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Kelkar AS, Nagpal M, Mondal S, Mehrotra N, Jain H, Sharma A, Camus E, Sathaye V. Chandelier-assisted scleral buckle surgery - contact versus non-contact wide-angle viewing system (CAB-CNV): A retrospective, multicenter, clinical study. Indian J Ophthalmol 2024:02223307-990000000-00155. [PMID: 38454850 DOI: 10.4103/ijo.ijo_2820_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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To investigate and compare the anatomic and functional outcomes of chandelier-assisted scleral buckling (CASB) surgery using contact versus non-contact lens-based wide-angle viewing systems (WAVSs) in rhegmatogenous retinal detachment (RRD) patients. METHODS This was a retrospective, multicenter study evaluating the anatomic (reattachment rate) and visual acuity (VA) outcomes at 6 months post-CASB for primary RRD. RESULTS Forty-seven RRD patients underwent CASB with a non-contact WAVS (Group C1) and 90 with a contact lens WAVS (Group C2). Preoperative parameters including myopia, macula-off RRD, posterior vitreous detachment, number of retinal breaks, and retinal dialysis as the etiology of RRD did not differ significantly between the two groups. The outcomes of retinal attachment (85.11% of C1 patients and 76.67% of C2 patients, P = 0.34) and final visual outcome (VA ≥6/12: C1 = 61.7%; C2 = 46.67%, P = 0.13) were also comparable. Furthermore, no significant difference in postoperative complications such as cataracts, glaucoma, infection, buckle exposure, and buckle failure was observed. Finally, both groups were comparable in terms of re-detachment rates (10.64% in C1 and 23.33% in C2, P = 0.11). CONCLUSION The two WAVS approaches used in CASB surgery have comparable surgical and functional outcomes and postoperative complications. The operating surgeon can freely choose between these viewing platforms during the contemporary scleral bucking (SB) surgery without impacting the outcome.
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Affiliation(s)
- Aditya S Kelkar
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Manish Nagpal
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Sukanya Mondal
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Navneet Mehrotra
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Harsh Jain
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Akansha Sharma
- Department of Vitreoretinal Services, Retina Foundation, Ahmedabad, India
| | - Erwin Camus
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
| | - Vaidehi Sathaye
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, India
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Kelkar AS, Sharma N, Verma L, Chandorkar SA, Saxena R, Mishra D, Kelkar JA, Sengupta S. Antibiotic prophylaxis for cataract surgery - Practice patterns amongst Indian Ophthalmologists. Indian J Ophthalmol 2023; 71:3235-3241. [PMID: 37602614 PMCID: PMC10565941 DOI: 10.4103/ijo.ijo_702_23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To assess the current trends in use of perioperative antibiotic prophylaxis, especially intracameral antibiotics (ICAB), for cataract surgery in India. Methods This was an E-survey using a previously validated questionnaire carried out by the All India Ophthalmological Society (AIOS) in August 2022. An E-mail invitation to complete an online 40-point survey was sent to all members of the AIOS using a digital E-mail service (Survey Monkey) and social media platforms. Results Out of 1804 total respondents, 58% (n = 1022) reported using routine ICAB prophylaxis. Of those using ICAB, 89% (n = 909) reported using it for all cases, whereas the rest used it for specific indications such as post-PC rent (n = 43), one eyed patient (n = 19), and high-risk cases (n = 50). Commercially available moxifloxacin was by far the commonest agent used for ICAB (n = 686, 67%). Eighty respondents (8%) reported noticing occasional toxic reactions and nontoxic corneal edema (n = 64, 6%) with ICAB. Surgeons with >10 years' experience especially practicing in medical colleges used fewer ICAB (OR = 0.52, 95%CI = 0.38 - 0.72, P < 0,001) compared to younger surgeons (<5-year experience) in solo clinics. The commonest reason for nonadoption of IC antibiotics was "unconvinced of the need to use it in my setting" (n = 296, 52% of those who answered this question). Conclusion IC antibiotic prophylaxis for cataract surgery has significantly increased in India from 40% in 2017 to 58% in 2022. Commercially available moxifloxacin was preferred by the majority users. Intraocular inflammation may occur occasionally and needs safer formulations to avoid this.
