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Ratra D, Murari S, Dalan D, Agarwal V. Immediate response to intravitreal treatment for macular edema due to diabetes and retinal vein occlusion. Eur J Ophthalmol 2024:11206721241255721. [PMID: 38767130 DOI: 10.1177/11206721241255721] [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: 05/22/2024]
Abstract
PURPOSE To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents. METHODS This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values. RESULTS There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n = 15), dexamethasone sustained release implant (DEX)(n = 22), ranibizumab (n = 19), and bevacizumab (n = 23). Statistically significant improvement in CRT was seen in all injection groups (p < 0.05) while improvement in mean BCVA was significant only in the TA group (p = 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p = 0.01). CONCLUSIONS Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Swetha Murari
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Vishvesh Agarwal
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Mohapatra A, Gupta P, Ratra D. Correction: Accelerated hydroxychloroquine toxic retinopathy (response to letter). Doc Ophthalmol 2024:10.1007/s10633-024-09976-9. [PMID: 38713327 DOI: 10.1007/s10633-024-09976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Ayushi Mohapatra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Prasad Gupta
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India.
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Ratra D, Lakshmipathy B, Ratra V. Finasteride-associated central retinal vein occlusion. Clin Exp Optom 2024:1-2. [PMID: 38710682 DOI: 10.1080/08164622.2024.2349557] [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: 09/04/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
| | | | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Sankara Nethralaya, Chennai, India
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Mohapatra A, Gupta P, Ratra D. Accelerated hydroxychloroquine toxic retinopathy (response to letter). Doc Ophthalmol 2024:10.1007/s10633-024-09974-x. [PMID: 38575772 DOI: 10.1007/s10633-024-09974-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Ayushi Mohapatra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Prasad Gupta
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India.
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Mohan S, Gaur R, Mahendrakar PA, J JB, Ratra V, Ratra D. Management of an inadvertent late filtering bleb and hypotony in a scleral fixated intraocular lens implantation. Eur J Ophthalmol 2024; 34:NP17-NP21. [PMID: 37853712 DOI: 10.1177/11206721231209355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE To report a case of inadvertent cystic filtering bleb in a patient with scleral fixated intraocular lens (SFIOL) implantation 7 years after initial procedure. CASE PRESENTATION A 14-year-old boy underwent lensectomy, vitrectomy and a sutured rigid SFIOL for microspherophakia in the right eye. Seven years later, the patient presented with hypotony related ocular changes. Examination revealed an inadvertent cystic filtering bleb at the scleral section. Anterior segment optical coherence tomography (ASOCT) revealed gap in inner lips of the scleral wound, bridged by a thin strip of scleral tissue. A conservative management with bandage contact lens (BCL) failed after an initial improvement. Injection of trypan blue dye in the anterior chamber confirmed the presence and site of wound filtration. Surgical closure of the fistula was done and patient showed both structural and visual improvement. CONCLUSION Meticulous wound construction and water tight closure at the end of the surgery can avoid such complications. ASOCT can be helpful in diagnosing the area of fistula. A conservative management with BCL can help by tamponading the filtering bleb. However, in unresponsive cases, surgical closure of the fistula is recommended to improve the hypotony-related changes.
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Affiliation(s)
- Sashwanthi Mohan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, TN, India
| | - Ritika Gaur
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, TN, India
| | | | - Jothi Balaji J
- Research Optometrist, Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, TN, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Sankara Nethralaya, Chennai, TN, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, TN, India
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Mohapatra A, Gupta P, Ratra D. Accelerated hydroxychloroquine toxic retinopathy. Doc Ophthalmol 2024; 148:37-45. [PMID: 37787933 DOI: 10.1007/s10633-023-09950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/25/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To report a case series of patients with retinal toxicity due to hydroxychloroquine (HCQ) within a short span of treatment. METHODS A retrospective review of case records of patients with accelerated HCQ toxicity within 1 year of starting the treatment was done. Systemic co-morbidities, details of HCQ treatment, details of ocular examination, and results of multimodal investigations were noted. RESULTS Nine patients (1 male, 8 females) with age ranging from 40 to 73 years (mean 54.2 ± 13.4 years) who showed accelerated HCQ toxicity were included. None had systemic conditions or drug history predisposing to early HCQ toxicity. The treatment duration ranged from 2 to 11 months and the cumulative HCQ dose ranged from 18 to 120 g (mean 45.0 ± 33.0 g). The visual acuity was normal in 8 (88.9%) patients and retinal evaluation was normal in 4 (44.4%). Optical coherence tomography was abnormal in 4 (44.4%). Six (66.6%) cases had reduced sensitivity in the parafoveal point on visual field testing. All 9 cases had multifocal electroretinographic changes diagnostic of HCQ toxicity. The HCQ treatment was stopped in 8 and continued with reduced dose in 1 patient. The mean duration of follow-up was 11.2 ± 9.6 months during which 5 patients showed improved mfERG and 1 patient had a stable mfERG. Visual fields improvement was noted in 2 cases. CONCLUSIONS Patients on HCQ need to be kept on regular monitoring with more frequent follow-ups to detect signs of early onset toxicity and prevent permanent visual impairment. mfERG is an important diagnostic tool for HCQ toxicity.
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Affiliation(s)
- Ayushi Mohapatra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Prasad Gupta
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, 600006, India.
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Nadig RR, Ratra D. Surgical management of a case of double optic disc pits with maculopathy. Indian J Ophthalmol 2024; 72:303. [PMID: 38273697 PMCID: PMC10941938 DOI: 10.4103/ijo.ijo_2205_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] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Double optic disc pit maculopathy is a rare entity. It can be difficult to manage because of excessive leakage and chronic maculopathy. PURPOSE To describe surgical management in a case of double optic disc pits with maculopathy. SYNOPSIS A 42-year-old male presented with double optic disc pits with macular detachment in the left eye. The best-corrected visual acuity (BCVA) was 20/60, N12. Preoperative OCT showed the presence of two disc pits. The macular region had large retinoschisis and subretinal fluid (SRF) with a central foveal thickness of 879 microns and loss of the ellipsoid zone. A shallow communication from the temporal aspect of the disc to the submacular area was also noted. Among the options of observation, laser photocoagulation, and surgery, the patient opted for surgical management. SURGICAL TECHNIQUE A standard-3 port 23-gauge pars plana vitrectomy was done. After staining the ILM with brilliant blue, ILM peeling was done with the help of forceps and Finesse loop. ILM flaps were inverted over to cover the optic disc pits and sealed with a drop of fibrin glue. Next, 20% SF6 gas was used for tamponade. Pre- and post-surgery parameters such as visual acuity and OCT were evaluated. POSTOPERATIVE EVALUATION After 6 weeks, left eye BCVA was 20/40 with OCT showing reduced SRF and reduced intraretinal schisis with a foveal thickness of 546 microns. At 3 months of follow-up, the vision in the left eye had improved to 20/30 with further reduction in the retinoschisis and foveal thickness of 482 microns. HIGHLIGHTS In this interesting case, we demonstrate a unique way of sealing the defect surgically by vitrectomy and inverted ILM flap with fibrin glue over the disc pits. Despite sealing the maculopathy is slow to resolve. VIDEO LINK https://youtu.be/s9nY5UPe1s4.
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Affiliation(s)
- Ramya R Nadig
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
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Ratra V, Preethi P, Surendran TS, Krishnakumar S, Ratra D. Duplicate iris: a case report on bilateral accessory iris membrane. Clin Exp Optom 2023:1-3. [PMID: 38057281 DOI: 10.1080/08164622.2023.2291066] [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: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - P Preethi
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | | | | | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Sindal MD, Ratra A, Ratra D. Enhancing surgical training - Role of simulators and mentors. Indian J Ophthalmol 2023; 71:3260-3261. [PMID: 37602619 PMCID: PMC10565920 DOI: 10.4103/ijo.ijo_1798_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Manavi D Sindal
- Vitreoretina Services, Aravind Eye Hospital, Pondicherry, India
| | - Aashna Ratra
- Department of Ophthalmology, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Subramanian B, Devishamani C, Raman R, Ratra D. Association of OCT biomarkers and visual impairment in patients with diabetic macular oedema with vitreomacular adhesion. PLoS One 2023; 18:e0288879. [PMID: 37463157 DOI: 10.1371/journal.pone.0288879] [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: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND To analyse the distribution of spectral domain optical coherence tomography (SD-OCT) biomarkers in different types of vitreomacular adhesion (VMA) associated visual impairment in diabetic macular oedema. METHODS A total of 317 eyes of 202 patients were enrolled. Cases were divided into two groups focal VMA and broad VMA and subjects with no VMA were enrolled as controls. A grading platform was used for evaluating the morphology of diabetic macular oedema (DME), using good-quality SD-OCT images. Grading was done for VMA and the biomarkers. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and central subfield thickness (CSFT) was also recorded. RESULTS The CRT (p = <0.001) and CSFT (p = <0.001) values were statistically significant between the groups. Except for Inner Nuclear Layer Cysts (p = <0.001), absence of Bridging Tissue that is composed of muller cell fibers and bipolar cells (p<0.001), and Hyper Reflective Dots (HRD) in cyst (p = 0.006) there were no significant differences in the distribution of OCT biomarkers among the 3 groups (focal VMA, broad VMA and no VMA). Only Disorganization of Retinal Inner Layers (DRIL) (p = 0.044) showed significant association with vision impairment in all the 3 groups. CONCLUSION The distribution of OCT biomarkers was similar across all eyes of cases and controls. However, they were more likely to be associated with visual impairment in the presence of VMA than no VMA.
