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Vikas SJ, Agarwal D, Seth S, Kumar A, Kumar A. Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients. Indian J Ophthalmol 2021; 69:3297-3301. [PMID: 34708792 PMCID: PMC8725148 DOI: 10.4103/ijo.ijo_1271_21] [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: 11/18/2022] Open
Abstract
Purpose: To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction. Methods: A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication. Results: The mean CMT improved significantly from 540.6 and 490.2 μm at the baseline to 292.5 and 270.6 μm at 6 months in groups 1 and 2, respectively (P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P1 wave amplitude in ring 2 (2–5°) (P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) (P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group. Conclusion: PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.
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Affiliation(s)
- S J Vikas
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sankalp Seth
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Bafna RK, Kalra N, Asif MI, Agarwal R, Lata S, Titiyal JS, Sharma N, Vikas SJ. Novel technique of tetra trephination for elliptical-shaped tectonic patch grafts in peripheral sterile keratolysis. Eur J Ophthalmol 2021; 31:2769-2775. [PMID: 33685255 DOI: 10.1177/1120672121998955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a novel technique of tectonic patch grafts for elliptical-shaped peripheral sterile keratolysis with iris prolapse. METHODS We performed a full thickness corneo-scleral patch graft in five eyes of five patients with elliptical-shaped peripheral sterile keratolysis with perforation and iris tissue prolapse. In this technique, four disposable trephines with predetermined diameter were employed to fashion both the host and the donor without any free-hand dissection. An intact anatomical integrity of the globe without the need for any repeat tectonic measures was considered as a successful outcome. RESULTS The mean age was 34.2 ± 10.2 years (18-45). The mean total surgical time and donor preparation time was 94.4 ± 7.12 min and 7.6 ± 1.14 min, respectively. The intraoperative course was uneventful in all cases and all eyes had a well-maintained corneal integrity till 6 months follow up. CONCLUSION We describe a simple, reproducible, and time-saving technique of performing elliptical shaped corneoscleral patch grafts for peripheral corneal perforations with iris prolapse.
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Affiliation(s)
- Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rinky Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Lata
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Jee Vikas
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Sundar M D, Chawla R, Balaji A, Garg I, Kalathil R, Hasan N, Vikas SJ, Kumar A. Clinical features, optical coherence tomography findings and treatment outcomes of post-fever retinitis. Ther Adv Ophthalmol 2021; 12:2515841420979111. [PMID: 33415316 PMCID: PMC7750750 DOI: 10.1177/2515841420979111] [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] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives: To study the clinical features, optical coherence tomography (OCT) findings,
treatment options and follow-up outcomes of post-fever retinitis (PFR). Subjects: A total of 19 eyes of 13 patients, diagnosed with PFR (retinitis following
febrile episode) over 2 years were retrospectively studied. Methods: Documented history, baseline clinical features and systemic investigations
performed for PFR were reviewed. Fundus findings, foveal architecture on
swept-source OCT, the treatment options and the follow-up outcomes including
best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were
reviewed and analyzed. Results: Common fundus findings included whitish retinitis lesions (100%), macular
star (95%, 18eyes), retinal flame-shaped hemorrhages (63%, 12 eyes),
inflammatory retinal vessels (30%, 6 eyes), vitreous hemorrhage (one eye)
and OCT findings included neuro-sensory detachment (79%, 15 eyes),
intraretinal white dots (89.5%,17 eyes). The baseline median log MAR BCVA
and CFT were 1.30 (interquartile range (IQR):0.8–1.8) and 423 microns
(IQR:182–555). Overall, nine patients (12 eyes) received a combination of
oral doxycycline and oral steroids and four patients (7 eyes) received a
combination of oral doxycycline, oral steroid and intravitreal anti-vascular
endothelial growth factor (IVA). Significant improvement was evident at 8
weeks in median BCVA (0.50, IQR: 0.3–0.8, p < 0.05) and
median CFT (223 micron, IQR: 170–256, p < 0.05) though
only 26% (5 eyes) attained BCVA > = 6/12. Conclusion: Our study puts forth certain characteristic fundus and OCT features of PFR. A
combination of oral doxycycline and oral steroids as a treatment option
showed improvement in BCVA and CFT. Additional IVA helps in faster visual
recovery in patients presenting with severe macular edema at onset.
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Affiliation(s)
- Dheepak Sundar M
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), Ansari Nagar, Delhi 110029, India
| | - Akshaya Balaji
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA; Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reshmi Kalathil
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - S J Vikas
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science (AIIMS), New Delhi, India
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Affiliation(s)
- Rebika Dhiman
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Srikant K Padhy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Toshit Varshney
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S J Vikas
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Prashant Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atul Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kumawat D, Sahay P, Mahalingam K, Vikas SJ, Sen S, Banerjee M, Venkatesh P. Multifocal electroretinogram in eyes with intravitreal silicone oil and changes following silicone oil removal. Doc Ophthalmol 2019; 139:197-205. [PMID: 31327119 DOI: 10.1007/s10633-019-09710-w] [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: 03/06/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the effect of intravitreal silicone oil (SO) on multifocal electroretinogram (mfERG) and the changes in mfERG following SO removal. METHODS Twelve eyes of 12 patients with SO in vitreous cavity with corrected distance visual acuity (CDVA) > 20/200 were prospectively enrolled as cases over a period from July 2016 to June 2018. The fellow normal eyes served as control. The eyes were evaluated with P1 and N1 wave amplitude and implicit time on mfERG at baseline, 1 and 4 weeks after SO removal. RESULTS The mean age was 44.9 ± 18.9 (range 18-74) years. The indication for SO injection was retinal detachment (n = 9, three macula-on eyes, six macula-off eyes) and endophthalmitis (n = 3). The median (range) LogMAR CDVA at baseline was 0.54 (0.18-0.78) in cases and did not change post-SO removal (p = 0.29). There was a significant decrease in average P1 and N1 wave amplitude (p = 0.0001 and 0.0001, respectively) and delay in average P1 and N1 wave implicit time (p = 0.0002 and 0.021, respectively) in cases as compared to controls. The macular status and duration of SO tamponade did not have a significant correlation with mfERG parameters. There was a significant increase in average P1 and N1 wave amplitude (p = 0.009 and 0.003, respectively) at 1 week following SO removal but no change in average P1 and N1 wave implicit time (p = 0.41 and 0.37, respectively). CONCLUSION mfERG may be reliably performed for the assessment of macular function in SO-filled eyes. Intravitreal SO exerts an insulating effect on the density of the electric potentials.
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Affiliation(s)
- Devesh Kumawat
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India.
| | - Pranita Sahay
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
| | - Karthikeyan Mahalingam
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
| | - S J Vikas
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
| | - Sagnik Sen
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
| | - Mousumi Banerjee
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
| | - Pradeep Venkatesh
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 485, Fourth Floor, New Delhi, 110029, India
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Kumar V, Tewari R, Yadav D, Vikas SJ. Acute macular neuroretinopathy in a young hypertensive patient. Clin Exp Optom 2016; 100:288-290. [PMID: 27624580 DOI: 10.1111/cxo.12466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dev Yadav
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S J Vikas
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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