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Affiliation(s)
- Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, (NIO) Pune, Maharashtra, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shraddha A Chandorkar
- Vitreo-Retinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Mishra
- Department of Ophthalmology, Regional Institute of Ophthalmology, IMS, BHU, Varanasi, UP, India
| | - Jai A Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Sabhyasachi Sengupta
- Department of Ophthalmology, Future Vision Eye Care and Research Centre, Mumbai, Maharashtra, India
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Mondal S, Kelkar AS, Singh R, Jayadev C, Saravanan VR, Kelkar JA. What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey. Indian J Ophthalmol 2023; 71:3064-3068. [PMID: 37530282 PMCID: PMC10538810 DOI: 10.4103/ijo.ijo_381_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To profile vitreoretinal (VR) fellows-in-training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill-transfer curriculum. Methods A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag-Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work-hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator-based training should be made mandatory before operating room exposure. Conclusion This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows-in-training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.
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Affiliation(s)
- Sukanya Mondal
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Ramandeep Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chaitra Jayadev
- Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | | | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Kelkar JA, Mondal S, Bolisetty M, Amrute T, Jain HH. Predictive factors and visual outcomes after immediate pars plana vitrectomy for posteriorly dislocated lens fragments during complicated phacoemulsification surgery. Indian J Ophthalmol 2023; 71:784-789. [PMID: 36872678 DOI: 10.4103/ijo.ijo_1968_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: 03/07/2023] Open
Abstract
Purpose To investigate the prognostic factors for visual outcome in patients undergoing immediate pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments during phacoemulsification surgery. Methods This was a single-center, retrospective, cross-sectional study of 37 eyes of 37 patients undergoing immediate PPV for posteriorly dislocated lens fragments from 2015 to 2021. The primary outcome measure was changes in the best-corrected visual acuity (BCVA). Additionally, we analyzed the predictive factors for poor visual outcomes (BCVA <20/40) and perioperative complications. Results The mean (±standard deviation [SD]) age of the patients was 66.57 (±10.86) years, with an almost identical gender profile (M: F = 18/19 [48.64%:51.36%]). The median (interquartile range [IQR]) log of minimum angle of resolution (logMAR) BCVA improved significantly from the baseline (1 [0.6-1.48], ~20/200) to the final visit (0.3 [0.2-0.6], ~20/40) (P < 0.0001) after a mean (±SD) follow-up of 6.35 (±6.32) months. The final BCVA was 20/40 or better in 59.5% of the eyes. Poor final BCVA (<20/40) was associated with small preoperative pupillary size (P = 0.02), presence of preoperative ocular pathology (P = 0.02) including uveitis, glaucoma, and clinically significant macular edema (CSME), intraoperative displacement of >50% of lens matter into the vitreous (P < 0.001), use of iris-claw lens (P < 0.001), and postoperative cystoid macular edema (CME; P = 0.007). The postoperative complications included CME (13.51%), retinal detachment (10.81%), chronic uveitis (8.11%), glaucoma (8.11%), iritis (2.7%), posterior chamber IOL (PCIOL) dislocation (2.7%), and vitreous hemorrhage (2.7%). Conclusion For retained lens fragments in complicated phacoemulsification surgery, immediate PPV is a viable approach with the potential for a good visual outcome. The important predictors for poor visual outcomes include a small preoperative pupil size, preexisting ocular pathology, displacement of significant volume of lens matter (>50%), use of an iris-claw lens, and CME.