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Affiliation(s)
- Brughanya Subramanian
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Chitralekha Devishamani
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Ophthalmology, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Subramanian B, Raman R, Ratra D. Correspondence. Retina 2023; 43:e48-e49. [PMID: 37126942 DOI: 10.1097/iae.0000000000003822] [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] [Indexed: 05/03/2023]
Affiliation(s)
- Brughanya Subramanian
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ratra D, Nag A, Sharma H. Retinal laser - Protocols and practical tips. Indian J Ophthalmol 2023; 71:2632. [PMID: 37322727 PMCID: PMC10417987 DOI: 10.4103/ijo.ijo_128_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] [Indexed: 06/17/2023] Open
Abstract
Background Many a young doctors in training find retinal laser photocoagulation a daunting task. However, if correct protocols are followed and checklists are observed, then it is not difficult to have a successful laser sitting with a happy patient. Most of the complications can be avoided with correct settings and techniques. Purpose To enumerate the basic protocols of retinal laser photocoagulation and provide practical tips including laser settings and checklists for hassle-free laser experience. Synopsis Laser settings for a pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy differ from those for a focal laser for macular edema. A fill in PRP is indicated when an active Proliferative diabetic retinopathy (PDR) is seen after the initial PRP is completed. The settings and protocols for laser photocoagulation for lattice degeneration are different, and various techniques of barrage laser are discussed. Practical tips and checklists are given, which will not be found in any textbooks. Highlights Animated illustrations and fundus photos are used to explain the correct techniques of performing laser photocoagulation in different indications and scenarios. Detailed instructions and checklists are provided, which can be very useful to avoid complications and medicolegal problems. The practical tips and guidelines in an easy-to-understand manner make this video highly educational for the novice retinal surgeons who want to perfect their technique of retinal laser photocoagulation. Video Link https://youtu.be/saQ4s49ciXI.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Adwaita Nag
- Ocular Oncology Fellow, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Hitesh Sharma
- Department of Vitreoretinal Diseases, Aditya Jyot Hospital, Mumbai, Maharashtra, India
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Sen P, Srikrupa N, Maitra P, Srilekha S, Porkodi P, Gnanasekaran H, Bhende M, Khetan V, Mathavan S, Bhende P, Ratra D, Raman R, Rao C, Sripriya S. Next-generation sequencing--based genetic testing and phenotype correlation in retinitis pigmentosa patients from India. Indian J Ophthalmol 2023; 71:2512-2520. [PMID: 37322672 PMCID: PMC10417947 DOI: 10.4103/ijo.ijo_2579_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Inherited retinal dystrophies (IRD) are a heterogeneous group of retinal diseases leading to progressive loss of photoreceptors through apoptosis. Retinitis pigmentosa (RP) is considered the most common form of IRD. Panel-based testing in RP has proven effective in identifying the causative genetic mutations in 70% and 80% of the patients. This is a retrospective, observational, single-center study of 107 RP patients who had undergone next-generation sequencing-based targeted gene panel testing for IRD genes. These patients were inspected for common phenotypic features to arrive at meaningful genotype-phenotype correlation. Methods Patients underwent complete ophthalmic examination, and blood was collected from the proband for DNA extraction after documenting the pedigree. Targeted Next Generation Sequencing (NGS) was done by panel-based testing for IRD genes followed by co-segregation analysis wherever applicable. Results Of the 107 patients, 72 patients had pathogenic mutations. The mean age of onset of symptoms was 14 ± 12 years (range: 5-55). Mean (Best Corrected Visual Acuity) BCVA was 6/48 (0.9 logMAR) (range 0.0-3.0). At presentation, over one-third of eyes had BCVA worse than 6/60 (<1 logMAR). Phenotype analysis with the gene defects showed overlapping features, such as peripheral well-defined chorioretinal atrophic patches in patients with CERKL, PROM1, and RPE65 gene mutations and large macular lesions in patients with RDH12 and CRX gene mutations, respectively. Nummular or clump-like pigmentation was noted in CRB1, TTC8, PDE6A, and PDE6B. Conclusion NGS-based genetic testing can help clinicians to diagnose RP more accurately, and phenotypic correlations can also help in better patient counselling with respect to prognosis and guidance regarding ongoing newer gene-based therapies.
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Affiliation(s)
- Parveen Sen
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Natarajan Srikrupa
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Puja Maitra
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sundaramurthy Srilekha
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Periyasamy Porkodi
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Harshavardhini Gnanasekaran
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sinnakaruppan Mathavan
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pramod Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Chetan Rao
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sarangapani Sripriya
- SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ratra D, Pradhana D, Dutta Majumder P. Surgical management for treatment-resistant cases of inflammatory exudative retinal detachment: Mission impossible? Indian J Ophthalmol 2023; 71:2543-2547. [PMID: 37322677 PMCID: PMC10418000 DOI: 10.4103/ijo.ijo_2575_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report the outcome of surgical intervention for inflammatory, exudative retinal detachment (ERD). Methods A retrospective analysis of eyes with ERD that underwent vitrectomy. Results Twelve eyes (10 patients) with ERD, non-responsive to medical therapy, underwent vitrectomy. The mean age was 35.7 ± 17.7 years. Five eyes (42%) had Vogt-Koyanagi-Harada disease, three (25%) had presumed tuberculosis (TB), two (17%) pars planitis, and one (8%) had sympathetic ophthalmia. The mean time of vitrectomy was 6.76 ± 4.1 months after onset. Six (50%) eyes had a recurrence, two settled with medical treatment, and four underwent re-surgery. The mean follow-up was 2.7 years. At the last visit, 10 (83.3%) eyes had attached retina; the best-corrected visual acuity (BCVA) had reduced to 1.6 ± 0.7 logarithms of the minimum angle of resolution (logMAR) from 1.3 ± 0.7 at baseline. Conclusion Vitrectomy in ERD can act as an adjuvant to conventional medical therapy and help maintain structural integrity. Early vitrectomy may help preserve visual function.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Divya Pradhana
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Parthopratim Dutta Majumder
- Department of Uvea and Intraocular Inflammation, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ratra D, Mohan S, Nadig R, Kashyap H. The deceptive coloboma. Indian J Ophthalmol 2023; 71:2632. [PMID: 37322728 PMCID: PMC10418011 DOI: 10.4103/ijo.ijo_250_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] [Indexed: 06/17/2023] Open
Abstract
Background Scleral fistulas are known to develop following blunt trauma in patients with retinochoroidal coloboma. These cases can be managed by surgical options such as silicone buckles, or with glue and scleral patch graft. Some cases have been shown to close spontaneously. We report the first-ever case managed by vitrectomy, endophotocoagulation, and gas tamponade. Purpose We present a rare and interesting case of an atypical choroidal coloboma with traumatic scleral fistula due to blunt trauma manifesting with hypotony-related disc edema, maculopathy, and chorioretinal folds, which was managed surgically with vitrectomy, endophotocoagulation, and gas tamponade with a good anatomical and visual outcome. Synopsis The video contains the case description and surgical management of a traumatic scleral fistula in a patient with atypical superotemporal choroidal coloboma. The patient developed hypotonic maculopathy and disc edema after 3 months following a blunt trauma sustained in a road traffic accident. A scleral fistula was suspected at the temporal edge of the coloboma but could not be accurately localized. In addition, due to the edge effect of the coloboma, the external repair was difficult. Hence, vitrectomy with internal tamponade was attempted. Highlights The video highlights a different surgical approach to managing a traumatic scleral fistula at the edge of a retinochoroidal coloboma. There was a risk of leakage of intravitreal fluid into the orbit through the fistula; however, the gas bubble gave a better tamponade due to higher surface tension. It sealed the fistula presumably by creating a trap-door-like effect. The endophotocoagulation helped create adhesion between the tissues at the edge of the coloboma effectively sealing it. This was followed by a rapid recovery of the hypotony-related problems with good vision. Traumatic scleral fistula, at a difficult place such as the edge of a coloboma, can be successfully closed from an internal approach with vitrectomy, endolaser, and gas tamponade. Video link https://youtu.be/6rxgtFyy6cw.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, SankaraNethralaya, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Department of Vitreoretinal Diseases, SankaraNethralaya, Chennai, Tamil Nadu, India
