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Sindal MD, Mohankumar A, Gondhale H, Ck N, Srinivasan K. Aqueous misdirection syndrome post silicone oil removal in a vitrectomized eye - a case report. Eur J Ophthalmol 2024; 34:NP121-NP125. [PMID: 37673074 DOI: 10.1177/11206721231200063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PUROPSE Aqueous misdirection syndrome (AMS) is an aggressive post-operative glaucoma unresponsive to conventional measures with grave outcomes. In this report, we describe a rare case of AMS following silicon oil removal in a vitrectomized eye. METHODS A diabetic patient with tractional retinal detachment underwent pars plana vitrectomy with silicon oil injection. Following retinal reattachment, silicon oil removal was performed at three months. Post oil removal she developed increased intraocular pressure with shallowing of both the peripheral and central anterior chamber suggestive of AMS. RESULTS Initial medical management with anti-glaucoma medications and cycloplegics was not beneficial. A pars plana lensectomy with complete anterior hyaloidectomy along with a surgical peripheral iridectomy helped relieve the aqueous misdirection. CONCLUSION AMS can rarely occur following vitrectomy and is likely secondary to intact anterior hyaloid. Lensectomy along with zonulo-hyaloido-iridectomy is essential. This report highlights the occurrence of this rare complication and its effective management.
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Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Arthi Mohankumar
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Harshal Gondhale
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Nagesha Ck
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Kavitha Srinivasan
- Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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2
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Baskaran P, Sindal MD, Ganne P, Madanagopalan VG, Krishnappa NC, Rajendran A, Dhoble P, Ratna B, Ghondale H, Mani I. Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes - A randomized controlled trial (InFlap Study). Indian J Ophthalmol 2024; 72:S75-S83. [PMID: 38131546 PMCID: PMC10833171 DOI: 10.4103/ijo.ijo_484_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH). METHODS A consecutive 99 eyes of 99 patients were enrolled {45 - conventional group and 54 - inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed. RESULTS At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group. CONCLUSION The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.
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Affiliation(s)
- Prabu Baskaran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Manavi D Sindal
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Pratyusha Ganne
- Department of Retina, All India Institute of Medical Science, Mangalagiri, Andhra Pradesh, India
| | | | | | - Anand Rajendran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Pankaja Dhoble
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Bholesh Ratna
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | | | - Iswarya Mani
- Department of Statistics, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Sindal MD, Tagare S. Dual-layered hyphema and pseudohypopyon: unusual presentation of leukaemia. Eye (Lond) 2023:10.1038/s41433-023-02862-9. [PMID: 38049628 DOI: 10.1038/s41433-023-02862-9] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India.
| | - Shivraj Tagare
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India
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4
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Shah PN, Mishra DK, Shanmugam MP, Agarwal M, Susvar P, Sen AC, Ramanjulu R, Dave V, Saravanan V, Kannan N, Sinha T, Sindal MD, Singh SR, Rajanna MK, Ayachit AG, Maitray A, Yadav NK, Balakrishnan D, Nigam E, Narula R, Khadar SMA, Atri N, Mittal S, Murthy H, Mahalingam PS, Pillai GS, Nagpal M, Walinjkar J, Gupta V, Kothari A. Incidence of post vitrectomy endophthalmitis in India - A multicentric study by VRSI study Group. Eye (Lond) 2023; 37:2915-2920. [PMID: 36754984 PMCID: PMC10516918 DOI: 10.1038/s41433-023-02430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.
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Affiliation(s)
| | | | | | | | | | - Alok C Sen
- Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | | | - Vivek Dave
- L V Prasad Eye Institute, Hyderabad, Telangana, India
| | | | | | | | - Manavi D Sindal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Eesh Nigam
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | | | | | | | | | - Hemanth Murthy
- Retina Institute Of Karnataka, Bengaluru, Karnataka, India
| | | | - Gopal S Pillai
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Jaydeep Walinjkar
- Aditya Jyot Eye Hospital (P) Limited (A Unit Of Dr Agarwals Eye Hospital), Mumbai, Maharashtra, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Sindal MD, Ratra A, Ratra D. Enhancing surgical training - Role of simulators and mentors. Indian J Ophthalmol 2023; 71:3260-3261. [PMID: 37602619 PMCID: PMC10565920 DOI: 10.4103/ijo.ijo_1798_23] [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: 08/22/2023] Open
Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India
| | - Aashna Ratra
- Department of Ophthalmology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Sindal MD, Ratna B, Tagare S. Retinal Leukemic Infiltrates. Ophthalmol Retina 2023:S2468-6530(23)00152-5. [PMID: 37149803 DOI: 10.1016/j.oret.2023.04.002] [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] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Manavi D Sindal
- Vitreoretinal services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Bholesh Ratna
- Vitreoretinal services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Shivraj Tagare
- Vitreoretinal services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Rao DP, Sindal MD, Sengupta S, Baskaran P, Venkatesh R, Sivaraman A, Savoy FM. Towards a Device Agnostic AI for Diabetic Retinopathy Screening: An External Validation Study. Clin Ophthalmol 2022; 16:2659-2667. [PMID: 36003071 PMCID: PMC9393096 DOI: 10.2147/opth.s369675] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Divya Parthasarathy Rao
- Artificial Intelligence R&D, Remidio Innovative Solutions Inc, Glen Allen, VA, USA
- Correspondence: Divya Parthasarathy Rao, Artificial Intelligence R&D, Remidio Innovative Solutions Inc, 11357 Nuckols Road, #102, Glen Allen, VA, 23059, USA, Tel +1 855 513-3335, Email
| | - Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Sabyasachi Sengupta
- Department of Retina, Future Vision Eye Care and Research Center, Mumbai, India
| | - Prabu Baskaran
- Vitreoretinal Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Chennai, India
| | - Rengaraj Venkatesh
- Vitreoretinal Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Anand Sivaraman
