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Chandrakanth P, Akkara JD, Joshi SM, Gosalia H, Chandrakanth KS, Narendran V. The Slitscope. Indian J Ophthalmol 2024; 72:741-744. [PMID: 38189430 DOI: 10.4103/ijo.ijo_1589_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Slit lamp biomicroscope is the right hand of an Ophthalmologist. Even though precise, its bulky design and complex working process are limiting constraints, making it difficult for screening at outreach camps, which are an integral part of this field for the purpose of eliminating needless blindness. The torchlight is the main tool used for screening. Recently, the integration of smartphones with instruments and the digitization of slit lamp has been explored, to provide simple and easy hacks. By bringing the slit of the slit lamp to traditional torchlight, we have created "The Slitscope". It combines the best of both worlds as a simple innovative do-it-yourself novel technique for precise cataract screening. It is especially useful in peripheral centers, vision centers, and outreach camps. We present two prototypes which can also be 3D printed.
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Affiliation(s)
- Prithvi Chandrakanth
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - John Davis Akkara
- Department of Glaucoma Services, Chaitanya Eye Hospital and Westend Eye Hospital, Kochi, Kerala, India
| | - Saloni M Joshi
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - Hirika Gosalia
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - K S Chandrakanth
- Chief Medical Officer, General Ophthalmology, Dr. Chandrakanth Nethralaya, Kozhikode, Kerala, India
| | - V Narendran
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Maitra P, Shah PK, S P, Das A, V N. Knobloch syndrome - a rare collagenopathy, revealing peripheral avascular retina. Ophthalmic Genet 2023; 44:618-622. [PMID: 36994995 DOI: 10.1080/13816810.2023.2188226] [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: 12/02/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Pediatric rhegmatogenous retinal detachments, especially those presenting at birth or soon afterward, have a high likelihood of syndromic associations that can be confirmed by genetic testing. MATERIALS AND METHODS A 5-month-old child was found to have high myopia in the right eye (RE) with highly tessellated fundus, opalescent vitreous, and peripheral thinning. Left eye had a shallow retinal detachment for which he underwent belt buckling. The baby had an occipital skin tag. A provisional diagnosis of Stickler syndrome was made. RESULTS On 1-month follow-up, left eye retina was attached and 360° laser barrage was done. Fluorescein angiography was done which revealed peripheral avascular retina in both eyes. MRI and genetic testing were suggestive of syndromic association. Genetic testing revealed pathogenic mutation in COL 18A1 suggestive of Knobloch syndrome in the baby, and both parents were found to be carriers of the same mutation. However, brain MRI showed features not pathognomonic of Knobloch syndrome. CONCLUSION Although Knobloch syndrome is associated with vitreoretinal degeneration and high risk of retinal detachment, there seems to be no recommendation for prophylaxis in the other eye and therefore we preferred to observe the RE closely. A unique feature noted in our case was the peripheral avascular zone (PAZ). The PAZ could be contributed by multiple factors such as high myopia, or due to endostatin deficiency (which is a derivative of collagen XVIII) or an underlying WNT signalling abnormality.
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Affiliation(s)
- Puja Maitra
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | - Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | - Prema S
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | - Abhishek Das
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
| | - Narendran V
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
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B Singh S, Kanakath AV, Saravanan V, K S J, V N. A Case of Idiopathic Retinitis Vasculitis Aneurysms and Neuroretinitis (IRVAN) Treated with Adalimumab. Ocul Immunol Inflamm 2022; 31:627-630. [PMID: 35316150 DOI: 10.1080/09273948.2022.2039209] [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: 10/18/2022]
Abstract
PURPOSE To report a case of IRVAN in a 13-year-old girl responding well to Adalimumab and Azathioprine. RESULTS A 13-year-old girl presented to us with central scotoma for a duration of 10 months. She was treated earlier with oral steroids with poor response. Fundus examination revealed features of IRVAN. She was treated with intravitreal dexamethasone implant in both eyes with oral Mycophenolate Mofetil (MMF) with transient response to it. So she was switched over to subcutaneous Adalimumab 40 mg once in 2 weeks and oral Azathioprine 50 mg BD. The disease activity was well controlled with the current regime. CONCLUSION Though various treatment modalities have been described in literature for the treatment of IRVAN. This is the first case of IRVAN to be treated with Adalimumab along with Azathioprine to be reported.
