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D'Souza S, Nair AP, Ashok N, Kannan R, Dickman MM, Nuijts RMMA, Shetty R, Sethu S, Ghosh A. Elevated Neutrophils and reduced NK cells are associated with altered tear molecular signatures and clinical sequelae of chronic ocular Stevens-Johnson Syndrome. Ocul Surf 2024:S1542-0124(24)00043-0. [PMID: 38703818 DOI: 10.1016/j.jtos.2024.04.003] [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: 09/08/2023] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Stevens-Johnson syndrome (SJS) is characterised as an immuno-inflammatory condition with potentially blinding ocular sequelae. Therefore, we have investigated the ocular surface immune cell profile and correlated it with secreted tear molecular factors and clinical ocular sequelae in SJS patients. METHODS 21 patients (42 eyes) with chronic ocular SJS and 16 healthy controls (20 eyes) were included in the study. Severity, types of keratopathies and ocular surface(OS) manifestations were determined. OS wash samples from study subjects were used to determine the status of 13 immune cell subsets using flow cytometry. Levels of 42 secreted immuno-inflammatory factors were measured by flow cytometry-based multiplex ELISA in tear samples. RESULTS Neutrophils (Total, activated), neutrophils/NK cells ratio, neutrophils/T cells ratio were significantly (p<0.05) elevated in SJS, while, proportions of T cells and NKT cells were significantly lower in SJS patients. Positive association between neutrophils and chronic ocular surface complication score (COCS) was observed, whereas, a negative association was noted between NK cells and COCS. Tear fluid levels of IL-6, IL-8, IL-18, IFNα/β/γ, TNFα, LIF, IL-8, HGF, sTNFR-I, NGAL, Granzyme, Perforins, MMP9/TIMP1 ratio were significantly higher in SJS. Loss of Limbal niche correlated significantly with immune profile and clinical sequelae. Increased neutrophils, decreased NK cells and specific set of altered secreted immuno-inflammatory mediators including bFGF, and IL-8 were observed in SJS patients with different types of keratopathies compared to those without keratopathy. CONCLUSION Distinct ocular surface immune profile variations were observed to correlate with clinical stages of chronic ocular SJS. Our findings uncover novel mechanisms and potential for targeted therapy in chronic ocular SJS patients.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Netralaya Foundation, Bangalore, India; Manipal Academy of Higher Education, Manipal, India
| | - Nikhil Ashok
- GROW Research Laboratory, Narayana Netralaya Foundation, Bangalore, India
| | - Ramaraj Kannan
- GROW Research Laboratory, Narayana Netralaya Foundation, Bangalore, India
| | - Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands;; MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Netralaya Foundation, Bangalore, India.
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Netralaya Foundation, Bangalore, India.
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D'Souza S, Shetty R. Spike sign - To predict the formation of big bubble in deep anterior lamellar keratoplasty in advanced keratoconus. Indian J Ophthalmol 2024; 72:745-747. [PMID: 38389247 DOI: 10.4103/ijo.ijo_1205_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: 05/08/2023] [Accepted: 11/07/2023] [Indexed: 02/24/2024] Open
Abstract
Lamellar surgeries have revolutionized our understanding and practice of keratoplasties. However, the learning curve in deep anterior lamellar keratoplasty (DALK) makes it daunting for novice surgeons. This paper describes a unique intraoperative sign - the radial "spike sign," which heralds the commencement of a big bubble in some cases of advanced keratoconus in eyes that have not undergone any previous surgery. The spike sign was noted during big bubble DALK surgery and was then retrospectively looked for in recorded DALK surgical videos and correlated with the formation of a big bubble. The movement of air after injection was classified into the direct formation of a big bubble, stromal emphysema with no big bubble, and emphysema with the spike sign followed by a big bubble. In total, 104 surgical videos of big bubble attempts were evaluated and classified as such. The spike sign helps reduce the number of unnecessary attempts at big bubble formation during DALK, thus improving surgical outcomes.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Davis L, D'Souza S. Private equity in radiology - Why aren't we more concerned? Curr Probl Diagn Radiol 2024:S0363-0188(24)00056-2. [PMID: 38604880 DOI: 10.1067/j.cpradiol.2024.04.001] [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: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
There has been recent scrutiny of private equity involvement in the healthcare market by federal and state governmental agencies who are concerned about the corporatization and financialization of healthcare in the United States. Data is emerging that patient costs increase, quality of healthcare decreases, physician autonomy decreases, and physician burnout and moral injury increases when corporate interests like private equity enter the medical market. Like other medical specialties, the field of radiology has been affected by corporatization and radiologists should understand how private equity interests may affect individual radiologists and the radiology workforce on a larger scale.
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Affiliation(s)
- Leah Davis
- Grand Traverse Radiologists, PC, 10850 Traverse Highway, Suite 1175, Traverse City, Michigan 49684, United States.
| | - Sharon D'Souza
- Tulsa Radiology Associates, 4111 S Darlington Ave Ste 700, Tulsa, OK 74135, United States
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Newman A, D'Souza S. Patient-Friendly Summary of the ACR Appropriateness Criteria®: Preprocedural Planning for Transcatheter Aortic Valve Replacement: 2023 Update. J Am Coll Radiol 2023:S1546-1440(23)00945-6. [PMID: 38007190 DOI: 10.1016/j.jacr.2023.11.017] [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: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
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Kundu G, Shetty N, Shetty R, Khamar P, D'Souza S, Meda TR, Nuijts RMMA, Narasimhan R, Roy AS. Artificial intelligence-based stratification of demographic, ocular surface high-risk factors in progression of keratoconus. Indian J Ophthalmol 2023; 71:1882-1888. [PMID: 37203049 PMCID: PMC10391495 DOI: 10.4103/ijo.ijo_2651_22] [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: 05/20/2023] Open
Abstract
Purpose The purpose of this study was to identify and analyze the clinical and ocular surface risk factors influencing the progression of keratoconus (KC) using an artificial intelligence (AI) model. Methods This was a prospective analysis in which 450 KC patients were included. We used the random forest (RF) classifier model from our previous study (which evaluated longitudinal changes in tomographic parameters to predict "progression" and "no progression") to classify these patients. Clinical and ocular surface risk factors were determined through a questionnaire, which included presence of eye rubbing, duration of indoor activity, usage of lubricants and immunomodulator topical medications, duration of computer use, hormonal disturbances, use of hand sanitizers, immunoglobulin E (IgE), and vitamins D and B12 from blood investigations. An AI model was then built to assess whether these risk factors were linked to the future progression versus no progression of KC. The area under the curve (AUC) and other metrics were evaluated. Results The tomographic AI model classified 322 eyes as progression and 128 eyes as no progression. Also, 76% of the cases that were classified as progression (from tomographic changes) were correctly predicted as progression and 67% of cases that were classified as no progression were predicted as no progression based on clinical risk factors at the first visit. IgE had the highest information gain, followed by presence of systemic allergies, vitamin D, and eye rubbing. The clinical risk factors AI model achieved an AUC of 0.812. Conclusion This study demonstrated the importance of using AI for risk stratification and profiling of patients based on clinical risk factors, which could impact the progression in KC eyes and help manage them better.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naren Shetty
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Tulasi R Meda
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rudy M M A Nuijts
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raghav Narasimhan
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
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Panigrahi T, D'Souza S, Suresh Babu V, Dickman MM, Nuijts RMMA, Sethu S, Shetty R. Type 1-type 2 interferon imbalance in dry eye disease. Indian J Ophthalmol 2023; 71:1526-1532. [PMID: 37026295 DOI: 10.4103/ijo.ijo_2842_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Purpose Dry eye disease (DED) is characterized by altered ocular surface proinflammatory and antiinflammatory factors. Interferons (IFNs) are a class of pleiotropic cytokines well known for their antimicrobial, inflammatory, and immunomodulatory roles. Hence, this study investigates the ocular surface expression of different types of IFNs in patients with DED. Methods The cross-sectional, observational study included patients with DED and normal subjects. Conjunctival impression cytology (CIC) samples were obtained from the study subjects (controls, n = 7; DED, n = 8). The mRNA expression levels of type 1 IFN (IFNα, IFNβ), type 2 IFN (IFNγ), and type 3 IFN (IFNλ1, IFNλ2, IFNλ3) were measured by quantitative PCR (polymerase chain reaction) in CIC samples. IFNα and IFNγ expression under hyperosmotic stress was also studied in human corneal epithelial cells (HCECs) in vitro. Results The mRNA expression levels of IFNα and IFNβ were significantly lower and that of IFNγ was significantly higher in DED patients compared to healthy controls. The mRNA levels of IFNα, IFNβ, and IFNλ were significantly lower compared to IFNγ in DED patients. An inverse association between tonicity-responsive enhancer-binding protein (TonEBP; hyperosmotic stress maker) and IFNα or IFNβ expression and a positive association between TonEBP and IFNγ expression was observed in CIC samples. The expression of IFNα was lower than IFNγ in HCECs undergoing hyperosmotic stress compared to HCECs without the stress. Conclusion The presence of an imbalance between type 1 and type 2 IFNs in DED patients suggests newer pathogenic processes in DED, plausible ocular surface infection susceptibility in DED patients, and potential therapeutic targets in the management of DED.