- Artificial Intelligence R&D, Remidio Innovative Solutions Pvt Ltd, Bangalore, India
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Sindal MD. Commentary: Predicting need for treatment in retinopathy of prematurity - The elusive Holy Grail. Indian J Ophthalmol 2022; 70:1277-1278. [PMID: 35326032 PMCID: PMC9240546 DOI: 10.4103/ijo.ijo_3024_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Manavi D Sindal
- Head, Clinical Retina and Training, Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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9
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Sengupta S, Sindal MD, Shanmugam PM, Bhende P, Ratra D, Nagpal M, Narayanan R, Rajendran A, Saravanan V, Kelkar A, Maiti A, Chakraborty D, Dogra M, Behera S. A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India. Indian J Ophthalmol 2021; 69:3308-3318. [PMID: 34708794 PMCID: PMC8725119 DOI: 10.4103/ijo.ijo_1265_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To derive consensus statements for surgical management of proliferative diabetic retinopathy (PDR) for vitreoretinal (VR) surgeons. Methods Thirteen prolific VR surgeons representing all regions of India were invited to participate in a 42-point questionnaire based on the Delphi methodology describing various surgical scenarios commonly encountered in PDR. Consensus was derived using predefined robust analytics. Scenarios that returned a moderate consensus in round 1 were taken to round 2 as per the Delphi methodology. After considering all inputs, the final consensus criteria were developed. Results A strong consensus was derived about waiting for 4 weeks before considering vitrectomy. In treatment-naïve eyes with fresh vitreous hemorrhage (VH), the wait time was slightly shorter for extramacular tractional retinal detachment (2-4 weeks) and longer (4-6 weeks) for eyes treated previously with laser or anti-VEGF agents. The expert panel recommended using preoperative anti-VEGF only in eyes with large membranes requiring extensive dissection. For post vitrectomy VH, while a conservative approach was recommended for the first episode of VH, experts recommended immediate vitreous lavage for recurrent episodes of VH. In eyes with iris neovascularization, the panel recommended immediate anti-VEGF injection followed by early vitreous lavage in nonresponsive eyes. A strong consensus was derived for stopping antiplatelet agents before surgery, while there was only a moderate consensus for performing vitrectomy for recalcitrant macular edema unresponsive to anti-VEGF injections in the absence of traction. Conclusion This study provides valuable consensus on managing the different scenarios encountered during surgical management of PDR and should help guide the VR surgeons in clinical decision-making.
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Affiliation(s)
- Sabyasachi Sengupta
- Vitreoretinal Services, Future Vision Eye Care, Borivali (East), Mumbai, Maharashtra, India
| | - Manavi D Sindal
- Viitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - P Mahesh Shanmugam
- Vitreoretinal and Oncology Service, Sankara Eye Hospital, Kundalahalli Gate, Airport, Varthur Road, Bengaluru, Karnataka, India
| | - Pramod Bhende
- Shri Bhagawan Mahavir Vitreo-Retinal Services, Medical Research Foundation, (Sankara Nethralaya), Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Shri Bhagawan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Manish Nagpal
- Vitreo Retinal Consultant, Retina Foundation, Ahmedabad, Gujarat, India
| | - Raja Narayanan
- Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand Rajendran
- Vitreoretinal Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | | | - Aditya Kelkar
- Vitreo-Retinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aniruddha Maiti
- Vitreoretinal Services, Susrut Eye Foundation and Research Centre, Kolkata, West Bengal, India
| | - Debdulal Chakraborty
- Vitreo- Retina Service, Disha Eye Hospital, Barackpore, Kolkata, West Bengal, India
| | - Mohit Dogra
- Vitreoretina and Uveitis Service, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Behera
- Viitreoretinal Services, Aravind Eye Hospital, Puducherry, India
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Sindal MD, Yadav D. Commentary: Are we there yet? Role of anti-vascular endothelial growth factor and laser in the management of retinopathy of prematurity. Indian J Ophthalmol 2021; 69:2176-2177. [PMID: 34304204 PMCID: PMC8482901 DOI: 10.4103/ijo.ijo_626_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Manavi D Sindal
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Divya Yadav
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Sindal MD, Ratna B, Umate M. Commentary: Parental involvement in retinopathy of prematurity care: An individualized approach. Indian J Ophthalmol 2021; 69:2141. [PMID: 34304195 PMCID: PMC8482890 DOI: 10.4103/ijo.ijo_763_21] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manavi D Sindal
- Head, Clinical Retina and Training, Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Bholesh Ratna
- Fellow, Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Maithili Umate
- Associate Professor, Department of Psychiatry, Grant Government Medical College, Mumbai, Maharashtra, India
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Arthi M, Sindal MD, Rashmita R. Hyperreflective foci as biomarkers for inflammation in diabetic macular edema: Retrospective analysis of treatment naïve eyes from south India. Indian J Ophthalmol 2021; 69:1197-1202. [PMID: 33913858 PMCID: PMC8186614 DOI: 10.4103/ijo.ijo_2627_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: The aim of this study was to analyze the factors associated with hyperreflective foci (HRF) in diabetic macular edema (DME) in treatment naïve eyes. Methods: This retrospective observational study included 131 eyes of 91 treatment naïve patients with DME. Details of ophthalmological examination with duration of vision loss and systemic parameters were noted. The spectral-domain optical coherence tomography (SD-OCT) images were analyzed for number and location of HRF and the associated imaging biomarkers. Results: Inner retinal (IR) HRF were seen in 88 eyes (67%), outer retinal (OR) in 28 (21%), and subretinal (SR) in 12 (9%). The IR had (7.1 ± 7) HRF, the OR (6.5 ± 4.8), and SR (3.9 ± 2.9). A greater proportion of eyes with HRF also had subretinal fluid (SRF), significantly higher blood pressure and lower serum triglycerides. Univariate linear regression analysis showed women (3 HRF greater vs. men, P = 0.04), eyes with cystoid spaces (2.95 more HRF vs. no cystoid spaces, P = 0.02), and SRF (2.96 more HRF vs. no SRF, P = 0.007) had more HRF, whereas higher triglycerides (1 HRF lesser per 50 mg lower TGL, P = 0.03) had lesser. Conclusion: Our study highlights the importance of HRF as an imaging biomarker in DME suggesting an inflammatory origin. Long-term observations of large cohorts with automated analysis can give more insights.
