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Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Rani P.K.,Shri Bhagwan Mahavir Vitreoretinal Services | Sharma T.,Shri Bhagwan Mahavir Vitreoretinal Services
Ophthalmology | Year: 2010

Purpose: To estimate the prevalence of diabetic macular edema, both clinically significant macular edema (CSME) and nonclinically significant macular edema (non-CSME), and report the associations of dyslipidemia on them. Design: A population-based cross-sectional study in India. Participants: After all exclusions, 1414 subjects with diabetes underwent an examination. Methods: The CSME was defined according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines; stereo digital fundus pairs were studied. The dyslipidemia cases were classified according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Main Outcome Measures: Prevalence of CSME and non-CSME and association of serum lipids with them. Results: The prevalence was 31.76% (95% confidence interval [CI], 26.04-37.47) for overall diabetic macular edema, 25.49% (95% Ci, 20.14-30.84) for non-CSME, and 6.27% (95% Ci, 3.29-9.24) for CSME. Univariate analysis identified macroalbuminuria and microalbuminuria, poor glycemic control, high total serum cholesterol, high serum low-density lipoprotein (LDL) cholesterol, and high serum non-high-density lipoprotein (HDL) cholesterol related to non-CSME and CSME (trend chi-square test, P<0.05). Logistic regression analysis (after adjusting variables such as age, gender, body mass index, duration, smoking, hypertension, glycosylated hemoglobin, macroalbuminuria and microalbuminuria, and insulin use) revealed high serum LDL cholesterol (odds ratio [OR], 2.72], high serum non-HDL cholesterol (OR, 1.99), and high cholesterol ratio (OR, 3.08) related to non-CSME, and poor glycemic control (OR, 8.06), microalbuminuria (OR, 14.23), and high serum total cholesterol (OR, 9.09) related to CSME. Conclusions: One third of the subjects had diabetic macular edema, and 6% of them showed evidence of CSME necessitating laser photocoagulation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2010 American Academy of Ophthalmology.


Roy R.,Vitreo Retina Services | Pal B.P.,Shri Bhagwan Mahavir Vitreoretinal Services | Mathur G.,Shri Bhagwan Mahavir Vitreoretinal Services | Rao C.,Shri Bhagwan Mahavir Vitreoretinal Services | And 2 more authors.
Ocular Immunology and Inflammation | Year: 2014

Purpose: To determine the viral diagnosis and clinical outcome of eyes with acute retinal necrosis (ARN). Method: A retrospective analysis was done of 62 eyes of 53 patients presenting to a tertiary care ophthalmic institute between 1997 and 2007 with features of ARN. All patients with active disease were started immediately on intravenous acyclovir followed by oral antivirals along with systemic steroids. A prophylactic laser retinopexy was performed in patients with a clear media to areas posterior to the necrotic retina. Results: The aqueous and the vitreous sample revealed herpes simplex virus in 19 (30.60%) and varicella zoster virus in 28 patients (45.16%). Forty-one (66.12%) eyes had retinal detachment. Prophylactic laser photocoagulation was given in 19 (30.64%) eyes. Surgical intervention was required in 32 (51.61%) eyes. Favorable functional outcome was seen in 28 (45.1%) eyes. Conclusion: ARN is a fulminant disorder, which if treated early and aggressively gives good results. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.


Rani P.K.,Shri Bhagwan Mahavir Vitreoretinal Services | Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Rachapalli S.R.,Sankara Nethralaya | Kulothungan V.,Sankara Nethralaya | And 2 more authors.
Ophthalmology | Year: 2010