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Affiliation(s)
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Vishnu Suresh Babu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Mor M Dickman
- Department of Ophthalmology, University Eye Clinic Maastricht, Maastricht University Medical Center; MERLN, Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, Netherlands
| | - Rudy M M A Nuijts
- Department of Ophthalmology, University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Kundu G, Shetty R, D'Souza S, Gorimanipalli B, Koul A, Sethu S. Effect of maqui-berry extract in dry eye disease - A clinical and molecular analysis. Indian J Ophthalmol 2023; 71:1613-1618. [PMID: 37026311 DOI: 10.4103/ijo.ijo_2909_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Purpose This study aims to investigate the effects of maqui-berry extract (MBE) in improving signs and symptoms of dry eye disease (DED) along with ocular surface inflammation in patients with DED. Methods Twenty patients were randomly assigned to a MBE or a placebo group (PLC). DED parameters including Schirmer's test 1 (ST1), tear film break-up time (TBUT), ocular surface disease index (OSDI), and corneal staining were assessed before treatment and 2 months post-treatment. Tear fluid samples before and after treatment from a subset of these patients were collected from the study subjects using sterile Schirmer's strips, and the levels of interleukin (IL)-1β, IL-10, IL-6, IL-17A, tumor necrosis factor-α (TNFα), matrix metalloproteinase-9 (MMP9), soluble intercellular adhesion molecule-1 (sICAM1), and vascular endothelial growth factor-A (VEGF-A) were measured using a microfluidic cartridge-based multiplex ELISA. Results The MBE group demonstrated a significant (p < 0.05) decrease in OSDI scores along with a significant increase in Schirmer's test 1 compared to the PLC group. No significant change in TBUT and corneal staining was observed between the study groups. Levels of proinflammatory factors such as IL-1β, IL-6, IL-17A, TNFα, and MMP9 were observed to be significantly reduced, along with a significant increase in IL-10 levels following treatment in the MBE group compared with the PLC group. Conclusion Consumption of MBE resulted in the resolution of DED signs and symptoms, along with a reduction in ocular surface inflammation.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhavya Gorimanipalli
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ameeta Koul
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
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D'Souza S, Khamar P, Shetty R. Fibromyalgia syndrome and the eye-Implications in corneal ultrastructure on confocal microscopy. Indian J Ophthalmol 2023; 71:1656-1657. [PMID: 37026320 DOI: 10.4103/ijo.ijo_2835_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Kumar NR, Praveen M, Narasimhan R, Khamar P, D'Souza S, Sinha-Roy A, Sethu S, Shetty R, Ghosh A. Tear biomarkers in dry eye disease: Progress in the last decade. Indian J Ophthalmol 2023; 71:1190-1202. [PMID: 37026250 DOI: 10.4103/ijo.ijo_2981_22] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Dry eye disease (DED) is a commonly occurring, multifactorial disease characterized by reduced tear film stability and hyperosmolarity at the ocular surface, leading to discomfort and visual compromise. DED is driven by chronic inflammation and its pathogenesis involves multiple ocular surface structures such as the cornea, conjunctiva, lacrimal glands, and meibomian glands. The tear film secretion and its composition are regulated by the ocular surface in orchestration with the environment and bodily cues. Thus, any dysregulation in ocular surface homeostasis causes an increase in tear break-up time (TBUT), osmolarity changes, and reduction in tear film volume, all of which are indicators of DED. Tear film abnormalities are perpetuated by underlying inflammatory signaling and secretion of inflammatory factors, leading to the recruitment of immune cells and clinical pathology. Tear-soluble factors such as cytokines and chemokines are the best surrogate markers of disease severity and can also drive the altered profile of ocular surface cells contributing to the disease. Soluble factors can thus help in disease classification and planning treatment strategies. Our analysis suggests increased levels of cytokines namely interleukin-1β (IL-1β), IL-2, IL-4, IL-6, IL-9, IL-12, IL-17A, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α); chemokines (CCL2, CCL3, CCL4, CXCL8); MMP-9, FGF, VEGF-A; soluble receptors (sICAM-1, sTNFR1), neurotrophic factors (NGF, substance P, serotonin) and IL1RA and reduced levels of IL-7, IL-17F, CXCL1, CXCL10, EGF and lactoferrin in DED. Due to the non-invasive sample collection and ease of quantitively measuring soluble factors, tears are one of the best-studied biological samples to molecularly stratify DED patients and monitor their response to therapy. In this review, we evaluate and summarize the soluble factors profiles in DED patients from the studies conducted over the past decade and across various patient groups and etiologies. The use of biomarker testing in clinical settings will aid in the advancement of personalized medicine and represents the next step in managing DED.
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Affiliation(s)
- Nimisha R Kumar
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Machiraju Praveen
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Raghav Narasimhan
- IBMS Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Abhijit Sinha-Roy
- IBMS Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
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Abstract
Dry eye disease (DED) which affects millions of people worldwide is an ocular surface disease that is strongly associated with pain, discomfort, and visual disturbances. Altered tear film dynamics, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities are the key contributors to DED pathogenesis. The presence of discordance between signs and symptoms of DED in patients and refractoriness to current therapies in some patients underpin the need for studying additional contributors that can be modulated. The presence of electrolytes or ions including sodium, potassium, chloride, bicarbonate, calcium, and magnesium in the tear fluid and ocular surface cells contribute to ocular surface homeostasis. Ionic or electrolyte imbalance and osmotic imbalance have been observed in DED and feed-forward interaction between ionic imbalances and inflammation alter cellular processes in the ocular surface resulting in DED. Ionic balances in various cellular and intercellular compartments are maintained by dynamic transport via ion channel proteins present in cell membranes. Hence, alterations in the expression and/or activity of about 33 types of ion channels that belong to voltage-gated channels, ligand-gated channels, mechanosensitive ion channel, aquaporins, chloride ion channel, sodium-potassium-chloride pumps or cotransporters have been investigated in the context of ocular surface health and DED in animal and/or human subjects. An increase in the expression or activity of TRPA1, TRPV1, Nav1.8, KCNJ6, ASIC1, ASIC3, P2X, P2Y, and NMDA receptor have been implicated in DED pathogenesis, whereas an increase in the expression or activity of TRPM8, GABAA receptor, CFTR, and NKA have been associated with resolution of DED.
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Affiliation(s)
- Nikhil Ashok
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Marlies Gijs
- Department of Ophthalmology, University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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D'Souza S, James E, Jois R, Mahendradas P, Koul A, Pradhan A. Systemic investigations in dry eye disease. Indian J Ophthalmol 2023; 71:1326-1331. [PMID: 37026264 DOI: 10.4103/ijo.ijo_3003_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The incidence of dry eye disease has increased manifold in the past few years with more patients presenting with these complaints to our clinics every day. In the more severe forms of disease, it is important to evaluate for any systemic association which could be driving the disease such as in Sjogren's syndrome. Understanding the possible varied etiopathogenesis and knowing when to evaluate, form an important part of treating this condition effectively. In addition, it is sometimes confusing as to which investigations to order and how to prognosticate the disease in these situations. This article simplifies this into an algorithmic approach with insights from the ocular and systemic point of view.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Edwin James
- Government Medical College, Paripally, Kollam District, Kerala, India
| | - Ramesh Jois
- Manipal Hospital, Millers Road, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Ameeta Koul
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Aditya Pradhan
- Department of Cornea, External Disease and Cataract, Disha Eye Hospitals, Kolkata, West Bengal, India
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Shetty R, Dua HS, Tong L, Kundu G, Khamar P, Gorimanipalli B, D'Souza S. Role of in vivo confocal microscopy in dry eye disease and eye pain. Indian J Ophthalmol 2023; 71:1099-1104. [PMID: 37026240 DOI: 10.4103/ijo.ijo_3013_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Dry eye disease is known to have a lot of variability in presentation with overlapping subtypes. Understanding the pathology of this condition will guide therapeutic options. In vivo confocal microscopy is a diagnostic and imaging modality that provides high magnification and high-resolution images of all layers of the cornea and ocular surface. Various structures in the cornea and their alterations due to dry eye have been imaged. The impact of the tear film instability, inflammation, and altered homeostasis on the corneal epithelium, nerves, keratocytes, and dendritic cells have been evaluated across different studies. In addition, key features of IVCM in patients with neuropathic pain have been highlighted in this paper.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Harminder S Dua
- Department of Ophthalmology and Visual Sciences, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of, Singapore
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Bhavya Gorimanipalli
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
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D'Souza S, James E, Koul A, Modak D, Kundu G, Shetty R. A randomized controlled study evaluating outcomes of intense pulsed light and low-level light therapy for treating meibomian gland dysfunction and evaporative dry eye. Indian J Ophthalmol 2023; 71:1608-1612. [PMID: 37026310 DOI: 10.4103/ijo.ijo_2834_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Purpose This randomized, controlled, blinded study evaluates the efficacy of intense pulsed light (IPL) therapy with low-level light therapy (LLLT) in the treatment of meibomian gland dysfunction (MGD) and evaporative dry eye (EDE) compared to a control group. Methods Hundred patients with MGD and EDE were randomized into control (50 subjects, 100 eyes) and study group (50 subjects, 100 eyes). The study group underwent three sittings of IPL with LLLT 15 days apart and were followed up 1 month and 2 months after the last treatment sitting. The control group underwent sham treatment and was followed up at the same intervals. The patients were evaluated at baseline and 1 month and 3 months (post 1st treatment) for dry eye. Schirmer's test and tear breakup time (TBUT), OSDI, meibomian gland expression, and meibography. Results The study group showed significant improvement in OSDI scores (P < 0.0001) compared to the control group and a significant improvement in TBUT (P < 0.005) compared to the control group. There was no change in schirmer's test and an improvement in the meibomian gland expression but not significant. Conclusion The results show that a combined therapy of IPL with LLT is effective in treating MGD with EDE compared to controls, and repeated treatment sessions have a cumulative effect on the disease outcomes.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Edwin James
- Department of Ophthalmology, Government Medical College, Paripally, Kollam District, Kerala, India
| | - Ameeta Koul
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Durgalaxmi Modak
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Narang P, Donthineni PR, D'Souza S, Basu S. Evaporative dry eye disease due to meibomian gland dysfunction: Preferred practice pattern guidelines for diagnosis and treatment. Indian J Ophthalmol 2023; 71:1348-1356. [PMID: 37026266 DOI: 10.4103/ijo.ijo_2841_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.