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Affiliation(s)
- Aditya S Kelkar
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai A Kelkar
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Sukanya Mondal
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Mounika Bolisetty
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Trupti Amrute
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Harsh H Jain
- Department of Vitreoretinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Kelkar J, Bhende P, Narayanan R, Maiti A, Bolisetty M, Singhvi P. Preferred practice patterns in aphakia management in adults in India: A survey. Indian J Ophthalmol 2022; 70:2855-2860. [PMID: 35918929 PMCID: PMC9672759 DOI: 10.4103/ijo.ijo_319_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/25/2022] Open
Abstract
Purpose: To assess different approaches in the management of aphakia in adults in Indian ophthalmologists via an online survey. Methods: A survey-monkey based online questionnaire was fielded to Indian ophthalmologists in accordance with the CHERRIES guidelines. We recorded participants’ demographics, practice settings, and preferred surgical options including the type of intraocular lens (IOL) preferred when encountering a case of aphakia in adults with and without adequate capsular support. Differences between anterior segment (AS) surgeons and vitreoretinal (VR) surgeons as well as differences between surgeons with more or less than 10 years of surgical experience were evaluated using analytic statistics. Results: Of the 481 surgeons who responded to the survey, 369 (77%) were AS surgeons and the remaining 112 (23%) were VR surgeons and represented all regions of India. When encountering posterior capsular rent during cataract surgery, a three-piece IOL in the ciliary sulcus was the most preferred (n = 275, 57%) when there was adequate capsular support, while a retrofixated iris-claw IOL (n = 91, 19%) was the commonest choice in eyes without adequate capsular support. With associated nucleus drop, 85% of surgeons preferred to refer the patient to a VR surgeon and left the eye aphakic. Multivariable logistic regression showed that VR surgeons were more than six times likely to prefer a scleral fixated intraocular lens (SFIOLs) [odds ratio (OR) = 6.5, 95% confidence interval (CI) = 3.4–12.5, P < 0.001] and surgeons with >10 years of experience were also twice more likely to prefer an SFIOL (OR = 2.4, 95% CI = 1.2–4.9, P = 0.02). Conclusion: The choice of IOL in absence of capsular support in adult eyes differs between AS and VR surgeons and is also influenced by the surgeon’s experience.
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Affiliation(s)
- Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Pramod Bhende
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Department of Ophthalmology, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Aniruddha Maiti
- Department of Ophthalmology, Netralayam-The Super specialty Eye Care Centre, Kolkata, West Bengal, India
| | - Mounika Bolisetty
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Priyanka Singhvi
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
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Abstract
PURPOSE To evaluate the outcome of prolonged ozurdex-macular contact following vitrectomy for macular hole. METHODS AND PATIENTS A 63-year-old woman with subtle vitreomacular traction and macula edema in the left eye underwent femto laser-assisted cataract surgery with lens implant and ozurdex injection. Postoperatively, patient developed macular hole for which she underwent vitrectomy. RESULTS The steroid implant that remained in contact with the fovea for 16 weeks disappeared on its own without causing any retinal toxicity, and the best-corrected visual acuity improved to 6/9. CONCLUSION Vitreomacular traction with edema may worsen after cataract surgery and ozurdex injection. Ophthalmologists should keep in mind this rare possible complication and make patients aware of the same.
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Affiliation(s)
- Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, India
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Kelkar AS, Kelkar JA, Tidke S, Agarwal A, Bolisetty M, Kelkar S. Does size of telangiectasia on optical coherence tomography angiography influence vision in eyes with type 2 macular telangiectasia? Indian J Ophthalmol 2021; 69:3570-3576. [PMID: 34826997 PMCID: PMC8837333 DOI: 10.4103/ijo.ijo_315_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: 11/30/2022] Open
Abstract
Purpose: To study the influence of dimensions of macular telangiectasia (MacTel) on enface optical coherence tomography angiography (OCTA) on vision and clinical parameters in eyes with MacTel type 2. Methods: MacTel was classified based on OCTA location, i.e. either temporal to the fovea (grade 1), or spread nasally (grade 2), or circumferentially (grade 3), or the presence of neovascular-like tissue in the outer retina–choriocapillary complex (ORCC) (grade 4). On enface images, the maximum dimensions of the MacTel in the deep plexus were noted using calipers by a single experienced observer. Results: Ninety-eight eyes of 49 patients with MacTel with a mean visual acuity was 0.46 + 0.26 logMAR and mean macular thickness of 202 ± 132 μ were included. Based on OCTA, grade 3 MacTel (n = 35, 36%) was the commonest followed by grade 4 (n = 28, 29%). The mean maximum vertical diameter of the MacTel was 2019 + 753 μ, and every 500 microns increment in vertical diameter of the MacTel was associated with a half-line drop in vision (95%CI = 0.005 to 0.08 logMAR, P = 0.03). Vision gradually reduced with increment in OCTA grades of MacTel from grade 1 to 3; however, the trend was not maintained in grade 4 MacTel, which showed better vision and lesser degenerative cysts. Conclusion: Larger telangiectasias were associated with significantly lower vision in MacTel. Eyes with deeper telangiectasia involving ORCC have better vision and evidence of far lesser neurodegeneration than type 3 disease, suggesting that this may not be part of the continuum and does not represent neovascularization.