| | - Ramya Nadig
- Department of Vitreoretinal Diseases, SankaraNethralaya, Chennai, Tamil Nadu, India
| | - Himanshu Kashyap
- Department of Vitreoretinal Diseases, SankaraNethralaya, Chennai, Tamil Nadu, India
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Ratra D, Ratra V, Raviselvan M. Splitting of retinal pigment epithelium and Bruch's membrane due to a focal choroidal excavation. Oman J Ophthalmol 2023; 16:347-350. [PMID: 37602152 PMCID: PMC10433044 DOI: 10.4103/ojo.ojo_304_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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/04/2023] [Indexed: 08/22/2023] Open
Abstract
We report an unusual finding of a split between the Bruch's membrane (BM) and retinal pigment epithelium (RPE) due to a focal choroidal excavation (FCE) in a healthy young girl with sudden onset visual disturbance. She was followed up regularly for over a year with serial optical coherence tomography (OCT) scans which revealed a parafoveal conforming type of FCE. Initial retinal edema subsided in a month. No associated pathology, such as a choroidal neovascular membrane, was seen. A split was seen between the RPE and the BM on one side of the FCE, which remained unchanged. We postulate this novel finding of the split between the RPE and BM to be due to the inelasticity of the BM, causing it to separate from the RPE due to the sudden outward force exerted during the formation of an FCE.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Munispriyan Raviselvan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Venkatesh R, Jayadev C, Mangla R, Chitturi SP, Mohan S, Ratra D. Ocular surface changes following vitreoretinal procedures. Indian J Ophthalmol 2023; 71:1123-1126. [PMID: 37026243 DOI: 10.4103/ijo.ijo_2573_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) can lead to ocular discomfort as well as visual disturbances. Older adults are more likely to develop DED. They are also more likely to develop retinal diseases such as diabetic retinopathy and age-related macular degeneration, which may require vitreoretinal surgeries, lasers, and intravitreal injections. Posterior segment surgery may cause or worsen existing dry eye symptoms, albeit temporarily. Despite good anatomic and functional outcomes, ocular surface dysfunction can have a significant impact on the quality of life, lowering a patient's satisfaction with the retinal treatment. Preexisting DED, intraoperative tissue handling, and postoperative treatment may all contribute to the severity of ocular surface dysfunction. In this article, we have reviewed all relevant studies on the development of ocular surface changes and DED, as well as the impact of vitreoretinal surgeries and procedures on the ocular surface.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | | | - Sashwanthi Mohan
- Department of Retina and Vitreous, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Retina and Vitreous, Sankara Nethralaya, Chennai, Tamil Nadu, India
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18
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Ratra D, Mohan S, Ratra V, Narayanaswamy A. Molecular and genetic changes in the tear film following microincisional vitrectomy surgery. Indian J Ophthalmol 2023; 71:1664-1665. [PMID: 37026325 PMCID: PMC10276714 DOI: 10.4103/ijo.ijo_2677_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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19
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Raviselvan M, Preethi B, Ratra D. Retinal perfusion density can predict cardiovascular disease risk in patients with retinal vein occlusion. Indian J Ophthalmol 2023; 71:379-384. [PMID: 36727323 DOI: 10.4103/ijo.ijo_1662_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: 02/03/2023] Open
Abstract
Purpose To correlate microvascular changes and assess the relationship between microvascular changes and cardiovascular disease (CVD) risk in patients with retinal vein occlusion (RVO). Methods Patients over 40 years of age with unilateral RVO were included in this prospective study. Those known to have cardiovascular disease were excluded. A detailed medical history was taken and physical exam was done to measure the height, weight, body mass index (BMI), and systolic blood pressure (SBP). A comprehensive eye check-up was followed by optical coherence tomography angiography (OCTA). Microvascular indices such as vessel density (VD) and perfusion density (PD) were noted. A statistical model was developed for prediction of CVD risk and was integrated with the World Health Organization (WHO)'s risk prediction charts. Results This study included 42 patients with RVO and 22 controls with an age range of 42-82 years. There were 40 males (62.5%) and 24 females (37.5%). Along with age, SBP, and gender, perfusion density was found to have significant impact on CVD risk (P = 0.030). Reduction in PD was associated with increase in CVD risk. PD had a greater influence on CVD in <50 years age than in >70 years group. Using linear regression, a model with accuracy of 72.1% was developed for CVD risk prediction and was converted into color coded charts similar to WHO risk prediction charts. Conclusion These findings suggest a significant correlation between microvascular parameters and CVD risk in RVO patients. Based on these parameters, an easy-to-use and color-coded risk prediction chart was developed.
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Affiliation(s)
| | - B Preethi
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
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20
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Lee S, Heisler M, Ratra D, Ratra V, Mackenzie PJ, Sarunic MV, Beg MF. Effects of Myopia and Glaucoma on the Neural Canal and Lamina Cribrosa Using Optical Coherence Tomography. J Glaucoma 2023; 32:48-56. [PMID: 36584358 PMCID: PMC10503542 DOI: 10.1097/ijg.0000000000002107] [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: 09/22/2021] [Accepted: 08/07/2022] [Indexed: 12/31/2022]
Abstract
PRCIS Glaucoma was associated with axial bowing and rotation of Bruchs membrane opening (BMO) and anterior laminar insertion (ALI), skewed neural canal, and deeper anterior lamina cribrosa surface (ALCS). Longer axial length was associated with wider, longer, and more skewed neural canal and flatter ALCS. PURPOSE Investigate the effects of myopia and glaucoma in the prelaminar neural canal and anterior lamina cribrosa using 1060-nm swept-source optical coherence tomography. PATIENTS 19 control (38 eyes) and 38 glaucomatous subjects (63 eyes). MATERIALS AND METHODS Participants were imaged with swept-source optical coherence tomography, and the images were analyzed for the BMO and ALI dimensions, prelaminar neural canal dimensions, and ALCS depth. RESULTS Glaucomatous eyes had more bowed and nasally rotated BMO and ALI, more horizontally skewed prelaminar neural canal, and deeper ALCS than the control eyes. Increased axial length was associated with a wider, longer, and more horizontally skewed neural canal and a decrease in the ALCS depth and curvature. CONCLUSION Our findings suggest that glaucomatous posterior bowing or cupping of lamina cribrosa can be significantly confounded by the myopic expansion of the neural canal. This may be related to higher glaucoma risk associated with myopia from decreased compliance and increased susceptibility to IOP-related damage of LC being pulled taut.
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Affiliation(s)
- Sieun Lee
- School of Engineering Science, Simon Fraser University
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham
| | | | | | - Vineet Ratra
- Sankara Nethralaya, College Road, Tamil Nadu, India
| | - Paul J. Mackenzie
- Department of Ophthalmology & Visual Sciences, Faculty of Medicine, University of British Columbia, BC, Canada
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Varma S, Mohan S, Ratra D, Nadig RR, Kashyap R. Scleral cut-down technique of subretinal fluid drainage in scleral buckle surgery for rhegmatogenous retinal detachment. Indian J Ophthalmol 2022; 70:3746. [PMID: 36190106 PMCID: PMC9789802 DOI: 10.4103/ijo.ijo_1587_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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The art of scleral buckle (SB) surgery is being largely forgotten. However, it still remains a good option for selected cases of rhegmatogenous retinal detachment. Drainage of subretinal fluid (SRF) is one of the most crucial steps of the surgery. When performed correctly, it gives the advantage of immediate retinal reattachment, and it hastens recovery. However, it has its own set of complications. Purpose To demonstrate, step by step, the scleral cut-down technique of SRF drainage in SB surgery for rhegmatogenous retinal detachment (RRD) and to discuss its indications, contraindications, and complications. Synopsis Longstanding RRDs with bullous detachments, old age, inferior breaks, or multiple breaks are indications of SRF drainage. In shallow RDs or young patients, a non-drainage procedure may be preferred. It is safer to drain at the bed of the buckle. After the sclera is cut and dissected, it is essential to inspect the choroid for the presence of large vessels. Choroidal vessels are avoided from getting injured while perforating. The release of pigments indicates the end of the drainage. Various possible complications can be prevented by being careful in the surgical technique. Highlights Diagrammatic illustrations explain the steps of the surgical technique. Intraoperative complications have been explained in an easy-to-understand manner with tips to manage such conditions and their prevention. The video highlights the correct way of performing SRF drainage. Online Video Link https://youtu.be/L0TrdkCwk20.