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Affiliation(s)
- Purvasha Narang
- Department of Ophthalmology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Pragnya Rao Donthineni
- The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sharon D'Souza
- Department of Cornea and Refractive surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sayan Basu
- The Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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15
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Nair AP, D'Souza S, Khamar P, Nuijts RMMA, Sethu S, Shetty R. Ocular surface immune cell diversity in dry eye disease. Indian J Ophthalmol 2023; 71:1237-1247. [PMID: 37026254 DOI: 10.4103/ijo.ijo_2986_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial chronic ocular surface inflammatory condition. Disease severity has been directly related to the immuno-inflammatory status of the ocular surface. Any perturbation in the orchestrated functional harmony between the ocular surface structural cells and immune cells, both resident and trafficking ones, can adversely affect ocular surface health. The diversity and contribution of ocular surface immune cells in DED have been of interest for over a couple of decades. As is true with any mucosal tissue, the ocular surface harbors a variety of immune cells of the innate-adaptive continuum and some of which are altered in DED. The current review curates and organizes the knowledge related to the ocular surface immune cell diversity in DED. Ten different major immune cell types and 21 immune cell subsets have been studied in the context of DED in human subjects and in animal models. The most pertinent observations are increased ocular surface proportions of neutrophils, dendritic cells, macrophages, and T cell subsets (CD4+; CD8+; Th17) along with a decrease in T regulatory cells. Some of these cells have demonstrated disease-causal association with ocular surface health parameters such as OSDI score, Schirmer's test-1, tear break-up time, and corneal staining. The review also summarizes various interventional strategies studied to modulate specific immune cell subsets and reduce DED severity. Further advancements would enable the use of ocular surface immune cell diversity, in patient stratification, i.e. DED-immunotypes, disease monitoring, and selective targeting to resolve the morbidity related to DED.
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Affiliation(s)
- Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rudy M M A Nuijts
- Department of Ophthalmology, University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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16
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Panigrahi T, James E, Khamar P, Gorimapalli B, D'Souza S. Modulation of mucin secretion using combined polyethylene glycol-propylene glycol topical formulation in a hyperosmotic stress-based explant model. Indian J Ophthalmol 2023; 71:1582-1586. [PMID: 37026305 DOI: 10.4103/ijo.ijo_2855_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Purpose Ocular surface discomfort and dry eye disease are caused by a dysfunctional tear film. The efficacy of lubricating eye drops on the human eye is known, but the compositions may show differential effects on rescuing the tear film. Mucins form a critical layer of the tear film, a reduction of which may be causative for ocular surface conditions. Therefore, it is essential to develop relevant human-derived models to test mucin production. Methods Human corneoscleral rims were obtained from a healthy donor (n = 8) post-corneal keratoplasty and cultured in DMEM/F12 media. Hyperosmolar stress mimicking dry eye disease was induced by exposing the corneoscleral rim tissues to +200 mOsml NaCl-containing media. The corneoscleral rims were treated with polyethylene glycol-propylene glycol (PEG-PG)-based topical formulation. Gene expression analysis was performed for NFAT5, MUC5AC, and MUC16. Secreted mucins were measured by enzyme-linked immunosorbent assay (ELISA) (Elabscience, Houston, TX, USA) for MUC5AC and MUC16. Results The corneoscleral rims responded to hyperosmolar stress by upregulating NFAT5, a marker for increased osmolarity, as observed in the case of dry eye disease. The expression of MUC5AC and MUC16 was reduced upon an increase in hyperosmotic stress. The corneoscleral rim tissues showed induction of MUC5AC and MUC16 expression upon treatment with PEG-PG topical formulation but did not show significant changes in the presence of hyperosmolar treatments. Conclusion Our findings showed that PEG-PG-based topical formulation slightly alleviated hyperosmolar stress-induced decrease in MUC5AC and MUC16 gene expression that is encountered in DED.
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Affiliation(s)
| | - Edwin James
- Government Medical College, Paripally, Kollam, Kerala, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Bhavya Gorimapalli
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Bedir A, Nageye F, Cherek P, Godley C, Ghani S, Cheong J, D'Souza S, Cecaro F, Petzer E, Martin W, Kabunga P. Single-chamber versus dual-chamber pacing in very elderly patients with sinus node disease and AV block: a real-world study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.494] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Elderly patients with sinus-node disease, have been reported to have better clinical outcomes with dual-chamber pacing compared with single chamber pacing. In contrast, randomized studies have shown no clinical benefit of dual-chamber pacing compared to single-chamber pacing in the elderly with high grade AV block., For truly elderly patients (>80 years), the optimal choice of pacing mode remains uncertain. In this real-world observational study, we analysed the clinical outcomes in a cohort of very elderly patients.
Methods
We analysed retrospective data of all new pacemaker implantations for sinus node disease or high-grade atrioventricular block in patients ≥80 years a district general hospital in south-east England, UK over a 7-year period. Patients with an existing diagnosis of stroke, congestive cardiac failure and/or atrial fibrillation (AF) were excluded from the study. Patients were categorised into two analysis cohorts based on pacing mode, i.e dual chamber (DDD) pacing versus single chamber (VVI) pacing. Clinical outcome data including all-cause mortality, new onset AF and CCF were recorded.
Results
A total of 208 patients were included in the study, of which 117 received (DDD) pacing vs 91 who underwent VVI pacing. The mean age was 85.8 years (84.63 DDD, 87.3 VVI, p=0.01). Single chamber pacing was associated with greater all-cause mortality (51.7% vs 31.5%, p=0.01). 23.1% of patients who underwent DDD pacing developed AF, vs 21.9% who underwent VVI pacing (p=0.85). Congestive cardiac failure was observed in 6.48% of patients who received DDD pacing vs 8.14% of patients who received VVI pacing, (p=0.66).
Conclusions
In this real-world observational study of very elderly patients with sinus node disease and/or high-grade AV block, single chamber pacing was associated with a greater all-cause mortality. However, the pacing mode did not affect the incidence of atrial fibrillation and congestive cardiac failure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Bedir
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - F Nageye
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - P Cherek
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - C Godley
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - S Ghani
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - J Cheong
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - S D'Souza
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - F Cecaro
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - E Petzer
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - W Martin
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
| | - P Kabunga
- Darent Valley Hospital, Cardiology , Dartford , United Kingdom
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D'Souza S, Padmanabhan Nair A, Iyappan G, Dickman MM, Thakur P, Mullick R, Kundu G, Sethu S, Ghosh A, Shetty R. Clinical and Molecular Outcomes After Combined Intense Pulsed Light Therapy With Low-Level Light Therapy in Recalcitrant Evaporative Dry Eye Disease With Meibomian Gland Dysfunction. Cornea 2022; 41:1080-1087. [PMID: 34907942 DOI: 10.1097/ico.0000000000002954] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/30/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Dry eye disease (DED) is a leading cause of ocular morbidity worldwide. This study evaluates the effects of combined light therapy [intense pulsed light (IPL) and low-level light therapy (LLLT)] on clinical and molecular outcomes in evaporative DED with meibomian gland dysfunction (MGD). METHODS This prospective study evaluated 94 eyes (47 subjects) with chronic MGD treated with combined light therapy. Patients underwent a detailed evaluation of MGD and DED using the Ocular Surface Disease Index, dry eye tests-tear breakup time and Schirmer test, ocular surface staining, meibomian gland expressibility scoring, and meibography. Patients underwent a single session of combined light therapy (IPL + LLLT treatment) using the Eye-light device. All these tests were repeated at 3 and 6 months after treatment. Tear fluid and ocular surface wash samples were collected from a subset of patients before and after treatment for cellular and secreted immune factor profiling by flow cytometry. RESULTS Combined light therapy (IPL + LLLT) demonstrated a marked improvement in the clinical metrics studied. Three months after treatment, Ocular Surface Disease Index showed a significant reduction in 95.6% ( P < 0.0001), tear breakup time increased in 72.3% ( P < 0.0001), and meibomian gland expressibility scoring increased in 80.8% ( P < 0.0001) of the eyes. These effects were observed to be sustained during the 6-month follow-up visit. Significant ( P < 0.05) reduction in tear fluid levels of interleukin-1β, interleukin-17F, and MMP9; MMP9/TIMP1 ratio; and ocular surface B-cell proportions was observed. CONCLUSIONS Combined light therapy shows promising results in patients with chronic MGD and DED, even in recalcitrant cases. Clinical and molecular factor alterations support the improved symptomatology and reduced inflammation.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | - Gowtham Iyappan
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Centre + MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, the Netherlands
| | - Prashansa Thakur
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; and
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, India
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Shah A, Sadowski EA, Thomas K, Fowler KJ, Do RKG, D'Souza S, Ramchandani P, Jha P. Gender and racial diversity among plenary session speakers at the Society of Abdominal Radiology Annual Meetings: a five-year assessment. Abdom Radiol (NY) 2022; 47:2545-2551. [PMID: 35596777 PMCID: PMC9226100 DOI: 10.1007/s00261-022-03548-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the gender and racial diversity of plenary session speakers in the annual meetings of Society of Abdominal Radiology (SAR) over 2016 to 2020. MATERIALS AND METHODS The brochures of the SAR annual meetings were reviewed for plenary session speakers and titles. Publicly available institutional profiles and social media were reviewed by the investigator in order to infer gender and race. Gender assessments were men, women, transgender men, transgender women or gender non-binary. Race was classified as White, Black or African American, American Indians and Alaskan Natives, Asian, Native Hawaiian and Pacific Islander and Multiracial. Statistical analysis was performed using chi square and T-tests. RESULTS Based on self-reported data, the SAR has 64% male and 36% female members. Over 2016-2020, plenary session speakers were more likely to be men [69.6% (183/263)] than women [30.4% (80/263)] (p-value = 0.0007). No speakers could be reliably identified as transgender, gender non-binary or gender expansive. In 2016, there were 24% women plenary speakers. This proportion was 28% in 2017, 33% in 2018 and 36% in 2019, and 30% in 2020. When assessing racial distribution, white speakers accounted for the majority of plenary speakers, ranging from 61 to 78%. Asians speakers accounted for 22 to 35%. There were no Black and African American, American Indian & Alaskan Native, Native Hawaiian & Pacific Islander plenary speakers (0%). Multiracial speakers were represented from 2018 to 2020, accounting for 2-4% speakers (p-value < 0.0001). CONCLUSIONS Plenary speakers at SAR Annual Meetings from 2016-2020 were more likely to be men, but with the proportion of women presenters increasing over time. White speakers represented the majority of plenary session speakers, followed by Asians. No plenary session speakers were identified as Black or African American or Native Americans.