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Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Sayali Tidke
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aanchal Agarwal
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar JA, Kelkar AS, Bolisetty M. Initial experience with three-dimensional heads-up display system for cataract surgery - A comparative study. Indian J Ophthalmol 2021; 69:2304-2309. [PMID: 34427206 PMCID: PMC8544108 DOI: 10.4103/ijo.ijo_231_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/01/2022] Open
Abstract
Purpose: To compare the complication rates, surgical time and learning curve using the 3-D Heads up display system in comparison with the conventional microscope for routine cataract surgery. Methods: Consecutive consenting adults with uncomplicated cataract were offered phacoemulsification using the 3-D Heads up display system (ARTEVO 800 Carl Zeiss Meditec) or the conventional microscope (Zeiss Lumera 700) by two experienced surgeons. Surgical time, measured from start of corneal incision to removal of microscope from the surgical field and complication rates were compared between the groups. Results: Of the 343 eyes enrolled, 100 (29%) underwent surgery using the 3-D Heads up display system. The surgical time for 3-D Heads up display system was significantly higher in the 3-D group (8.4 ± 2.1 vs. 6.5 ± 1.8 minutes, P < 0.001). There were no group differences in surgical complications (2% in 3-D vs. 2.5% in conventional microscope, P = 0.28). Comparing across 4 quartiles within the 3-D group, the mean surgical time was slightly higher during the 1st quartile (n = 25, 9.1 ± 1.9 minutes) compared to the last quartile (n = 25, 8.2 ± 1.9 minutes) (p = 0.17). Complications in the 3-D group occurred only in the initial 50% of cases. Seven (7%) cases in the 3-D group were converted to conventional binocular microscope of which 3 each were due to difficulty in depth perception and low illumination while one was due to intraoperative pupillary constriction. Conclusion: Phacoemulsification with the 3-D Heads up display system takes longer time but offers excellent visualization, ergonomics and safety compared to conventional microscopes. Experienced surgeons should be able to adapt easily after their first 50 surgeries.
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Affiliation(s)
- Jai A Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Mounika Bolisetty
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Kelkar J, Bolisetty M, Kelkar SB. Visual outcomes, safety profile and morphometric response of optical coherence tomography biomarkers to ranibizumab biosimilar treatment in neovascular age-related macular degeneration: Real-world evidence. Indian J Ophthalmol 2021; 69:1469-1474. [PMID: 34011722 PMCID: PMC8302301 DOI: 10.4103/ijo.ijo_2977_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the safety, efficacy, and morphological response of intravitreal ranibizumab biosimilar (Razumab) in neovascular age-related macular degeneration (n-AMD) up to 12 weeks. Methods: Retrospective analysis of 20 eyes of n-AMD receiving 4 weekly intravitreal Razumab. Main outcome measures were mean change in best-corrected visual acuity (BCVA), intraretinal-fluid (IRF), subretinal-fluid (SRF), central-subfield thickness (CSFT), maximum central-retinal thickness (CRT), and dimensions of pigment epithelial detachment (PED) from baseline to weeks 4, 8 and 12. Results: Improvement in BCVA was seen at all visits, although not significantly (4 weeks: P = 0.18; 8 weeks: P = 0.4; 12 weeks: P = 0. 06). At 12 weeks, 90% of eyes either maintained or had an improvement in BCVA, with 40% of them showing an improvement of ≥3-lines and only 5% of them losing ≥3-lines of visual acuity. The median PED height and PED width reduced by 20.5 µm (P = 0.03) and 557.5 µm (P = 0.14), respectively, along with a mean reduction of 57.26 µmin CSFT (P < 0.001) and 44.15 µm in CRT (P = 0.004), respectively, at 12 weeks. On qualitative analysis, resolution of SRF and IRF was observed in 45% and 25% of eyes ‘ at 12 weeks. There were no serious ocular or systemic side effects identified. Conclusion: In real-world scenario, Razumab is an efficacious and economical anti-vascular endothelial growth factor (anti-VEGF) agent for optimal management of n-AMD. The therapeutic outcomes demonstrated reasonable stabilization and improvement in visual acuity, favorable anatomical outcomes pertaining to OCT-biomarkers with an acceptable safety profile.