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Affiliation(s)
- Shobhit Varma
- Shri Bhagwan Mahavir, Department of Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Shri Bhagwan Mahavir, Department of Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Shri Bhagwan Mahavir, Department of Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India,Correspondence to: Dr. Dhanashree Ratra, Senior Consultant, Shri Bhagwan Mahavir, Department of Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu, India. E-mail:
| | - Ramya R Nadig
- Shri Bhagwan Mahavir, Department of Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rengappa Kashyap
- Shri Bhagwan Mahavir, Department of Vitreoretina Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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22
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Dhami A, Biswas RK, Dogra M, Singh R, Mittal S, Ratra D. Comparison of three techniques of harvesting full-thickness retinal tissue for large or persistent macular holes. Indian J Ophthalmol 2022; 70:3610-3616. [PMID: 36190056 PMCID: PMC9789844 DOI: 10.4103/ijo.ijo_743_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the success rate of autologous retinal graft (ARG) for the closure of full-thickness macular holes (MHs) and compare the outcomes of three different techniques of harvesting the graft. Methods Clinic files of all patients who had undergone ARG for MH using intraocular scissors, membrane loop, or retinal punch to harvest retinal tissue were retrospectively reviewed. All patients were evaluated for MH closure, retinal reattachment, and visual improvement. Results Twenty-two eyes of 22 patients were included. ARG was done for 16 eyes (72.7%) with failed, large persistent MH, and six eyes (27.3%) also underwent simultaneous repair of retinal detachment. The basal diameter of MH was 1103.67 ± 310.09 (range 650-1529) μm. Intraocular scissors were used in 10 eyes (45.5%), a membrane loop in five eyes (22.7%), and a retinal punch in seven eyes (31.8%). Silicone oil tamponade was used in seven (31.8%) eyes and gas in 15 (68.1%) eyes. The follow-up ranged from 6 to 18 months. The hole closure rate was 72.7% (16/22). Visual improvement was noted in 18 eyes (81.8%). Retinal reattachment was seen in all eyes. Good graft integration with the surrounding area was seen in 17 eyes (77.3%). Graft retraction was seen in four eyes (18.18%) and graft loss in one eye (4.55%). No significant differences were noted among the three groups. Conclusion ARG is successful in closing large, failed MH with and without retinal detachment. A membrane loop and retinal punch are equally useful in harvesting the graft, but scissors are preferable in case the retina is detached. With all three techniques, integration of the graft with the surrounding tissue can be achieved.
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Affiliation(s)
| | - Rupak Kanti Biswas
- Netralayam- The Superspeciality Eye Care Centre, Kolkata, West Bengal, India
| | - Mohit Dogra
- Department of Vitreoretinal Diseases, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Vitreoretinal Diseases, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sangeet Mittal
- Department of Vitreoretinal Diseases, Thind Eye Hospital, Jalandhar, Punjab, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India,Correspondence to: Dr. Dhanashree Ratra, Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai - 600 006, Tamil Nadu, India. E-mail:
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Venkatesh R, Sharief S, Thadani A, Ratra D, Mohan S, Narayanan R, Narula R, Asad Y, Roy R, Jayadev C, Yadav NK. Recommendations for management of peripheral retinal degenerations. Indian J Ophthalmol 2022; 70:3681-3686. [PMID: 36190072 PMCID: PMC9789835 DOI: 10.4103/ijo.ijo_689_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Some degenerations involving the peripheral retina can result in a rhegmatogenous retinal detachment. Currently, there are no clear guidelines for retinal screening and/or management of these peripheral retinal degenerations in patients with or without recent onset posterior vitreous detachment or in those prior to refractive surgery or intraocular procedures. This article aims to provide a set of recommendations for the screening and management of peripheral retinal degenerations based on a common consensus obtained from an expert panel of retinal specialists.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India,Correspondence to: Dr. Ramesh Venkatesh, Narayana Nethralaya, Department of Retina and Vitreous, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru – 560 010, Karnataka, India. E-mail:
| | - Shama Sharief
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Atul Thadani
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Raja Narayanan
- Department of Vitreoretinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Ritesh Narula
- Department of Vitreoretinal Diseases, Centre for Sight, New Delhi, India
| | - Yusra Asad
- Department of Vitreoretinal Diseases, Centre for Sight, New Delhi, India
| | - Rupak Roy
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Kolkata, West Bengal, India
| | - Chaitra Jayadev
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naresh K. Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
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Ratra D. Commentary: Internal audit for assessment and improvement of quality of medical records. Indian J Ophthalmol 2022; 70:2966. [PMID: 35918954 DOI: 10.4103/ijo.ijo_1140_22] [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] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Abstract
Inherited retinal diseases (IRD) are genotypically and phenotypically varied disorders that lead to progressive degeneration of the outer retina and the retinal pigment epithelium (RPE) eventually resulting in severe vision loss. Recent research and developments in gene therapy and cell therapy have shown therapeutic promise in these hitherto incurable diseases. In gene therapy, copies of a healthy gene are introduced into the host cells via a viral vector. Clinical trials for several genes are underway while treatment for RPE65 called voretigene neparvovec, is already approved and commercially available. Cell therapy involves the introduction of stem cells that can replace degenerated cells. These therapies are delivered to the target tissues, namely the photoreceptors (PR) and RPE via subretinal, intravitreal, or suprachoroidal delivery systems. Although there are several limitations to these therapies, they are expected to slow the disease progression and restore some visual functions. Further advances such as gene editing technologies are likely to result in more precise and personalized treatments. Currently, several IRDs such as retinitis pigmentosa, Stargardt disease, Leber congenital amaurosis, choroideremia, achromatopsia, and Usher syndrome are being evaluated for possible gene therapy or cell therapy. It is important to encourage patients to undergo gene testing and maintain a nationwide registry of IRDs. This article provides an overview of the basics of these therapies and their current status.
