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Vasavada A.R.,Iladevi Cataract and Research Center | Raj S.M.,Iladevi Cataract and Research Center
Journal of Cataract and Refractive Surgery | Year: 2011

It is difficult to completely divide a hard nucleus. Excessive force is required, which may inadvertently lead to capsular bag distortion and cause stress to the zonules. We describe a chop technique that enables the surgeon to consistently achieve complete division of brunescent and black cataracts. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.


Vasavada V.A.,Iladevi Cataract and Research Center | Praveen M.R.,Iladevi Cataract and Research Center | Shah S.K.,Iladevi Cataract and Research Center | Trivedi R.H.,Medical University of South Carolina | Vasavada A.R.,Iladevi Cataract and Research Center
American Journal of Ophthalmology | Year: 2012

• PURPOSE: To determine if intraocular infusion of low-molecular-weight heparin (enoxaparin) reduces postoperative inflammation in pediatric eyes undergoing cataract surgery with IOL implantation. • DESIGN: Prospective masked randomized controlled trial. • METHODS: SETTING: Private, institutional practice. STUDY POPULATION: Twenty children (40 eyes) undergoing bilateral cataract surgery with IOL implantation were randomized to receive enoxaparin in the intraocular infusion fluid (BSS) (Group I) or not to receive enoxaparin (Group II). The first eye was randomly assigned to 1 of the 2 groups and the second eye received alternate treatment. OBSERVATION PROCEDURE: Patients were followed up in the first week and 1 and 3 months after surgery. MAIN OUTCOME MEASURES: Anterior chamber flare and cells (Hogan's criteria), cell deposits on IOL, posterior synechiae. • RESULTS: One week postoperatively, no eyes had >grade 2 flare/cells. Proportion of eyes with grade 2 cells was higher in eyes that did not receive enoxaparin (Group II: 80% vs Group I: 40%, P = .009). In the first week >10 small cell deposits were noted in the eyes that received enoxaparin (Group I: 20%, Group II: none, P = .005). Large cell deposits first appeared at 1 month in 40% of eyes in Group I and 55% of eyes in Group II (P = .34) and increased at 3 months (60% in both groups, P > .999). Posterior synechiae were seen in 10% of eyes in Group I at 1 month, which persisted at 3 months; no eyes in Group II showed posterior synechiae (P = .14). • CONCLUSION: The results of our study suggest that there does not seem to be a benefit of using enoxaparin in the infusion fluid with respect to early postoperative inflammation. © 2012 by Elsevier Inc. All rights reserved.


Pal A.K.,Iladevi Cataract and Research Center | Pal A.K.,Manipal University India | Gajjar D.U.,Iladevi Cataract and Research Center | Vasavada A.R.,Iladevi Cataract and Research Center
Medical Mycology | Year: 2014

Melanins are high molecular weight hydrophobic pigments that have been studied for their role in the virulence of fungal pathogens. We investigated the amount and type of melanin in 20 isolates of Aspergillus spp.; A. niger (n = 3), A. flavus (n = 5), A. tamarii (n = 3), A. terreus (n = 3), A. tubingensis (n = 3), A. sydowii (n = 3). Aspergillus spp. were identified by sequencing the internal transcribed spacer (ITS) region. Extraction of melanin from culture filtrate and fungal biomass was done and followed by qualitative and quantitative analysis of melanin pigment. Ultraviolet (UV), Fourier transformed infrared (FT-IR), and electron paramagnetic resonance (EPR) spectra analyses confirmed the presence of melanin. The melanin pathway was studied by analyzing the effects of inhibitors; kojic acid, tropolone, phthalide, and tricyclazole. The results indicate that in A. niger and A. tubingensis melanin was found in both culture filtrate and fungal biomass. For A. tamarii and A. flavus melanin was extracted from biomass only, whereas melanin was found only in culture filtrate for A. terreus. A negligible amount of melanin was found in A. sydowii. The maximum amount of melanin from culture filtrate and fungal biomass was found in A. niger and A. tamarrii, respectively. The DOPA (3,4- dihydroxyphenylalanine) pathway produces melanin in A. niger, A. tamarii and A. flavus, whereas the DHN (1,8-dihydroxynaphthalene) pathway produces melanin in A. tubingensis and A. terreus. It can be concluded that the amount and type of melanin in aspergilli largely differ from species to species. © 2013 The International Society for Human and Animal Mycology. All rights reserved.