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Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Kelkar JA, Kothari AA, Kelkar SB. Comparison of flanged intrascleral intraocular lens fixation versus iris claw intraocular lens fixation: A retrospective study. Indian J Ophthalmol 2020; 67:1838-1842. [PMID: 31638045 PMCID: PMC6836613 DOI: 10.4103/ijo.ijo_300_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 02/07/2023] Open
Abstract
Purpose To compare the visual outcome and complications of retropupillary fixated iris claw intraocular lens (IOL) and sutureless intrascleral IOL fixation using the flanged fixation technique at 1 year. Methods In this retrospective study, eyes that underwent either iris claw or flanged SFIOL from January 2016 to July 2017 with a minimum of 1-year follow-up were enrolled. Improvement in visual acuity, intraocular pressure measurements, endothelial cell count, central macular thickness, and complications were compared between and within groups at 6 weeks, 3 months, and 1 year postoperatively. Results Data from 150 eyes were analyzed (n = 90 in the iris claw group and n = 60 in the flanged SFIOL group). Posterior capsular rent was the most common indication for IOL implantation (n = 51, 34%). The iris claw and SFIOL groups were comparable in terms of demographics and baseline characteristics. There was significant improvement in uncorrected distance visual acuity (UCDVA) at 6 weeks in both groups (P = 0.77), and at 1 year, the UCDVA was comparable between groups (0.36 ± 0.32 in the iris claw group and 0.30 ± 0.28 in the SFIOL, P= 0.75). Transient elevation of intraocular pressure was seen slightly more in eyes with SFIOL (17%), while ovalization of the pupil was the main sequelae seen in the iris claw group (20%). Conclusion Both iris claw IOL fixation and SFIOL using flange are viable options for surgical correction of aphakia. Visual outcomes are excellent at 6 weeks and are maintained till 1-year follow-up, and complication rates are acceptably low, although ovalization of pupil is common with iris claw IOLs.
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Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar JA, Mehta HM, Kelkar AS, Agarwal AA, Kothari AA, Kelkar SB. Precision pulse capsulotomy in phacoemulsification: Clinical experience in Indian eyes. Indian J Ophthalmol 2018; 66:1272-1277. [PMID: 30127138 PMCID: PMC6113831 DOI: 10.4103/ijo.ijo_146_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To evaluate the surgical outcome of precision pulse capsulotomy (PPC) in phacoemulsification surgery. Methods: One hundred twenty-three eyes of 99 consecutive patients who underwent phacoemulsification with PPC through a 2.8 mm clear corneal incision were prospectively studied at a tertiary care centre. The size, shape of capsulotomy and intraoperative capsulotomy, and surgery-related complications were noted. Visual outcome, IOL stability, and signs of capsular opacification/contraction were evaluated at 3 and 6 months. Results: The mean age of patients was 49.5 ± 7.77 years. Complete, circular capsulotomy averaging 5.5 mm diameter was achieved in 117 of 123 eyes. In seven eyes, we experienced complications like capsulorhexis tear (n = 6) and inadvertent iris capture (n = 1). Probe malfunction occurred in six cases. Stable intracapsular intraocular lens (IOLs) fixation and centration was achieved in all eyes. None of the eyes had any significant posterior capsular opacification or capsular contraction at 3 and 6 months. In one eye anterior capsular opacification at the capsulotomy edge was noted at 6 months. Conclusion: PPC is a useful device for achieving a perfectly round capsulorrhexis. However, it has a learning curve and chances of skip areas in capsulorhexis, capsular tag, and its extension should be kept in mind. Special care should be taken in initial cases and while operating on eyes with poorly dilating pupil and mature cataracts.