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Affiliation(s)
- Sanjana B Singh
- Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, India
| | | | - V Saravanan
- Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, India
| | - Jayakumar K S
- Department of Rheumatology and Clinical Immunology, Sri Ramakrishna Hospital, Coimbatore, India
| | - Narendran V
- Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, India
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Chandrakanth P, Duggirala V, Narendran K, Narendran V. Do it yourself automatic liquid dispenser for the COVID-19 aeon. Indian J Ophthalmol 2021; 69:999-1000. [PMID: 33727480 PMCID: PMC8012935 DOI: 10.4103/ijo.ijo_2996_20] [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] [Indexed: 11/04/2022] Open
Affiliation(s)
- Prithvi Chandrakanth
- Retina Fellow, Vitreo-Retina Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Varun Duggirala
- Medical Officer, IOL and Cataract Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Kalpana Narendran
- Senior Medical Officer and Head of Department, IOL and Cataract Services and Paediatric Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - V Narendran
- Chief Medical Officer, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Khanna A, Jain MA, Narendran V. Retinal injury following intravitreal injection of a dexamethasone implant in a non-vitrectimised eye. Indian J Ophthalmol 2020; 68:1178. [PMID: 32461468 PMCID: PMC7508110 DOI: 10.4103/ijo.ijo_1618_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jain NF, Manayath GJ, Narendran V, Saravanan VR, Kumarasamy K, Appanraj R. A rare case of focal choroidal excavation associated choroidal neovascularization in angioid streaks. Oman J Ophthalmol 2019; 12:200-202. [PMID: 31902999 PMCID: PMC6826599 DOI: 10.4103/ojo.ojo_61_2018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose is to report a case of focal choroidal excavation (FCE) in a patient with angioid streaks (ASs) associated with secondary choroidal neovascularization (CNV). A 26-year-old man was referred for the treatment of CNV. On further evaluation, he was found to have ASs and optical coherence tomography revealed the presence of the choroidal neovascular complex associated with FCE. The patient was treated with a single dose of intravitreal bevacizumab (1.25 μg/0.05 ml). There was resolution of the lesion, and on further follow-up over 6 months, there were no recurrences. CNV in patients with ASs may also be associated with FCE. These patients have a good response to intravitreal antivascular endothelial growth factor injection.
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Affiliation(s)
- Nidhee F Jain
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - George J Manayath
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V Narendran
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V R Saravanan
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Karan Kumarasamy
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Ramya Appanraj
- Department of Vitreoretinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Shah PK, Narendran V, Kalpana N. Evolution of ROP screening at Aravind Eye Hospital, Coimbatore - Lessons learnt and the way ahead. Community Eye Health 2018; 31:S23-S24. [PMID: 30275665 PMCID: PMC6157806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Parag K. Shah
- Consultant: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
| | - V. Narendran
- Chief Medical Officer: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
| | - N. Kalpana
- Senior Medical Officer: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
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Bhat V, D'Souza P, Shah PK, Narendran V. Risk of Tractional Retinal Detachment Following Intravitreal Bevacizumab Along with Subretinal Fluid Drainage and Cryotherapy for Stage 3B Coats' Disease. Middle East Afr J Ophthalmol 2017; 23:208-11. [PMID: 27162454 PMCID: PMC4845620 DOI: 10.4103/0974-9233.175895] [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] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To review the surgical outcomes of intravitreal bevacizumab (IVB) along with subretinal fluid drainage with cryotherapy in patients with stage 3B Coats' disease. MATERIALS AND METHODS A retrospective study of seven cases of stage 3B Coats' disease, who underwent subretinal fluid drainage with cryopexy, from May 2011 to March 2014. Five eyes received additional IVB at the end of surgery. Green laser therapy was performed on telangiectatic vessels postoperatively. RESULTS The mean age was 34 months (range, 10-84 months). Mean follow-up was 19 months. Six patients (85.7%) had an attached retina at final follow-up. Three out of four patients (75%) that received IVB developed tractional retinal detachments (TRDs). Two eyes that did not receive bevacizumab did not develop any traction. None progressed to neovascular glaucoma or phthisis bulbi. CONCLUSION Simultaneous injection of bevacizumab along with subretinal drainage and cryotherapy for advanced Coats' disease could not avoid TRD.
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Affiliation(s)
- Vishalakshi Bhat
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Palmeera D'Souza
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V Narendran
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Prabakar S, Porkumaran K, Shah PK, Narendran V. Implementation of Stochastic Approach for Vessel and Ridge Studies in Retinopathy of Prematurity Screening. CURR SCI INDIA 2017. [DOI: 10.18520/cs/v112/i03/517-526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shah PK, Narendran V, Kalpana N. Evolution of ROP screening at Aravind Eye Hospital, Coimbatore - Lessons learnt and the way ahead. Community Eye Health 2017; 30:S23-S24. [PMID: 35586855 PMCID: PMC9112209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Parag K. Shah
- Consultant: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
| | - V. Narendran
- Chief Medical Officer: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
| | - N. Kalpana
- Senior Medical Officer: Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Coimbatore, India
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Seto TL, Tabangin ME, Langdon G, Mangeot C, Dawodu A, Steinhoff M, Narendran V. Racial disparities in cord blood vitamin D levels and its association with small-for-gestational-age infants. J Perinatol 2016; 36:623-8. [PMID: 27101387 PMCID: PMC4973215 DOI: 10.1038/jp.2016.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship of race and maternal characteristics and their association with cord blood vitamin D levels and small-for-gestational-age (SGA) status. STUDY DESIGN Cord blood vitamin D levels were measured in 438 infants (276 black and 162 white). Multivariable logistic regression models were used to evaluate associations between maternal characteristics, vitamin D status and SGA. RESULTS Black race, Medicaid status, mean body mass index at delivery and lack of prenatal vitamin use were associated with vitamin D deficiency. Black infants had 3.6 greater adjusted odds (95% confidence interval (CI): 2.4, 5.6) of vitamin D deficiency when compared with white infants. Black infants with vitamin D deficiency had 2.4 greater adjusted odds (95% CI: 1.0, 5.8) of SGA. Vitamin D deficiency was not significantly associated with SGA in white infants. CONCLUSION Identification of risk factors (black race, Medicaid status, obesity and lack of prenatal vitamin use) can lead to opportunities for targeted prenatal vitamin supplementation to reduce the risk of neonatal vitamin D deficiency and SGA status.
