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Baskaran P, Sindal MD, Ganne P, Madanagopalan VG, Krishnappa NC, Rajendran A, Dhoble P, Ratna B, Ghondale H, Mani I. Closure rate and recovery of subfoveal microstructures following conventional internal limiting membrane peeling versus per fluoro octane-assisted inverted flap for large macular holes - A randomized controlled trial (InFlap Study). Indian J Ophthalmol 2024; 72:S75-S83. [PMID: 38131546 PMCID: PMC10833171 DOI: 10.4103/ijo.ijo_484_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the outcomes following conventional internal limiting membrane (ILM) peeling versus perfluoro octane-assisted inverted flap technique for large macular holes (MH). METHODS A consecutive 99 eyes of 99 patients were enrolled {45 - conventional group and 54 - inverted flap (InFlap) group}. The primary outcome was a difference in closure rate. Secondary outcomes were differences in best-corrected visual acuity (BCVA), restoration of external limiting membrane (ELM) and ellipsoid zone (EZ) between groups at 3 (primary endpoint), 6 and 12 (secondary endpoints) months. Additionally, the effect of different gas tamponades on closure rates, ILM flap disintegration in InFlap group, and subfoveal thickness (SFT) between groups in closed. RESULTS At 3 months, there was no difference in the closure rate and BCVA between groups. At six months, closure rate was significantly better in the InFlap group. However, this difference was not maintained at 12 months. There was no difference in BCVA between groups at any visit. The ELM recovery was significantly higher in the conventional group at three months; however, there was no difference in ELM/EZ recovery between groups at other visits. The closure rate in the InFlap group was the same irrespective of gas tamponade. The ILM flap was identifiable in one-third of patients at 12 months. In closed MH, SFT was significantly more in InFlap group. CONCLUSION The closure rate and visual outcomes remained similar in both groups in the immediate and long term. Conventional ILM peeling technique seems to have early ELM recovery when compared to inverted flap technique.
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Affiliation(s)
- Prabu Baskaran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Manavi D Sindal
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Pratyusha Ganne
- Department of Retina, All India Institute of Medical Science, Mangalagiri, Andhra Pradesh, India
| | | | | | - Anand Rajendran
- Department of Retina, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Pankaja Dhoble
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | - Bholesh Ratna
- Department of Retina, Aravind Eye Hospital, Pondicherry, India
| | | | - Iswarya Mani
- Department of Statistics, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Madhivanan N, Nivean PD, Madanagopalan VG, Priya S, Madhivanan N, Arthi M. Clinical results after binocular implantation of a unique nondiffractive enhanced monofocal intraocular lens designed for enhanced monovision to increase the depth of focus. Indian J Ophthalmol 2024; 72:63-65. [PMID: 38131571 PMCID: PMC10841775 DOI: 10.4103/ijo.ijo_447_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/16/2023] [Accepted: 08/05/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To provide the reports of a pilot study to assess the visual acuity (VA) and contrast sensitivity with RayOne enhanced monovision (EMV), a unique nondiffractive enhanced monofocal intraocular lens (IOL) to increase the range of focus. METHODS A retrospective case series study was conducted by analyzing 25 patients (50 eyes) who had bilateral implantation of EMV IOL after cataract surgery. Data collected included biometry, spherical equivalent (SE), and VA for near, intermediate, and distance. Patients were reviewed at 1 day, 1 week, and 1 month after surgery. Contrast sensitivity (CS) was checked at 1 month. RESULTS The study included 14 males (56%). Age of participants was 61.4 ± 7.4 years. Uniocular uncorrected near and distance VA improved from 0.33 ± 0.13 to 0.05 ± 0.07 and from 0.63 ± 0.31 to 0.05 ± 0.10 log of minimum angle of resolution (logMAR) at 1 month (P < 0.001 for both). Binocular uncorrected near and distance VA improved from 0.09 ± 0.18 and 0.14 ± 0.27 to 0.05 ± 0.06 and 0.00 ± 0.09 logMAR, respectively (P < 0.001). SE changed from - 0.23 ± 2.55 to - 0.33 ± 0.46. CS at 3 months was 1.74 ± 0.21. At 1 month, 48 eyes (96%) achieved uncorrected intermediate VA 6/15 (0.4 logMAR) or better. When comparing eyes that had uncorrected intermediate vision of ≥ 0.2 (6/9 or better) to eyes that had < 0.2 logMAR at 1 month, there was no difference between groups with respect to baseline parameters. CONCLUSION The pilot study shows that the nondiffractive EMV IOL is safe, effective, and stable, providing excellent distance and intermediate vision and good near vision.