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Affiliation(s)
- Jai A Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal M Mehta
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aanchal A Agarwal
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Akshay A Kothari
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Shreekant B Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Chang DF, Kelkar JA, Mehta HM, Lahane T, Parekh R. Antibiotic prophylaxis practice patterns for cataract surgery in India - Results from an online survey. Indian J Ophthalmol 2017; 65:1470-1474. [PMID: 29208837 PMCID: PMC5742985 DOI: 10.4103/ijo.ijo_842_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India. Methods: This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented. Results: Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P < 0.001) and more than 500 cataract surgeries annually (45% vs. 33%, P < 0.001) reported greater use of IC moxifloxacin. Self-reported endophthalmitis rates were statistically significantly greater in those not using IC antibiotics (0.045% vs. 0.036, P = 0.04). Although a majority of respondents believe that IC antibiotics are an important option (54%) and that it is important to have a commercially available solution (68%), many believe that other antibiotic prophylaxis methods are sufficient (31%). Conclusion: IC antibiotic prophylaxis for cataract surgery has sharply increased in India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.
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Affiliation(s)
- Aditya S Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - David F Chang
- Department of Ophthalmology, Altos Eye Physicians, Los Altos, California, USA
| | - Jai A Kelkar
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal M Mehta
- Department of Ophthalmology, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Tatyarao Lahane
- Department of Ophthalmology, Grand Medical College and JJ group of Hospitals, Mumbai, Maharashtra, India
| | - Ragini Parekh
- Department of Ophthalmology, Grand Medical College and JJ group of Hospitals, Mumbai, Maharashtra, India
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Abstract
Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.
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Affiliation(s)
- Jai Aditya Kelkar
- Department of Paediatric Ophthalmology and Strabismus, National Institute of Ophthalmology, Pune, Maharashtra, India
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Kelkar AS, Kelkar JA, Barve PM, Mulay A, Sharma S, Amoaku W. Post-clear corneal phacoemulsification endophthalmitis: profile and management outcomes at a tertiary eye care center in western India. J Ophthalmic Inflamm Infect 2016; 6:48. [PMID: 27896783 PMCID: PMC5126034 DOI: 10.1186/s12348-016-0115-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Received: 08/31/2016] [Accepted: 11/17/2016] [Indexed: 11/22/2022] Open
Abstract
Background Infectious endophthalmitis is a serious sight threatening intraocular inflammation that results from exogenous or endogenous spread of organisms into the eye.A retrospective case series to study the profile of endophthalmitis following clear corneal phacoemulsification in western India between years 2008 and 2014 was held in the National Institute of Ophthalmology, Pune, India. Cases of endophthalmitis post-clear corneal phacoemulsification were reviewed pertaining to demography, clinical history, surgeon experience, surgical complications, time of onset following surgery, duration between onset of symptoms and presentation to the center, presenting visual acuity and at follow-ups, slit-lamp examination and ultrasound findings, vitreous tap culture results, treatment, and final functional and anatomical outcomes. Results Of 60 cases, 34 were operated in the tertiary center and 26 were referred. The incidence of endophthalmitis post clear corneal phacoemulsification performed at the tertiary center was 0.17%. Mean time delay between onset of symptoms and presentation to the tertiary care center was 2.6 days. Fifty percent cases were culture +ve, of which 80% were Gram +ve and 20% were Gram −ve, no fungal isolates. Coagulase –ve staphylococcus was the most common causative organism; rare isolates included Sphingomonas paucimobilis and Streptococcus mitis. Twenty-six eyes underwent primary vitrectomy. Mean presenting visual acuity was 2.14 ± 0.07 logMAR units which improved to logMAR 0.98 ± 0.12 at final follow-up. Presenting VA was >20/200 in 13.3% and <HM in 60% cases. 66.7% of eyes had visual improvement; 26.7% cases achieved VA 20/40 at final follow-up. Gram +ve and culture –ve cases, better presenting VA, and less time delay between onset and presentation had a favorable visual outcome. Conclusions The shift of the clinico-microbiological spectrum of endophthalmitis could be due to change in surgical technique to clear corneal phacoemulsification. Predictors of good visual outcome include good presenting visual acuity, early presentation to the center, culture negativity, and coagulase negative organisms. Electronic supplementary material The online version of this article (doi:10.1186/s12348-016-0115-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, 1187/30 Off Ghole Road, Near Mahatma Phule Museum, Shivajinagar, Pune, 411005, India.