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Affiliation(s)
- Amani Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Elizabeth A Sadowski
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Kerry Thomas
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Richard Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Parvati Ramchandani
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94143-0628, USA.
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20
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Kundu G, Shetty R, Khamar P, Gupta S, Mullick R, Ganesan VL, D'Souza S. Impact of tear optics on the repeatability of Pentacam AXL wave and iTrace in measuring anterior segment parameters and aberrations. Indian J Ophthalmol 2022; 70:1150-1157. [PMID: 35326004 PMCID: PMC9240491 DOI: 10.4103/ijo.ijo_2153_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/02/2022] Open
Abstract
Purpose: To assess impact of tear optics on repeatability of a Scheimpflug device with a Hartmann Shack aberrometer and a ray tracing aberrometer. Methods: One hundred healthy and 100 postrefractive surgery eyes underwent dry eye evaluation including Schirmer’s test and tear film break-up time (TBUT). They underwent optical quality analyzer (OQAS, Visio metrics S.L, Terrassa, Spain) to assess objective scatter index (OSI), three scans each on Pentacam AXL wave (OCULUS Optikgerate Gmbh, Wetzlar, Germany), iTrace (Tracey™ Technologies, Texas, USA) for flat, steep keratometry, thinnest corneal thickness, root mean square higher-order aberrations (RMS HOA), RMS lower-order aberrations (LOA), spherical aberrations, RMS COMA. Repeatability of Pentacam AXL wave and iTrace in healthy and postrefractive eyes (OSI >1 vs OSI <1) was studied using within-subject standard deviation (Sw) test–retest repeatability (TRT), coefficient of variation (COV). Results: OSI showed an inverse association with TBUT (P < 0.001). All measurements with Pentacam AXL wave with OSI < 1 had excellent repeatability, intraclass correlation coefficient (ICC) ranging from 0.88 for HOA, to 0.92 for LOA. The Sw, TRT, and COV of all aberration measurements were significantly lower (better) than those of iTrace. In eyes with OSI ≥1, the repeatability with Pentacam AXL wave dropped with ICC ranging from 0.77 for HOA, to 0.84 for LOA with lower Sw, TRT, and COV of all aberration measurements as compared to iTrace. Maximum variation was seen with HOA and minimum with LOA Conclusion: Tear optics affected repeatability of Pentacam wave and iTrace. Pentacam wave had better repeatability in eyes with a poor tear film as compared to iTrace. Thus, the tear film can impact repeatability of an instrument and it is important to assess the tear film prior to imaging patients, which can change the way we interpret and image these patients.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sneha Gupta
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Vaitheeswaran L Ganesan
- Department of Cornea, External Disease and Refractive Surgery, The Ottawa Hospital (TOH) and Precision Cornea Centre, Ottawa, Canada
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Adenwala A, Shetty R, D'Souza S, Mahendradas P, Kundu G. Nodular scleritis-a rare presentation of COVID-19& variation with testing. Am J Ophthalmol Case Rep 2022; 25:101396. [PMID: 35136848 PMCID: PMC8810438 DOI: 10.1016/j.ajoc.2022.101396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose – To report a rare case of patient presenting with nodular scleritis and SARS-CoV2. Observations This case highlights a unique presentation of SARS-CoV2 positive patient with nodular scleritis as a presenting feature. Patient initially had ocular symptoms and developed only mild systemic features subsequently which did not require hospitalization. COVID testing done at different time points showed variable results which correlated with the ocular features. This patient was followed up during quarantine using tele-ophthalmology. Conclusion and importance This case highlights a possible rare presentation of a SARS-CoV2 patient with nodular scleritis and also importance of tele medicine during these unprecedented times.
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D'Souza S, Du Plessis SM, Egieyeh S, Bekale RB, Maphasa RE, Irabin AF, Sampson SL, Dube A. Physicochemical and Biological Evaluation of Curdlan-Poly(Lactic-Co-Glycolic Acid) Nanoparticles as a Host-Directed Therapy Against Mycobacterium Tuberculosis. J Pharm Sci 2022; 111:469-478. [PMID: 34534573 PMCID: PMC8792347 DOI: 10.1016/j.xphs.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022]
Abstract
Nanoparticles (NPs) that can activate macrophages infected with the tuberculosis causative pathogen Mycobacterium tuberculosis, could be an effective host directed therapy for the disease. In this study, curdlan was conjugated to poly(lactic-co-glycolic acid) (PLGA) to produce immunotherapeutic NPs. Various physicochemical characterizations were used to evaluate the curdlan-PLGA copolymer and the NPs. Molecular dynamics and simulation studies were used to characterize the interaction between curdlan, on the polymer and on NPs, with the Dectin-1 macrophage receptor. NPs with varying curdlan densities were evaluated for their effects on the production of pro- and anti-inflammatory cytokines in M. tuberculosis infected RAW264.7 macrophages. The killing efficacy of the NPs against intracellular M. tuberculosis was assessed. Physicochemical characterization of the curdlan-PLGA copolymer and NPs indicated successful formation of curdlan-PLGA copolymer and NPs of varying curdlan density (0-8% w/w) had sizes between 330 and 453 nm. Modelling studies showed curdlan to have a strong affinity for Dectin-1. Cytotoxicity assays showed the NPs to be non-toxic over 72 h. The proinflammatory cytokine TNF-α was found to be significantly upregulated by the NPs. The NPs reduced intracellular M. tuberculosis burden over 72 h. These NPs are a promising host directed therapy for intracellular eradication of M. tuberculosis.
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Affiliation(s)
- S D'Souza
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - S M Du Plessis
- NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Egieyeh
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - R B Bekale
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - R E Maphasa
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - A F Irabin
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - S L Sampson
- NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Dube
- School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa.
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23
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Mullick R, Annavajjhala S, Thakur P, Mohapatra A, Shetty R, D'Souza S. Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation. Indian J Ophthalmol 2021; 69:3473-3477. [PMID: 34826977 PMCID: PMC8837309 DOI: 10.4103/ijo.ijo_3822_20] [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 evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops on patients with dry eye disease (DED) with inflammation as measured by raised tear matrix metalloproteinases (MMP-9). Methods This prospective study included 106 eyes of 53 patients diagnosed with DED based on any of the following DED criteria (Ocular Surface Disease Index [OSDI] score >12, tear film breakup time [TBUT] <10 s, Schirmer's I test result <10 mm/5 min, ocular surface staining). Ocular surface inflammation was assessed by assessing MMP-9 positivity from tears of the patients in the study (Inflammadry kit Quidel corporation). Patients were prescribed osmoprotective lubricating eye drops (Osmodrops, Cipla Ltd) four times a day and cyclosporine A 0.05% eye drops (Imudrops, Cipla Ltd) twice a day for 6 months. Efficacy of the formulations was evaluated by OSDI scores, Schirmer's test, TBUT change, reduction in ocular surface staining, and reduction in MMP-9 levels after 6 months of usage. Check P value and add from results. Results After 6 months of topical therapy, improvement was observed in OSDI scores (mean pretreatment: 25.7 ± 12.8, and mean posttreatment: 15.2 ± 8.4), P < 0.001. There was also reduction number of patients who were MMP-9 positive. Out of 75 eyes that tested MMP-9 positive, 70.66% showed reduction in MMP-9 levels P < 0.0001). Ocular surface staining also improved. Conclusion Topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduce inflammation in cases of DED, which correlates with improvement in OSDI scores, ocular surface staining, and reduction in inflammation as measured by levels of tear MMP-9.
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Affiliation(s)
- Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sriram Annavajjhala
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Prashansa Thakur
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Ayushi Mohapatra
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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D'Souza S, Nair AP, Sahu GR, Vaidya T, Shetty R, Khamar P, Mullick R, Gupta S, Dickman MM, Nuijts RMMA, Mohan RR, Ghosh A, Sethu S. Keratoconus patients exhibit a distinct ocular surface immune cell and inflammatory profile. Sci Rep 2021; 11:20891. [PMID: 34686755 PMCID: PMC8536707 DOI: 10.1038/s41598-021-99805-9] [Citation(s) in RCA: 4] [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] [Received: 07/23/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory factors have been considered to contribute to keratoconus (KC) pathogenesis. This study aims to determine the immune cells subsets and soluble inflammatory factor profile on the ocular surface of KC patients. 32 KC subjects (51 eyes) across different grades of severity and 15 healthy controls (23 eyes) were included in the study. Keratometry and pachymetry measurements were recorded. Ocular surface immune cells (collected by ocular surface wash) immunophenotyped using flow cytometry include leukocytes, neutrophils, macrophages, natural killer (NK) cells, pan-T cells, gamma delta T (γδT) cells and NKT cells. Tear fluid collected using Schirmer's strip was used to measure 50 soluble factors by multiplex ELISA. Proportions of activated neutrophils, NK cells and γδT cells were significantly increased in KC patients. Significantly higher levels of tear fluid IL-1β, IL-6, LIF, IL-17A, TNFα, IFNα/β/γ, EPO, TGFβ1, PDGF-BB, sVCAM, sL-selectin, granzyme-B, perforin, MMP2, sFasL and IgE, along with significantly lower levels of IL-1α and IL-9 were observed in KC patients. Alterations observed in few of the immuno-inflammatory parameters correlated with grades of disease, allergy, eye rubbing and keratometry or pachymetry measurements. The observation implies a distinct immuno-inflammatory component in KC pathogenesis and its potential as an additional therapeutic target in KC management.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, 3rd Floor, Narayana Nethralaya, #258/A Hosur Road, Bommasandra, Bangalore, 560099, India.,Manipal Academy of Higher Education, Manipal, India
| | - Ganesh Ram Sahu
- GROW Research Laboratory, Narayana Nethralaya Foundation, 3rd Floor, Narayana Nethralaya, #258/A Hosur Road, Bommasandra, Bangalore, 560099, India
| | - Tanuja Vaidya
- GROW Research Laboratory, Narayana Nethralaya Foundation, 3rd Floor, Narayana Nethralaya, #258/A Hosur Road, Bommasandra, Bangalore, 560099, India.,Manipal Academy of Higher Education, Manipal, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Sneha Gupta
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rajiv R Mohan
- Department of Veterinary Medicine and Surgery, University of Missouri, 1600 E. Rollins Rd, Columbia, MO, 65211, USA. .,Mason Eye Institute, School of Medicine, University of Missouri, Columbia, MO, USA. .,Harry S Truman Veterans' Memorial Hospital, Columbia, MO, USA.