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Affiliation(s)
- Rajani Battu
- Aster CMI Hospital; Centre for Eye Genetics and Research, Bengaluru, Karnataka, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Gopal
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Eye Research, Singapore
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Ratra D, Ozdek S, Raviselvan M, Elchuri S, Sharma T. Approach to inherited retinal diseases. Indian J Ophthalmol 2022; 70:2305-2315. [PMID: 35791111 PMCID: PMC9426075 DOI: 10.4103/ijo.ijo_314_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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Inherited retinal diseases (IRDs) are a group of phenotypically diverse disorders with varied genetic mutations, which result in retinal degeneration leading to visual impairment. When a patient presents to a clinician who is not an IRD expert, establishing a correct diagnosis can be challenging. The patient and the family members are often anxious about further vision loss. They are eager to know the prognosis and chance of further worsening of the vision. It is important for every eye specialist to educate himself/herself about the basics of IRD. It would help to familiarize oneself about how to approach a patient with an IRD. An early and accurate diagnosis can help predict the vision loss and also help the patient plan his/her education and choose appropriate career choices. An updated knowledge about the genetic mutations, mode of inheritance, and possible therapies would empower the eye specialist to help his/her patients. This article gives a broad plan of how to approach a patient with IRD with regards to characterization and diagnosis of the disorder, visual rehabilitation, and possible therapy.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sengul Ozdek
- School of Medicine, Gazi University, Besevler, Ankara, Turkey
| | - Munispriyan Raviselvan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sailaja Elchuri
- Department of Nanotechnology, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University, New York, USA
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27
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Ratra D, Chattree S, Raviselvan M, Pradhan A, Giridhar S. Structural and functional phenotypic features and molecular analysis of Indian patients with Bietti crystalline dystrophy. Indian J Ophthalmol 2022; 70:2526-2532. [PMID: 35791149 PMCID: PMC9426155 DOI: 10.4103/ijo.ijo_2146_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Bietti crystalline dystrophy (BCD) is a rare retinal dystrophy, uncommon in Indians. This study describes the various phenotypic features seen in the Indian population. Methods: In this retrospective, descriptive case series, records of patients with either clinical or molecular diagnosis of BCD from 2009 to 2020 were perused. Phenotypic and genotype information was collected and analyzed. Results: This study included 58 patients of BCD (31 males) aged 21–79 years (mean: 47 ± 14 years). The age at onset ranged from 7 to 41 years (mean: 28.8 ± 5.1 years). Vision ranged from 20/20 to counting fingers. There were 18 (31%) patients with stage 1 with crystals and mild retinochoroidal atrophy, 22 (38%) with stage 2 with atrophy extending beyond arcades, and 18 (31%) with absent crystals and extensive atrophy of stage 3. Choroidal neovascular membrane was seen in four patients. The optical coherence tomography showed retinochoroidal thinning (84.6%), outer retinal tubulations (71.8%), and paradoxical foveal thickening with interlaminar bridges (7.7%). Electrophysiology and visual fields showed reduced responses in advanced retinochoroidal changes. Molecular confirmation was available in five patients; five mutations were seen in the CYP4V2. Conclusion: A wide variation is seen in the phenotypic picture of BCD. A molecular diagnosis is helpful in differentiating from other retinal dystrophies. The OCT shows the peculiar feature of the interlaminar bridge in early cases with photoreceptor loss. Further investigations into this OCT feature may provide insights into the pathogenesis of BCD. A genotype–phenotype correlation could not be done.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Surabhi Chattree
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Munispriyan Raviselvan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Arkaprava Pradhan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sneha Giridhar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Kumar P P, Bhowmick A, Mahabale N, Hussaindeen JR, Ratra D. Diagnosis and Management of Post Traumatic Recurrent Unilateral Accommodative Spasm-A Case Report. J Binocul Vis Ocul Motil 2022; 72:151-155. [PMID: 35639032] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Spasm of accommodation refers to constant contraction of the ciliary muscles of the eye, which fail to relax. Neurological issues, head injury, and psychogenic factors can lead to spasm of accommodation, which is generally bilateral. This case report describes the clinical presentation of traumatic, unilateral accommodative spasm in an army person. A 26-year-old male presented with complaints of diminution of near vision in the left eye noticed accidentally. History revealed a blunt injury in the eyebrow region of the left eye two months back. His best corrected visual acuity was 6/6, 0.8 M (N6) in the right eye and 6/9, 2.5 M (N18) in the left eye. Accommodative response was documented using an open-field autorefractometer that showed asymmetry in the accommodation response and pupillary diameter between the two eyes. One percent Atropine sulfate eye ointment - twice a day for 3 days - was prescribed. On the fourth day, the spasm was resolved in the left eye. Pre- and post-Atropine administration, lens thickness measurements were documented, which showed significant changes. Accommodative facility exercise was initiated after the pharmacological management. Unilateral accommodative spasm is rare and needs careful investigations. Objective assessment of accommodative response and lens thickness measurement play a vital role in confirming the diagnosis.
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Affiliation(s)
- Praveen Kumar P
- Binocular Vision and Vision Therapy Department, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Amit Bhowmick
- Binocular Vision and Vision Therapy Department, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Neha Mahabale
- Binocular Vision and Vision Therapy Department, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Jameel Rizwana Hussaindeen
- Binocular Vision and Vision Therapy Department, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
| | - Dhanashree Ratra
- Department of Vitreo-Retinal Diseases, Sankara Nethralaya, Unit of Medical Research Foundation, Chennai, India
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Ratra D, Mohan S. Commentary: Glaucoma drainage device and retinal detachment. Indian J Ophthalmol 2022; 70:1293-1294. [PMID: 35326037 PMCID: PMC9240554 DOI: 10.4103/ijo.ijo_3149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sashwanthi Mohan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ratra D. Commentary: Customized extended peeling of the internal limiting membrane. Indian J Ophthalmol 2021; 70:187-188. [PMID: 34937236 PMCID: PMC8917545 DOI: 10.4103/ijo.ijo_2392_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ratra D, Roy K, Giridhar S, Madaan S. Comparison Between Ranibizumab Biosimilar, Innovator Ranibizumab and Bevacizumab in a Real-World Situation. Ophthalmol Ther 2021; 11:135-149. [PMID: 34738211 PMCID: PMC8770791 DOI: 10.1007/s40123-021-00416-4] [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] [Received: 08/16/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction To analyze the efficacy of biosimilar ranibizumab compared to innovator ranibizumab and bevacizumab. Methods We retrospectively analyzed consecutive patients treated with biosimilar ranibizumab for wet age-related macular degeneration (AMD) and macular edema (ME) (due to diabetes and vein occlusion) and compared them with ranibizumab- and bevacizumab-treated patients. Results Of 202 patients, 67 (33.2%) received biosimilar ranibizumab (BSR), 69 (34.2%) ranibizumab (RBZ) and 66 (32.7%) bevacizumab (BEV). All patients received three consecutive injections followed by pro re nata dosing. The follow-up ranged from 3 to 24 months. The mean numbers of injections were 6.68 for RBZ, 6.4 for BEV and 4.7 for BSR. At 3 months, nAMD (n = 115, 56.9%) and ME (n = 87, 43.1%) groups showed significant improvement in vision and central foveal thickness (CFT) across all three agents. After ≥ 6 months, the effects were maintained in the AMD group but not in the ME group. Maximum effect was seen at 1 month. At no point in time was a significant difference noted among the three anti-vascular endothelial growth factor (anti-VEGF) agents. No major safety concerns were noted. Conclusions Biosimilar ranibizumab is comparable to innovator ranibizumab and bevacizumab in efficacy and safety.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, 600006, India.
| | - Krishnakanta Roy
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, 600006, India
| | - Sneha Giridhar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, 600006, India
| | - Sushant Madaan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, 600006, India
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Sengupta S, Sindal MD, Shanmugam PM, Bhende P, Ratra D, Nagpal M, Narayanan R, Rajendran A, Saravanan V, Kelkar A, Maiti A, Chakraborty D, Dogra M, Behera S. A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India. Indian J Ophthalmol 2021; 69:3308-3318. [PMID: 34708794 PMCID: PMC8725119 DOI: 10.4103/ijo.ijo_1265_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To derive consensus statements for surgical management of proliferative diabetic retinopathy (PDR) for vitreoretinal (VR) surgeons. Methods Thirteen prolific VR surgeons representing all regions of India were invited to participate in a 42-point questionnaire based on the Delphi methodology describing various surgical scenarios commonly encountered in PDR. Consensus was derived using predefined robust analytics. Scenarios that returned a moderate consensus in round 1 were taken to round 2 as per the Delphi methodology. After considering all inputs, the final consensus criteria were developed. Results A strong consensus was derived about waiting for 4 weeks before considering vitrectomy. In treatment-naïve eyes with fresh vitreous hemorrhage (VH), the wait time was slightly shorter for extramacular tractional retinal detachment (2-4 weeks) and longer (4-6 weeks) for eyes treated previously with laser or anti-VEGF agents. The expert panel recommended using preoperative anti-VEGF only in eyes with large membranes requiring extensive dissection. For post vitrectomy VH, while a conservative approach was recommended for the first episode of VH, experts recommended immediate vitreous lavage for recurrent episodes of VH. In eyes with iris neovascularization, the panel recommended immediate anti-VEGF injection followed by early vitreous lavage in nonresponsive eyes. A strong consensus was derived for stopping antiplatelet agents before surgery, while there was only a moderate consensus for performing vitrectomy for recalcitrant macular edema unresponsive to anti-VEGF injections in the absence of traction. Conclusion This study provides valuable consensus on managing the different scenarios encountered during surgical management of PDR and should help guide the VR surgeons in clinical decision-making.