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Affiliation(s)
- T L Seto
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - G Langdon
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - C Mangeot
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Dawodu
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - M Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - V Narendran
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
BACKGROUND Retinoblastoma is the most common intraocular malignancy of childhood. There is a paucity of genetic testing and prenatal genetic diagnosis from India, which has the highest incidence worldwide. MATERIALS AND METHODS RB1 gene screening of an 8-month-old female child with bilateral retinoblastoma was accomplished using next generation sequencing. The results were used for prenatal testing in this family. RESULTS A heterozygous germline mutation (chr13: 48951119delA; c.1281delA) was detected, which resulted in premature termination of a protein product (p.Glu428Argfs*29). Prenatal testing in maternal DNA revealed carrier status of the mother. Further clinical examination in the family members revealed retinocytomas in both eyes of the mother and maternal grandmother. Prenatal genetic testing of the developing fetus showed positivity for the mutation. As the family preferred to continue the pregnancy, serial 3-D ultrasounds were carried out every 2 weeks in the third trimester. Ten days after delivery, small extrafoveal tumors developed in both eyes, which were then treated successfully with transpupillary thermotherapy. CONCLUSION We report the significance of genetic testing in the early detection and management of retinoblastoma from India.
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Affiliation(s)
- Parag K Shah
- a Department of Pediatric Retina & Ocular Oncology , Aravind Eye Hospital & Postgraduate Institute of Ophthalmology , Coimbatore , Tamilnadu , India
| | - S Sripriya
- b Sankara Nethralaya ONGC Department of Genetics and Molecular Biology , Vision Research Foundation , Chennai , Tamilnadu , India
| | - V Narendran
- a Department of Pediatric Retina & Ocular Oncology , Aravind Eye Hospital & Postgraduate Institute of Ophthalmology , Coimbatore , Tamilnadu , India
| | - A J Pandian
- b Sankara Nethralaya ONGC Department of Genetics and Molecular Biology , Vision Research Foundation , Chennai , Tamilnadu , India
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Shah PK, Narendran V, Kalpana N. Safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity. Eye (Lond) 2015; 29:1046-50. [PMID: 25998945 DOI: 10.1038/eye.2015.78] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/01/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To report the safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity (ROP). METHODS Retrospective, noncomparative, consecutive case series. Twenty eyes of 10 babies who presented with vascularly active stage 4 ROP in both the eyes underwent simultaneous bilateral 25-gauge lens-sparing vitrectomy. After completing surgery for one eye, the other eye was re-prepped as performed before starting any new case of a different patient and an entire new set of disposable 25-gauge instruments were used. During the post-operative period parents were advised to keep separate eye drops for each eye and to wash their hands in between switching the eyes to put the drops. RESULTS The mean follow-up was 8.7 months (range 4-17 months). None of the cases developed any signs of infection. The anatomic success rate for stage 4a was 100% (11/11 eyes) and for stage 4b was 8/9 eyes (89%). CONCLUSION These results show that simultaneous bilateral 25-gauge lens-sparing vitrectomy for stage 4 ROP is a safe and effective procedure with a good outcome provided both eyes of the baby are treated as eyes of two different patients.
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Affiliation(s)
- P K Shah
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - V Narendran
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - N Kalpana
- Department of Paediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Shah PK, Ramakrishnan M, Sadat B, Bachu S, Narendran V, Kalpana N. Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity. Oman J Ophthalmol 2014; 7:116-9. [PMID: 25378874 PMCID: PMC4220396 DOI: 10.4103/0974-620x.142592] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/04/2022] Open
Abstract
AIM To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). MATERIALS AND METHODS A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, nystagmus, detailed anterior segment and posterior segment examination, and refractive status including best corrected visual acuity. RESULTS Forty-eight eyes of 25 infants were included in the study. Average follow-up was 6.91 years (range, 3.8-9.5years) after laser treatment. Astigmatism was noted in 43 out of 48 eyes (89.6%). Two eyes had simple myopia whereas three eyes had no refractive error. CONCLUSION After successful laser treatment for zone 1 retinopathy of prematurity (ROP), 94% of our cases developed refractive error. Although most had a favorable anatomical and visual outcome, long-term follow-up even after a successful laser treatment in ROP was necessary.
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Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Minu Ramakrishnan
- Department of Ophthalmology, K J Somaiya Medical College and Research Centre, Mumbai, Maharashtra, India
| | - Bani Sadat
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Sandeep Bachu
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V Narendran
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - N Kalpana
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Shah PK, Narendran V, Selvaraj U, Guhan P, Saxena SK, Dash A, Astrahan M. Episcleral plaque brachytherapy using 'BARC I-125 Ocu-Prosta seeds' in the treatment of intraocular tumors: a single-institution experience in India. Indian J Ophthalmol 2013; 60:289-95. [PMID: 22824598 PMCID: PMC3442464 DOI: 10.4103/0301-4738.98708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/18/2022] Open
Abstract
Context: To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute. AIM: To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT). Materials and Methods: We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT. Results: For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy. Conclusion: Plaque radiotherapy using 125I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India.
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Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
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Kothari A, Narendran V, Saravanan VR. In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems. Indian J Ophthalmol 2012; 60:235-9. [PMID: 22569394 PMCID: PMC3361828 DOI: 10.4103/0301-4738.95885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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
Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.