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Affiliation(s)
- Nivean Madhivanan
- Cataract and Vitreoretinal Services, MN Eye Hospital, Chennai, Tamil Nadu, India
| | | | - V G Madanagopalan
- Cataract and Vitreoretinal Services, JB Eye Hospital, Salem, Tamil Nadu, India
| | - Shanmuga Priya
- Department of Comprehensive Ophthalmology, MN Eye Hospital, Chennai, Tamil Nadu, India
| | | | - M Arthi
- Cataract and Vitreoretinal Services, JB Eye Hospital, Salem, Tamil Nadu, India
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Seethapathy G, Madanagopalan VG. Thyroid eye disease: Etiopathogenesis and management. TNOA J Ophthalmic Sci Res 2022. [DOI: 10.4103/tjosr.tjosr_76_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Abstract
Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.
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Affiliation(s)
| | - V G Madanagopalan
- Cataract and Vitreoretinal Services, JB Eye Hospital, Salem, Tamil Nadu, India
| | - Raja Narayanan
- Director-The Retina Institute and Suven Clinical Research Centre, Consultant Ophthalmologist, Vitreo Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Chandrasekaran PR, Madanagopalan VG. KSI-301: antibody biopolymer conjugate in retinal disorders. Ther Adv Ophthalmol 2021; 13:25158414211027708. [PMID: 34291186 PMCID: PMC8278447 DOI: 10.1177/25158414211027708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
KSI-301 is a new intravitreal anti-vascular endothelial growth factor (VEGF) antibody biopolymer conjugate under investigation for the treatment of age-related macular degeneration (AMD), diabetic macular oedema (DME) and retinal vein occlusion (RVO). Preclinical and early clinical trials so far have shown promising results in retinal vascular diseases. When using anti-VEGF agents for treatment of retinal disorders, the frequency of injections and follow-up visits has increased the treatment burden, greatly affecting the treatment outcome. There are new anti-VEGF agents in the horizon with extended duration of action, durability, safety profile and efficacy, which seem to address the above issues. PubMed search and Medline search were performed on newer anti-VEGF agents, KSI-301, antibody biopolymer conjugate in retina, KODIAK KSI-301, DAZZLE study, GLEAM study, GLIMMER study, GLOW study and BEACON study. This review article showcases the biophysical properties and ongoing trials related to KSI-301. Moreover, we discuss the efficacy and safety profile of KSI-301 on the basis of the results of available trials.