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Affiliation(s)
- Sabyasachi Sengupta
- Vitreoretinal Services, Future Vision Eye Care, Borivali (East), Mumbai, Maharashtra, India
| | - Manavi D Sindal
- Viitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - P Mahesh Shanmugam
- Vitreoretinal and Oncology Service, Sankara Eye Hospital, Kundalahalli Gate, Airport, Varthur Road, Bengaluru, Karnataka, India
| | - Pramod Bhende
- Shri Bhagawan Mahavir Vitreo-Retinal Services, Medical Research Foundation, (Sankara Nethralaya), Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Shri Bhagawan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Manish Nagpal
- Vitreo Retinal Consultant, Retina Foundation, Ahmedabad, Gujarat, India
| | - Raja Narayanan
- Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand Rajendran
- Vitreoretinal Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | | | - Aditya Kelkar
- Vitreo-Retinal Services, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aniruddha Maiti
- Vitreoretinal Services, Susrut Eye Foundation and Research Centre, Kolkata, West Bengal, India
| | - Debdulal Chakraborty
- Vitreo- Retina Service, Disha Eye Hospital, Barackpore, Kolkata, West Bengal, India
| | - Mohit Dogra
- Vitreoretina and Uveitis Service, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Behera
- Viitreoretinal Services, Aravind Eye Hospital, Puducherry, India
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Ratra D, Dalan D, Prakash N, Kaviarasan K, Thanikachalam S, Das UN, Angayarkanni N. Quantitative analysis of retinal microvascular changes in prediabetic and diabetic patients. Indian J Ophthalmol 2021; 69:3226-3234. [PMID: 34708778 PMCID: PMC8725133 DOI: 10.4103/ijo.ijo_1254_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: To evaluate and correlate retinal microvascular changes in prediabetic and diabetic patients with functional and systemic parameters. Methods: Optical coherence tomography angiography (OCTA) was performed on all subjects after medical evaluation and laboratory investigations for blood sugar, glycosylated hemoglobin, and others. Automated quantification of vascular indices of the superficial plexus were analyzed. Results: Hundred and eleven persons (222 eyes) were grouped into prediabetic (PDM) (60 eyes), diabetic without retinopathy (NDR) (56 eyes), diabetic with retinopathy (DR) (66 eyes), and healthy controls (CTR) (40 eyes). The superficial retinal capillary plexus showed no significant changes in the prediabetic and NDR groups; however, central foveal thickness (CFT) was significantly reduced in PDM (P = 0.04). The circularity of the foveal avascular zone (FAZ) (P = 0.03) and the vessel density (VD) (P = 0.01) showed significant reduction from PDM to NDR. All vascular parameters were significantly reduced in DR and correlated with disease severity. The CFT correlated significantly with FAZ area. The VD and perfusion density were seen to correlate significantly with HbA1c and contrast sensitivity. The visual acuity was significantly correlated with the FAZ. Logistic regression revealed VD [OR 20.42 (7.9–53)] and FAZ perimeter [OR 9.8 (4.2–23.2)] as the strongest predictors of DR. Conclusion: The changes in OCTA can help predict onset of DR. FAZ changes are seen in early stages and are correlated well with systemic parameters, making it an easy target to monitor and screen for severity of DR. Significant reduction in the CFT in PDM suggests that neuronal damage precedes vascular changes.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nandini Prakash
- RS Mehta Jain Department of Biochemistry, Vision Research Foundation, Chennai, Tamil Nadu, India
| | - Kuppan Kaviarasan
- Department of Biomedical Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sadagopan Thanikachalam
- Cardiology Care Center, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Undurti N Das
- BioScience Research Centre, GVP Hospital and Medical College, Visakhapatnam, Andhra Pradesh, India
| | - Narayansamy Angayarkanni
- RS Mehta Jain Department of Biochemistry, Vision Research Foundation, Chennai, Tamil Nadu, India
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Ratra D, Ratra A. Commentary: Effect of exercise on ocular blood flow. Indian J Ophthalmol 2021; 69:2340. [PMID: 34427216 PMCID: PMC8544044 DOI: 10.4103/ijo.ijo_960_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Aashna Ratra
- Department of Physiology, Stanley Medical College, Chennai, Tamil Nadu, India
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Ratra D. Commentary: Switching of anti-vascular endothelial growth factor agents in refractory diabetic macular edema. Indian J Ophthalmol 2021; 69:367-368. [PMID: 33463594 PMCID: PMC7933902 DOI: 10.4103/ijo.ijo_2611_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Sivagurunathan S, Selvan LDN, Khan AA, Parameswaran S, Bhattacharjee H, Gogoi K, Gowda H, Keshava Prasad TS, Pandey A, Kumar SA, Rishi P, Rishi E, Ratra D, Bhende M, Janakiraman N, Biswas J, Krishnakumar S. Proteomics-based approach for differentiation of age-related macular degeneration sub-types. Indian J Ophthalmol 2021; 69:647-654. [PMID: 33595494 PMCID: PMC7942106 DOI: 10.4103/ijo.ijo_470_20] [Citation(s) in RCA: 7] [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: 11/18/2022] Open
Abstract
Purpose: Age-related macular degeneration (AMD) is one of the leading causes of irreversible central vision loss in the elderly population. The current study aims to find non-invasive prognostic biomarkers in the urine specimens of the AMD patients. Methods: Peripheral blood and urine samples were collected from 23 controls and 61 AMD patients. Genomic DNA was extracted from the buffy coat of peripheral blood. Allele specific PCR was used to assay SNPs in complement factor H (CFH), complement component 3 (C3). Comparative proteomic analysis of urine samples from early AMD, choroidal neovascular membrane (CNVM), geographic atrophy (GA), and healthy controls was performed using isobaric labelling followed by mass spectrometry. Validation was performed using enzyme-linked immunosorbent assay (ELISA). Results: Comparative proteomic analysis of urine samples identified 751 proteins, of which 383 proteins were found to be differentially expressed in various groups of AMD patients. Gene ontology classification of differentially expressed proteins revealed the majority of them were involved in catalytic functions and binding activities. Pathway analysis showed cell adhesion molecule pathways (CAMs), Complement and coagulation cascades, to be significantly deregulated in AMD. Upon validation by ELISA, SERPINA-1 (Alpha1 antitrypsin), TIMP-1 (Tissue inhibitor of matrix metaloprotease-1), APOA-1 (Apolipoprotein A-1) were significantly over-expressed in AMD (n = 61) patients compared to controls (n = 23). A logistic model of APOA-1 in combination with CFH and C3 polymorphisms predicted the risk of developing AMD with 82% accuracy. Conclusion: This study gives us a preliminary data on non-invasive predictive biomarkers for AMD, which can be further validated in a large cohort and translated for diagnostic use.
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Affiliation(s)
- Sivapriya Sivagurunathan
- L&T Opthalmic Pathology, Vision Research Foundation, Sankara Nethralaya; Centre for Biotechnology, Anna University, Chennai, India
| | | | - Aafaque Ahmad Khan
- Institute of Bioinformatics, International Technology Park, Bangalore, India
| | - Sowmya Parameswaran
- Radheshyam Kanoi Stem Cell Laboratory, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Krishna Gogoi
- Sri Sankaradeva Nethralaya, Beltola, Guwahati, Assam, India
| | - Harsha Gowda
- Institute of Bioinformatics, International Technology Park, Bangalore, India
| | - T S Keshava Prasad
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Akhilesh Pandey
- Institute of Bioinformatics, International Technology Park, Bangalore, India
| | - S Ashok Kumar
- Centre for Biotechnology, Anna University, Chennai, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Dhanashree Ratra
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Narayanan Janakiraman
- Department of Nanobiotechnology, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Jyotirmay Biswas
- L&T Opthalmic Pathology, Vision Research Foundation; Department of Uvea, Sankara Nethralaya, Chennai, India
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Ratra D, Gopalakrishnan S, Dalan D, Ratra V, Damkondwar D, Laxmi G. Visual rehabilitation using microperimetric acoustic biofeedback training in individuals with central scotoma. Clin Exp Optom 2021; 102:172-179. [DOI: 10.1111/cxo.12834] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/30/2018] [Accepted: 08/11/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Chennai, India,
| | - Sarika Gopalakrishnan
- Low Vision Care Clinic, Department of Optometry, Shanmugha Arts, Science, Technology & Research Academy, Thanjavur, India,
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Low Vision Care Clinic, Chennai, India,
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Chennai, India,
| | - Deepali Damkondwar
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Chennai, India,
| | - Gella Laxmi
- Department of Optometry, School of Medical Sciences, University of Hyderabad, Hyderabad, India,
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Das K, Gopalakrishnan S, Dalan D, Velu S, Ratra V, Ratra D. Factors influencing the choice of low‐vision devices for visual rehabilitation in Stargardt disease. Clin Exp Optom 2021; 102:426-433. [DOI: 10.1111/cxo.12867] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Kalpita Das
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Sarika Gopalakrishnan
- Department of Optometry, Shanmugha Arts, Science, Technology and Research Academy, Thanjavur, India,
- Department of Low Vision Care, Sankara Nethralaya, Chennai, India,
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Saranya Velu