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Affiliation(s)
- M Arthi
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - R Rashmita
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Pan U, Jain A, Gubert J, Kumari B, Sindal MD. Antibiotic sensitivity trends of pseudomonas endophthalmitis in a tertiary eye care center in South India: A 12-year retrospective study. Indian J Ophthalmol 2021; 68:627-631. [PMID: 32174583 PMCID: PMC7210830 DOI: 10.4103/ijo.ijo_1145_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To assess trends in antibiotic sensitivity of pseudomonas and compare multidrug resistance (MDR) between Pseudomonas endophthalmitis cases presenting in two consecutive 6-year time frames in a tertiary center in South India. Methods: This is a retrospective comparative series of all Pseudomonas endophthalmitis cases treated from June 2004 to May 2016. Microbiological culture results in all endophthalmitis patients were screened for pseudomonas. Positive cases in the initial 6 and final 6 years were compared for sensitivity to antibiotics and the proportion of MDR. MDR was defined as resistance to at least two different classes of antibiotics. Results: Pseudomonas accounted for 74 of 389 endophthalmitis cases (19%), 42 in initial 6 and 32 in final 6 years. Sensitivity to ciprofloxacin, ofloxacin, gatifloxacin, moxifloxacin, and ceftazidime was 85.7%, 82.9%, 76.5%, 76.9%, 88.1% up to 2010 which reduced to 75%, 59.4%, 68.8%, 56.3%, 56.3%, respectively, after 2010, being significant for ofloxacin (P = 0.0349) and ceftazidime (P = 0.0028). Susceptibility to amikacin, gentamicin, and tobramycin changed non-significantly from 83.3%, 43.9%, 47.6% to 71.9%, 61.3%, 61.3%, respectively. Twenty of 74 cases (27%) were MDR with 16.7% in first 6 years versus 40.6% in final 6 years. Postoperative MDR cases rose from 10.3% to 50% (P = 0.0048). Conclusion: This study shows rising resistance of Pseudomonas to fluoroquinolones, amikacin, and ceftazidime in endophthalmitis. MDR also showed an upward trend, particularly in postsurgical cases.
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Affiliation(s)
- Utsab Pan
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry; Vitreoretina Services, Susrut Eye Foundation and Research Centre, Berhampore, West Bengal, India
| | - Aarti Jain
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry; Vitreoretina Services, Giridhar Eye Institute, Kochi, Kerala, India
| | - Joseph Gubert
- Microbiology Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Bibha Kumari
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry; Geetasri Retina Institute, Ranchi, Jharkhand, India
| | - Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Sindal MD, Sathe T, Sengupta S, Yadav D. Proportion of diabetic retinopathy among diabetics presenting for the first time to a tertiary eye institute in South India. Int Ophthalmol 2021; 41:2789-2796. [PMID: 33813650 DOI: 10.1007/s10792-021-01835-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To detect the proportion of diabetic retinopathy (DR) among diabetics visiting a tertiary eye care institute and correlate presenting symptoms to clinical diagnosis. METHODS The study recruited 1000 eyes of 1000 diabetics visiting a tertiary eye care institute in South India for the first time. Along with basic demographic data and systemic history, details of presenting complaints and clinical diagnosis were noted. RESULTS Data from 956 cases were analyzed. There were 29 (3%) newly diagnosed diabetics and 927 (97%) known diabetics. The commonest reason for the hospital visit was diminution of vision (66%) followed by "visiting for a routine checkup" (22.3%). Diabetic retinopathy was seen in 492 (51.5%), cataract in 161(17%) and refractive error in 240 patients (79.2%). Vision-threatening DR was present in 216 cases (22.59%) and clinically significant macular edema in 73 cases (7.63%) at first presentation itself. CONCLUSION The cohort from a tertiary eye care institute has higher proportion of diabetic retinopathy, with vision-threatening DR at presentation. These data emphasize the need for more robust screening for DR, along with population awareness programs.
