Koh A.H.C.,Camden Medical Center |
Chen L.-J.,Mackay Memorial Hospital |
Chen S.-J.,Taipei Veterans General Hospital |
Chen Y.,Peking Union Medical College |
And 12 more authors.
Retina | Year: 2013
BACKGROUND: Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy affecting vision, with clinical features distinct from neovascular age-related macular degeneration.Currently, no evidence-based guidelines exist for its diagnosis and treatment.METHODS: A panel of experts analyzed a systematic literature search on PCV together with results of the EVEREST trial, the only published randomized controlled clinical trial in PCV.At a subsequent Roundtable meeting, recommendations for the management of PCV were agreed based on this analysis and their own expert opinion.RESULTS: Diagnosis of PCV should be based on early-phase nodular hyperfluorescence from choroidal vasculature visualized using indocyanine green angiography.Recommended initial treatment of juxtafoveal and subfoveal PCV is either indocyanine green angiography-guided verteporfin photodynamic therapy or verteporfin photodynamic therapy plus 3 × 0.5 mg ranibizumab intravitreal injections 1 month apart.If there is incomplete regression of polyps by indocyanine green angiography, eyes should be retreated with verteporfin photodynamic therapy monotherapy or verteporfin photodynamic therapy plus ranibizumab.If there is complete regression of polyps by indocyanine green angiography, but there is leakage on fluorescein angiography and other clinical or anatomical signs of disease activity, eyes should be retreated with ranibizumab.CONCLUSION: Practical guidance on the clinical management of PCV is proposed based on expert evaluation of current evidence.
Langmann T.,University of Regensburg |
Di Gioia S.A.,University of Lausanne |
Rau I.,University of Hamburg |
Stohr H.,University of Regensburg |
And 10 more authors.
American Journal of Human Genetics | Year: 2010
Retinitis pigmentosa (RP) is a degenerative disease of the retina leading to progressive loss of vision and, in many instances, to legal blindness at the end stage. The RP28 locus was assigned in 1999 to the short arm of chromosome 2 by homozygosity mapping in a large Indian family segregating autosomal-recessive RP (arRP). Following a combined approach of chromatin immunoprecipitation and parallel sequencing of genomic DNA, we identified a gene, FAM161A, which was shown to carry a homozygous nonsense mutation (p.Arg229X) in patients from the original RP28 pedigree. Another homozygous FAM161A stop mutation (p.Arg437X) was detected in three subjects from a cohort of 118 apparently unrelated German RP patients. Age at disease onset in these patients was in the second to third decade, with severe visual handicap in the fifth decade and legal blindness in the sixth to seventh decades. FAM161A is a phylogenetically conserved gene, expressed in the retina at relatively high levels and encoding a putative 76 kDa protein of unknown function. In the mouse retina, Fam161a mRNA is developmentally regulated and controlled by the transcription factor Crx, as demonstrated by chromatin immunoprecipitation and organotypic reporter assays on explanted retinas. Fam161a protein localizes to photoreceptor cells during development, and in adult animals it is present in the inner segment as well as the outer plexiform layer of the retina, the synaptic interface between photoreceptors and their efferent neurons. Taken together, our data indicate that null mutations in FAM161A are responsible for the RP28-associated arRP. © 2010 The American Society of Human Genetics.
Das T.,LV Prasad Eye Institute |
Pathengay A.,LV Prasad Eye Institute |
Hussain N.,Al Zahara Hospital |
Biswas J.,Sankara Nethralaya
Eye | Year: 2010
Eales' disease is an idiopathic inflammatory venous occlusive disease. It primarily affects young adults and is often bilateral. It is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization. Diagnosis is mostly clinical and requires exclusion of other systemic or ocular conditions that could present with similar retinal features. Recurrent vitreous haemorrhage is the hall mark of Eales disease. Treatment is usually corticosteroids in the inflammation stage and photocoagulation in the proliferative stage of the disease. Visual prognosis is good if treated early in the course of the disease. © 2010 Macmillan Publishers Limited All rights reserved.
Das T.,L v Prasad Eye Institute |
Raman R.,Sankara Nethralaya |
Ramasamy K.,Aravind Eye Care System |
Rani P.K.,L v Prasad Eye Institute
Middle East African Journal of Ophthalmology | Year: 2015
Telemedicine is exchange of medical data by electronic telecommunications technology that allows a patient's medical problems evaluated and monitored by a remotely located physician. Over the years, telemedicine and telescreening have become important components in health care, in both disease detection and treatment. Highly visual and image intensive ophthalmology is uniquely suited for telemedicine. Because of rising disease burden coupled with high opportunity cost in detection, diabetic retinopathy is an ideal ophthalmic disease for telescreening and decision-making. It fits to Wilson and Jungner's all 10 criteria of screening for chronic diseases and the American Telehealth Association's 4 screening categories.