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Affiliation(s)
- Abhishek Kothari
- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Shah TA, Meinzen-Derr J, Gratton T, Steichen J, Donovan EF, Yolton K, Alexander B, Narendran V, Schibler KR. Hospital and neurodevelopmental outcomes of extremely low-birth-weight infants with necrotizing enterocolitis and spontaneous intestinal perforation. J Perinatol 2012; 32:552-8. [PMID: 22157625 PMCID: PMC3496418 DOI: 10.1038/jp.2011.176] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We sought to determine the incidence of necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) in surviving extremely low-birth-weight (ELBW, <1000 g birth weight) infants and to establish the impact of NEC on outcomes by hospital discharge and at 18 to 22 months adjusted age in a large, contemporary, population-based practice. STUDY DESIGN Hospital outcome data for all ELBW infants born in the greater Cincinnati region from 1998 to 2009 were extracted from the National Institute of Child Health Neonatal Research Network Database. Neurodevelopmental outcome at 18 to 22 months was assessed using Bayley Scales of Infant Development-II scores for Mental Developmental Index and Psychomotor Developmental Index. Multivariable logistic regression was used and adjusted odds ratios reported to control for confounders. RESULT From 1998 to 2009, ELBW infants accounted for 0.5% of the 352 176 live-born infants in greater Cincinnati. The incidence of NEC was 12%, with a 50% case-fatality rate. Death before discharge, morbid complications of prematurity and neurodevelopmental impairment were all increased among infants diagnosed with NEC. Infants with surgical NEC and SIP had a higher incidence of death, but long-term neurodevelopmental outcomes were not different comparing surviving ELBW infants with medical NEC, surgical NEC and SIP. CONCLUSION Although ELBW infants comprise a very small proportion of live-born infants, those who develop NEC and SIP are at an increased risk for death, morbid complications of prematurity and neurodevelopmental impairment. No significant differences in neurodevelopmental outcomes were observed between the medical and surgical NEC and SIP groups.
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Affiliation(s)
- TA Shah
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - J Meinzen-Derr
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - T Gratton
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - J Steichen
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - EF Donovan
- Department of Pediatrics, Child Policy Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - K Yolton
- Department of Pediatrics, General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - B Alexander
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - V Narendran
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - KR Schibler
- Department of Pediatrics, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Morris RJ, Prabhu VV, Shah PK, Narendran V. Combination therapy of low-fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane in choroidal osteoma. Indian J Ophthalmol 2012; 59:394-6. [PMID: 21836351 PMCID: PMC3159327 DOI: 10.4103/0301-4738.83622] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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
Choroidal osteoma is an unusual form of intraocular calcification seen in otherwise healthy eyes. It is a benign idiopathic osseous tumor of the choroid, typically seen in young females. Choroidal neovascular membrane (CNVM) is a complication seen in one-third of these patients and carries a poor visual outcome. We report a case of a 25-year-old hyperthyroid female with choroidal osteoma and subfoveal CNVM in her left eye which was successfully treated using low-fluence photodynamic therapy (PDT) with verteporfin followed by a single injection of intravitreal ranibizumab.
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Affiliation(s)
- Rodney J Morris
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore - 641 014, Tamilnadu, India.
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Shah PK, Narendran V, Narendran K. Author's reply. Indian J Ophthalmol 2012. [PMCID: PMC3545145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India,Correspondence to: Dr. Parag K Shah, Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore - 641 014, Tamil Nadu, India. E-mail:
| | - V Narendran
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
| | - Kalpana Narendran
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore, Tamil Nadu, India
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Sathiamohanraj SR, Shah PK, Senthilkumar D, Narendran V, Kalpana N. Awareness of retinopathy of prematurity among pediatricians in a tier two city of South India. Oman J Ophthalmol 2011; 4:77-80. [PMID: 21897623 PMCID: PMC3160074 DOI: 10.4103/0974-620x.83658] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 01/17/2023] Open
Abstract
Purpose: To analyze the level of awareness and knowledge about retinopathy of prematurity (ROP) among pediatricians in Coimbatore, which is a tier two city in South India. Materials and Methods: A questionnaire was framed on the knowledge attitude and practice (KAP) pattern. The questionnaire was given to 83 practicing pediatricians in government and private practice in Coimbatore and collected in person between November and December 2009. Answers were obtained on criteria like knowledge, prevention, screening, treatment and awareness of ROP. Results: Only 54 (65.1%) pediatricians were aware of ROP, while 29 (34.9%) were not aware of the disease. Thirty-three (39.8%) answered that ROP is preventable, while 24 (28.9%) responded that ROP is not preventable. Thirty-four (41%) pediatricians had no idea as to which part of the eye is affected in ROP, while 38 (45.8%) did not know when ROP screening should be started. Only 43 (51.8%) pediatricians were sure that ROP is treatable. Pediatricians in private hospitals were more aware of ROP compared to their counterparts in government hospitals (P = 0.006). Conclusion: Awareness among pediatricians in Coimbatore about ROP is poor. Our study emphasizes the need to increase awareness of this avoidable cause of blindness.
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Affiliation(s)
- S R Sathiamohanraj
- Department of Statistics, PSG College of Arts and Science, Coimbatore, Tamil Nadu, India
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Abstract
Retinocytoma is a rare benign form of retinoblastoma. It is usually found on routine examinations and also while screening families of patients with retinoblastoma. Distinctive features are a translucent retinal mass with calcification, retinal pigment epithelial disturbance, chorioretinal atrophy and absence of growth. We report a case with all the above features along with diffuse vitreous seeds and optical coherence tomographic documentation of intralesional cavitary lesions.