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Affiliation(s)
- Manavi D Sindal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India.
| | - Tejashree Sathe
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
| | | | - Divya Yadav
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Cuddalore Main Road, Pondicherry, 605007, India
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Sindal MD, Chhabra K, Khanna V. Profile of patients receiving intravitreal anti-vascular endothelial growth factor injections during COVID-19-related lockdown. Indian J Ophthalmol 2021; 69:730-733. [PMID: 33595512 PMCID: PMC7942127 DOI: 10.4103/ijo.ijo_2807_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: The aim of this study was to analyze the impact on vision due to delay in presentation of patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, consequent to COVID-19-related travel restrictions. Methods: Data were collected retrospectively of patients who received anti-VEGF injections during four months of the COVID-19 pandemic. Visual acuities, indication for treatment were noted along with basic demographic characteristics. Results: Data were analyzed for 303 eyes of 263 patients. The indication for treatment was age-related macular degeneration (AMD) in 60 eyes (19.8%), while 162 eyes (53.5%) had Diabetic Macular Edema, 71 eyes (23.4%) had Retinal Vein Occlusion and 10 eyes (3.3%) had other diagnosis. The visual acuity in the treatment naïve eyes (Group A, n = 168) was significantly worse (P < 0.001) than those who presented for retreatment (Group B, n = 135). In Group B, there was a significant decline in vision for the entire cohort (P = 0.009) and those with AMD (P = 0.036). Those in Group B presented at a mean interval of 19.1 ± 10.6 (range, 4–64) weeks for retreatment. Conclusion: The COVID-19 pandemic has led to a delay in patients receiving anti-VEGF injections. The visual acuity is worse in both treatment naïve as well as those requiring retreatment. This could have long-term impact on vision of patients requiring this vision preserving treatment.
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Affiliation(s)
- Manavi D Sindal
- Clinical Retina and Training, Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Kanika Chhabra
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Vaibhav Khanna
- Cornea Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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16
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Sindal MD, Gondhale HP, Srivastav K. Clinical profile and outcomes of rhegmatogenous retinal detachment related to trauma in pediatric population. Can J Ophthalmol 2020; 56:231-236. [PMID: 33358673 DOI: 10.1016/j.jcjo.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the outcomes of trauma-related rhegmatogenous retinal detachment (RD) in pediatric population. DESIGN Retrospective observational series. PARTICIPANTS All patients under 18 years of age who underwent surgery for RD following trauma from 2010 to 2018. METHODS Data were recorded from medical records regarding type of trauma, ocular status at presentation, details of RD (extent, number of breaks, proliferative vitreoretinopathy, choroidal detachment). The surgical intervention (scleral buckling or vitrectomy; tamponade used) and postoperative outcomes, including anatomical success, resurgeries, and visual acuity, were noted. RESULTS We included 32 eyes of 32 patients, where closed globe injury was seen in 13 eyes (41%) and open globe injury (OGI) in 19 eyes (59%). At presentation, 50% of the eyes had RD, with total RD in 20 eyes (63%). Scleral buckling was performed in 9 eyes (28%), whereas the remainder (n = 23) underwent pars plana vitrectomy with silicon oil tamponade for RD repair. Silicone oil removal was done in 16 eyes (70%) and recurrent or persistent RD was seen 17 eyes (53%). Final reattachment rate was 75% (n = 24). The final best-corrected visual acuity was better in the closed globe injury group (mean = 5/60 Snellen's vs 1/60 Snellen's in OGI group), though this was only marginally significant statistically. Late complications were seen in 26 eyes (81%), of which 18 (69%) had previous OGI. CONCLUSION Pediatric traumatic RDs have very poor anatomical and visual outcomes. OGI fares worse than closed globe. Loss of vision in children can be prevented by better safety measures so as to avoid trauma.
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Affiliation(s)
- Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India.
| | - Harshal P Gondhale
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Khushboo Srivastav
- Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Sindal MD, Arthi M. Outcomes of sutureless and sutured scleral fixated intraocular lens in paediatric population. Eur J Ophthalmol 2020; 31:3379-3385. [PMID: 33073609 DOI: 10.1177/1120672120965493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyse the outcomes of sutureless and sutured scleral fixated intraocular lenses (SFIOL) in paediatric population. SETTING Vitreoretina department of a tertiary eye care institute in Southern India. DESIGN Retrospective case series. METHODS Data were collected from January 2010 to December 2018 for children less than 18 years of age, based on the following parameters: demographics, pre-operative characteristics, duration between aphakia and surgery, previous amblyopia treatment, the uncorrected (UCVA) and the best corrected visual acuity (BCVA) at baseline and, 1,6 and 12 months or final visit. Early and late post-operative complications along with details of any resurgery was recorded. RESULTS The study included 45 eyes of 43 patients. The mean age when children became aphakic was 8.8±3.6 years and the mean age at SFIOL implantation 10.1 ± 3.9 years. Sutureless SFIOL was performed for 36 (80%) eyes. The improvement in UCVA was statistically significant at 1-month follow up. Transient hypotony (n = 3), vitreous hemorrhage (n = 7) and raised IOP (n = 4) were the most observed early post-operative complications, while haptic exposure or disinsertion (n = 4, 9%) was a delayed postoperative complication. The mean spherical equivalent at the last follow up was 1.96 ± 0.83D and mean postoperative cylinder 2.32 ± 1.3D. The children were followed up for a mean duration of 20 ± 21.7 months. History of previous vitrectomy was found to be associated with two line reduction in UCVA (95% CI = 0.03-0.5 logMAR, p = 0.008). CONCLUSION SFIOLs- sutured and sutureless; both were suitable for the rehabilitation of paediatric aphakia. Sutureless scleral fixation is a safe alternative for children but prospective studies with longer follow-up are needed.