Shah G.D.,Iladevi Cataract and Research Center | Praveen M.R.,Iladevi Cataract and Research Center | Vasavada A.R.,Iladevi Cataract and Research Center | Vasavada V.A.,Iladevi Cataract and Research Center | And 2 more authors.
Journal of Cataract and Refractive Surgery | Year: 2012

Purpose: To evaluate the rotational stability of a toric intraocular lens (IOL) using purpose-designed software and to determine the influence of axial length (AL) and in-the-bag IOL alignment on IOL rotation. Setting: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Design: Prospective observational case series. Methods: This study enrolled eyes that had AcrySof toric IOL implantation. The AL was measured using optical coherence biometry or immersion A-scan biometry. Corneal astigmatism was determined by manual keratometry and topography. The IOL alignment was vertical, horizontal, or oblique. Rotational stability was measured using the purpose-designed software, and the mean absolute difference was determined. The effect of AL and IOL alignment on rotational stability was determined 6 months postoperatively. Results: The study evaluated 168 eyes (168 patients). The mean AL was 23.86 mm ± 1.63 (SD), (range 19.50 to 29.03 mm). The median IOL rotation was 0.3 degree from baseline to 1 week, 1.0 degree from 1 week to 1 month, 0.2 degree from 1 to 3 months, and 0.1 degree from 3 to 6 months. The maximum rotation occurred between 1 week and 1 month. There was a strong correlation between AL and IOL rotation at 6 months (r = 0.93, P<.001). The mean absolute difference at 6 months was not significantly different between the 3 axis placement categories when correlated with the rotation (P=.102, analysis of variance). Conclusions: Toric IOL rotation was greater in eyes with a longer AL. Alignment of the IOL in the capsular bag had no influence on rotation. © 2012 ASCRS and ESCRS.


Vasavada V.,Iladevi Cataract and Research Center | Vasavada A.R.,Iladevi Cataract and Research Center | Vasavada V.A.,Iladevi Cataract and Research Center | Srivastava S.,Iladevi Cataract and Research Center | And 2 more authors.
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose: To compare incision integrity and clinical outcomes of 2 microcoaxial phacoemulsification systems. Setting: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Design: Prospective randomized clinical trial. Methods: Eyes were randomized to have phacoemulsification using a 1.8 mm clear corneal incision (CCI) system (Group 1, Stellaris system) or a 2.2 mm CCI system (Group 2, Intrepid Infiniti system). Incision enlargement at end of surgery was measured. At the conclusion of surgery, trypan blue was applied over the conjunctival surface, anterior chamber aspirate withdrawn, and ingress into anterior chamber measured. Postoperative observations included evaluation of the CCI using anterior segment optical coherence tomography (AS-OCT), change in central corneal thickness (CCT), and anterior segment inflammation at 1 day, 1 week, and 1 month and endothelial cell loss and surgically induced astigmatism (SIA) at 3 months. Results: Incision enlargement (P<.001) and trypan blue ingress in the anterior chamber (mean 1.7 log units ± 0.6 [SD] versus 3.8 ± 0.6 log units, P<.001) was significantly greater in Group 1 (n = 50) than in Group 2 (n = 50). On AS-OCT, endothelial misalignment and gaping were more frequent in Group 1 at 1 day (P=.001) and 1 week (P=.018). There were no significant differences in SIA, change in CCT, endothelial cell loss, or anterior segment inflammation (P>.05). Conclusion: At the end of surgery, it is not the initial incision size alone but also the distortion of the incision during subsequent stages of surgery that determine the integrity of the CCI. Financial Disclosure: Iladevi Cataract & IOL Research Centre receives occasional travel support from Alcon Laboratories, Inc. No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Kayastha F.,Iladevi Cataract and Research Center | Madhu H.,Iladevi Cataract and Research Center | Vasavada A.,Iladevi Cataract and Research Center | Johar K.,Iladevi Cataract and Research Center
Experimental Eye Research | Year: 2014

Lens epithelial cell proliferation, migration, and transdifferentiation are involved in the development of subcapsular cataracts and postoperative capsular opacification (PCO). PI3K/Akt pathway is involved in the proliferation and migration of lens epithelial cells. Andrographolide is the main bioactive component of Andrographis paniculata and is known to possess anti-proliferative and anti-migratory activities. The purpose of this study is to evaluate the effect of andrographolide on proliferation and migration induced by growth factors (TGF-β and bFGF) in the lens epithelial cell line, FHL 124. We have also evaluated the role of the PI3K/Akt pathway and its alteration by andrographolide during proliferation and migration of lens epithelial cells. The results showed that andrographolide significantly inhibited proliferation in a dose and time dependent manner. The growth factors, TGF-β and bFGF, induced migration of lens epithelial cells, which was lowered by andrographolide. The growth factors also up regulated phosphorylated Akt (Ser473) and Akt (Thr308), which was abolished by simultaneous treatment of andrographolide. Similar changes were also observed with the PI3K inhibitor, LY290042. Our findings suggest that andrographolide reduces proliferation, migration, and phosphorylated Akt levels in lens epithelial cells. Hence andrographolide can be utilized for the prevention of PCO. © 2014 Elsevier Ltd.


