthy SI. Endothelial keratoplasty in children: surgical challenges and early outcomes. Br J Ophthalmol 2012; 96:1149-51. [PMID: 22539750 DOI: 10.1136/bjophthalmol-2011-300941] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
81
|
Ramappa M, Murthy SI, Chaurasia S, Singhla R, Rathi VM, Vemuganti GK, Sangwan VS. Lens-preserving excision of congenital hyperplastic pupillary membranes with clinicopathological correlation. J AAPOS 2012; 16:201-3. [PMID: 22525182 DOI: 10.1016/j.jaapos.2011.12.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/22/2011] [Accepted: 12/31/2011] [Indexed: 11/24/2022]
Abstract
Persistent pupillary membrane is a congenital, incomplete involution of the tunica vasculosa lentis. These membranes are usually tenacious, with fine fibrils attached to the iris collarette on one side, with the other end either free floating or attached to the lens or iris focally on the opposite side. This condition is thought to represent ectopic iris tissue on the lens with abnormal iris stroma caused by aberrant involutional changes in the primitive embryological vascular system of anterior segment. Dense and thick membranes, particularly within the pupil, may result in deprivation amblyopia. We report clinical and histopathological findings in a case of a 12-year-old boy with bilateral extensive hyperplastic persistent pupillary membrane that was surgically removed without injury to the crystalline lens.
Collapse
|
82
|
Chaurasia S, Ramappa M, Sangwan V, Vemuganti GK, Nalmada S. Chronic unilateral conjunctivitis. THE LANCET. INFECTIOUS DISEASES 2012; 12:354. [PMID: 22459089 DOI: 10.1016/s1473-3099(12)70057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
83
|
Ramappa M, Majji AB, Murthy SI, Balne PK, Nalamada S, Garudadri C, Mathai A, Gopinathan U, Garg P. An outbreak of acute post-cataract surgery Pseudomonas sp. endophthalmitis caused by contaminated hydrophilic intraocular lens solution. Ophthalmology 2012; 119:564-70. [PMID: 22218145 DOI: 10.1016/j.ophtha.2011.09.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To report the investigation for the source of infection and the clinical course and treatment response of 11 cases of acute post-cataract surgery endophthalmitis that developed during an outbreak. DESIGN Retrospective, consecutive, interventional case series. PARTICIPANTS Eleven patients who developed acute postoperative endophthalmitis after an uneventful cataract surgery with intraocular lens implantation from September 6 to 29, 2010, at a tertiary eye care center in South India. METHODS Aqueous aspirates, vitreous aspirates, and environmental surveillance specimens were sampled. All specimens were subjected to smear and culture. Positive cultures were subjected to antibiotic susceptibility. Genotypic diversity was determined by polymerase chain reaction (PCR) with enterobacterial repetitive intergenic consensus (ERIC) primers of each strain and was used to establish the clonal relationship between clinical and environmental isolates. The clinical patterns were analyzed. MAIN OUTCOME MEASURES Positive microbiology, molecular diagnostic similarity among the culture positive endophthalmitis cases, and surveillance specimens. RESULTS Aqueous and vitreous samples showed gram-negative bacilli in the smears of 8 of 11 eyes, and cultures grew Pseudomonas aeruginosa in 5 of 11 eyes. Among the samples from various surveillance specimens cultured, only the hydrophilic acrylic intraocular lenses and their solution grew P. aeruginosa, with antibiotic susceptibility pattern identical to the clinical isolates. The isolates from the patients and the intraocular lens solution revealed matching patterns similar to an American Type Culture Collection (ATCC) strain of P. aeruginosa on ERIC-PCR. The intraocular lenses of the same make were discontinued at our hospital, and the endophthalmitis did not recur. The final visual acuity improved to ≥ 20/50 in 8 of 11 patients (72.7%). One patient developed retinal detachment, but was treated successfully, and 2 other patients progressed to phthisis bulbi. CONCLUSIONS Positive microbiology and the ERIC-PCR results proved that contamination of hydrophilic intraocular lenses and the preservative solution was the source of infection in this outbreak. Early detection and a planned approach during the outbreak helped us to achieve good visual and anatomic outcomes, even though the offending organism was identified as P. aeruginosa.
Collapse
|
84
|
Chaurasia S, Ramappa M, Sangwan VS. Cataract surgery in eyes with congenital iridolenticular choroidal coloboma. Br J Ophthalmol 2011; 96:138-40. [PMID: 22034540 DOI: 10.1136/bjophthalmol-2011-300233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
85
|
Chaurasia S, Ramappa M. Traumatic wound dehiscence after deep anterior lamellar keratoplasty. J AAPOS 2011; 15:484-5. [PMID: 22108362 DOI: 10.1016/j.jaapos.2011.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 06/14/2011] [Accepted: 06/26/2011] [Indexed: 10/15/2022]
Abstract
A 5-year-old boy who had undergone deep anterior lamellar keratoplasty (DALK) in the right eye 8 months earlier presented with a full-thickness graft-host junction dehiscence and iris prolapse following an injury with a rubber ball. The junction was resutured and the graft became clear within 5 weeks. To our knowledge, this is the first reported case of wound dehiscence after DALK in a child. Although Descemet's membrane might be considered a protective barrier following DALK, the graft-host junction remains vulnerable and can rupture with blunt trauma.
Collapse
|
86
|
Chaurasia S, Vaddavalli PK, Ramappa M, Garg P, Sangwan VS. Clinical profile of graft detachment and outcomes of rebubbling after Descemet stripping endothelial keratoplasty. Br J Ophthalmol 2011; 95:1509-12. [DOI: 10.1136/bjophthalmol-2011-300155] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
87
|
Gupta A, Ramappa M, Kekunnaya R, Vaddavalli PK, Ray D, Chaurasia S, Rao HL, Garudadri CS. Comparing the astigmatic outcome after paediatric cataract surgery with different incisions. Br J Ophthalmol 2011; 96:386-9. [DOI: 10.1136/bjo.2011.202622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
88
|
Chaurasia S, Ramappa M, Murthy SI, Garg P, Sangwan VS. Endothelial keratoplasty without stripping the Descemet's membrane. Br J Ophthalmol 2011; 95:1473-4. [PMID: 21602477 DOI: 10.1136/bjo.2011.204008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
89
|
Basu S, Vaddavalli PK, Ramappa M, Shah S, Murthy SI, Sangwan VS. Intracameral Perfluoropropane Gas in the Treatment of Acute Corneal Hydrops. Ophthalmology 2011; 118:934-9. [PMID: 21211841 DOI: 10.1016/j.ophtha.2010.09.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 09/29/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022] Open
|
90
|
Gupta A, Kekunnaya R, Ramappa M, Vaddavalli PK. Safety profile of primary intraocular lens implantation in children below 2 years of age. Br J Ophthalmol 2010; 95:477-80. [DOI: 10.1136/bjo.2010.184606] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|