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Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Coimbatore, India
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Prabhu VV, Morris RJ, Shah PK, Narendran V. Combination treatment of low fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane secondary to angioid streaks in Paget's disease - 12 month results. Indian J Ophthalmol 2011; 59:306-8. [PMID: 21666317 PMCID: PMC3129757 DOI: 10.4103/0301-4738.82000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 11/08/2022] Open
Abstract
Angioid streaks also called Knapp striae are small breaks in the Bruch's membrane and have been reported with a host of systemic diseases. Rupture of streaks or development of secondary choroidal neovascular membrane (CNVM) carries a dismal visual prognosis. We report the successful treatment of CNVM secondary to Paget's disease using low fluence photodynamic therapy (PDT) and intravitreal ranibizumab.
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Affiliation(s)
- Varsha V Prabhu
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India
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Manayath GJ, Narendran V, Al-Kharousi N, Wali UK. Bevacizumab therapy for macular edema in central retinal vein occlusion: Long-term results. Oman J Ophthalmol 2011; 2:73-8. [PMID: 20671833 PMCID: PMC2905183 DOI: 10.4103/0974-620x.53036] [Citation(s) in RCA: 4] [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] [Indexed: 11/29/2022] Open
Abstract
Background: There is no proven effective treatment for vision loss in central retinal vein occlusion (CRVO). Bevacizumab has been reported in small series with limited follow-up, to have a positive effect in reducing cystoid macular edema (CME) and improving vision in CRVO. Purpose: To report long-term results with the use of bevacizumab in CRVO. Materials and Methods: Prospective interventional case series included 15 patients, serially evaluated with best corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography, and tonometry. Results were statistically analyzed. Results: Mean follow-up was 12 ± 3.6 months (range, 6–18 months); mean number of injections was 2.2 (range, 1–4) per patient. Statistically significant reduction of macular thickness (P < 0.001) was seen at six weeks (mean, 346 μ); three months (mean, 353 μ); six months (mean, 348 μ); and final follow-up (mean, 342 μ). Significant BCVA improvement was seen at six weeks (mean, 0.27 logMAR), three months (mean, 0.3 logMAR), three months (0.15 logMAR), and final follow-up (mean, 0.21 logMAR) (P = 0.009). Also, 73.3% patients had BCVA improvement at the last follow-up. Conclusion: Intravitreal bevacizumab is an effective treatment option for CME in CRVO patients. Reinjections at appropriate timing, based on the OCT findings, are important for better visual outcome.
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Shah PK, Narendran V, Kalpana N. Triamcinolone acetonide-assisted vitrectomy for stage 4 retinopathy of prematurity. Int Ophthalmol 2011; 31:237-8. [PMID: 21626166 DOI: 10.1007/s10792-011-9445-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Accepted: 05/11/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina & Ocular Oncology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore, Tamil Nadu, India.
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Shah PK, Morris RJ, Narendran V, Kalpana N. Visual acuity and electroretinography findings 3 ½ years after the first intravitreal injection of bevacizumab (Avastin) in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2011; 59:73-4. [PMID: 21157086 PMCID: PMC3032257 DOI: 10.4103/0301-4738.73707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Shah PK, Kalpana N, Narendran V, Ramakrishnan M. Severe aseptic orbital cellulitis with subtenon carboplatin for intraocular retinoblastoma. Indian J Ophthalmol 2011; 59:49-51. [PMID: 21157073 PMCID: PMC3032243 DOI: 10.4103/0301-4738.73714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 11/06/2022] Open
Abstract
Retinoblastoma is a rare intraocular tumor of childhood. Chemoreduction followed by laser or cryotherapy is the treatment of choice. Subtenon carboplatin injection is also an accepted treatment modality for vitreous seeds, along with systemic chemotherapy. Transient periocular edema, optic neuropathy and fibrosis of orbital tissues are the known side effects of subteneon carboplatin injection. We report a case of severe aseptic orbital cellulitis with necrosis and prolapse of the conjunctiva 48 h after the injection, which resolved well on only conservative management.
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Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
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Shah PK, Narendran V, Kalpana N. Large spot transpupillary thermotherapy: a quicker laser for treatment of high risk prethreshold retinopathy of prematurity - a randomized study. Indian J Ophthalmol 2011; 59:155-8. [PMID: 21350289 PMCID: PMC3116548 DOI: 10.4103/0301-4738.77046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/06/2022] Open
Abstract
To compare structural and functional outcome and time efficiency between standard spot sized conventional pulsed mode diode laser and continuous mode large spot transpupillary thermotherapy (LS TTT) for treatment of high risk prethreshold retinopathy of prematurity (ROP). Ten eyes of five preterm babies having bilateral symmetrical high risk prethreshold ROP were included in this study. One eye of each baby was randomized to get either standard spot sized conventional pulsed mode diode laser or continuous mode LS TTT. There was no significant difference between structural or functional outcome in either group. The mean time taken for conventional diode laser was 20.07 minutes, while that for LS TTT was 12.3 minutes. LS TTT was 40% more time efficient than the conventional laser. It may be better suited for the very small fragile premature infants as it is quicker than the conventional laser.
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Affiliation(s)
- Parag K Shah
- Department of Pediatric Retina, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
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Abstract
Retinoblastoma is a rare malignancy of the retina seen exclusively in children. It is known to cause rapid growth inside the eye and hence treatment should be started as soon as it is diagnosed. We report a case in a five-day-old infant in whom treatment (chemotherapy) was delayed by a month due to high bilirubin levels secondary to physiological jaundice, which gave us the unique opportunity to measure the growth of the tumor over a month. This case emphasizes that immediate treatment is warranted once this rare disease is diagnosed.
