Baird P.N.,University of Melbourne |
Chakrabarti S.,Lv Prasad Eye Institute
Clinical and Experimental Ophthalmology | Year: 2014
The last 10 years have seen an unprecedented explosion in our knowledge regarding the genomic basis of age-related macular degeneration. This has come about through major advances in computing power, microfabrication of large numbers of molecular markers on chips and improved statistical algorithms for analysis. In tandem, it has become clear that age-related macular degeneration appears to be a multifactorial disease with influences from genetic and structural variants, as well as epigenetic involvement. The combination of these factors with known environmental determinants indicates the highly complex nature of this disease, but at the same time also offers insights into risk prediction and disease stratification through genotype profiling. © 2013 Royal Australian and New Zealand College of Ophthalmologists.
Naik M.N.,LV Prasad Eye Institute
Journal of Cutaneous and Aesthetic Surgery | Year: 2016
Soft tissue deflation and descent have long been implicated in the pathogenesis of facial aging. In the periorbital area, the upper orbital region is thought to change by descent of the eyebrow, as well as deflation of brow fat. While the understanding of the aging changes in the upper eyelid region are relatively simple, the lower eyelid poses a myriad of aging changes, each demanding a specific management plan. These can be best described in terms of elevations, or 'Hills' and hollows, or 'Valleys'. This article simplifies the understanding of the lower eyelid in the light of anatomical knowledge, and available literature. It forms a basis of easy diagnosis and treatment of the soft tissue changes in the lower eyelid and malar region.
Rao A.,LV Prasad Eye Institute
Journal of Glaucoma | Year: 2013
PURPOSE:: We report resolution of bilateral angle closure in a young patient with plateau iris following clear lens extraction METHODS:: A 30 year old female presented with bilateral angle closure. RESULT:: After a failed attempt of laser iridotomy, there was immediate resolution of angle closure following clear lens extraction by phacoemulsification and intraocular lens implantation. Postoperative ultrasound biomicroscopy identified anteriorly rotated ciliary processes in both eyes. CONCLUSIONS:: This case report highlights the role of therapeutic clear lens extraction in angle closure due to plateau iris. Copyright © 2012 by Lippincott Williams & Wilkins.
Fernandes M.,LV Prasad Eye Institute |
Sharma S.,LV Prasad Eye Institute
Contact Lens and Anterior Eye | Year: 2013
Aim: To report a rare case of microsporidial and polymicrobial keratitis in a patient with Sjogren's syndrome and ocular cicatricial pemphigoid. Method: This is a descriptive case report. A 66-year-old lady diagnosed with Sjogren's syndrome (SS) and ocular cicatricial pemphigoid (OCP) presented to us with microbial keratitis after using a Boston sclera contact lens for a painful epithelial defect. After 9 days of medical treatment, she underwent therapeutic penetrating keratoplasty. Results: 10% potassium hydroxide and calcofluor white wet mount revealed microsporidial spores. Gram positive cocci and Gram variable bacilli on Gram stain were identified as Staphylococcus epidermidis and Corynebacterium accolens in culture. Histopathological examination of the corneal tissue confirmed the presence of microsporidial spores. Conclusion: Microsporidal keratitis can occur in patients with severe ocular surface disease due to SS and OCP. Predisposing factors include dry eye, local and systemic immunosuppression and Boston scleral contact lens. Early surgical intervention may be needed to eradicate the infection. © 2012 British Contact Lens Association.
Monga S.,Lv Prasad Eye Institute
American journal of ophthalmology | Year: 2012
To describe the demographic features, clinical characteristics, and management in cases of childhood pterygium. Observational case series. A retrospective review was done of 19 children (total 26 eyes) under the age of 16 years, consecutively presenting with pterygium and evaluated at a single tertiary care center between January 2000 and August 2011. The main outcome measures were clinical features, associated ocular or systemic diseases, approach towards its management, and histopathology of operated cases. Of the 19 patients, 10 were girls and 9 were boys. The mean age at presentation was 10.63 ± 3.48 years (range 2-15 years). Seven patients (37%) had bilateral involvement. None of the cases had familial history. The median refractive astigmatism was found to be -0.5 diopter cylinder. All the eyes had primary pterygium, except 1, which was recurrent. The majority of the eyes (85%) were managed conservatively. Four eyes (15%) required surgery, where pterygium excision with conjunctival-limbal autograft with fibrin glue application was done. The follow-up of surgical cases ranged from 5 to 38 months (median 6 months). One operated case recurred 1 year after surgery. Development of pterygium is a possibility in younger age groups. No specific predisposing factors, either environmental or familial, were identified as contributing to childhood pterygium. The majority of the cases required conservative management. Copyright © 2012 Elsevier Inc. All rights reserved.
Naik M.,LV Prasad Eye Institute
Indian Journal of Dermatology, Venereology and Leprology | Year: 2013
The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist's point of view.