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Madanagopalan VG. Heads-up surgery in ophthalmology. TNOA J Ophthalmic Sci Res 2021. [DOI: 10.4103/tjosr.tjosr_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Madanagopalan VG, Sriram Gopal MR, Sengupta S. Perspectives of physicians in general and ophthalmologists in particular about restarting services post-COVID-19 lockdown. Indian J Ophthalmol 2020; 68:1401-1406. [PMID: 32587176 PMCID: PMC7574103 DOI: 10.4103/ijo.ijo_1221_20] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To assess the perspectives of physicians in general and ophthalmologists in particular about restarting elective out-patient (OP) and operating (OT) services after relaxation of lockdown for COVID-19. METHODS An online survey, containing 31 questions, was conducted among medical doctors using a secure Google forms link. The survey was open for 48 hours from 16th-18th April 2020. RESULTS Responses were received from 556 physicians (including 266 ophthalmologists). About a third (n = 205) wanted to start OP immediately after lockdown. In OP, mask of any kind for patient (60.8%), 3-ply for assistants (52.7%) and N95 for doctors (72.7%) were most common preferences. In OP, 31.5% and 46.6% felt full PPE and gloves alone were sufficient respectively. Ophthalmologists were more likely to start immediately after lockdown compared to other specialists (P = 0.004). Among 299 surgeons, an almost equal number (27%) wanted to start routine OT services immediately and 2 weeks post lockdown. A large majority (76.9%) would mandate COVID-19 tests before elective surgeries. In OT, 34.1% wanted N95 for surgical team and 3-ply for patient, 23.4% wanted 3-ply masks for everyone. 40.5% felt additional personal protective equipment (PPE) is not required and 33.1% felt that full PPE is required for everyone in OT. Ophthalmic surgeons preferred 3-ply masks and were less inclined to use full PPE (P < 0.001). CONCLUSION Perspectives of doctors vary, especially with regarding to timing of restarting services and precautions to be taken in the OT. Ophthalmologists may tend to err on the side of taking lesser stringent precautions when restarting services post lockdown.
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Affiliation(s)
- V G Madanagopalan
- Vitreoretinal Services, JB Eye Care & Retina Centre, Salem, Tamil Nadu, India
| | - M R Sriram Gopal
- Vitreoretinal Services, Athreya Retinal Centre, Tiruchirapalli, Tamil Nadu, India
| | - Sabyasachi Sengupta
- Vitreoretinal Services, Future Vision Eye Care & Sengupta's Research Academy, Mumbai, India
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Madanagopalan VG. Commentary: Systemic immune-inflammatory indices and their association with ocular disorders-Do we have economical and reliable biomarkers? Indian J Ophthalmol 2020; 68:859-860. [PMID: 32317463 PMCID: PMC7350505 DOI: 10.4103/ijo.ijo_2100_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: 11/20/2022] Open
Affiliation(s)
- V G Madanagopalan
- Vitreoretinal Services, Arasan Eye Hospital, Erode, Tamil Nadu, India
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Madanagopalan VG, Nagesha CK, Velis G, Sindal MD. Gradual resolution of foveal herniation after epiretinal membrane peeling. Oman J Ophthalmol 2020; 13:49-50. [PMID: 32174744 PMCID: PMC7050455 DOI: 10.4103/ojo.ojo_104_2018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/26/2019] [Accepted: 11/25/2019] [Indexed: 11/07/2022] Open
Abstract
We demonstrate the gradual resolution of foveal herniation with optical coherence tomography (OCT) images after epiretinal membrane (ERM) removal. A young male presented with diminished vision in the left eye (OS). Examination of OS revealed an ERM and thickening of the foveal region. OCT delineated the ERM clearly. It also showed a central defect in the ERM through which the inner retinal layers had prolapsed into the vitreous cavity leading to foveal herniation. The patient underwent vitrectomy and surgical removal of the ERM. After removing the source of macular traction, over a period of 4 months, gradual reduction in height of the elevated central foveal tissue was observed. At 6 months, the foveal bulge had reduced remarkably and remained stable. The resolution of foveal herniation after ERM removal is a slow process. The OCT images convey that it may take few months for the foveal bulge to decrease in height. When the outer retinal layers are normal, visual recovery, though delayed, is appreciable.