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Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - M Arthi
- Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Madanagopalan VG, Nagesha CK, Velis G, Sindal MD. Gradual resolution of foveal herniation after epiretinal membrane peeling. Oman J Ophthalmol 2020; 13:49-50. [PMID: 32174744 PMCID: PMC7050455 DOI: 10.4103/ojo.ojo_104_2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/26/2019] [Accepted: 11/25/2019] [Indexed: 11/07/2022] Open
Abstract
We demonstrate the gradual resolution of foveal herniation with optical coherence tomography (OCT) images after epiretinal membrane (ERM) removal. A young male presented with diminished vision in the left eye (OS). Examination of OS revealed an ERM and thickening of the foveal region. OCT delineated the ERM clearly. It also showed a central defect in the ERM through which the inner retinal layers had prolapsed into the vitreous cavity leading to foveal herniation. The patient underwent vitrectomy and surgical removal of the ERM. After removing the source of macular traction, over a period of 4 months, gradual reduction in height of the elevated central foveal tissue was observed. At 6 months, the foveal bulge had reduced remarkably and remained stable. The resolution of foveal herniation after ERM removal is a slow process. The OCT images convey that it may take few months for the foveal bulge to decrease in height. When the outer retinal layers are normal, visual recovery, though delayed, is appreciable.
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Affiliation(s)
| | - C K Nagesha
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - Girish Velis
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
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Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India
| | - M Arthi
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India
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Affiliation(s)
- Manavi D Sindal
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Kanika Chhabra
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Sindal MD, Arthi M. Commentary: Continuation of care - Refraction beyond regression. Indian J Ophthalmol 2019; 67:877-878. [PMID: 31124507 PMCID: PMC6552576 DOI: 10.4103/ijo.ijo_767_19] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manavi D Sindal
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - M Arthi
- Vitreo-Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Sengupta S, Sindal MD, Baskaran P, Pan U, Venkatesh R. Sensitivity and Specificity of Smartphone-Based Retinal Imaging for Diabetic Retinopathy: A Comparative Study. Ophthalmol Retina 2018; 3:146-153. [PMID: 31014763 DOI: 10.1016/j.oret.2018.09.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the sensitivity and specificity of a smartphone-based fundus camera, the Remidio Fundus on Phone (FOP; Remidio Innovative Solutions Pvt. Ltd., Bengaluru, India) in detecting diabetic retinopathy (DR) compared with a conventional tabletop fundus camera and clinical examination. DESIGN Cross-sectional, single-site, instrument validation study. PARTICIPANTS Consecutive patients with diabetes who had no DR (n = 55 eyes), mild to moderate nonproliferative diabetic retinopathy (NPDR; n = 70 eyes), severe NPDR (n = 46 eyes), proliferative diabetic retinopathy (PDR; n = 62 eyes), and diabetic macular edema (DME; n = 44 eyes). METHODS All participants underwent a dilated examination to determine the grade of DR. Then all participants had mydriatic 45° fundus photographs obtained from three fields of view with the Remidio FOP and a Topcon tabletop fundus camera (Topcon Medical Systems, Inc., Oakland, NJ). Two masked retina specialists graded images for DR and DME, using National Health Service guidelines as well as for image quality using predefined criteria. MAIN OUTCOME MEASURE Sensitivity and specificity of the Remidio FOP for the detection of any DR compared to clinical examination. RESULTS One hundred thirty-five subjects (233 eyes) were recruited for the study. Compared with the reference clinical examination, using images from the Remidio FOP, graders 1 and 2 reported a sensitivity of 93.1% (95% confidence interval [CI] = 88.3-96.4) and 94.3% (95% CI = 89.7-97.2) and a specificity of 89.1% (95% CI = 68.2-92.2) and 94.5% (95% CI = 84.9-98.9), respectively, in identifying any DR (κ = 0.55; 95% CI = 0.50-0.57). With images from the Topcon camera, graders reported similar sensitivities and specificities with marginally better agreement (κ = 0.68; 95% CI = 0.67-0.73). The sensitivity of detecting DR gradually increased from R1 to R3 disease using both cameras. Both graders classified significantly fewer images as "ungradable" (2.6%-4.3% for Topcon vs. 1.7%-2.1% for Remidio FOP) and more images as excellent from the Remidio FOP (59%-74%) than the Topcon device (52%-61%). CONCLUSIONS The Remidio FOP device was found to have high sensitivity and specificity for the detection of any grade of DR with good agreement between graders. The rate of ungradable images was acceptably low and image quality was marginally better with the Remidio FOP.