Purpose: To report the prevalence of refractive errors and the associated risk factors in subjects with type 2 diabetes mellitus from an urban Indian population. Design: Population-based, cross-sectional study. Participants: One thousand eighty participants selected from a pool of 1414 subjects with diabetes. Methods: A population-based sample of 1414 persons (age >40 years) with diabetes (identified as per the World Health Organization criteria) underwent a comprehensive eye examination, including objective and subjective refractions. Main Outcome Measures: One thousand eighty subjects who were phakic in the right eye with best corrected visual acuity of ≥20/40 were included in the analysis for prevalence of refractive errors. Univariate and multivariate analyses were done to find out the independent risk factors associated with the refractive errors. Results: The mean refraction was +0.20±1.72, and the Median, +0.25 diopters. The prevalence of emmetropia (spherical equivalent [SE], -0.50 to +0.50 diopter sphere [DS]) was 39.26%. The prevalence of myopia (SE <-0.50 DS), high myopia (SE <-5.00 DS), hyperopia (SE >+0.50 DS), and astigmatism (SE <-0.50 cyl) was 19.4%, 1.6%, 39.7%, and 47.4%, respectively. The advancing age was an important risk factor for the three refractive errors: for myopia, odds ratio (OR; 95% confidence interval [CI] 4.06 [1.74-9.50]; for hyperopia, OR [95% CI] 5.85 [2.56-13.39]; and for astigmatism, OR [95% CI] 2.51 [1.34-4.71]). Poor glycemic control was associated with myopia (OR [95% CI] 4.15 [1.44-11.92]) and astigmatism (OR [95% CI] 2.01 [1.04-3.88]). Female gender was associated with hyperopia alone) OR [95% CI] 2.00 [1.42-2.82]. Conclusions: The present population-based study from urban India noted a high prevalence of refractive errors (60%) among diabetic subjects >40 years old; the prevalence of astigmatism (47%) was higher than hyperopia (40%) or myopia (20%). Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2010 American Academy of Ophthalmology.


Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Pal S.S.,Shri Bhagwan Mahavir Vitreoretinal Services | Adams J.S.K.,Shri Bhagwan Mahavir Vitreoretinal Services | Rani P.K.,Shri Bhagwan Mahavir Vitreoretinal Services | And 2 more authors.
Investigative Ophthalmology and Visual Science | Year: 2010

PURPOSE. To report the prevalence of cataract and its subtypes in patients with type 2 diabetes mellitus and the risk factors associated with these cataracts. METHODS. One thousand two hundred eighty-three eligible subjects with type 2 diabetes mellitus, enrolled from a crosssectional study, underwent examination at the base hospital. Lens opacity was graded by a trained ophthalmologist according to the Lens Opacity Classification System (LOCS) III system. RESULTS. The age- and sex-adjusted prevalence of cataract in the study was 65.7% (95% confidence interval [CI], 65.6-65.8). Mixed cataracts were more common than monotype ones (41.6% vs. 19.4%). The prevalence of cataract was higher in women, subjects with known diabetes and those with longer duration of diabetes (51.4%, 50.3%, and 64.5%, respectively). The risk factors for any type of cataract were increasing age (odds ratio [OR], 1.14; 95% CI, 1.11-1.16), macroalbuminuria (OR, 4.61; 95% CI, 1.56 -13.59) and increasing glycosylated hemoglobin (OR, 1.92; 95% CI, 1.22-3.00); higher hemoglobin (OR, 0.38; 95% CI, 0.22- 0.64) was the protective factor. The risk factors for nuclear cataract included increasing age (OR, 1.15) and high serum triglycerides (OR, 6.83). For cortical cataract, increasing age (OR, 1.14) and poor glycemic control (OR, 2.43) were the risk factors; increasing hemoglobin (OR, 0.41) was the protective factor. For posterior subcapsular cataract, the risk factors included increasing age (OR, 1.11), being of the female sex (OR, 9.12), employment (OR, 9.80), and duration of diabetes (OR, 21.37). CONCLUSIONS. Nearly two thirds of the diabetic population showed evidence of cataract; mixed cataracts were more common than the monotypes ones. © Association for Research in Vision and Ophthalmology.


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.


