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Abstract
Immediately sequential bilateral cataract surgery (ISBCS) involves performing phacoemulsification with intraocular lens implantation in both the eyes of a patient, sequentially in the same operative sitting. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. As a result of the COVID-19 pandemic, all elective surgeries were stopped. This has resulted in a large backlog of deferred cataract surgeries. Now more than ever before, we should consider ISBCS as an excellent alternative to delayed sequential bilateral cataract surgery in the right hospital or surgical setting. In the age of COVID-19, it can help to decrease surgical scheduling and follow-up visits. The one change in practice that could have the most significant benefit in reducing infection exposure risk is ISBCS.
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Affiliation(s)
- Jatinder S Bhalla
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India
| | - Mohmad Uzair Zakai
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India
| | - Amit Mehtani
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, India
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2
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Abstract
Optic neuritis (ON) refers to conditions that involve inflammation of the optic nerve. Various autoantibodies have been found, which are associated with central nervous system inflammatory disorders and have provided much information about the immune targets and mechanisms that impact the prognosis, treatment, and recurrence of atypical ON. Therefore, neurologists and ophthalmologists together should work to find out clinical, laboratory, and imaging findings that may provide important clues to the etiology of atypical ON and its management. Various biomarkers have been identified to confirm and distinguish atypical optic neuritis from others. The purpose of this review is to present the current scenario of atypical ON and its clinical management.
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Affiliation(s)
- Prathama Sarkar
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Amit Mehtani
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - H C Gandhi
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Vinita Dubey
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, New Delhi, India
| | | | - Mohit Kumar Gupta
- Department of Ophthalmology, Deen Dayal Upadhyay Hospital, New Delhi, India
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3
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Abstract
PURPOSE We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well. METHODS We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol. RESULTS Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%. CONCLUSION We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S. Chand
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - A. Mehtani
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - A. Sud
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - J. Prakash
- Central Institute of Orthopaedics, VMMC & Safdarjung Hospital, New Delhi, India
| | - A. Sinha
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - A. Agnihotri
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
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Mehtani A, Agarwal MC, Sharma S, Chaudhary S. Diagnosis of limbal stem cell deficiency based on corneal epithelial thickness measured on anterior segment optical coherence tomography. Indian J Ophthalmol 2017; 65:1120-1126. [PMID: 29133636 PMCID: PMC5700578 DOI: 10.4103/ijo.ijo_218_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the epithelial thickness in the cornea and limbus in limbal stem cell deficiency (LSCD) using anterior segment optical coherence tomography (AS-OCT). METHODS This was a cross-sectional, comparative study. OCT images of 30 eyes of 19 patients with LSCD collected by AS-OCT were scanned. Corneal epithelial thickness was recorded at the central cornea and the superior, nasal, inferior, and temporal limbus. Measurment of the same region of 30 normal eyes served as control. Epithelial thickness in all locations was measured by 2 independent observers. RESULTS The mean epithelial layer thickness was 61.3 ± 2.9 μ in the central cornea and 62.7 ± 4.3 μ in the limbus in the control. The epithelial thickness in LSCD patients was found to be 41.33 ± 2.8 μ. An average reduction of 22.2% in the central cornea and 32.15% in the limbus was found in patients with LSCD (P < 0.05). Epithelial thinning correlated with the severity of LSCD in both cornea and limbus. In eyes with sectoral LSCD, a similar degree of epithelial thinning was also detected in the clinically unaffected limbal regions. CONCLUSION Both corneal and limbal epithelia become progressively thinner in LSCD. Epithelial thickness assessment using AS-OCT as a noninvasive tool could be used as a diagnostic measure of LSCD.
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Affiliation(s)
- Amit Mehtani
- Department of Ophthalmology, Deen Dayal Upadhyay, Hospital Hari Nagar, New Delhi, India
| | | | - Sushant Sharma
- Department of Ophthalmology, Deen Dayal Upadhyay, Hospital Hari Nagar, New Delhi, India
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Fahey R, Gilmore W, Papageorge M, Chang D, Azzouni L, Chaudhary S, Balint A, Ashrafi A, Darwish G, Oreadi D, Viswanath A, English R, Mehtani A, Alharthi K, Vyas H, Decoteau C, Stark P. Evaluation of postoperative oedema and pain following third molar extraction with application of pulsed electromagnetic field therapy. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prakash J, Mehtani A, Agnihotari A. Letter to the Editor: Epidural versus intra-articular infusion analgesia following total knee replacement. J Orthop Surg (Hong Kong) 2016; 24:135-6. [PMID: 27122532 DOI: 10.1177/230949901602400134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Prakash
- Lady Hardinge Medical College, North Delhi, India
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Prakash J, Mehtani A. Letter to the Editor: Intra-articular tranexamic acid wash during bilateral total knee arthroplasty. J Orthop Surg (Hong Kong) 2016; 24:132-3. [PMID: 27122530 DOI: 10.1177/230949901602400130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Prakash
- Lady Hardinge Medical College, North Delhi, India
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8
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Abstract
This paper presents six cases who had a contracture of the long flexor tendons of the fingers and exhibited Volkmann's sign due to a chronic abscess or cysticercosis in the belly of the flexor digitorum profundus. All of them were treated conservatively, with full functional recovery in all the cases and with no recurrence.
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Affiliation(s)
- V Jain
- Maulana Azad Medical College and associated LN Hospital, N. Delhi, India.
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9
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Abstract
Vesicocutaneous fistula can occur secondary to numerous factors. We present a case of 14-year-old girl who presented with a discharging sinus beside her labia majora with bony ankylosis of her left hip secondary to infection. Investigations revealed the femoral head protruding into the urinary bladder, resulting in a vesicocutaneous fistula. This case highlights the bizarre presentation of infection in the hip and the difficulty in diagnosis of a resultant vesicocutaneous fistula.
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Affiliation(s)
- Vineet Jain
- Department of Orthopaedics, Maulana Azad Medical College and associated L N Hospital, N Delhi, India.
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Kapoor S, Mehtani A, Batra S. Fever with pain in bilateral shoulder joints. Postgrad Med J 2001; 77:E5. [PMID: 11571398 PMCID: PMC1742124 DOI: 10.1136/pmj.77.912.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Kapoor
- Maulana Azad Medical College and Associated Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi, India
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11
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Abstract
Thirty patients with infected non-union of long bones were treated with radical resection of the necrotic bone and bone transport or compression/distraction osteosynthesis. Non-union, infection, deformity, bone gap and shortening were all addressed simultaneously using the Ilizarov principles. There were 15 cases with bone loss ranging from 4 to 12 cm (median bone gap of 7 cm), 10 cases of stiff non-union (six of which had an associated deformity) and five cases of mobile non-union. The median time in the Ilizarov frame was 150 days. Median follow up time after frame removal was 23.5 months. Bone grafting at the docking site was only required in three cases (10%). There were three cases of refracture (10%) and three cases of recurrence of infection (10%). The bone result was excellent in 21 patients (70%), good in three (10%), fair in none (0%) and poor in six (20%). The functional results were excellent in eight patients (26.7%), good in 12 (40.0%), fair in three (10%) and poor in seven (23.3%). It is difficult to precisely define the indications for preservation and reconstruction of severe injuries. The surgical team has to take into account the length, disability, complications and cost of treatment. Patients must be aware of the limitations of functional results and the possible difficulty of return to work despite the reconstructive attempt.
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Affiliation(s)
- L Maini
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi 110002, India
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