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Affiliation(s)
- Sabyasachi Sengupta
- Vitreoretinal Services, Aravind Eye Hospitals, and Postgraduate Institute of Ophthalmology, Pondicherry, India.
| | - Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospitals, and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Prabu Baskaran
- Vitreoretinal Services, Aravind Eye Hospitals, and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Utsab Pan
- Vitreoretinal Services, Aravind Eye Hospitals, and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Rengaraj Venkatesh
- Vitreoretinal Services, Aravind Eye Hospitals, and Postgraduate Institute of Ophthalmology, Pondicherry, India
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23
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Murugan SB, Velis GB, Sindal MD. Bilateral acute retinal necrosis associated with bilateral uveal effusion in an immunocompetent patient: A challenging association. Indian J Ophthalmol 2018; 66:866-868. [PMID: 29786007 PMCID: PMC5989521 DOI: 10.4103/ijo.ijo_954_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Bilateral uveal effusion syndrome associated with bilateral acute retinal necrosis is a diagnostic and therapeutic challenge. A 52 year old man presented with bilateral angle closure with choroidal detachment. With restricted fundus view, parenteral steroid was started. During close follow up bilateral discrete areas of peripheral retinitis were noted. Parenteral steroids were promptly stopped and parenteral antivirals with oral steroids were continued. It showed healing response with nil recurrences till last follow up. Aggressive treatment of bilateral uveal effusion with parenteral steroids can cause progression of bilateral acute retinal necrosis leading to phthisis bulbi. However early diagnosis, prompt intervention and close follow up are the key elements to therapeutic success even during diagnostic surprises and avoid costly mistakes.
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Affiliation(s)
- S Bala Murugan
- Department of Uvea and Vitreo Retina, Aravind Eye Hospital, Puducherry, India
| | - Girish Bharat Velis
- Department of Uvea and Vitreo Retina, Aravind Eye Hospital, Puducherry, India
| | - Manavi D Sindal
- Department of Uvea and Vitreo Retina, Aravind Eye Hospital, Puducherry, India
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Sengupta S, Sindal MD, Besirli CG, Upadhyaya S, Venkatesh R, Niziol LM, Robin AL, Woodward MA, Newman-Casey PA. Screening for vision-threatening diabetic retinopathy in South India: comparing portable non-mydriatic and standard fundus cameras and clinical exam. Eye (Lond) 2018; 32:375-383. [PMID: 28912515 PMCID: PMC5811716 DOI: 10.1038/eye.2017.199] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/06/2017] [Indexed: 12/19/2022] Open
Abstract
PurposeTo evaluate the sensitivity and specificity of a portable non-mydriatic fundus camera to diagnose vision-threatening diabetic retinopathy (VTDR).Patients and methodsA prospective, single-site, comparative instrument validation study was undertaken at the Aravind Eye Care System. Overall, 155 subjects with and without diabetes were recruited. Images from 275 eyes were obtained with the (1) non-mydriatic Smartscope, (2) mydriatic Smartscope, and (3) mydriatic table-top camera of the macular, nasal, and superotemporal fields. A retina specialist performed a dilated fundus examination (DFE), (reference standard). Two masked retina specialists graded the images. Sensitivity and specificity to detect VTDR with the undilated Smartscope was calculated compared to DFE.ResultsGraders 1 and 2 had a sensitivity of 93% (95% confidence interval (CI): 87-97%) and 88% (95% CI: 81-93%) and a specificity of 84% (95% CI: 77-89%) and 90% (95% CI: 84-94%), respectively, in diagnosing VTDR with the undilated Smartscope compared to DFE. Compared with the dilated Topcon images, graders 1 and 2 had sensitivity of 88% (95% CI: 81-93%) and 82% (95% CI: 73-88%) and specificity of 99% (95% CI: 96-100%) and 99% (95% CI: 95-100%).ConclusionsRemote graders had high sensitivity and specificity in diagnosing VTDR with undilated Smartscope images, suggesting utility where portability is a necessity.
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Affiliation(s)
- S Sengupta
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - M D Sindal
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - C G Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - S Upadhyaya
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - R Venkatesh
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - L M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - A L Robin
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Ophthalmology, Wilmer Institute, Johns Hopkins University, Baltimore, MD, USA
| | - M A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - P A Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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25
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Sindal MD, Sengupta S, Vasavada D, Balamurugan S. Retained intraocular iron foreign body presenting with acute retinal necrosis. Indian J Ophthalmol 2017; 65:1036-1038. [PMID: 29044081 PMCID: PMC5678309 DOI: 10.4103/ijo.ijo_363_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
We report an unusual case of retained metallic intraocular foreign body (IOFB) presenting with acute retinal necrosis (ARN). A healthy young man presented with signs of ARN including hypopyon, dense vitritis, and peripheral retinal necrosis following alleged history of trauma with a high-velocity projectile. After initial management of ARN with systemic antivirals, a retained metallic IOFB was identified and subsequently removed surgically. The patient was followed up for 12 months postoperatively and retained excellent vision without recurrence of the ARN. The diagnosis of an IOFB in a case with associated inflammation can be challenging. A strong clinical suspicion with proper investigations can achieve optimum results.