Mathur G.,Shri Bhagwan Mahavir Vitreoretinal Services | George A.E.,Shri Bhagwan Mahavir Vitreoretinal Services | Sen P.,Shri Bhagwan Mahavir Vitreoretinal Services
Oman Journal of Ophthalmology | Year: 2014

The purpose of this report was to evaluate the role anti-VEGF in management of CNVM secondary to ocular toxoplasmosis. Young female diagnosed as a case of bilateral ocular toxoplasmosis presented with complaints of diminution of vision in the right eye. Fundus examination showed an active CNVM adjacent to toxoplasmosis scar. In view of active CNVM, patient was administered intravitreal ranibizumab. A total of 2 injections of intravitreal ranibizumab were given. Fundus showed a scarred CNVM adjacent to the toxoplasma scar with no clinical signs of activity. Anti-VEGF therapy has been successfully used to improve visual and anatomical outcome in juxtafoveal (deleted subfoveal)CNVM secondary to toxoplasmosis. Copyright: © 2014 Mathur G et al.


Ramon R.,Shri Bhagwan Mahavir Vitreoretinal Services | Bhojwani D.N.,Shri Bhagwan Mahavir Vitreoretinal Services | Sharma T.,Shri Bhagwan Mahavir Vitreoretinal Services
Rural and Remote Health | Year: 2014

Context: Diabetes mellitus is a healthcare burden in India. Seventy-four percent of India's population lives in rural areas with limited access to healthcare resources. Telemedicine can play a big role in screening people with diabetes at grassroots level. In the telescreening model, single field 45-degree photographs are used for detecting diabetic retinopathy. The American Academy of Ophthalmology does not recommends single-field fundus photography as an adequate substitute for a comprehensive ophthalmic examination because it may lead to a higher rate of underdiagnosis. We conducted a telescreening project using single-field fundus photography to determine its accuracy compared to the traditional camp-based screenings. Issues: In this project we compared the prevalence of diabetic retinopathy between an ophthalmologist-based and an ophthalmologist-led model on two different samples of people self-reporting with diabetes in rural South India. Between 2004 and 2005 in rural South India, 3522 people with diabetes mellitus underwent ophthalmologist-based diabetic retinopathy screening and 4456 people with diabetes underwent ophthalmologist-led (telescreening) diabetic retinopathy screening. The two population groups were randomly separated. In the ophthalmologist-based program, a trained retina specialist travels along with the camp team and screens patients at the camp site for diabetic retinopathy. In the ophthalmologist-led program (telescreening), fundus photographs are transmitted to the base hospital for further evaluation and grading. A total of 519 people (14.7%) were diagnosed to have diabetic retinopathy in the ophthalmologist-based model, and 853 people (19.1%) in the ophthalmologist-led model (p<0.0001). More sight-threatening retinopathies were found in the ophthalmologist-led model than in the ophthalmologist-based model (6.3% vs 5%). Lessons learned: The ophthalmologist-led (telescreening) model did not underestimate the prevalence of diabetic retinopathy. Therefore, because it obviates the need for travel by an ophthalmologist, it is a good method for diabetic retinopathy screening in rural areas of India. © R Ramon, DN Bhojwani, T Sharma, 2014.


Rishi P.,Shri Bhagwan Mahavir Vitreoretinal Services | Raka N.,Shri Bhagwan Mahavir Vitreoretinal Services | Rishi E.,Shri Bhagwan Mahavir Vitreoretinal Services
PLoS ONE | Year: 2016