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Affiliation(s)
- Parag K Shah
- Pediatric Retina and Ocular Oncology Department, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Abstract
We report a case of branch retinal artery occlusion (BRAO) in a healthy young girl. An eight-year-old girl presented with sudden loss of vision in her left eye. She had a pale retina with macular edema consistent with extensive BRAO. A thorough workup was performed to determine any etiologic factor. All test results were within normal limits. Her visual acuity improved from finger counting to 20/40 over two weeks, on immediate treatment with intravenous steroids (methyl prednisolone). This case suggests that BRAO can occur in healthy children without any detectable systemic or ocular disorders and a dramatic improvement may be achieved with prompt treatment with intravenous steroids.
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Affiliation(s)
- George J Manayath
- Department of Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Shah PK, Narendran V, Kalpana N, Gilbert C. Severe retinopathy of prematurity in big babies in India: history repeating itself? Indian J Pediatr 2009; 76:801-4. [PMID: 19802548 DOI: 10.1007/s12098-009-0175-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 10/23/2008] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the characteristics of babies with severe retinopathy of prematurity (ROP) attending a tertiary referral eye hospital in South India. METHODS Data on consecutive preterm infants with severe ROP presenting between July 2002 and October 2007 were retrieved from medical records. Severe ROP was defined as high risk prethreshold disease or worse. RESULTS 144 babies with severe ROP were divided into two groups: group 1 had high risk prethreshold or threshold ROP while group 2 had stages 4 or 5 ROP. The overall mean gestational age was 30.7 weeks (range 25-35 weeks) and the mean birth weight was 1410 g (range 650-2310 g). Most babies had received unmonitored supplemental oxygen (ascertained through discussion with the treating pediatricians). CONCLUSION More bigger and mature babies are developing severe ROP in South India than in industrialized countries. The characteristics of babies affected are similar to those seen during the first epidemic of ROP which occurred during the 1950s in Europe and North America. Guidelines on oxygenation and screening policies should be jointly developed by pediatricians and ophthalmologists to end this epidemic of avoidable blindness in India.
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Affiliation(s)
- Parag K Shah
- Pediatric Retina Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore 641 014, Tamil Nadu, India.
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Abstract
Aicardi syndrome is a rare genetic disorder. The salient features of this syndrome include agenesis of corpus callosum, chorioretinal lacunae and infantile spasms. Of these three, chorioretinal lacunae is the most constant feature present. This case highlights the importance of fundus findings by an ophthalmologist in making the diagnosis of this rare syndrome.
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Affiliation(s)
- Parag K Shah
- Pediatric Retina Department, Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.
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Manikandan P, Vismer HF, Kredics L, Dóczi I, Marasas WFO, Bhaskar M, Anita R, Revathi R, Narendran V. Corneal ulcer due toNeocosmospora vasinfectain an immunocompetent patient. Med Mycol 2008; 46:279-84. [PMID: 17885942 DOI: 10.1080/13693780701625149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
We report a case of Neocosmospora vasinfecta keratitis in a 55-year-old man. While the patient did not recall any specific trauma or eye injury, he might have sustained a trivial wound during the course of his duties as a farmer. Direct examination of corneal scrapings revealed fungus filaments. As topical treatment with natamycin and econazole and subsequent systemic ketoconazole therapy failed, a full thickness therapeutic keratoplasty was performed. Post-operative treatment with amphotericin B and clotrimazole combined with cyclosporine resulted in a complete cure. The residual corneal infiltration in the recipient cornea became clear in a week. The fungal isolate was initially identified as a Fusarium species, but later reidentified through the use of morphological characteristics and sequence analysis of the internal transcribed spacer region as N. vasinfecta. The latters is a Hypocrealean fungus not hitherto reported as a causative agent of keratomycosis.
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Affiliation(s)
- P Manikandan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India.
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Raghuram A, Saravanan VR, Narendran V. Intracameral injection of bevacizumab (Avastin) to treat anterior chamber neovascular membrane in a painful blind eye. Indian J Ophthalmol 2007; 55:460-2. [PMID: 17951906 PMCID: PMC2635977 DOI: 10.4103/0301-4738.36484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/08/2022] Open
Abstract
Intracameral injection of bevacizumab (Avastin) helped in the successful regression of an anterior chamber neovascular membrane in a painful blind eye. The effect was persistent even after six months of follow-up. This is the first report on intracameral administration of bevacizumab with six months of follow-up.
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Affiliation(s)
- A Raghuram
- Retina and Vitreous Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Avinashi Road, Coimbatore - 641 014, Tamil Nadu, India.