Vasavada A.R.,Iladevi Cataract and Research Center | Johar Sr. K.,Iladevi Cataract and Research Center | Praveen M.R.,Iladevi Cataract and Research Center | Vasavada V.A.,Iladevi Cataract and Research Center | Arora A.I.,Iladevi Cataract and Research Center
Journal of Cataract and Refractive Surgery | Year: 2013

Purpose: To compare changes in the incision's histomorphology and denaturation of collagen I in rabbit eyes having microcoaxial phacoemulsification through 2.2 mm and 1.8 mm incision-compatible systems. Design: Randomized experimental trial. Setting: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. Methods: Thirty rabbit eyes were randomized into Group 1 (microcoaxial phacoemulsification through 2.2 mm incisions using Infiniti system [torsional ultrasound]) and Group 2 (microcoaxial phacoemulsification through 1.8 mm incisions using Stellaris system [longitudinal ultrasound]). Each group was then divided into 3 subgroups of 5 eyes each based on 1 of the 3 intervention options: phacoemulsification only, intraocular lens (IOL) insertion only, and phacoemulsification with IOL insertion. Left eyes were randomized for microcoaxial phacoemulsification, and right eyes were treated as controls. Results: After phacoemulsification, eyes in Group 1 showed loss of epithelium at the roof of the incisions and Descemet membrane detachment at the floor of the incisions. These findings did not change after IOL insertion. After phacoemulsification, eyes in Group 2 showed loss of epithelium, but Descemet membrane remained attached. There was a longitudinal split in the incision's stroma in the direction of internal entry. The stromal damage increased after IOL implantation. Immunofluorescence studies showed no obvious irregularities in the arrangement of collagen I in either group. A dot blot analysis showed significant denaturation of collagen I in Group 2. Conclusion: The histomorphology of the 2.2 mm system incision showed localized Descemet membrane detachment and endothelial cell loss. The 1.8 mm system incision showed exaggerated stromal damage after IOL insertion. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.


Vasavada A.R.,Iladevi Cataract and Research Center | Raj S.M.,Iladevi Cataract and Research Center | Shah A.,Iladevi Cataract and Research Center | Shah G.,Iladevi Cataract and Research Center | Vasavada V.,Iladevi Cataract and Research Center
Journal of Cataract and Refractive Surgery | Year: 2011

Purpose: To compare posterior capsule opacification (PCO) 3 years postoperatively in contralateral eyes with a single-piece hydrophobic acrylic and 1 of 2 single-piece hydrophilic acrylic intraocular lenses (IOLs) with different configurations. Setting: Iladevi Cataract and IOL Research Institute, Ahmedabad, India. Design: Prospective randomized clinical trial. Methods: A hydrophobic Acrysof (hydrophobic group) or a hydrophilic C-flex (hydrophilic group C) or Akreos Adapt IOL (hydrophilic group A) was randomized for implantation in the fellow eye or vice versa of each patient. The Evaluation of Posterior Capsule Opacification (EPCO) area, EPCO score, and neodymium:YAG (Nd:YAG) capsulotomy rates were compared using digital photographs. Results: The study enrolled 68 patients. Although there was no significant difference at 1 month, the median EPCO score was statistically significantly lower in the hydrophobic group than in hydrophilic group C (P=.00) and hydrophilic group A (P=.000) at 3 years. There were no significant differences in the median EPCO area at 1 month; however, the area was statistically significantly less in the hydrophobic group than in hydrophilic group C and hydrophilic group A at 3 years (both P=.000). Four (12.9%) of 31 eyes in hydrophilic group C and 5 (16%) of 31 eyes in hydrophilic group A required an Nd:YAG capsulotomy; no eye in the hydrophobic group required a capsulotomy (P=.04 and P=.02, respectively). Conclusion: Posterior capsule opacification was significantly less with the Acrysof hydrophobic acrylic IOL at 3 years. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned. © 2011 ASCRS and ESCRS.