- Department of Low Vision Care, Sankara Nethralaya, Chennai, India,
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
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Sharma S, Gupta V, Maiti A, Natesh S, Saxena S, Dave V, Parmar V, Sampangi R, Murthy H, Dharwadkar S, Yadav NK, Joshi S, Mayor R, Ratra D, Basu S, Goel N, Chaturvedi A, Patel R, Jose V. Safety and efficacy of Razumab™ (world's first biosimilar ranibizumab) in wet age-related macular degeneration: a post-marketing, prospective ASSET study. Int J Retina Vitreous 2021; 7:24. [PMID: 33762008 PMCID: PMC7992797 DOI: 10.1186/s40942-021-00293-w] [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: 09/24/2020] [Accepted: 03/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Razumab™ (world’s first biosimilar ranibizumab) is approved for several macular disorders including wet age-related macular degeneration (AMD). We evaluated the safety and efficacy of biosimilar ranibizumab in wet AMD. Methods This prospective, multicentre, rAnibizumab bioSimilar Safety Efficacy postmarkeTing (ASSET) study enrolled patients aged ≥ 50 years with wet AMD having best-corrected visual acuity (BCVA) between 20/40 and 20/320. The patients received intravitreal biosimilar ranibizumab 0.5 mg every 4 weeks for 24 weeks. Safety endpoints included the incidence of adverse events (AEs), serious AEs (SAEs), and immunoreactivity after 6 months. The efficacy endpoints were the proportion of patients who lose fewer than 15 letters, increase in BCVA, change in central retinal thickness (CRT), and change in Visual Function Questionnaire-25 (VFQ-25) score, from baseline to 24 weeks. Results Of the 126 enrolled patients, majority (95.24%) of the patients received all 6 doses of biosimilar ranibizumab (total 3 mg). Nineteen AEs were reported (n = 16; 12.7%); majority (78.9%) were mild. There were no serious AEs reported, except one AE of death which was unrelated to the study drug. None of the patients discontinued the study due to an AE. The most common ocular AE was increase in intraocular pressure (4 events) and non-ocular AE was pyrexia (5 events). A total of 7.9% (10/126) patients prior to dosing and 7.1% (9/126) patients post-treatment were positive for anti-ranibizumab antibodies. No AEs suggestive of immunogenicity were noted. At 24-weeks, 97.60% patients in the intent-to-treat (ITT) population (N = 125) and 97.41% patients in the per-protocol (PP) population (N = 116) lost < 15 letters from baseline visual acuity. In the ITT and PP populations, 31.20% and 32.76% patients, respectively, showed improved visual acuity by ≥ 15 letters. Significant improvements in BCVA (mean difference: 8.8, 9.2, p < 0.001 for ITT, PP) and VFQ-25 (8.5, 9.2, p < 0.001 for ITT, PP) were seen; CRT reduced significantly (125 µm, 119.3 µm, p < 0.001 for ITT, PP). Conclusion Razumab™ (world’s first biosimilar ranibizumab) was well-tolerated without new safety concerns and significantly improved visual acuity in wet AMD patients. Trial registration CTRI/2016/03/006739. Registered 18 March 2016—Prospectively registered, http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=13141&EncHid=&userName=2016/03/006739 Supplementary Information The online version contains supplementary material available at 10.1186/s40942-021-00293-w.
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Affiliation(s)
- Shashikant Sharma
- Medical Affairs, Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Maiti
- Susrut Eye Foundation & Research Centre, Kolkata, West Bengal, India
| | | | - Sandeep Saxena
- Department of Ophthalmology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Dave
- L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vimal Parmar
- PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Raju Sampangi
- Gurushree Hi-Tech Multi Speciality Hospital, Bangalore, Karnataka, India
| | - Hemanth Murthy
- Retina Institute of Karnataka, Bangalore, Karnataka, India
| | - Sandhya Dharwadkar
- K.R. Hospital, Mysore Medical College & Research Institute, Mysore, India
| | | | | | - Rahul Mayor
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Soumyava Basu
- L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Neha Goel
- ICARE Eye Hospital & Post Graduate Institute, Noida, Uttar Pradesh, India.,Eye7 Chaudhary Eye Centre, New Delhi, India
| | - Alok Chaturvedi
- Medical Affairs, Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India
| | - Ronak Patel
- Department of Biostatistics and Programming, Lambda Therapeutic Research Ltd., Ahmedabad, Gujarat, India
| | - Vinu Jose
- Clinical Development & Medical Affairs, Intas Pharmaceuticals Ltd. (Biopharma), Ahmedabad, Gujarat, India
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Dalan D, Nandini P, Angayarkanni N, Kaviarasan K, Thanikachalam S, Das UN, Ratra D. Interchangeability of retinal perfusion indices in different-sized angiocubes: An optical coherence tomography angiography study in diabetic retinopathy. Indian J Ophthalmol 2021; 68:484-489. [PMID: 32057009 PMCID: PMC7043157 DOI: 10.4103/ijo.ijo_783_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the differences in vascular indices in different scan sizes of optical coherence tomography angiography (OCTA) images in normal persons versus persons with diabetic retinopathy. Methods OCTA scans of diabetic patients and age-matched controls were performed by a single operator. Automated quantification of vascular indices of the superficial plexus was analyzed in two angiocubes of 3 × 3 mm and 6 × 6 mm, respectively. The agreement was analyzed with the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results Forty-eight eyes with DR, 36 eyes with no diabetic retinopathy (No DR), and 26 eyes of age-matched normals were scanned. The foveal avascular zone (FAZ) area and perimeter were highly reliable and interchangeable in both angiocubes of the healthy eyes (ICC 0.94, 0.75), No DR (ICC 0.92, 0.85), and DR eyes (ICC 0.97, 0.89). The vessel density (VD) and perfusion density (PD) showed excellent agreement in normal (ICC 0.89, 0.80) and No DR eyes (ICC 0.92, 0.81). But, only fair ICC was observed in DR eyes (0.56, 0.42). Conclusion The FAZ area and perimeter showed excellent reproducibility. The macular perfusion parameters are not interchangeable despite automated estimation. The variability is more with changes in the vascular network like DR. This variability should be considered while comparing different scans.
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Affiliation(s)
- Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Visakhapatnam, India
| | - Prakash Nandini
- RS Mehta Jain Department of Biochemistry, Vision Research Foundation, Visakhapatnam, India
| | | | - Kuppan Kaviarasan
- Department of Biomedical Sciences, Sri Ramachandra Institute of Higher Education and Research, Visakhapatnam, India
| | - Sadagopan Thanikachalam
- Cardiology Care Center, Sri Ramachandra Institute of Higher Education and Research, Visakhapatnam, India
| | - Undurti N Das
- BioScience Research Centre, GVP Hospital and Medical College, Visakhapatnam, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Visakhapatnam, India
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Ratra D, Mishra S. Multilayered retinal pigment epithelial detachment: an optical coherence tomography angiography perspective. GMS Ophthalmol Cases 2021; 11:Doc04. [PMID: 33654651 PMCID: PMC7894128 DOI: 10.3205/oc000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new entity termed multilayered pigment epithelial detachment is seen to occur with the use of multiple intravitreal anti-VEGF agents. A distinct appearance of a spindle-shaped elevation with bands of hyporeflective and hyperreflective tissue is seen on optical coherence tomography. We describe a novel finding on optical coherence tomography angiography which includes a large type 1 choroidal neovascular membrane underlying this elevation. A large vascular network is seen. It is thought to be protective in nature and may prevent further degeneration.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India,*To whom correspondence should be addressed: Dhanashree Ratra, Department of Vitreoretinal Diseases, Sankara Nethralaya, 41/18 College Road, Chennai 600006, India, E-mail:
| | - Samarth Mishra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
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Ratra D. Commentary: Retinal pigment epithelium-choroid patch graft for large submacular hemorrhage. Indian J Ophthalmol 2020; 68:2153-2154. [PMID: 32971628 PMCID: PMC7727970 DOI: 10.4103/ijo.ijo_774_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, SankaraNethralaya, Chennai, Tamil Nadu, India
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Govindaswamy N, Ratra D, Dalan D, Doralli S, Tirumalai AA, Nagarajan R, Mochi T, Shetty N, Sinha Roy A. Vascular changes precede tomographic changes in diabetic eyes without retinopathy and improve artificial intelligence diagnostics. J Biophotonics 2020; 13:e202000107. [PMID: 32392370 DOI: 10.1002/jbio.202000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to evaluate early vascular and tomographic changes in the retina of diabetic patients using artificial intelligence (AI). The study included 74 age-matched normal eyes, 171 diabetic eyes without retinopathy (DWR) eyes and 69 mild non-proliferative diabetic retinopathy (NPDR) eyes. All patients underwent optical coherence tomography angiography (OCTA) imaging. Tomographic features (thickness and volume) were derived from the OCTA B-scans. These features were used in AI models. Both OCT and OCTA features showed significant differences between the groups (P < .05). However, the OCTA features indicated early retinal changes in DWR eyes better than OCT (P < .05). In the AI model using both OCT and OCTA features simultaneously, the best area under the curve of 0.91 ± 0.02 was obtained (P < .05). Thus, the combined use of AI, OCT and OCTA significantly improved the early diagnosis of diabetic changes in the retina.