| | - Jai A Kelkar
- National Institute of Ophthalmology, 1187/30 Off Ghole Road, Near Mahatma Phule Museum, Shivajinagar, Pune, 411005, India
| | - Prajakta M Barve
- National Institute of Ophthalmology, 1187/30 Off Ghole Road, Near Mahatma Phule Museum, Shivajinagar, Pune, 411005, India
| | - Aishwarya Mulay
- National Institute of Ophthalmology, 1187/30 Off Ghole Road, Near Mahatma Phule Museum, Shivajinagar, Pune, 411005, India
| | - Shubhangi Sharma
- National Institute of Ophthalmology, 1187/30 Off Ghole Road, Near Mahatma Phule Museum, Shivajinagar, Pune, 411005, India
| | - Winfried Amoaku
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
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Kelkar AS, Lisa M, Mulay A, Datar S. Corneoscleral patch graft combined with vitrectomy and intravitreal antibiotics for the management of Morganella morganii endophthalmitis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcro.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kelkar AS, Kelkar JA, Kelkar SB, Bhanushali D. Authors' reply. Indian J Ophthalmol 2014; 62:753. [PMID: 25136724 PMCID: PMC4131348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India,Correspondence to: Dr. Aditya S Kelkar, 1219 Nis Y Nos Society, Deccan Gymkhana, Pune - 411 004, India. E-mail:
| | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Pandit RS, Kelkar AS, Bodhankar SL. Retinal and lens protective effect of sitagliptin in streptozotocin induced type-I diabetic wistar rats. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.biomag.2013.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Phenol is an industrially important compound which has a wide range of applications. Being highly soluble in water, it appears as the major pollutant in waste waters arising from both phenol manufacturing and from industrial units that utilise phenol. Because of its toxicity, bioremediation of phenol is necessary. Since some of the phenol-bearing industrial waste waters are alkaline in nature, use of alkaliphilic bacteria for bioremediation of phenol was investigated. Alkaliphilic bacteria were isolated from sediments of an alkaline lake in Lonar, Dist. Buldhana, Maharashtra State, India, by phenol enrichment at pH 10.0 and phenol concentration of 500 mg/l. The lake (lat. 19°58'45", long. 76°34') is known to be a unique inland saline lake in Asia. It has a circular periphery and diameter of 2 km around the top of the banks and 1.2 km at the bottom. The lake has a high saline level (∼ 2649 mg/l sodium chloride) and a high level of alkalinity (∼ 2605 mg/l calcium carbonate). Alkaliphilic strains of Arthrobacter spp., Bacillus cereus, Citrobacter freundii, Micrococcus agilis and Pseudomonas putida biovar B were capable of removing phenol from waste waters arising from industries manufacturing methyl violet (using phenol as one of the major raw materials) and cumene-phenol. The waste waters from both these units were alkaline in nature (pH ∼ 9.95-10.1) and had a high phenol content (368-660 mg/l). The alkaliphilic bacteria being studied removed 100% of the phenol from the industrial waste waters within 48 h of incubation under shake culture conditions and at an ambient temperature of 28 ± 2 °C. Bioremediation of phenol by alkaliphilic strains of Arthrobacter spp., B. cereus, C. freundii and M. agilis seems to be the first report.
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Affiliation(s)
- P P Kanekar
- Microbial Sciences Division, Agharkar Research Institute, Pune, India.