Background To study potential ischemic effects of intravitreal Bevacizumab (IVB) on unaffected retina in treatment-naive eyes with macular edema secondary to branch retinal vein occlusion (BRVO) and contralateral eyes secondary to systemic absorption. Methods and Findings Prospective, interventional series included 27 treatment-naive eyes with BRVO and macular edema. Exclusion criteria: Eyes with diabetic retinopathy, glaucoma, vasculitides, papilledema or systemic neurologic condition. Subjects underwent complete ophthalmological examination including fluoroscein angiography (FA), optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG). All subjects received single 1.25 mg/0.05ml IVB injection. Two observers measured all parameters; inter-observer agreements were expressed as kappa values. Paired t-test was used to compare values at baseline and follow-up. The statistical analysis was done using SPSS for Windows, Version 14.0. (Chicago, SPSS Inc.) Presenting mean CFT (central foveal thickness) was 499.5(+/-229.7) μm, mean BCVA (best corrected visual acuity) was 0.64(+/-0.41) logMAR. At last followup, mean CFT was 267.9(+/-159.3) μm (P<0.001), 95% CI [127.18, 422.32]; mean BCVA was 0.28(+/-0.24) logMAR. Respectively, mean N1 and P1 amplitudes of mfERG in 'unaffected quadrant' at presentation were -6.10(+/-4.00) nV/deg2 and 17.17(+/-11.54)nV/deg2 ; and -5.33(+/-1.30)nV/deg2 and 15.29(+/-4.69)nV/deg2 at final follow-up (P = 0.631 and 0.197, respectively), (95% CIs [-0.93, 1.42] and [-4.22, 1.08] respectively). In fundus quadrant of fellow eyes corresponding to unaffected quadrant in treated eyes, mean N1 and P1 amplitudes at presentation were -5.39(+/-1.56)nV/deg2 and 15.89(+/-3.89)nV/deg2 ; and -5.39(+/-1.90)nV/deg2 and 15.9(+/-5.52)nV/deg2 (P = 0.380 and 0.208), (95% CIs [-0.57, 1.28] and [-4.1, 1.1]) at last follow-up, respectively. Limitations: This study analysed the effects with a single injection of bevacizumab. However, whether ischemic adverse effects will emerge with repeated IVB injections as a consequence of cumulative dosing needs further investigation. The setting of our study being a tertiarycare centre, the numbers of fresh BRVO cases without prior intervention were limited. Thus, the limitations of our study include a small sample size with a small follow-up period. No major ocular/systemic adverse event was observed in the study period. Conclusion No evidence of progressive ischaemia attributable to single bevacizumab treatment was observed in this study. However, a larger prospective study involving subjects with cumulative dosing of bevacizumab and a longer follow-up could provide a better understanding of the potential ischaemic effects of bevacizumab or other anti-VEGF agents. © 2016 Rishi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | Shri Bhagwan Mahavir Vitreoretinal Services
Type: Journal Article | Journal: Oman journal of ophthalmology | Year: 2016

To evaluate the efficacy of combination therapy of argon laser photocoagulation and intravitreal antivascular endothelial growth factor (VEGF) injection in idiopathic polypoidal choroidal vasculopathy (PCV) involving macula.A retrospective interventional study involving 12 eyes of 11 patients diagnosed with PCV involving the macula on indocyanine green angiography (ICGA). Intravitreal anti-VEGF was given in eyes with significant subretinal/sub retinal pigment epithelium hemorrhage or exudation. ICGA-guided focal laser was done to extrafoveal leaking polyps. Mean change in best-corrected visual acuity (BCVA) and regression of polyp as seen on ICGA were evaluated at the final follow-up.It was done using SPSS 17.0. - Mann-Whitney test.12 eyes of 11 patients underwent argon laser with intravitreal anti-VEGF injection. Ten patients were males and one female. Mean age was 65.75 5.2 years. The mean number of injections given was 3.66 1.5 (2-6) per eye. Mean number of laser sessions required was 1.33 0.65 (1-3) per eye. BCVA improved in 25% (Combined argon laser photocoagulation with intravitreal anti-VEGF injection helps in decreasing exudation and results in stabilization of the disease with visual improvement in eyes with PCV involving macula.


PubMed | Shri Bhagwan Mahavir Vitreoretinal Services
Type: Journal Article | Journal: Oman journal of ophthalmology | Year: 2016

A 56 year-old-male presented with diminution of vision in right eye of 2 months duration. His best corrected visual acuity (BCVA) was 20/25. Anterior segment examination was bilaterally normal. Right fundus revealed oval, raised, pigmented lesion in superotemporal quadrant with subfoveal fluid. Fundus fluroscein angiography (FFA) showed multiple pinpoint leakages. Acoustic hollowing on ultrasound (USG) was typical of choroidal melanoma. A high index of suspicion is required for the diagnosis of small choroidal melanoma that could present with multiple focal leaks and subretinal fluid simulating multifocal central serous retinopathy (CSR).

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