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Abstract
AIM To describe our experience in surgical management of stages 4 and 5 retinopathy of prematurity (ROP) and assess its anatomical and visual outcome. MATERIALS AND METHODS This study is a retrospective, interventional, consecutive case series. It involved 33 eyes of 29 infants. The data were retrieved retrospectively for each case from their medical records. All the eyes underwent primary vitrectomy with additional procedures like scleral buckling (two eyes), lensectomy (14 eyes), subretinal fluid drainage (two eyes), and one case of corneal transplant (open sky vitrectomy). The anatomical and visual outcome was reviewed at the final follow-up. RESULTS The mean gestational age was 29.7 weeks (range 25-34 weeks) and mean birth weight was 1332 g (range 650-2050 g). Anatomical success for stage 4A was defined as complete retinal attachment with undistorted or minimally distorted posterior pole. For stage 4B, partial residual retinal detachment and for stage 5 at least posterior pole attachment. Visual acuity was measured in anatomically successful eyes that were cooperative. The anatomical outcome was 90% (9/10 eyes) for stage 4A, 44.4% (4/9 eyes) for stage 4B, and 14.3% (2/14) for stage 5. The mean follow-up was 19.1 months. Posterior retinotomy was the commonest complication for stage 4B (66.7%). CONCLUSION Anatomical and visual success was the best for stage 4A ROP. Surgery for stage 4A can halt progression to stages 4B or 5 ROP. Aggressive peeling of posterior membranes should be avoided for stage 4B. Anatomical and visual outcome is very poor for stage 5.
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Affiliation(s)
- P K Shah
- Department of Pediatric Retina, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.
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Manikandan P, Bhaskar M, Revathi R, Anita R, Abarna Lakshmi LR, Narendran V. Isolation and antimicrobial susceptibility pattern of Nocardia among people with culture-proven ocular infections attending a tertiary care eye hospital in Tamilnadu, South India. Eye (Lond) 2007; 21:1102-8. [PMID: 16858437 DOI: 10.1038/sj.eye.6702513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To evaluate the epidemiology, microbiological features, as well as antibiotic susceptibility patterns of Nocardiafrom cases with ocular nocardial infections seen over a period of 8 years in a tertiary eye care hospital. METHODS Microbiology records of 164 cases of culture-proven ocular nocardial infection diagnosed between March 1997 and February 2005 were reviewed retrospectively. The outcome data included isolation rate, predisposing factors, demography (age and sex), and category of infection, utility of conventional diagnostic methods, microbiological profile, and antibiogram-resistogram patterns. RESULTS A total of 164 (3.1%) Nocardiaspecies were identified among 5378 culture-proven cases. Ninety-six (58.5%) isolates were from corneal scrapings followed by vitreous biopsy (17.0%). Most (58.0%) of the cases were between 51 and 80 age groups. Male preponderance was obvious. All the 164 (100%) nocardial infections were identified by culture. Of 125 ocular specimens subjected to Gram's staining, nocaridal filaments were identified in 70 (56%) specimens. In addition to KOH mounting, modified AFB staining was also found to be helpful. Upon in vitrosusceptibility testing, 98.7 and 90.2% of nocardial isolates showed sensitivity towards amikacin and ciprofloxacin, respectively. CONCLUSIONS Ocular nocardiosis is relatively rare among ocular infections. Amikacin and ciprofloxacin are highly effective in treating ocular nocardiasis. Prompt and accurate microbiological diagnosis and early administration of these antibiotics may have a positive effect on the ocular outcome as well as in controlling nocardial prevalence.
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Affiliation(s)
- P Manikandan
- 1Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Aravind Eye Care System, Avinashi Road, Coimbatore, Tamilnadu 641014, India.
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Shah PK, Narendran V, Tawansy KA, Raghuram A, Narendran K. Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity. Indian J Ophthalmol 2007; 55:75-6. [PMID: 17189897 DOI: 10.4103/0301-4738.29505] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease) occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin) in a case of anterior segment ischemia.
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Affiliation(s)
- Parag K Shah
- Vitreo-Retinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
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Kredics L, Manikandan P, Kocsubé S, Dóczi I, Narendran V, Varga J, Antal Z, Vágvölgyi C, Revathi R, Nagy E. P1291 Aspergillus keratomycosis at an eye hospital in south India: a retrospective study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71131-7] [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: 10/23/2022]
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Shah P, Narendran V, Tawansy K, Raghuram A, Narendran K. Authors′ reply. Indian J Ophthalmol 2007. [DOI: 10.4103/0301-4738.33058] [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: 11/04/2022] Open
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Tawansy K, Shah P, Narendran V, Raghuram A, Narendran K. Authors′ reply. Indian J Ophthalmol 2007. [DOI: 10.4103/0301-4738.33054] [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: 11/04/2022] Open
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Myint K, Sahay R, Mon S, Saravanan VR, Narendran V, Dhillon B. "Worm in the eye": the rationale for treatment of DUSN in south India. Br J Ophthalmol 2006; 90:1125-7. [PMID: 16707523 PMCID: PMC1857373 DOI: 10.1136/bjo.2006.094490] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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] [Accepted: 05/04/2006] [Indexed: 11/03/2022]
Abstract
AIM To discuss the rationale for different techniques of treatment for DUSN (diffuse unilateral subacute neuroretinitis) and their effectiveness in two patients from south India. METHODS Two rare cases of live worms in DUSN from India are reported, where filarial Brugia malayi is endemic. Both cases presented with progressive unilateral loss of vision with no history of animal contact. They were 40 year old, apparently healthy men. In case 1, the worm (1500-2000 microm) was easy to identify with wriggling movements among crisscrossing diffuse subretinal tracks. The worm was destroyed by a single shot of laser to its advancing end, which was followed by oral steroid to control the inflammation caused by the dead worm. In case 2, the worm was small and difficult to identify. Initially diffuse neuroretinitis was diagnosed and treated with intravenous methylprednisolone and oral corticosteroid. A week later, a small live worm (400-600 microm) was found and subsequently destroyed by laser photocoagulation followed by a combination of anthelminthics. RESULTS The patients' vision had improved to 6/60-6/36 from counting fingers after a few weeks. CONCLUSION The role of a combination of laser treatment, systemic steroid, and anthelminthics is discussed.