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Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Puducherry, India
| | - Sabyasachi Sengupta
- Vitreoretina Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Puducherry, India
| | - Dhaivat Vasavada
- Vitreoretina Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Puducherry, India
| | - Sivaraman Balamurugan
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Puducherry, India
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26
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Vengadesan N, Ahmad M, Sindal MD, Sengupta S. Delayed follow-up in patients with diabetic retinopathy in South India: Social factors and impact on disease progression. Indian J Ophthalmol 2017; 65:376-384. [PMID: 28573993 PMCID: PMC5565887 DOI: 10.4103/ijo.ijo_620_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/20/2023] Open
Abstract
Purpose: To identify social factors associated with delayed follow-up in South Indian patients with diabetic retinopathy (DR) and to study DR progression during the delayed follow-up period. Materials and Methods: In this cross-sectional study, 500 consecutive patients with DR returning after greater than twice the advised follow-up period were identified from a tertiary referral center in South India. A previously validated 19-item questionnaire was administered to study patients to assess causes for the follow-up delay. Patient demographics, DR status, and treatment plan were recorded at the study visit and the visit immediately before the delay. The eye with the most severe disease was included in the analysis. Results: Complete data were available for 491 (98.2%) patients. Among these, 248 (50.5%) cited “my eyes were okay at the time,” 201 (41.0%) cited “no attender to accompany me,” and 190 (38.6%) cited “financial cost” as causes of the follow-up delay. Those with vision-threatening DR (VTDR, n = 233) predominantly reported “financial cost” (47% vs. 32%, P = 0.001), whereas those with non-VTDR more frequently reported “my eyes were okay at the time” (58% vs. 42%, P = 0.001). Evidence of disease progression from non-VTDR to VTDR was seen in 67 (26%) patients. Almost 1/3rd (29%) of patients who were previously advised regular examination required additional intervention. Conclusion: Many patient-level factors affect poor compliance with follow-up in DR, and these factors vary by disease severity. Targeting these barriers to care through patient education and clinic procedures may promote timely follow-up and better outcomes in these patients.
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Affiliation(s)
| | - Meleha Ahmad
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Manavi D Sindal
- Department of VitreoRetina, Aravind Eye Hospital, Puducherry, India
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27
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Davila JR, Sengupta SS, Niziol LM, Sindal MD, Besirli CG, Upadhyaya S, Woodward MA, Venkatesh R, Robin AL, Grubbs J, Newman-Casey PA. Predictors of Photographic Quality with a Handheld Nonmydriatic Fundus Camera Used for Screening of Vision-Threatening Diabetic Retinopathy. Ophthalmologica 2017; 238:89-99. [PMID: 28675903 DOI: 10.1159/000475773] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/10/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze predictors of image quality for a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy. METHODS An ophthalmic photographer at an Aravind Eye Hospital obtained nonmydriatic and mydriatic fundus images from 3 fields in 275 eyes of 155 participants over 13 months using a Smartscope camera (Optomed, Oulu, Finland) and a Topcon tabletop fundus camera (Topcon, Tokyo, Japan). Two fellowship-trained retina specialists graded the images. Repeated-measures logistic regression assessed predictors of the main outcome measure: gradability of the fundus images. RESULTS Of 2,475 images, 76.2% of the Smartscope nonmydriatic images, 90.1% of the Smartscope mydriatic images, and 92.0% of the Topcon mydriatic images were gradable. Eyes with vitreous hemorrhage (OR = 0.24, p < 0.0001) or advanced cataract (OR = 0.08, p < 0.0001) had decreased odds of image gradability. Excluding eyes with cataract or vitreous hemorrhage, nonmydriatic macular image gradability improved from 68.4% in the first set of 55 eyes to 94.6% in the final set of 55 eyes. CONCLUSION With sufficient training, paraprofessional health care staff can obtain high-quality images with a portable nonmydriatic fundus camera, particularly in patients with clear lenses and clear ocular media.
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Affiliation(s)
- Jose R Davila
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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28
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Baskaran P, Sindal MD, Dhoble P, Ramakrishnan S, Rengaraj V, Ramulu P. Acute angle closure glaucoma secondary to polypoidal choroidal vasculopathy - a devastating complication. GMS Ophthalmol Cases 2017; 7:Doc01. [PMID: 28154791 PMCID: PMC5244078 DOI: 10.3205/oc000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute angle closure glaucoma (ACG) in the setting of polypoidal choroidal vasculopathy (PCV) is a catastrophic complication that has been documented infrequently in literature. Ours is the second only report that describes hemorrhagic choroidal detachment as an event leading to acute angle closure glaucoma in PCV patients and the first one to describe the use of diode cyclophotocoagulation (CPC) for this condition. The purpose of this article is to familiarize readers with this entity that has an extremely dismal visual prognosis. Ours is a descriptive case report of two patients with PCV complicated by sudden onset hemorrhagic choroidal detachment (CD) and acute ACG. Both patients had severe pain with no perception of light at presentation with an acute angle closure attack. Both underwent diode CPC for pain relief and control of intraocular pressure (IOP). Both our patients did not regain any vision, but their pain was relieved by diode CPC. Both eyes eventually became phthisical. Acute ACG following massive hemorrhagic CD is a rare but grave complication of PCV, not amenable to treatment. Diode CPC is an effective palliative modality of management to achieve pain relief in such cases.
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Affiliation(s)
- Prabu Baskaran
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Manavi D Sindal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Pankaja Dhoble
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Seema Ramakrishnan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Venkatesh Rengaraj
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Pradeep Ramulu
- Wilmer Eye Institute, John Hopkins University, Baltimore, USA
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Abstract
Dislocation of crystalline lens into the anterior subconjunctival or subtenon's space is a rare but known complication of blunt trauma. Dislocation into the posterior subtenon's space is even rarer and can be associated with a complication such as occult scleral tear and retinal detachment. We report a case of traumatic posterior subtenon's dislocation of crystalline lens after blunt trauma and its successful surgical management.