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Affiliation(s)
| | - C K Nagesha
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - Girish Velis
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
| | - Manavi D Sindal
- Vitreoretinal Services, Aravind Eye Hospital, Puducherry, India
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Madanagopalan VG, Raman R. Commentary: Artificial intelligence and smartphone fundus photography - Are we at the cusp of revolutionary changes in retinal disease detection? Indian J Ophthalmol 2020; 68:396-397. [PMID: 31957736 PMCID: PMC7003606 DOI: 10.4103/ijo.ijo_2175_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- V G Madanagopalan
- Vitreoretinal Services, Arasan Eye Hospital, Erode, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Madanagopalan VG. Innovations in retinal diagnosis and surgery. TNOA J Ophthalmic Sci Res 2020. [DOI: 10.4103/tjosr.tjosr_125_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- V G Madanagopalan
- Vitreo-Retinal Services, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | - Girish Velis
- Vitreo-Retinal Services, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
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Madanagopalan VG, Arthi M. The use of air from the infusion line to confirm infusion tip positioning in vitreous surgery for eyes with media opacities. J Curr Ophthalmol 2019; 31:339-341. [PMID: 31528772 PMCID: PMC6742618 DOI: 10.1016/j.joco.2019.01.005] [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: 11/25/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To demonstrate the use of an air bubble in infusion to ascertain infusion tip (IT) positioning before commencing vitreoretinal surgery (VRS) in eyes with media opacities. Methods Twenty-four eyes were studied. An air bubble was introduced into the IT by manually expelling fluid from the distal end of the IT. Passage of this air bubble into the vitreous cavity immediately on opening the infusion line confirmed IT position and VRS was commenced only after this event. Results The air bubble was seen within the eye in 18/24 eyes immediately on opening the infusion line. In 6 eyes, the air bubble did not exit the infusion line, and VRS was commenced only after IT position was confirmed by other methods. In all 24 eyes, no untoward effect attributable to the air bubble was noticed during subsequent VRS. Conclusions An air bubble introduced into the IT helps to quickly confirm IT position when direct visualization of the IT is difficult. There were no untoward events in eyes where the air bubble could not enter the vitreous cavity.
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Affiliation(s)
| | - M Arthi
- Eye and Retina Speciality Hospital, Tirupur, India
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Madanagopalan VG, Susvar P, Arthi M. Refractive outcomes of a single-step and a two-step approach for silicone oil removal and cataract surgery. Indian J Ophthalmol 2019; 67:625-629. [PMID: 31007222 PMCID: PMC6498926 DOI: 10.4103/ijo.ijo_1380_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/09/2022] Open
Abstract
Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ≤±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (−1.73 ± 2.04 vs. −0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ≤±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.
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Affiliation(s)
- V G Madanagopalan
- Shri Bhagwan Mahavir Vitreo Retinal Services, Sankara Nethralaya, Chennai, India
| | - Pradeep Susvar
- Shri Bhagwan Mahavir Vitreo Retinal Services, Sankara Nethralaya, Chennai, India
| | - M Arthi
- Department of Comprehensive Ophthalmology, Sankara Nethralaya, Chennai, India
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Madanagopalan VG, Shah K, Nagesha CK, Baskaran P. Peripheral retinal avascularity and capillary leakage in central serous chorioretinopathy. J Curr Ophthalmol 2019; 31:220-224. [PMID: 31317104 PMCID: PMC6611917 DOI: 10.1016/j.joco.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a novel finding of peripheral retinal avascularity (PRA) and peripheral capillary leakage (PCL) on wide-field fluorescein angiography (WFA) in non-dependent quadrants, in eyes with bilateral chronic central serous chorioretinopathy (CSCR). Methods Forty six patients with bilateral CSCR were studied. Four patients had PRA and PCL, and 42 patients did not. The demographic profile, clinical findings, and imaging characteristics of the two groups were compared. Results There was no significant difference between those patients with and without PRA and PCL with respect to the demographic profile, clinical findings, and imaging characteristics. Laser photocoagulation to extrafoveal points of leakage seen on fluorescein angiography (FA) was sufficient to cause complete resolution of CSCR in these 4 patients. PRA areas were not treated. Conclusion The PRA and PCL in CSCR are novel findings, which have not been previously described.