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Kelkar AS, Kelkar JA, Kelkar SB, Shaikh AI. Late posterior subluxation of rollable intraocular lens after an uneventful microphacoemulsification cataract surgery. Indian J Ophthalmol 2010; 58:350-1. [PMID: 20534940 PMCID: PMC2907054 DOI: 10.4103/0301-4738.64144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kelkar AS, Sayyad MG, Kelkar JA, Kelkar SB, Narvankar R, Shaikh A. Comparison of single injection of intravitreal triamcinolone versus single injection of intravitreal bevacizumab in macular edema secondary to branch retinal vein occlusions with regard to changes in best corrected visual acuity and central macular thickness in the short term. Indian J Ophthalmol 2009; 57:243-4. [PMID: 19384028 PMCID: PMC2683440 DOI: 10.4103/0301-4738.49408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Joshi AA, Kanekar PP, Kelkar AS, Sarnaik SS, Shouche Y, Wani A. Moderately halophilic, alkalitolerantHalomonas campisalis MCM B-365 from Lonar Lake, India. J Basic Microbiol 2007; 47:213-21. [PMID: 17518414 DOI: 10.1002/jobm.200610223] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Seven bacterial isolates obtained from sediment and water samples, collected from the alkaline Lonar Lake were identified on the basis of their morphological, physiological and biochemical characteristics and were confirmed by 16S rDNA sequencing to be Halomonas campisalis. They were capable of using a variety of electron donors and were found to grow in the presence of sodium chloride (NaCl) up to 4 M, at pH from 7 to 11, 9 being the optimum. The isolates could grow over a wide range of temperatures (from 4 to 45 degrees C) and showed temperature-dependent salt tolerance. They exhibited requirement of sodium for growth and could grow in any medium where NaCl is replaced by NaNO(3) and Na(2)S(2)O(3) but not in the presence of salts like LiCl, MgCl(2) . 6H(2)O, KCl and NH(4)Cl. One of the seven isolates, ARI 351, was able to produce lipase at pH-9.0, while two isolates, ARI 351 and ARI 360, could accumulate polyhydroxyalkanoic acid (PHA) granules when grown in a medium containing maltose. Thus the H. campisalis isolated from Lonar Lake was different from the previously reported one, with respect to its biotechnological potential for production of Lipase and PHA.
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Affiliation(s)
- A A Joshi
- Microbial Sciences Division, Agharkar Research Institute, Pune, India
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Kelkar AS, Kelkar SB, Kelkar JA, Nagpal M, Patil SP. The use of intravitreal bevacizumab in neovascular glaucoma: a case report. Bull Soc Belge Ophtalmol 2007:43-5. [PMID: 17894286] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To assess the short-term safety and efficacy of an intravitreal injection of bevacizumab in a patient with neovascular glaucoma. CASE REPORT Intravitreal bevacizumab injection was given in a patient with neovascular glaucoma and the changes in the visual acuity, intraocular pressure (lOP), iris neovascularisation were noted before injection and after one day, one week, three weeks and six weeks. Regression of the iris new vessels and normalization of the intraocular pressure was noted. CONCLUSION Intravitreal bevacizumab was effective and safe in the short-term in a patient with neovascular glaucoma. It may be a useful adjunctive treatment.
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Affiliation(s)
- A S Kelkar
- National Institute of Ophthalmology, Pune, India
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Abstract
Chronic sclerosing osteomyelitis in a metacarpal is presented. Bacterial cultures were negative, and radiographs and an isotope scan were non-specific. Histopathological assessment confirmed the diagnosis. Iliac bone grafting resulted in symptomatic relief to the patient.
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Affiliation(s)
- A S Kelkar
- Orthopaedic Department, King Edward Memorial Hospital, Rasta Peth, Pune 411011, India.
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Kanekar PP, Nilegaonkar SS, Sarnaik SS, Kelkar AS. Optimization of protease activity of alkaliphilic bacteria isolated from an alkaline lake in India. Bioresour Technol 2002; 85:87-93. [PMID: 12146649 DOI: 10.1016/s0960-8524(02)00018-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Alkaliphilic bacteria belonging to the genera Bacillus, Staphylococcus, Micrococcus, Pseudomonas and Arthrobacter isolated from sediment samples of the alkaline Lonar lake situated in the Buldhana District of Maharashtra State, India, were studied for the production of protease activity. Among the 54 isolates obtained, Arthrobacter ramosus and Bacillus alcalophilus exhibited high protease activity using soyacake as a sole source of carbon and nitrogen. Protease activity was optimum at 1% initial substrate concentration, at 30 degrees C and under shake culture condition for both organisms. The enzyme was thermostable (65 degrees C), stable at pH 12 and also active in the presence of commercial detergent. This enzyme removed blood stains from cotton fabric indicating its potential use in detergent formulations.
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Affiliation(s)
- P P Kanekar
- Division of Microbial Sciences, Agharkar Research Institute, Maharashtra, India.
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