Rao A.,LV Prasad Eye Institute
Seminars in Ophthalmology | Year: 2012
Purpose: To evaluate the effect of phacoemulsification on the diurnal curve in patients with pseudoexfoliation syndrome. Method: 2052 patients aged 40 years and older attending our OPD services were screened, of whom 62 patients with pseudoexfoliation and associated significant cataract were selected for the study. All underwent a detailed examination including slit lamp examination, IOP, gonioscopy, and fundus examination. Diurnal variation of intraocular pressure was done at baseline and two and four weeks after phacoemulsification with IOL implantation. The IOP differences after surgery were compared and analyzed. Results: All 62 patients underwent successful phacoemulsification with IOL implantation. Anterior chamber IOL was implanted in 2 of the 6 cases with vitreous loss. The peak IOP of the diurnal curve reduced from 26±3.2mmHg pre surgery to 19±1.2mmHg, p<0.01, while the mean baseline IOP reduced from 22±5.3mmHg to 15±2.1mmHg at 2 months after cataract extraction, p=0.02. The IOP fluctuations (max-min IOP difference) in the diurnal curve also flattened significantly post-surgery in eyes with both open and occludable angles, p<0.01, with the maximum difference observed during the later part of the day in both groups. Conclusions: Early cataract extraction with IOL can smooth out intraocular pressure fluctuations in patients with pseudoexfoliation and associated cataract with open or narrow angles. Copyright © 2012 Informa Healthcare USA, Inc.
Vazirani J.,Lv Prasad eye institute |
Basu S.,Lv Prasad eye institute
Clinical Ophthalmology | Year: 2013
Keratoconus is characterized by progressive corneal protrusion and thinning, leading to irregular astigmatism and impairment in visual function. The etiology and pathogenesis of the condition are not fully understood. However, significant strides have been made in early clinical detection of the disease, as well as towards providing optimal optical and surgical correction for improving the quality of vision in affected patients. The past two decades, in particular, have seen exciting new developments promising to alter the natural history of keratoconus in a favorable way for the first time. This comprehensive review focuses on analyzing the role of advanced imaging techniques in the diagnosis and treatment of keratoconus and evaluating the evidence supporting or refuting the efficacy of therapeutic advances for keratoconus, such as newer contact lens designs, collagen crosslinking, deep anterior lamellar keratoplasty, intracorneal ring segments, photorefractive keratectomy, and phakic intraocular lenses. © 2013 Vazirani and Basu.
Rao A.,LV Prasad Eye Institute
Journal of Ophthalmic and Vision Research | Year: 2012
Purpose: To compare clinical findings and peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) in affected and fellow eyes of patients with unilateral pseudoexfoliation (PXF) syndrome with that of bilateral cases. Methods: This cross-sectional study enrolled 91 subjects with PXF including 32 unilateral and 59 bilateral cases. Subjects with elevated intraocular pressure or findings suggestive of glaucoma were excluded. RNFL thickness and optic nerve head profile were studied in all eyes using the RNFL and optic nerve head analysis OCT protocol. Clinical and OCT features were compared in affected and unaffected eyes of unilateral PXF subjects to bilateral cases. Results: Bilateral cases with PXF were older (P<0.01) and had thinner RNFL (P=0.04) than unilateral cases. From a total of 32 unilateral PXF cases, 7 subjects demonstrated RNFL thinning in the clinically normal fellow eye; all of these eyes had evidence of pupillary ruff atrophy on slit lamp examination in the absence of evident exfoliation material in the eye. Similar ruff atrophy with RNFL thinning was seen in 38 of 59 bilateral and in 16 of 32 unilateral cases. Pupillary ruff atrophy predicted RNFL thinning with sensitivity of 88.9% (95% CI, 73-96.7%) and 79.2% (95% CI, 74-84.5%) in bilateral and unilateral cases respectively, with low specificity of 45.8% (95% CI, 33.9-51.7%) and 45.5% (95% CI, 22.9-68.8%) in the same order. Conclusion: Patients with bilateral PXF have significantly thinner RNFL as compared to unilateral cases. Iris sphincter abnormality, clinically detected as pupillary ruff atrophy, may reflect early glaucomatous damage; however the specificity of this sign for predicting RNFL thinning is low.
Garg P.,LV Prasad Eye Institute
Eye | Year: 2012
Although relatively uncommon, fungi, atypical Mycobacteria, and Nocardia have been isolated from a variety of infections of eye including keratitis, scleritis, canaliculitis, dacryocystitis, endophthalmitis and orbital cellulites. The organisms typically cause a slowly progressive disease. The diseases caused by the organisms can pose both diagnostic and therapeutic challenges. In this manuscript we will describe updates on important aspects of the ocular infections caused by these organisms. © 2012 Macmillan Publishers Limited All rights reserved.