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Affiliation(s)
| | - Karan Shah
- Aravind Eye Hospital and Postgraduate Institute, Pondicherry, India
| | - C K Nagesha
- Aravind Eye Hospital and Postgraduate Institute, Pondicherry, India
| | - Prabu Baskaran
- Aravind Eye Hospital and Postgraduate Institute, Pondicherry, India
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Madanagopalan VG, Shivananda N, Krishnan T. Surgically induced necrotizing scleritis after retinal detachment surgery masquerading as scleral abscess. GMS Ophthalmol Cases 2019; 9:Doc18. [PMID: 31293874 PMCID: PMC6607444 DOI: 10.3205/oc000107] [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: 11/30/2022]
Abstract
Scleral necrosis is a rare occurrence after many ocular procedures. In the absence of infection or use of surgical adjuncts such as antimetabolites or radiation, the necrosis is presumed to be directly related to surgical trauma and is hence termed surgically induced necrotizing scleritis (SINS). A high index of suspicion is required for an early diagnosis of SINS and its differentiation from infective scleritis is important as the treatment modalities of these two related conditions are different. We report a case of SINS at sclerotomy site following 23-gauge transconjunctival retinal detachment surgery that was initially suspected to be a scleral abscess. Prompt recognition and institution of topical and systemic steroid therapy helped in limiting the extent of scleral damage.
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Madanagopalan VG. Sandwich Technique with Anterior Silicone Oil and Posterior Perfluorocarbon Liquid for Intraoperative Retinal Stabilization in Eyes with Large Retinal Breaks. J Ophthalmic Vis Res 2019; 14:232-235. [PMID: 31114664 PMCID: PMC6504719 DOI: 10.4103/jovr.jovr_225_17] [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: 11/16/2022] Open
Abstract
During retinal surgeries, the presence of large retinal defects or breaks (giant retinal tears or retinotomies ≥3 clock hours) requires the use of perfluorocarbon liquid (PFCL) to stabilize the posterior retina. Thereafter, direct PFCL-oil exchange is preferred to avoid posterior slippage of the retina. However, in an eye filled with PFCL, fluid currents at the surface of the PFCL pose a few problems when laser is attempted. Multiple bubbles are formed due to fluid currents, and the fluid jet from the infusion port may continually dislodge the free end of the retina despite the presence of PFCL. This effect is accentuated when instruments are exchanged or if the active port is unoccluded. On the other hand, if laser is postponed until the eye is filled with oil, fluid accumulation may occur under the macula, as posterior tamponade is absent. We present a modified technique that entails the use of a “sandwich” of anterior SO and posterior PFCL to comfortably perform laser in a well-formed closed vitreous chamber with continuous maintenance of retinal attachment.
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Madanagopalan VG, Mouttapa F, Singh J. Early Buckle Migration and Restrictive Strabismus after Successful Medical Management of Scleral Buckle Infection. J Binocul Vis Ocul Motil 2019; 69:61-63. [PMID: 30951443 DOI: 10.1080/2576117x.2019.1590140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of restrictive strabismus caused by early scleral buckle (SB) migration within 1 month of surgery after successful medical management of SB infection. A 24 year-old man underwent scleral buckling surgery for left eye inferior retinal detachment (RD). A solid silicone buckle element was placed inferiorly along with an encircling silicone band. Two days after surgery, he presented with SB infection. Methicillin resistant Staphylococcus aureus was cultured from the exudate at conjunctival suture sites. Since the retina was well attached and it was only the second postoperative day, it was decided to retain the buckle. SB infection was treated with intravenous cefotaxime and topical fortified cefazolin and successfully eradicated. One month thereafter, anterior SB migration was noted on slit lamp biomicroscopy. Restrictive strabismus and diplopia were also noted. Eventually, SB removal was performed at 2 months. This case report highlights the role of infection and subsequent inflammation as a cause for buckle migration and restrictive strabismus in the early post-operative period. These changes can be seen as early as 1 month after primary surgery and may occur even after successful medical management of the SB infection.