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Affiliation(s)
- Nivedhitha Govindaswamy
- Imaging, Biomechanics and Mathematical Modeling solutions Lab, Narayana Nethralaya Foundation, Bangalore, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
| | | | | | - Rajesh Nagarajan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
| | - Thirumalesh Mochi
- Department of Vitreoretinal Diseases, Narayana Nethralaya, Bangalore, India
| | - Naren Shetty
- Department of Refractive and Cataract surgery, Narayana Nethralaya, Bangalore, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling solutions Lab, Narayana Nethralaya Foundation, Bangalore, India
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Dalan D, Jaishankar D, Madhu A, Mani K, Ratra D. Macular function assessment by multifocal electroretinogram and microperimetry in macular hole and correlation with visual acuity. Nepal J Ophthalmol 2020; 12:4-6. [PMID: 32799234 DOI: 10.3126/nepjoph.v12i1.25759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better assessment than the Snellen visual acuity alone. OBJECTIVES To evaluate macular function with mfERG and microperimetry, and assess their correlation with visual acuity in MH. MATERIALS AND METHODS A prospective study was done in patients with unilateral,idiopathic full thickness MH. Standard surgery with vitrectomy, internal limiting membrane peeling and gas tamponade was done. Snellen and logMAR visual acuity, mfERG, microperimetry and optical coherence tomography were done pre and postoperatively. RESULTS Twenty six patients with unilateral macular hole and twenty five age matched controls were included. The mean age of patients was 59.92±9.39 years (range: 40 to 74 years). All the holes were closed after surgery (two required second surgery). The mean visual acuity improved from 0.77±0.34 logMAR to 0.43±0.36 (p =0.03). The mfERG amplitudes differed ring wise, but the average amplitude changed from 26.31±8.82 to 20.52±7.11 (p =0.03). The mean retinal sensitivity changed from 12.98±2.59 to 13.42±2.53 (p =0.11). There was significant correlation between visual acuity and mfERG amplitudes and retinal sensitivity. Regression equations to predict visual outcome could be derived. CONCLUSIONS In MH, mfERG and microperimetry show reduced responses, delay in recovery of function. They show a strong correlation with visual acuity. It is possible to predict vision after surgery with the help of mfERG and MP. Improved ability to predict visual outcome can increase the utility of anatomic success predictors.
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Affiliation(s)
- Daleena Dalan
- Department Of Vitreoretinal Diseases, Sankara Nethralaya, 41/18, College Road, Chennai, India
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Ratra D, Sharma U, Dalan D. Efficacy and safety of intravitreal dexamethasone implant in treatment naïve eyes with diabetic macular edema: Real world experience. Eur J Ophthalmol 2020; 31:1899-1906. [PMID: 32772850 DOI: 10.1177/1120672120949761] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of intravitreal dexamethasone implant in treatment naïve eyes with diabetic macular edema (DME). METHODS A retrospective analysis of treatment naïve eyes with DME which received intravitreal dexamethasone implant between January 2016 and March 2018 was done. Demographic details of the patients, ocular examination findings at baseline and on follow up visits were noted. Morphological features of DME and central macular thickness were noted on optical coherence tomography at each visit. The details regarding additional treatment for macular edema on follow up were noted. RESULTS Sixty five eyes were included in the study. The mean age was 59.14 ± 9.59 years. The follow up ranged from 6 to 48 months. Psuedophakic eyes showed visual improvement whereas the phakic eyes showed stable vision. The central foveal thickness showed significant reduction (p = 0.05) in all the eyes. The best corrected visual acuity at final follow up (+0.65 logMAR) was slightly less as compared to baseline (+0.62 logMAR). Retreatment was needed in 37% eyes and antiglaucoma medications in 8% eyes. Cataract progression was noted in 24 eyes (37%); 17 eyes (26.1%) underwent surgery. Notably, 27 eyes (41.5%) had some degree of macular ischemia at baseline. And five eyes (7.7%) showed progression of retinopathy leading to vitreous hemorrhage. CONCLUSION Dexamethasone implant is helpful in reducing the macular thickness and stabilizing the vision in treatment naïve DME; requiring less number of treatment sessions. However, it does not prevent progression of diabetic retinopathy. The visual improvement may be affected by cataract and macular ischemia.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
| | | | - Daleena Dalan
- Department of Vitreoretinal Diseases, Sankara Nethralaya, Chennai, India
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Kaushal A, Ratra D. Commentary: Retinal branch vein occlusion and arteriosclerosis: Can cardio-ankle vascular index be a useful biomarker? Indian J Ophthalmol 2020; 68:873-874. [PMID: 32317468 PMCID: PMC7350425 DOI: 10.4103/ijo.ijo_2293_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anshu Kaushal
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Sen P, Attiku Y, Bhende P, Rishi E, Ratra D, Sreelakshmi K. Outcome of sutured scleral fixated intraocular lens in Marfan syndrome in pediatric eyes. Int Ophthalmol 2020; 40:1531-1538. [DOI: 10.1007/s10792-020-01322-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/14/2020] [Indexed: 11/28/2022]
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Dalan D, Jaisankar D, Mani K, Madhu A, Ratra D. A multifocal electroretinography study to evaluate risk of developing macular hole in the fellow eye of patients suffering with unilateral macular hole. Ther Adv Ophthalmol 2020; 12:2515841420908697. [PMID: 32154503 PMCID: PMC7045290 DOI: 10.1177/2515841420908697] [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] [Received: 06/27/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background Visual outcome of eyes has often been found to be unsatisfactory even after successful closure of a macular hole, owing to factors like persistent metamorphopsia, scotoma, and reduced sensitivity. Therefore, it becomes critical to evaluate and study the probability and risk of developing a macular hole in the fellow eyes of the patient. This study analyzed the multifocal electroretinographic responses to help predict the risk of macular hole development in fellow eyes. Methods In total 26 fellow eyes, 26 eyes with macular hole, and 50 eyes of 25 controls were enrolled prospectively. The retinal responses from the different rings were compared in the three groups. Optical coherence tomography was done to rule out macular pathology or vitreomacular traction in the fellow eyes. Results All the fellow eyes under observation showed significantly reduced mean amplitudes of retinal response densities, in all rings as compared with controls (31.45 ± 10.38 versus 48.87 ± 7.55, p = 0.00). Three of the fellow eyes developed a macular hole during the 24 months observation period. The prevalence of fellow eye involvement was 11.5%. Relative risk of developing macular hole in the fellow eye ranged from 25 to 75. Conclusion All the fellow eyes, including those that did not develop a macular hole, showed significantly reduced responses on multifocal electroretinogram. This indicates that macular hole may not be a focal disease. It may have widespread functional deficit which is bilateral in nature and suggestive of a degenerative or ischemic insult.
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Affiliation(s)
- Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Durgasri Jaisankar
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Karthiga Mani
- Department of Electrophysiologic Studies, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Abinaya Madhu
- Department of Electrophysiologic Studies, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, 600006 Chennai, India
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Abstract
Sturge–Weber syndrome (SWS) includes facial, leptomeningeal and choroidal hemangioma. The retinal vasculature is essentially normal. Rare cases of retinal vascular tortuosity and arterio-venous malformations have been reported. We report two cases with rare concomitant retinal vascular abnormalities along with SWS. Both the patients had nevus flammeus, hemifacial hypertrophy, and choroidal hemangioma. In one case, retinal cavernous hemangioma was seen in the affected eye. The other case revealed retinal neovascularization secondary to proliferative diabetic retinopathy in the eye with choroidal hemangioma.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Hitesh Yadav
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Preet Kanwar Singh Sodhi
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India
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Anshuman K, Ratra D. Commentary: Ziv-aflibercept: An alternative antivascular endothelial growth factor agent for polypoidal choroidal vasculopathy. Indian J Ophthalmol 2019; 67:1119-1120. [PMID: 31238424 PMCID: PMC6611272 DOI: 10.4103/ijo.ijo_204_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kumar Anshuman
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, India
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, Chennai, Tamil Nadu, India
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