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, 3rd Floor, Narayana Nethralaya, #258/A Hosur Road, Bommasandra, Bangalore, 560099, India. .,Singapore Eye Research Institute, Singapore, Singapore.
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, 3rd Floor, Narayana Nethralaya, #258/A Hosur Road, Bommasandra, Bangalore, 560099, India.
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D'Souza S, Shetty R, Kundu G, Sharma N, Tandon R, Matalia H, Gorimanipalli B, Jayadev C. COVID-19 positivity rate in corneal tissue donors - A cause for concern! Indian J Ophthalmol 2021; 69:2808-2811. [PMID: 34571639 PMCID: PMC8597523 DOI: 10.4103/ijo.ijo_1163_21] [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: 12/11/2022] Open
Abstract
Purpose To determine the postmortem positivity for COVID-19 among voluntary eye donors who had been certified to have died of non-COVID-19 causes. Methods All donors who donated their corneas (from March 2021 onward) were assessed for COVID-19 positivity tested by nasopharyngeal swab reverse transcription-polymerase chain reaction (RT-PCR) test. Relevant screening history was taken prior to collection. Strict precautions were taken during the retrieval as per the guidelines issued by the National Program for Control of Blindness and Visual Impairment and the Eye Bank Association of India, and the tissues were handled as per standard operating protocol. Results 85 eye calls were attended during this period, of which 56 were home-based and 29 were from a hospital setting. Samples from 12 of the former group of donors were found to be positive for COVID-19 (14%). Conclusion This study highlights the possibility of postmortem RT-PCR positivity in voluntary corneal tissue donors without a prior history of symptoms, signs, or diagnosis of illness suggestive of COVID-19. It is recommended that postmortem testing of donors should be done by RT-PCR for retrievals made during the pandemic.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Gairik Kundu
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Namrata Sharma
- Cornea, Cataract and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Cataract and Refractive Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Himanshu Matalia
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Bhavya Gorimanipalli
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreoretina Services, Narayana Nethralaya, Bangalore, Karnataka, India
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Shetty R, Ahuja P, D'Souza S, Khamar P, Paritekar P, Dadachanji Z, Sinha Roy A. Simultaneous Topography-Guided PRK/CXL Versus Topography-Assisted PTK/CXL: 1-Year Prospective Outcomes in Keratoconic Eyes. J Refract Surg 2021; 37:562-569. [PMID: 34388071 DOI: 10.3928/1081597x-20210609-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare 1-year visual and tomographic outcomes of topography-guided photorefractive keratectomy (TGPRK) and topography-assisted phototherapeutic keratectomy (TPTK) with corneal cross-linking (CXL). METHODS TGPRK and TPTK were performed in 72 eyes (68 patients) and 74 eyes (71 patients), respectively. Based on the TGPRK ablation plan, the eyes underwent TPTK where the theoretical minimum corneal thickness (MCT) after surgery was less than 400 µm. In the TGPRK group, the theoretical maximum ablation depth was 50 µm after epithelium removal. In TPTK, a decentered single-step PTK was performed only in the steepest anterior curvature zone and the stromal ablation depth was limited to 25 µm. After ablation, accelerated CXL was performed in the central 8-mm zone (9 mW/cm2 for 10 minutes in "epithelium-off" mode) in both TGPRK and TPTK. The visual acuity and tomography were assessed. RESULTS Improvement in uncorrected (P = .73) and corrected (P = .66) distance visual acuity was similar between the two groups. However, TGPRK eyes had a greater decrease in keratometry, anterior defocus, and spherical aberration (P < .001) at the cost of greater ablation of tissue (P < .001). The median MCT decreased by 27 and 52.5 µm in the TPTK and TGPRK eyes, respectively. Both groups had similar decreases in anterior root mean square of lower (P = .10) and higher (P = .12) order aberrations. CONCLUSIONS Both TGPRK and TPTK improved visual acuity in the keratoconic eyes at 1 year of follow-up. However, TPTK removed less volume of tissue. Further, it could be an alternative to TGPRK if the theoretical stromal ablation exceeds 50 µm in thin keratoconic corneas. [J Refract Surg. 2021;37(8):562-569.].
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D'Souza S, James E, Swarup R, Mahuvakar S, Pradhan A, Gupta K. Algorithmic approach to diagnosis and management of post-refractive surgery dry eye disease. Indian J Ophthalmol 2021; 68:2888-2894. [PMID: 33229664 PMCID: PMC7856989 DOI: 10.4103/ijo.ijo_1957_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/06/2022] Open
Abstract
Dry eye disease (DED) is a condition that is fast reaching epidemic proportions around the world. Dry eye post-refractive surgery is the leading cause of iatrogenically induced DED. The wide variety of presentations and the disparity between signs and symptoms in many patients make this a very challenging aspect of our clinical practice. There has been a paradigm shift in the way we approach and treat this condition. The International Dry eye workshop has added new knowledge and focus to our management of dry eye. A wide range of newer diagnostic modalities are available for the diagnosis of DED. Dry eye is one of the most common side effects of refractive surgery and can have a bearing the patient's perception of surgical outcomes as well. A thorough understanding of the possible underlying etiopathologies of this disease and the difference in etiopathogenesis of postrefractive dry eye is essential for optimal outcomes. It is important to approach each case in a unique fashion and customize the therapy to the patient presentation. This review article compiles all these aspects of management of dry eye in general, and postrefractive surgery dry eye in particular; from the ones commonly practiced in the clinic to the newer modalities of therapy with insights into the disease from a more practical point of view.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Edwin James
- Department of Ophthalmology, Government Medical College, Paripally, Kerala, India
| | - Rishi Swarup
- Director and Consultant Cornea, Cataract and Refractive, Swarup Eye Centre, Hyderabad, Telangana, India
| | - Sheetal Mahuvakar
- Consultant Cataract Cornea and Refractive Surgery, Retina Foundation, Ahmedabad, Gujarat, India
| | - Aditya Pradhan
- Consultant Cataract, Cornea and External Disease, Disha Eye Hospital, Barrakpore, Kolkata, West Bengal, India
| | - Krati Gupta
- Department of Cornea and Refractive, Narayana Nethralaya, Bangalore, Karnataka, India
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Ahuja P, Dadachanji Z, Shetty R, Nagarajan SA, Khamar P, Sethu S, D'Souza S. Relevance of IgE, allergy and eye rubbing in the pathogenesis and management of Keratoconus. Indian J Ophthalmol 2021; 68:2067-2074. [PMID: 32971611 PMCID: PMC7727983 DOI: 10.4103/ijo.ijo_1191_19] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/31/2022] Open
Abstract
Keratoconus (KC) is an ectatic disease of the cornea characterized by localized thinning and protrusion causing irregular astigmatism, which can lead to significant visual impairment. KC has often been associated with allergy and/or atopy, which are immune-mediated inflammatory reactions primarily driven by IgE. A higher proportion of KC patients were reported to have history or suffer from systemic and/or ocular allergy with elevated allergen-specific IgE and/or total serum IgE. Eye rubbing, one of the risk factors for worsening of the disease and developing related complications in KC, is associated with IgE driven conditions. The current review enumerates and contextualizes the evidence related to IgE in mediating KC pathogenesis, including aberrant extra-cellular matrix remodeling. This review also discusses clinical strategies directed at modulating IgE-mediated responses in the management of KC, and the emerging academic and plausible clinical relevance of assessing serum and tear IgE (allergen-specific and total) status in improving the understanding of disease pathobiology, treatment planning, and prognosis.
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Affiliation(s)
- Prerna Ahuja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Zelda Dadachanji
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sowmya Arudi Nagarajan
- Department of Paediatrics, Allergy and Immunology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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Nair AP, D'Souza S, Shetty R, Ahuja P, Kundu G, Khamar P, Dadachanji Z, Paritekar P, Patel P, Dickman MM, Nuijts RM, Mohan RR, Ghosh A, Sethu S. Altered ocular surface immune cell profile in patients with dry eye disease. Ocul Surf 2021; 21:96-106. [PMID: 33862224 DOI: 10.1016/j.jtos.2021.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/18/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Aberrant inflammation and immune dysregulation are known pathogenic contributors in dry eye disease (DED). Aim of the study was to determine the proportions of immune cell subsets on the ocular surface (OS) of DED patients. METHODS 15 healthy controls (22 eyes) and 48 DED subjects (36 eyes with evaporative DED - EDED; 60 eyes with aqueous deficient DED - ADED) were included in the study. Tear break up time (TBUT), Schirmer's test 1 (ST1), corneal staining (CS) and ocular surface disease index (OSDI) scoring were recorded. OS wash was used to collect immune cells on the OS of study subjects. The cells immunophenotyped using flow cytometry include leukocytes, neutrophils, macrophages, natural killer-NK cells and T cell subsets (CD4; CD8; double positive-DP; gamma delta-γδ and NK T cells). RESULTS Significantly higher proportions of leukocytes, neutrophils, CD4 T cells, CD8 T cells, DP T cells and CD4/CD8 T cells ratio were observed in EDED and/or ADED patients. Significantly higher proportions of neutrophils and lower proportions of NK cells were observed in ADED subjects with corneal staining compared to those without and controls. Neutrophils/NK cells ratio was significantly higher in EDED and ADED subjects compared to controls. Correlation analysis revealed pathological relationships between proportions of leukocytes, neutrophils, CD4 T cells and Neutrophil/NK cells ratio with DED clinical parameters. CONCLUSION OS immune cell subset proportion changes in DED patients were associated with DED types and severity. The data suggests the potential for a new generation of therapies targeting immune cells on the ocular surface.