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Affiliation(s)
- Manavi D Sindal
- Retina Clinic, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
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Sindal MD, Nakhwa CP, Sengupta S. Comparison of sutured versus sutureless scleral-fixated intraocular lenses. J Cataract Refract Surg 2016; 42:27-34. [PMID: 26948775 DOI: 10.1016/j.jcrs.2015.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the intermediate-term anatomic and visual results of scleral-fixated intraocular lens (IOL) implantation using 4-point suture fixation or transscleral sutureless fixation. SETTING Tertiary referral eye care center in South India. DESIGN Retrospective case series. METHODS Medical records of consecutive patients who had scleral-fixated IOL surgery from January 1, 2010, to March 31, 2014, with more than 1 year of follow-up were retrospectively analyzed. Indication for scleral-fixated IOL implantation was aphakia after cataract extraction or trauma. The surgical technique was based on individual surgeon preference. The uncorrected distance visual acuity (UDVA), previous surgery, type of trauma, surgical technique, and complications were analyzed. RESULTS One hundred nine cases were analyzed. The mean follow-up was 18.9 months ± 8.7 (SD). The majority of eyes experienced an improvement in UDVA after surgery; 93 eyes (86%) had a Snellen equivalent corrected distance visual acuity of 6/12 or better. The baseline characteristics and final visual outcomes in the sutured scleral-fixated IOL group (n = 52) and sutureless scleral-fixated IOL group (n = 59) were comparable. Patients with previous trauma (n = 52) were predominantly men and were significantly younger than those in the cataract group. The visual and refractive outcomes were comparable between eyes with previous trauma and eyes with previous cataract surgery. Transient cystoid macular edema was the most common complication (12%); retinal detachment occurred in 5 cases (4.5%). CONCLUSIONS Scleral-fixated IOLs provided excellent visual rehabilitation of aphakic eyes without capsular support. The sutured technique and sutureless technique appear to be equally good in eyes with aphakia after cataract surgery or trauma. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Manavi D Sindal
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India.
| | - Chinmay P Nakhwa
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Sabyasachi Sengupta
- From Vitreoretina Services, Aravind Eye Hospital, and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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Sindal MD, Nakhwa CP, Sengupta S. Reply. J Cataract Refract Surg 2016; 42:806. [DOI: 10.1016/j.jcrs.2016.03.030] [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] [Received: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 11/24/2022]
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Abstract
The authors report a case of a preterm neonate who presented with lid edema, corneal edema, and an inflammatory membrane with whitish exudates in the pupillary area, suggestive of endophthalmitis. There was also a cutaneous ulcer with an eschar on the right wrist at the site of extravasation associated with previous intravenous catheter. Cultures from the ulcer and vitreous samples both grew Serratia marcescens with identical antibiotic sensitivity and resistance patterns. The ocular infection was rapidly progressive and did not respond to administered medical and surgical therapy leading to subsequent phthisis bulbi. Serratia can cause endophthalmitis refractory to antibiotics and despite aggressive and timely treatment can have an unfavorable outcome. This report aims at highlighting the possibility of metastatic infection from an extravasation injury with a potentially fatal outcome.
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Affiliation(s)
- Manavi D Sindal
- Department of Vitreoretina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - Chinmay P Nakhwa
- Department of Vitreoretina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
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Abstract
INTRODUCTION Tamoxifen citrate is an anti-estrogen agent used in the treatment of breast carcinoma. Crystalline maculopathy is a rare complication of tamoxifen therapy. The clinical picture resembles that of idiopathic macular telangiectasia (IMT) Type 2, which is a more common clinical entity. OBJECTIVE To report a case of crystalline maculopathy secondary to tamoxifen and highlight the importance of the medical history and investigations in differentiating it from IMT Type 2. CASE A diabetic female with a past history of breast carcinoma treated with tamoxifen came to the hospital for a routine eye check-up. Crystalline deposits were seen in the parafoveal region in both the eyes.The spectral domain optical coherence tomography (SD-OCT) showed foveal cysts in the inner retinal layer and fundus autofluorescence (FAF) and fundus fluorescein angiography (FFA) were within normal limits. CONCLUSION While tamoxifen maculopathy is reversible on stopping the therapy, IMT needs a long-term follow-up to monitor the potential risk of loss of vision due to choroidal neovascularization, hence necessitating the distinction between these two different clinical entities.
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Affiliation(s)
- Roshija Khanal Rijal
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, 605007 India
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Nakhwa CP, Sindal MD. Idiopathic Macular Telangiectasia Type 1 with Ruptured Retinal Arterial Macroaneurysm Post Intravitreal Bevacizumab. Middle East Afr J Ophthalmol 2015; 22:396-8. [PMID: 26180485 PMCID: PMC4502190 DOI: 10.4103/0974-9233.159779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 50-year-old Indian male presented with defective vision in the right eye for 6 months. He was diagnosed to have idiopathic macular telangiectasia (IMT) type 1 associated with diffuse macular edema and multiple retinal arterial macroaneurysms (RAM). Intravitreal bevacizumab was administered for the treatment of macular edema, following which there was a rupture of a preexisting RAM with multilevel retinal hemorrhages. The hemorrhage gradually resolved over time with foveal thinning noted at last visit. We report this case for the rare occurrence of IMT type 1 and also the possibly associated rupture of RAM post intravitreal bevacizumab injection.
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Affiliation(s)
- Chinmay P Nakhwa
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Puducherry, India
| | - Manavi D Sindal
- Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Puducherry, India
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