Majumder P.,Sankara Nethralaya |
Biswas J.,College Road
Oman Journal of Ophthalmology | Year: 2013
Because of their varied spectrum of clinical presentation and difficulty in management, pediatric uveitis remains a challenge to the ophthalmologist. Variations in clinical presentation, difficulties in eye examination, extended burden of the inflammation over quality of life, limited treatment modalities, risk of amblyopia are the main challenges in the management of pediatric uveitis. Pediatric uveitis is a cause of significant ocular morbidity and severe vision loss is found in 25-33% of such cases. This article summarizes the common causes of uveitis in children with special approach to the evaluation and diagnosis of each clinical entity. Copyright: © 2013 Khandekar RB.
Venkatakrishnan J.,Sankara Nethralaya |
Jagadeesh V.,Sankara Nethralaya |
Kannan R.,Sankara Nethralaya
European Journal of Ophthalmology | Year: 2011
PURPOSE. To report a case of pulmonary edema, in a child under general anesthesia, due to iatrogenic acute hypertensive crisis following instillation of 1 drop of 5% phenylephrine eyedrops. METHODS. A 2-year-old boy was scheduled for examination of both eyes and enucleation of the left eye under general anesthesia. In the preoperative ward, 1 drop of 2.5% phenylephrine eyedrops was instilled 3 times by the nursing staff. The child was induced with the volatile agent Sevoflurane and intubated with Inj atracurium besylate 0.5 mg/kg IV. Anesthesia was maintained with N2O/oxygen (2:1)/Sevoflurane 1.5% and Inj fentanyl 1 μg/kg IV. As the pupil was not dilated optimally for examination, 1 drop of 5% phenylephrine eyedrops was instilled. Approximately 10 minutes following its instillation, tachycardia and rise in blood pressure occurred. Auscultation of the chest revealed bilateral coarse crepitations and pink frothy secretions were noted in the Portex endotracheal tube. RESULTS. Pulmonary edema was effectively settled using positive pressure ventilation with 100% oxygen, Inj lasix 1 mg/kg IV, and Inj hydrocortisone 100 mg IV. The concentration of inhalational agent, Sevoflurane, was increased. Within about 15 minutes, both heart rate and blood pressure gradually returned to normal limits. Following surgery, the child was extubated, fully awake. CONCLUSIONS. To produce maximum mydriasis, with minimum systemic effects, preventive strategies such as using the lowest drug concentration, punctual occlusion, eyelid closure, allowing adequate time for the pharmacologic effect to occur, and the use of microdrops in infants should be adopted. © 2010 Wichtig Editore.
Management of Elevated Intraocular Pressure Associated With Subluxated/Dislocated Lenses by Combining Trabeculectomy With Adjunctive Mitomycin C With Lensectomy, Vitrectomy, and Scleral Fixation of Intraocular Lens
David R.L.,Sankara Nethralaya
Journal of Glaucoma | Year: 2015
AIM:: To evaluate the short-term outcomes of lensectomy, combined with vitrectomy, scleral-fixated intraocular lens (SFIOL), and trabeculectomy with adjunctive mitomycin C (MMC) in patients with subluxated/dislocated crystalline lenses with associated elevated intraocular pressure (IOP). MATERIALS AND METHODS:: This retrospective case series included 51 eyes of 51 patients who underwent lensectomy, vitrectomy, and SFIOL combined with trabeculectomy with MMC between 2003 and 2012. The main outcome measures assessed were IOP, change in visual acuity, IOP-lowering medications, and the complications and reoperation rates. RESULTS:: The most common etiology observed was blunt trauma in 35 eyes (68.6%). Glaucomatous optic neuropathy was detected in 13 eyes (25.49%) preoperatively. The IOP reduced significantly from a preoperative mean of 26.3±11.5 mm Hg to 13±4.6 mm Hg (P<0.001) at the final visit. The mean preoperative number of IOP-lowering medications of 2.9±0.8 reduced to 0.3±0.7 at last follow-up (P<0.001). The best-corrected visual acuity (Snellens) improved significantly from 20/600 to 20/60 (P<0.001). Complete success defined as IOP≤21 mm Hg without medications was achieved in 93%±5% and 80%±13% at 1 and 2 years, respectively. Major postoperative complications included retinal detachment in one eye and SFIOL dislocation in another. CONCLUSIONS:: The technique of combining SFIOLs with trabeculectomy with adjunctive MMC in the management of subluxated/dislocated lenses resulted in good IOP control and improvement in visual acuity. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 27)
Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services |
Gupta A.,Shri Bhagwan Mahavir Vitreoretinal Services |
Krishna S.,Shri Bhagwan Mahavir Vitreoretinal Services |
Kulothungan V.,Sankara Nethralaya |
Sharma T.,Shri Bhagwan Mahavir Vitreoretinal Services
Journal of Diabetes and its Complications | Year: 2012
Purpose: The aims of this study were to report the prevalence of various microvascular complications and to identify the various clinical and biochemical characteristics related to these complications in subjects with newly diagnosed type II diabetes. Methods: Of the 5999 subjects enumerated, 1414 subjects with diabetes (both known and newly diagnosed) were analyzed for the study. Among the diabetic subjects, 248 (17.5%) were newly diagnosed with diabetes and the remaining had history of diabetes. All subjects underwent a detailed standard evaluation to detect diabetic retinopathy (fundus photography), neuropathy (vibration pressure threshold), and nephropathy (microalbuminuria). Results: The prevalence of any form of microvascular complication was 30.2% (95% confidence interval [CI] = 24.5-35.9). The prevalence of diabetic retinopathy was 4.8%, and that of diabetic nephropathy and neuropathy was 10.5%. The risk factors for developing any form of microvascular complication were increasing age (odds ratio [OR] = 1.07, 95% CI = 1.04-1.11, P <.0001), increasing systolic blood pressure (OR = 1.03, 95% CI = 1.01-1.06, P =.001), and increasing hemoglobin (OR = 1.39, 95% CI = 1.09-1.79, P =.011). The risk factors for diabetic retinopathy and diabetic nephropathy were increasing systolic blood pressure (OR = 1.06 [P =.001] for retinopathy and OR = 1.04 [P =.012] for nephropathy) and increasing hemoglobin (OR = 2.20 [P =.007] for retinopathy and OR = 1.57 [P =.023] for nephropathy). The risk factor for diabetic neuropathy was increasing age (OR = 1.12, P <.0001). Conclusions: Nearly one third of the newly diagnosed type II diabetes subjects had some form of microvascular complication; nephropathy, and neuropathy being commoner than retinopathy. © 2012 Elsevier Inc. All rights reserved.
Saurabh K.,Sankara Nethralaya |
Das R.R.,Sankara Nethralaya |
Biswas J.,Sankara Nethralaya |
Kumar A.,Sankara Nethralaya
Indian Journal of Ophthalmology | Year: 2011
Aims: To provide a fact file on the etiology, clinical presentations and management of retinal vasculitis in Eastern India. Materials and Methods: Retrospective, record based analysis of retinal vasculitis cases in a tertiary care center in Eastern India from January 2007 to December 2009. Results: One hundred and thirteen eyes of 70 patients of retinal vasculitis were included in this study. Sixty (85.7%) patients were male (mean age 33 11.1 years) and 10 (14.3%) were female (mean age 32.4 13.6 years). Vasculitis was bilateral in 43 (61.4%) and unilateral in 27 (38.6%) patients. Commonest symptoms were dimness of vision (73; 64.6%) and floaters (36; 31.9%). Vascular sheathing (82; 72.6%) and vitritis (51; 45.1%) were commonest signs. Mantoux test was positive in 21 (30%) patients but tuberculosis was confirmed in only four (5.71%) patients. Raised serum angiotensin-converting enzyme level and positive antinuclear antibody level were reported in four (5.71%) patients each. Human leukocyte antigen B5 (HLA B5) marker was present in one (1.4%) patient. However, none of the total 70 patients were found to have a conclusively proven systemic disease attributable as the cause of retinal vasculitis. Oral corticosteroid (60; 85.7%) was the mainstay of treatment. Forty-eight (42.5%) eyes maintained their initial visual acuity and 43 (38%) gained one or more line at mean follow-up of 16.6 6.3 months. Conclusion: Retinal vasculitis cases had similar clinical presentations and common treatment plan. There was no systemic disease association with vasculitis warranting a careful approach in prescribing investigations.
Khetan V.,Sankara Nethralaya
Journal of pediatric ophthalmology and strabismus | Year: 2011
The authors report a case of diffuse anterior retinoblastoma with ciliary body origin and no retinal involvement. This again raises a question of the cell origin of retinoblastoma. The child was treated with enucleation of the presenting eye. Copyright 2011, SLACK Incorporated.