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Affiliation(s)
- K Myint
- Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh EH3 9HA, UK.
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Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M, Morris RJ, Vijay N, Raghuraman V, Shah V. Fulminate retinopathy of prematurity - clinical characteristics and laser outcome. Indian J Ophthalmol 2006; 53:261-5. [PMID: 16333175 DOI: 10.4103/0301-4738.18908] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To analyse the clinical characteristics and treatment outcome of zone 1 Fulminate type of Retinopathy of Prematurity (ROP) and compare it to Conventional ROP. METHODS Preterm infants from two neonatal intensive care units (NICU) born between July 2002 and November 2003 were screened for ROP. Cases with Conventional ROP were classified according to the International Classification of Retinopathy of Prematurity (ICROP) while that of Fulminate ROP according to Shapiro's classification. Threshold disease was kept the cut off for treatment for Conventional ROP and stage 3A for Fulminate ROP. RESULTS Of the 54 cases that had treatable ROP, 36 (66.67%) had Fulminate type. The mean gestational age and birth weight was higher in Fulminate ROP compared to Conventional disease (31.75 weeks and 1554 gms vs 31 weeks 1387 gms) whereas the mean postnatal age at laser was lower (4.62 weeks vs 6.3 weeks). The average number of laser spots given was 3036.6 for Fulminate disease. CONCLUSION Fulminate ROP had an atypical morphology which was difficult to classify according to ICROP classification and we would like to lay stress upon the importance of screening of premature infants from the age of 4 weeks and to start treatment immediately once Fulminate ROP has been diagnosed.
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Affiliation(s)
- Parag K Shah
- Vitreo-Retinal Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
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Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M. Screening for retinopathy of prematurity-a comparison between binocular indirect ophthalmoscopy and RetCam 120. Indian J Ophthalmol 2006; 54:35-8. [PMID: 16531668 DOI: 10.4103/0301-4738.21612] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard. SETTING AND DESIGN Prospective, comparative study. MATERIALS AND METHODS A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method. RESULTS ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively. CONCLUSION Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.
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Affiliation(s)
- Parag K Shah
- Vitreo-Retinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India.
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Manikandan P, Bhaskar M, Revathy R, John RK, Narendran K, Narendran V. Speciation of coagulase negative staphylococcus causing bacterial keratitis. Indian J Ophthalmol 2005; 53:59-60. [PMID: 15829750 DOI: 10.4103/0301-4738.15288] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thirty-five coagulase negative Staphylococcus (CoNS) cultured from corneal ulcer were speciated and antibiotic sensitivity tested. S epidermidis was the commonest isolate and it was sensitive to ampicillin and vancomycin.
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Affiliation(s)
- P Manikandan
- Department of Microbiology, Aravind Eye Hospital, Avinashi Road, Coimbatore 641-014, Tamil Nadu, India
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Myint K, Sahay R, Mon S, Saravanan VR, Narendran V, Dhillon B. The Indian case of live worm in diffuse unilateral subacute neuroretinitis. Eye (Lond) 2005; 20:612-3. [PMID: 15920564 DOI: 10.1038/sj.eye.6701936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M, Devraj S. Fulminate type of retinopathy of prematurity. Indian J Ophthalmol 2004; 52:319-20. [PMID: 15693324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Routine ophthalmoscopic screening for retinopathy of prematurity (ROP) from the age of 2 weeks is necessary to detect and treat fulminate ROP.
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Affiliation(s)
- Parag K Shah
- Department of Vitreous & Retina, Aravind Eye Hospital, Coimbatore, India
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Manikandan P, Bhaskar M, Revathy R, John RK, Narendran V, Panneerselvam K. Acanthamoeba keratitis - a six year epidemiological review from a tertiary care eye hospital in south India. Indian J Med Microbiol 2004; 22:226-30. [PMID: 17642743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE This study analyses the prevalence, demography, predisposing factors and seasonal variation of Acanthamoeba keratitis. METHODS A retrospective review of all cases presenting with keratitis at the cornea clinic, Aravind Eye Hospital, Coimbatore, from August 1997 to July 2003, was done for screening patients with a provisional diagnosis of Acanthamoeba keratitis. Their records were further analyzed for microbiological details. Cases with culture proven Acanthamoeba keratitis were included for epidemiological analysis. RESULTS From a total of 4519 patients who attended cornea clinic 32 (33 eyes) patients were confirmed to be positive for Acanthamoeba keratitis. Twenty cases (62.5%) were males. Majority (18; 54.2%) of the Acanthamoeba keratitis eyes reported corneal trauma by solid objects. No peak period was observed in a year, as the number of cases was almost uniform in all months. CONCLUSION This study indicates the increasing prevalence of Acanthamoeba keratitis among non-contact lens users in this region during the 6-year period.
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Affiliation(s)
- P Manikandan
- Department of Microbiology, Aravind Eye Care System, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Avinashi Road, Coimbatore- 641 014, India
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Manikandan P, Bhaskar M, Revathy R, John RK, Narendran V, Panneerselvam K. ACANTHAMOEBA KERATITIS – A SIX YEAR EPIDEMIOLOGICAL REVIEW FROM A TERTIARY CARE EYE HOSPITAL IN SOUTH INDIA. Indian J Med Microbiol 2004. [DOI: 10.1016/s0255-0857(21)02767-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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