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Affiliation(s)
- Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; Manipal Academy of Higher Education, Manipal, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Prerna Ahuja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Zelda Dadachanji
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Prajakta Paritekar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Pavitra Patel
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands; MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - Rudy Mma Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rajiv R Mohan
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA; Mason Eye Institute, School of Medicine, University of Missouri, Columbia, MO, USA; Harry S Truman Veterans' Memorial Hospital, Columbia, MO, USA.
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India; Singapore Eye Research Institute, Singapore.
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.
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Vohra V, Shetty R, James E, Kundu G, D'Souza S. Evaluating the safety and efficacy of compression sutures with intracameral perfluoropropane (C3F8) in the management of acute corneal hydrops. Int Ophthalmol 2021; 41:2027-2031. [PMID: 33616834 DOI: 10.1007/s10792-021-01758-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the safety and efficacy of using corneal compression sutures with intracameral perfluoropropane (C3F8) in patients presenting with acute corneal hydrops in ectatic disorders. METHODS A retrospective analysis was done for 43 eyes of patients of acute corneal hydrops, managed using a combination of intracameral 14% C3F8 and full-thickness compression sutures. Time for resolution of edema, corneal thickness (CT) change on anterior segment ocular coherence tomography (ASOCT), and visual outcomes were assessed. RESULTS Corneal edema resolved with a mean duration of 14.8 ± 3.5 days (range 10-21). The mean CT on ASOCT decreased from a mean of 1437 µm (689-2770 µm) preoperatively to 543 µm (434 -66 µm) on the complete resolution of corneal edema. CONCLUSION Our results suggest that full-thickness compression sutures and intracameral C3F8 injection can restore the imperviousness of posterior stroma. This technique appears to be a safe and effective technique for faster resolution of corneal edema post hydrops.
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Affiliation(s)
- Vishal Vohra
- Narayana Nethralaya Eye Hospital, Bangalore, India. .,Department of Ophthalmology, Royal Victoria Infirmary, NE1 4LP, New Castle Upon Tyne, UK.
| | - Rohit Shetty
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Edwin James
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Gairik Kundu
- Narayana Nethralaya Eye Hospital, Bangalore, India
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Abstract
Purpose: To evaluate the relation of the tear film on the quality of vision comparing parameters in normal patients to those having dry eye disease. Methods: 50 normal and 50 eyes with dry eye disease (DED) were included in the study. Patients were screened for dry eye with Schirmer's test, tear break up time, ocular surface staining, and assessment of meibomian gland disease. Their quality of vision was assessed using the Optical quality analysis system (OQAS). The results of dry eye evaluation were correlated with the parameters on the OQAS especially the mean objective scatter index (OSI). Results: Patients with dry eye and unstable tear film were found to have a significantly worse quality of vision and optical scatter (P < 0.05). They were also noted to have fluctuation of vision between blinks. Conclusion: Tear film optics can have an important bearing on the quality of vision and quality of life. A detailed assessment preoperatively will help improve surgical outcomes and patient satisfaction.
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Affiliation(s)
- Sharon D'Souza
- Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | | | | | - Ritika Mullick
- Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - S J Tejal
- Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Naren Shetty
- Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Abstract
Keratoconus (KC) is a corneal ectatic condition characterized by focal structural changes, resulting in progressive thinning, biomechanical weakening, and steeping of the cornea that can lead to worsening visual acuity due to irregular astigmatism and corneal scarring in more advanced cases. It is a relatively common ectatic disease of the cornea predominantly affecting the younger population. Despite its worldwide prevalence, its incidence is rather varied with a higher incidence among the Middle Eastern and South Asian population. Dysregulated corneal extracellular matrix remodeling underlies KC pathogenesis. However, a lack of absolute clarity regarding the factors that initiate and drive progression poses a significant challenge in its prevention and management. KC is a complex multifactorial disease as it is associated with a wide variety of etiological factors such as environmental stimuli/insults, oxidative stress, genetic predisposition, comorbidities, and eye rubbing. A series of studies using corneal tissues (epithelium, stroma), cultured corneal fibroblasts/keratocytes, tear fluid, aqueous humor, and blood from KC subjects has reported significant alterations in various biochemical factors such as extracellular matrix components, cellular homeostasis regulators, inflammatory factors, hormones, metabolic products, and chemical elements. It has become apparent that alterations in the biochemical mediators (related to various etiologies) could contribute to KC pathogenesis by altering the dynamics of extracellular matrix remodeling events such as collagen deposition, degradation, and cross-linking in the cornea. Determining key disease contributing biochemical mediators would aid in disease monitoring, prediction or abatement of disease progression, and development of targeted therapeutics to improve disease prognosis.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Arkasubhra Ghosh
- GROW Research Lab, Narayana Nethralaya Foundation, Bangalore, India
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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Kundu G, D'Souza S, Lalgudi VG, Arora V, Chhabra A, Deshpande K, Shetty R. Photorefractive keratectomy (PRK) Prediction, Examination, tReatment, Follow-up, Evaluation, Chronic Treatment (PERFECT) protocol - A new algorithmic approach for managing post PRK haze. Indian J Ophthalmol 2020; 68:2950-2955. [PMID: 33229676 PMCID: PMC7857001 DOI: 10.4103/ijo.ijo_2623_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to discuss the possible risk factors predisposing to post photorefractive keratectomy (PRK) haze formation and develop and validate a risk scoring system, so that this could be applied to our clinical practice as an algorithmic approach. Methods Study was divided into 2 arms, in the retrospective arm we looked at 238 eyes of patients undergoing PRK where certain presumed risk factors from literature and clinical experience were identified and statistical significance of association was studied in the development of corneal haze. The risk scoring system was applied to the 450 eyes in the prospective arm for validation. This was then used to formulate an algorithmic approach to manage post-PRK haze. Results 22 out of 238 eyes in the retrospective arm developed haze where risk factors such as contact lens intolerance, altered tear film break up time, meibomian gland drop out and vitamin d levels were significantly associated with post-PRK haze (p < 0.05) and these factors were identified in the prospective arm. Treatment of these modifiable factors led to a significant reduction in post-PRK haze. Conclusion Thus identifying and treating risk factors of haze in patients undergoing PRK could improve surgical outcomes and patient satisfaction.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | | | | | - Aishwarya Chhabra
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | | | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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D'Souza RS, D'Souza S, Sharpe EE. YouTube as a source of medical information about epidural analgesia for labor pain. Int J Obstet Anesth 2020; 45:133-137. [PMID: 33339713 DOI: 10.1016/j.ijoa.2020.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Large gaps remain in our understanding of the role of social media platforms in the dissemination of medical information. This cross-sectional study quantitatively assessed the accuracy and quality of information on YouTube regarding epidural labor analgesia. METHODS YouTube was searched on May 23, 2020 using keywords 'epidural,' 'epidural for labor,' 'epidural for pregnancy,' 'epidural experience,' and 'epidural risks,' and the top 50 viewed videos from each search were screened. Primary outcomes included the proportion of videos containing non-factual information, and video quality analyzed using the modified DISCERN (mDISCERN) score. RESULTS Thirteen of 60 (21.7%) videos included non-factual information about epidural analgesia; these videos were viewed more than 16.5 million times (60% of total viewership of the videos analyzed). Mean (standard deviation) mDISCERN score for all included videos was 1.9 (1.3), which is below the threshold for high video-quality. Videos from medical sources (hospitals, medical practices, physicians, other medical professionals) had a higher mDISCERN score compared with videos by non-medical sources (P <0.001). Educational videos from professional societies of obstetrics or obstetric anesthesiology were not captured. CONCLUSION YouTube is an accessible platform for medical information on epidural labor analgesia, although a significant proportion of videos studied contained non-factual information and presented low video quality. Increased efforts by reputable sources including hospitals, physicians, other medical professionals, and professional societies, to disseminate accurate information, are warranted.
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Affiliation(s)
- R S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic Hospital, Rochester, MN, USA.
| | - S D'Souza
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - E E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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Dua HS, Sinha R, D'Souza S, Potgieter F, Ross A, Kenawy M, Scott I, Said DG. "Descemet Membrane Detachment": A Novel Concept in Diagnosis and Classification. Am J Ophthalmol 2020; 218:84-98. [PMID: 32574777 DOI: 10.1016/j.ajo.2020.05.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the optical coherence tomography (OCT) and histologic features of Descemet membrane detachment (DMD) to ascertain the involvement of the pre-Descemet layer (PDL). DESIGN Retrospective, observational case series. METHODS Clinical, histopathologic, and OCT features of a cohort of 41 cases with diagnosis of DMD from 4 centers were studied. OCT images were evaluated independently by 3 observers for number of detached layers (1 or 2), reflectivity, configuration (straight line or wavy), distance from posterior stroma, and presence or absence of a tear with any scrolling of the torn edges. Five had a histology specimen. The main outcome measure was the involvement of the PDL in DMD and its confirmation by histology. RESULTS Three types of DMD were identified: type 1, where the PDL and DM were detached together; type 2, where only the DM was detached; and mixed, where the PDL and DM were detached but also separated from each other. These were further found to be rhegmatogenous or nonrhegmatogenous depending on the presence of absence of a tear in DM or both layers. Histology confirmed involvement of PDL in all 5 cases and showed it to be infiltrated by cells in 3 of 5 cases. CONCLUSIONS The PDL is involved in DMD. This fact significantly changes our understanding of DMD and could have implications for management. The detached PDL can be infiltrated with cells. A prospective study in relation to etiology and types of DMD is needed.