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Affiliation(s)
- V G Madanagopalan
- a Vitreoretinal Services , Aravind Eye Hospital , Pondicherry , India
| | - Fredrick Mouttapa
- b Pediatric Ophthalmology and Strabismus Services , Aravind Eye Hospital , Pondicherry , India
| | - Jivitesh Singh
- c Department of Comprehensive Ophthalmology , Aravind Eye Hospital , Pondicherry , India
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Madanagopalan VG, Paneer Selvam V, Sarath Sivan NV, Govindaraju NV. Central retinal vein occlusion in a patient with breast carcinoma. GMS Ophthalmol Cases 2019; 9:Doc04. [PMID: 30828514 PMCID: PMC6381396 DOI: 10.3205/oc000093] [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: 11/30/2022]
Abstract
Purpose: Systemic malignancies may have ocular manifestations in the form of metastatic tumors, carcinoma associated retinopathy or central retinal vein occlusion (CRVO). Although CRVO has been mentioned in association with renal, lung, prostatic and ovarian malignancies, the association of CRVO with breast carcinoma is unreported. We report a patient with one such rare association. Methods: We describe a patient with breast carcinoma who was diagnosed to have CRVO. The history, ocular examination, retinal optical coherence tomography scan, ocular ultrasound scan, hematological profile, mammogram details and aspiration cytology description of the malignant breast lesion are reported in this article. Results: The retina showed extensive hemorrhages and dilated retinal veins. Complete hematologic evaluation revealed the presence of microcytic hypochromic anemia and increased hematocrit. These changes are possibly related to the malignant disease and might contribute to the pathogenesis of CRVO. Coclusion: This case report demonstrates the rare association between breast malignancy and CRVO.
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Madanagopalan VG, Kim R, Kumar A, Raman R, Narayanan R, Nagpal M, Ruamviboonsuk P. Expert corner - diabetic retinopathy. TNOA J Ophthalmic Sci Res 2019. [DOI: 10.4103/tjosr.tjosr_44_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Madanagopalan VG, Nagesha CK, Khodifad AM, Raman R. Influence of orientation of the external linear incision created by the 25-gauge trocar and related factors on sclerotomy closure: A clinical and optical coherence tomographic study. Indian J Ophthalmol 2018; 66:1809-1814. [PMID: 30451184 PMCID: PMC6256909 DOI: 10.4103/ijo.ijo_458_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). Methods: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. Results: Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ≥5 when circumferential sclerotomies were used. Conclusion: Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.
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Affiliation(s)
- V G Madanagopalan
- Vitreoretinal Services, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | - C K Nagesha
- Vitreoretinal Services, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | - Ashish M Khodifad
- Vitreoretinal Services, Aravind Eye Hospital, Pondicherry, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Madanagopalan VG, Kumari B. Predictive Value of Baseline Biochemical Parameters for Clinical Response of Macular Edema to Bevacizumab in Eyes With Central Retinal Vein Occlusion: A Retrospective Analysis. Asia Pac J Ophthalmol (Phila) 2018; 7:321-330. [PMID: 29082677 DOI: 10.22608/apo.2017205] [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: 11/08/2022] Open
Abstract
PURPOSE To evaluate the influence of baseline biochemical parameters on the improvement in best corrected visual acuity (BCVA) and reduction in central foveal thickness (CFT) in patients treated with intravitreal bevacizumab (IVB; Avastin, Genentech, Inc) for macular edema (ME) secondary to central retinal vein occlusion (CRVO). DESIGN A retrospective study. METHODS Seventy eyes of 70 participants with CRVO who underwent IVB for ME and had at least 1 month of follow-up after the last injection were studied. Demographic variables, systolic and diastolic blood pressure (SBP and DBP), BCVA, CFT measured by optical coherence tomography (OCT), and biochemical investigations [hemoglobin, fasting and postprandial blood sugar (FBS and PPBS), lipid profile, blood urea (BU), serum creatinine (SC), glycosylated hemoglobin (HbA1c)] at baseline were noted. IVB need at every visit was based on clinical and OCT parameters. Changes in BCVA (ΔBCVA) and CFT (ΔCFT) from baseline to last injection were estimated. RESULTS After IVB, there was a statistically significant reduction in mean CFT (P < 0.01). The group of patients with normal BU and SC had more than 2 lines of improvement compared with those with elevated values (P = 0.043 and 0.009, respectively). Other parameters like FBS, PPBS, hemoglobin, HbA1c, and serum lipids were not associated with improvement of BCVA and reduction of CFT. CONCLUSIONS Normal baseline renal parameters (BU and SC) predict better visual outcome after treatment for ME in CRVO and offer additional benefit over and above that obtained with ME reduction.