Vasavada A.R.,Iladevi Cataract and Research Center | Praveen M.R.,Iladevi Cataract and Research Center | Vasavada V.A.,Iladevi Cataract and Research Center | Shah S.K.,Iladevi Cataract and Research Center | And 2 more authors.
American Journal of Ophthalmology | Year: 2012

• PURPOSE: To observe longitudinal changes in the corneal endothelium after pediatric cataract surgery with intraocular lens implantation. • DESIGN: Prospective, longitudinal study. • METHODS: SETTINGS: Iladevi Cataract and IOL Research Centre, Ahmedabad, India. STUDY POPULATION: This study included 100 pediatric eyes undergoing cataract surgery with intraocular lens implantation. Posterior capsule management was based on the status of the posterior capsule. Two-port anterior limbal vitrectomy was carried out after posterior capsule plaque peeling. OBSERVATION PROCEDURES: Corneal endothelial morphologic features: endothelial cell density (cell/mm 2), coefficient of variation, percentage of hexagonality, and central corneal thickness were assessed. MAIN OUTCOME MEASURES: To evaluate whether there is a difference in endothelial cell morphologic features before surgery and 3 months after surgery and also whether pediatric cataract surgery with and without anterior vitrectomy has any impact on the endothelial cell morphologic features. • RESULTS: A comparison of preoperative and postoperative specular microscopy is given here: endothelial cell density, 3225.1 ± 346.8 cells/mm 2 versus 3057.7 ± 330.1 cells/mm 2 (P < .001); coefficient of variation, 27.5 ± 10.6 versus 37.7 ± 16.3 (P < .001); percentage of hexagonality, 58.1 ± 15.3 versus 48.6 ± 13.4 (P < .001); and central corneal thickness, 529 ± 30 μm versus 527 ± 34 μm (P = .64). There was 5.1% decrease in mean endothelial cell loss at 3 months after surgery. No statistically significant difference was noted in the percentage decrease in mean endothelial cell density between eyes undergoing cataract surgery with intact posterior capsules, eyes undergoing manual posterior capsulorrhexis without anterior limbal vitrectomy, and eyes undergoing anterior limbal vitrectomy (P = .543). • CONCLUSIONS: Endothelial cell loss with currently practiced techniques of pediatric cataract surgery is within acceptable limits by adhering to the principles of close chamber technique. © 2012 by Elsevier Inc. All rights reserved.


Vasavada A.R.,Iladevi Cataract and Research Center | Praveen M.R.,Iladevi Cataract and Research Center | Vasavada V.A.,Iladevi Cataract and Research Center | Yeh R.-Y.,Iladevi Cataract and Research Center | And 3 more authors.
American Journal of Ophthalmology | Year: 2012

Purpose: To report the intraoperative performance and postoperative outcomes of the Cionni-modified capsule tension ring (CTR) implantation in eyes with subluxated lenses. Design: Prospective, observational case series. Methods: This study was carried out at Iladevi Cataract & IOL Research Centre, Ahmedabad, India. The study population comprised 41 eyes with subluxated lenses that underwent lens extraction, capsular bag fixation with modified CTR, and in-the-bag single-piece AcrySof intraocular lens (IOL) implantation. Main outcome measures were intraoperative performance and postoperative best-corrected visual acuity (BCVA), IOL centration, and complications. Results: The mean age was 29.46 ± 16.16 years (3-68 years). Mean extent of subluxation was 6.1 ± 1.0 clock hours. Preoperatively, vitreous was detected in the anterior chambers of 5 eyes (12.2%). Two-port anterior chamber vitrectomy was performed in 2 eyes. Mean follow-up was 45.8 ± 2.9 months. Mean preoperative BCVA was 0.66 ± 0.22 logMAR (35 eyes). Mean postoperative BCVA at final follow-up was 0.33 ± 0.21 logMAR (41 eyes) (P <.001). BCVA improved in 35 eyes (85.4%) at the last follow-up. In 3 eyes (7.3%) IOL decentration was noted and repositioning was required in 2 eyes. Posterior capsule opacification developed in 14 eyes (34.2%); 12 eyes (29.3%) required Nd:YAG capsulotomy. Other complications included cystoid macular edema in 1 eye (2.4%), posterior synechiae in 1 eye (2.4%), and retinal detachment in 1 eye (2.4%). Conclusion: In-the-bag implantation of a Cionni-modified CTR with IOL appears to be a safe option in eyes with subluxated cataract, ensuring a stable IOL with few complications. © 2012 Elsevier Inc. All rights reserved.

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