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Panigrahi T, D'Souza S, Shetty R, Padmanabhan Nair A, Ghosh A, Jacob Remington Nelson E, Ghosh A, Sethu S. Genistein-Calcitriol Mitigates Hyperosmotic Stress-Induced TonEBP, CFTR Dysfunction, VDR Degradation and Inflammation in Dry Eye Disease. Clin Transl Sci 2020; 14:288-298. [PMID: 32896986 PMCID: PMC7877851 DOI: 10.1111/cts.12858] [Citation(s) in RCA: 3] [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] [Received: 05/01/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023] Open
Abstract
Dry eye disease (DED) signs and symptoms are causally associated with increased ocular surface (OS) inflammation. Modulation of key regulators of aberrant OS inflammation is of interest for clinical management. We investigated the status and the potential to harness key endogenous protective factors, such as cystic fibrosis transmembrane conductance regulator (CFTR) and vitamin D receptor (VDR) in hyperosmotic stress‐associated inflammation in patients with DED and in vitro. Conjunctival impression cytology samples from control subjects (n = 11) and patients with DED (n = 15) were used to determine the status of hyperosmotic stress (TonEBP/NFAT5), inflammation (IL‐6, IL‐8, IL‐17A/F, TNFα, MMP9, and MCP1), VDR, and intracellular chloride ion (GLRX5) by quantitative polymerase chain reaction and/or immunofluorescence. Human corneal epithelial cells (HCECs) were used to study the effect of CFTR activator (genistein) and vitamin D (calcitriol) in hyperosmotic stress (HOs)‐induced response in vitro. Western blotting was used to determine the expression of these proteins, along with p‐p38. Significantly, higher expression of inflammatory factors, TonEBP, GLRX5, and reduced VDR were observed in patients with DED and in HOs‐induced HCECs in vitro. Expression of TonEBP positively correlated with expression of inflammatory genes in DED. Increased TonEBP and GLRX5 provides confirmation of osmotic stress and chloride ion imbalance in OS epithelium in DED. These along with reduced VDR suggests dysregulated OS homeostasis in DED. Combination of genistein and calcitriol reduced HOs‐induced TonEBP, inflammatory gene expression, and p‐p38, and abated VDR degradation in HCECs. Henceforth, this combination should be further explored for its relevance in the management of DED.
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Affiliation(s)
- Trailokyanath Panigrahi
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Gene Therapy Laboratory, Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India
| | - Anuprita Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Everette Jacob Remington Nelson
- Gene Therapy Laboratory, Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Singapore Eye Research Institute, Singapore, Singapore
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
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Jayadev C, Mahendradas P, Vinekar A, Kemmanu V, Gupta R, Pradhan ZS, D'Souza S, Aroor CD, Kaweri L, Shetty R, Honavar SG, Shetty B. Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology. Indian J Ophthalmol 2020; 68:1316-1327. [PMID: 32587157 PMCID: PMC7574118 DOI: 10.4103/ijo.ijo_1509_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 12/20/2022] Open
Abstract
While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.
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Affiliation(s)
- Chaitra Jayadev
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Anand Vinekar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Vasudha Kemmanu
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Roshmi Gupta
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Zia S Pradhan
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Chaithra D Aroor
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Santosh G Honavar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Bhujang Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
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Sharma N, D'Souza S, Nathawat R, Sinha R, Gokhale NS, Fogla R, Titiyal JS, Maskati QB, Mukherjee G, Sachdev MS. All India Ophthalmological Society - Eye Bank Association of India consensus statement on guidelines for cornea and eyebanking during COVID-19 era. Indian J Ophthalmol 2020; 68:1258-1262. [PMID: 32587148 PMCID: PMC7574107 DOI: 10.4103/ijo.ijo_1554_20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 01/19/2023] Open
Abstract
The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread. A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe. This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time. These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients.
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Affiliation(s)
- Namrata Sharma
- Secretary, All India Ophthalmological Society, Secretary, Eye Bank Association of India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakhi Nathawat
- Consultant, Eye Bank Association of India, All India Ophthalmological Society, New Delhi, India
| | - Rajesh Sinha
- Treasurer, All India Ophthalmological Society, Secretary Indian Society of Cornea & Keratorefractive Surgeons, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil S Gokhale
- President, Cornea Society of India, Gokhale Eye Hospital, Mumbai, Maharashtra, India
| | - Rajesh Fogla
- Director, Cornea Clinic, Apollo Hospital, Hyderabad, India
| | - J S Titiyal
- President, Indian Society of Cornea & Keratorefractive Surgeons, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Quresh B Maskati
- Past President, Cornea Society of India, Maskati Eye Clinic, Mumbai, Maharashtra, India
| | - Gobinda Mukherjee
- President, Eye Bank Association of India, Mukherjee Eye Clinic, New Delhi, India
| | - Mahipal S Sachdev
- President, All India Ophthalmological Society, Chairman, Centre for Sight, New Delhi, India
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Shetty R, Lalgudi VG, Khamar P, Gupta K, Sethu S, Nair A, Honavar SG, Ghosh A, D'Souza S. Potential ocular and systemic COVID-19 prophylaxis approaches for healthcare professionals. Indian J Ophthalmol 2020; 68:1349-1356. [PMID: 32587162 PMCID: PMC7574070 DOI: 10.4103/ijo.ijo_1589_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has brought with it, innumerable challenges in healthcare, both through the direct burden of morbidity and mortality of the disease, and also by the curtailing of other essential albeit less emergency medical services to reduce the risk of community spread. Reports from around the world are showing mounting number of cases even in healthcare professionals spite of usage of adequate personal protective equipment. There are a number of factors which could account for this, be it the affinity of the virus to the respiratory and other mucosa or to patient risk factors for developing severe forms of the disease. In view of the growing need for resuming other medical services, it is essential to find newer ways to protect ourselves better, whether by systemic or topical mucosal prophylaxis with various medications or lifestyle changes promoting wellbeing and immunity. This article discusses additional prophylactic measures including drug repurposing or new indication paradigms to render protection. Certain medications such as chloroquine, trehalose, antihistaminics, and interferons used topically for various ocular conditions with reasonably good safety records are known to have anti-viral properties. Hence, can be harnessed in preventing SARS-CoV-2 attachment, entry, and/or replication in host cells. Similarly, use of hypertonic saline for nasal and oral mucosa and dietary changes are possible methods of improving our resistance. These additional prophylactic measures can be cautiously explored by healthcare professionals to protect themselves and their patients.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | | | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Krati Gupta
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Archana Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Santosh G Honavar
- Department of Orbit, Ocular Oncology and Facial Plastic Surgery, Centre for Sight Superspeciality Eye Hospital, Hyderabad, Telangana, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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Shetty R, Jayadev C, Chabra A, Maheshwari S, D'Souza S, Khamar P, Sethu S, Honavar SG. Sanitizer aerosol-driven ocular surface disease (SADOSD)-A COVID-19 repercussion? Indian J Ophthalmol 2020; 68:981-983. [PMID: 32461409 PMCID: PMC7508141 DOI: 10.4103/ijo.ijo_1308_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/21/2022] Open
Abstract
Since the onset of the COVID-19 pandemic, there has been an advisory for regular and thorough cleaning of hands besides other measures such as social distancing and self-isolation. The rationale for the same is to prevent the transfer of the virus from hands that have come in contact with fomites. While both alcohol-based hand rubs (ABHR) or washing with soap and water are claimed to have been effective, hand sanitizers have gained more popularity due to the ease of use. The increased frequency of ABHR use and the aerosols generated pose a potential threat to the skin and exposed mucosal surfaces, especially that of the eye due to the proximity of use. The adverse effects of alcohol in these sanitizers can be manifold. An allergic or inflammatory response can occur depending on the predisposing or preexisting conditions. This article describes the risks, underlying mechanisms, and preventive measures for sanitizer aerosol-driven ocular surface disease.
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Affiliation(s)
- Rohit Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Aishwarya Chabra
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Sonia Maheshwari
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Swaminathan Sethu
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Santosh G Honavar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
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Affiliation(s)
- Rohit Shetty
- Consultant, Cornea and Refractive Surgery Department, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Consultant, Cornea and Refractive Surgery Department, Narayana Nethralaya, Bengaluru, Karnataka, India
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Shetty R, Naidu JR, Nair AP, Vaidya TA, D'Souza S, Matalia H, Deshpande V, Sethu S, Ghosh A, Chakrabarty K. Distinct ocular surface soluble factor profile in human corneal dystrophies. Ocul Surf 2019; 18:237-248. [PMID: 31756391 DOI: 10.1016/j.jtos.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/13/2019] [Revised: 09/30/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Corneal dystrophies (CD) are classified as rare eye diseases that results in visual impairment and requires corneal transplant in advanced stages. Ocular surface inflammatory status in different types of CD remains underexplored. Hence, we studied the levels of tear soluble factors in the tears of patients with various types of corneal dystrophies. METHODS 17 healthy subjects and 30 CD subjects (including epithelial, stromal and endothelial CD) were included in the study. Schirmer's strips were used to collect the tear fluid in all subjects. 27 soluble factors including cytokines, chemokines, soluble cell adhesion molecules and growth factors were measured in the eluted tears by multiplex ELISA or single analyte sandwich ELISA. RESULTS Percentages of subjects with detectable levels of tear soluble factors were significantly higher in CD compared to controls. Significant higher level of IL-2 was observed in both epithelial and stromal CD. IL-4, TGFβ1 and IgE were significantly higher in stromal CD. VCAM, IL-13 and Fractalkine were significantly elevated in epithelial and macular CD. IL-1α, IL-8, IL-12, ANG, Eotaxin, MCP1, RANTES, ICAM1, L-selectin and P-selectin were significantly higher in epithelial CD. TGFBIp was significantly elevated in lattice CD and endothelial CD. CONCLUSION Distinct set of the tear soluble factors were dysregulated in various types of CD. Increase in tear inflammatory factors was observed in majority of the CD subjects depending on their sub-types. This suggests a plausible role of aberrant inflammation in CD pathobiology. Hence, modulating inflammation could be a potential strategy in improving the prognosis of CD.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Jagadeesh R Naidu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | | | - Tanuja Arun Vaidya
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Himanshu Matalia
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bengaluru, India; Singapore Eye Research Institute, Singapore.