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Affiliation(s)
- V G Madanagopalan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
| | - Bibha Kumari
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Thavalakuppam, Pondicherry, India
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Madanagopalan VG, Nagesha CK, Velis G, Devulapally S, Balamurugan S. Frosted branch angiitis with penetrating ocular trauma and retained intraocular foreign body. Indian J Ophthalmol 2018; 66:1031-1033. [PMID: 29941765 PMCID: PMC6032755 DOI: 10.4103/ijo.ijo_1276_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 54-year-old male sustained ocular trauma with a projectile. Examination of the right eye revealed an intraocular foreign body (IOFB) adjacent to the optic nerve head, vitritis, vitreous hemorrhage, and translucent perivascular sheathing of the retinal vessels in all quadrants suggesting frosted branch angiitis (FBA). The patient underwent vitrectomy with removal of the IOFB and silicone oil tamponade under steroid cover. With continued use of systemic and topical steroids after surgery, complete resolution of FBA and improvement in vision were noted in a week. Prompt resolution of FBA after IOFB removal points toward a strong association between the presence of IOFB and FBA.
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Affiliation(s)
| | - C K Nagesha
- Vitreo-Retinal Services, Aravind Eye Hospital, Puducherry, India
| | - Girish Velis
- Vitreo-Retinal Services, Aravind Eye Hospital, Puducherry, India
| | | | - S Balamurugan
- Uvea Services, Aravind Eye Hospital, Puducherry, India
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Madanagopalan VG, Das S, Ramkumar R. Clear Vitreous Cyst and Iridescence. Ophthalmol Retina 2018; 2:557. [PMID: 31047608 DOI: 10.1016/j.oret.2017.11.002] [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: 10/29/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 06/09/2023]
Affiliation(s)
| | - Suman Das
- Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | - R Ramkumar
- Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
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Madanagopalan VG, Thotakura M, Dhoble P. Macular Horseshoe-Shaped Tear Following Cricket Injury. JAMA Ophthalmol 2017; 135:e173855. [PMID: 29121189 DOI: 10.1001/jamaophthalmol.2017.3855] [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: 11/14/2022]
Affiliation(s)
- V G Madanagopalan
- Vitreo-Retinal Service, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | - Meena Thotakura
- Vitreo-Retinal Service, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | - Pankaja Dhoble
- Vitreo-Retinal Service, Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
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Kajave A, Madanagopalan VG, Nagesha CK. Massive Retinal Cavernous Hemangioma Imaged with Fluorescein Angiography. Ophthalmol Retina 2017; 1:544. [PMID: 31047449 DOI: 10.1016/j.oret.2017.07.008] [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: 06/27/2017] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 06/09/2023]
Affiliation(s)
- Aditya Kajave
- Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
| | | | - C K Nagesha
- Aravind Eye Hospital, Thavalakuppam, Pondicherry, India
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Madanagopalan VG. Scleral buckling: Principles, utility, and relevance today. TNOA J Ophthalmic Sci Res 2017. [DOI: 10.4103/tjosr.tjosr_22_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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