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Shetty R, D'Souza S. Reply. J Cataract Refract Surg 2019; 45:1693-1694. [PMID: 31706534 DOI: 10.1016/j.jcrs.2019.08.051] [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: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 10/25/2022]
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Yong SA, D'Souza S, Philpot S, Pilcher DV. The Alfred Hospital experience of resumption of cardiac activity after withdrawal of life-sustaining therapy. Anaesth Intensive Care 2017; 44:605-6. [PMID: 27608344 DOI: 10.1177/0310057x1604400508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
With the advent of donation after circulatory death programs in Australia and New Zealand, greater knowledge is needed about physiologic variation in haemodynamic activity following withdrawal of cardiorespiratory support. The ANZICS Statement on Death and Organ Donation allows provision for variation in the observation times between two and five minutes after cessation of the circulation prior to declaration of death. We report our experience of two cases, the first where electrical activity and pulse returned after a 102 second pause and the second where electrical activity returned after a three minute pause; both longer than previously reported cases.
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Affiliation(s)
- S A Yong
- Intensivist, Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria
| | - S D'Souza
- Donation Specialist Nursing , Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria
| | - S Philpot
- Intensivist, Department of Intensive Care, Cabrini Hospital, Adjunct Senior Lecturer, Monash University, Melbourne, Victoria
| | - D V Pilcher
- Intensivist, Department of Intensive Care, The Alfred Hospital, Adjunct Clinical Professor, Department of Epidemiology & Preventive Medicine, Monash University, Chairman, ANZICS Centre for Outcome and Resource Evaluation, Director, ANZICS Adult Patient Database, Medical Advisor, DonateLife, Melbourne, Victoria
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Hartman H, Dodd C, Rao M, DeBlasio D, Labowsky C, D'Souza S, Lenkauskas S, Roeser E, Heffernan A, Assa'ad A. Parental timing of allergenic food introduction in urban and suburban populations. Ann Allergy Asthma Immunol 2016; 117:56-60.e2. [PMID: 27184198 DOI: 10.1016/j.anai.2016.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Recommendations on timing for introduction of allergenic foods in an infant diet have changed twice during the past decade. How families with different demographic characteristics implement the change has not been studied in the United States. OBJECTIVE To compare the age of introduction of allergenic foods between an urban Medicaid-based population and a suburban private insurance-based population in Cincinnati, Ohio. METHODS Two hundred parent surveys were distributed at well-child checkups between 4 and 36 months of age. Data were analyzed using distribution mapping to determine the difference in the age of introduction of infant formula, infant solids, whole cow's milk, eggs, peanut, and fish. Random forest analysis was used to determine the most important factors affecting the age of introduction for both populations. RESULTS There was no statistically significant difference in the age of infant solid introduction, but urban populations introduced allergenic foods earlier than suburban populations, with a statistically significant difference in the age of introduction of infant formula, whole cow's milk, eggs, peanut, and fish. The most important factor for the timing of all food introductions was the recommended age of introduction from health care professionals. CONCLUSION There is a difference between urban and suburban populations in the timing of introduction of allergenic foods but not in other infant solid foods. The reliance on physician recommendation for both populations supports the need for education and guidance to health care professionals on up-to-date guidance and recommendations.
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Affiliation(s)
- Heather Hartman
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Caitlin Dodd
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marepalli Rao
- Center for Clinical and Translational Science and Training, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati, Ohio
| | - Dominick DeBlasio
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. amal.assa'
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D'Souza S, Master S, Jobst C, Switzer L, Cheyne D, Fehlings D. 27: Exploring Sensorimotor Plasticity in Hemiplegic Cerebral Palsy Following Constraint-Induced Movement Therapy. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e43] [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: 11/13/2022] Open
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Abstract
Purpose: To create a nomogram for the insertion of intrastromal corneal ring segments (ICRS) (Intacs® ) in eyes with keratoconus. Setting: Tertiary eye care center in South India. Materials and Methods: This prospective, non-randomized, interventional case series used a self-designed decision-making nomogram for the selection of ICRS in keratoconus patients based on the centration of the cone, mean refractive spherical equivalent (MRSE), and mean keratometry (Km) values. The 3, 6, and 12 months clinical outcomes were compared to historical controls. Primary endpoints were improvement in uncorrected and best-corrected vision and change in the keratometric values. Results: Group A comprised of 52 eyes of 50 patients that followed the nomogram, while Group B comprised of 25 eyes of 23 non-nomogram historical controls matched for baseline parameters. In Group A, the uncorrected distance visual acuity (UDVA) improved from 0.16 ± 0.15 to 0.25 ± 0.16 (P < 0.001), corrected distance visual acuity (CDVA) from 0.58 ± 0.2 to 0.69 ± 0.21 (P = 0.022), MRSE from -5.41 ± 4.94 to -1.71 ± 2.88 (P < 0.001), Km from 51.77 ± 5.45 to 48.63 ± 4.37 (P < 0.001), and astigmatism reduced from 5.86 ± 2.61 to 4.91 ± 2.72 diopters (P < 0.001).In Group B, improvement in the average MRSE was from -6.44 ± 5.32 to -3.26 ± 2.82 (P < 0.013) and in the average Km from 53.64 ± 5.32 to 50.31 ± 5.02 (P < 0.001). Other parameters did not improve significantly. A statistically significant difference was present in the percentage of patients achieving a good clinical outcome between the two groups (P < 0.001; Chi-square). Conclusion: The nomogram provides a means to choose the appropriate ICRS, hence improving the outcome in patients with keratoconus.
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Affiliation(s)
- Rohit Shetty
- Head of Department, Refractive Surgery, Narayana Nethralaya Superspeciality Eye Institute, Bangalore, Karnataka, India
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48
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Abstract
Keratoconus is a progressive ectatic disorder of the cornea which often presents with fluctuating refraction and high irregular astigmatism. Correcting the vision of these patients is often a challenge because glasses are unable to correct the irregular astigmatism and regular contact lenses may not fit them very well. Topography-guided custom ablation treatment (T-CAT) is a procedure of limited ablation of the cornea using excimer laser with the aim of regularizing the cornea, improving the quality of vision and possibly contact lens fit. The aim of the procedure is not to give a complete refractive correction. It has been tried with a lot of success by various groups of refractive surgeons around the world but a meticulous and methodical planning of the procedure is essential to ensure optimum results. In this paper, we attempt to elucidate the planning for a T-CAT procedure for various types of cones and asphericities.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Superspeciality Eye Hospital and Postgraduate Institute, Bangalore, Karnataka, India
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49
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Abstract
Keratoconus is a progressive corneal ectasia, which can be managed both by conservative measures like glasses or contact lenses in non-progressive cases or surgical procedures like collagen crosslinking (CXL) with or without adjuvant measures like intrastromal corneal rings segments (ICRS) or topography guided ablation. Various kinds of ICRS are available to the surgeon, but it is most essential to be able to plan the implantation of the ring to optimize outcomes.
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Affiliation(s)
- Sri Ganesh
- Department of Refractive Surgery, Narayana Nethralaya, Superspeciality Eye Institute, Bangalore, Karnataka, India
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50
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D'Souza S, Petznick A, Tong L, Hall RC, Rosman M, Chan C, Koh SK, Beuerman RW, Zhou L, Mehta JS. Comparative analysis of two femtosecond LASIK platforms using iTRAQ quantitative proteomics. Invest Ophthalmol Vis Sci 2014; 55:3396-402. [PMID: 24801511 DOI: 10.1167/iovs.14-14113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/24/2022] Open
Abstract
PURPOSE New femtosecond laser platforms may reduce ocular surface interference and LASIK-associated dry eye. This study investigated tear protein profiles in subjects who underwent LASIK using two femtosecond lasers to assess differences in protein expression. METHODS This was a randomized interventional clinical trial involving 22 patients who underwent femtosecond laser refractive surgery with a contralateral paired eye design. Corneal flaps of 22 subjects were created by either Visumax or Intralase laser. Tear samples were collected preoperatively, and at 1 week and 3 months postoperatively using Schirmer's strips. Tear protein ratios were calculated relative to preoperative protein levels at baseline. The main outcome measures were the levels of a panel of dry eye protein markers analyzed using isobaric tagging for relative and absolute quantitation (iTRAQ) mass spectrometry. RESULTS A total of 824 unique proteins were quantifiable. Tear protein ratios were differentially regulated between the eyes treated with different lasers. The secretoglobulins Lipophilin A (1.80-fold) and Lipophilin C (1.77) were significantly upregulated (P < 0.05) at 1 week postoperatively in Visumax but not in Intralase-treated eyes. At 1 week, orosomucoid1 was upregulated (1.78) in Intralase but not Visumax-treated eyes. In the same eyes, lysozyme, cathepsin B, and lipo-oxygenase were downregulated at 0.44-, 0.64-, and 0.64-folds, respectively. Transglutaminase-2 was downregulated in both groups of eyes. CONCLUSIONS Different laser platforms induce distinct biological responses in the cornea and ocular surface, which manifests as different levels of tear proteins. This study has implications for surgical technology and modulation of wound healing responses. (ClinicalTrials.gov number, NCT01252654.).
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Affiliation(s)
| | | | - Louis Tong
- Singapore Eye Research Institute, Singapore
| | | | - Mohamad Rosman
- Singapore Eye Research Institute, Singapore Singapore National Eye Centre, Singapore
| | | | | | - Roger W Beuerman
- Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Signature Research Program (SRP) Neuroscience and Behavioural Disorder, DUKE-National University of Singapore Graduate Medical School, Singapore
| | - Lei Zhou
- Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Signature Research Program (SRP) Neuroscience and Behavioural Disorder, DUKE-National University of Singapore Graduate Medical School, Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore Singapore National Eye Centre, Singapore Office of Clinical, Academic, and Faculty Affairs, Duke-National University of Singapore Graduate Medical School, Singapore
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