Shri Bhagwan Mahavir Vitreoretinal Services

Chennai, India

Shri Bhagwan Mahavir Vitreoretinal Services

Chennai, India
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Nagesha C.,Shri Bhagwan Mahavir Vitreoretinal Services | Rishi P.,Shri Bhagwan Mahavir Vitreoretinal Services | Rishi E.,Shri Bhagwan Mahavir Vitreoretinal Services
Oman Journal of Ophthalmology | Year: 2017

Vitreopapillary traction (VPT) is an unusual clinical entity and its management and prognosis have been sparsely studied. It has been described in adults with various vitreomacular pathologies and the possible effects on visual functions. However, the role of surgical intervention in altering the course of the disease is not well understood. Hereby, we describe a case of idiopathic VPT in a 16-year-old girl who presented with decreased vision and visual field changes corresponding to the area of retinal traction. This case was managed with pars plana vitrectomy and epiretinal membrane removal that resulted in improved visual field sensitivity; thus, emphasizing the role of surgical intervention in such eyes. © 2017 Oman Ophthalmic Society | Published by Wolters Kluwer - Medknow.


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.


Agarkar S.,Sankara Nethralaya | Gokhale V.V.,Sankara Nethralaya | Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services | Bhende M.,Shri Bhagwan Mahavir Vitreoretinal Services | And 2 more authors.
Ophthalmology | Year: 2017

Purpose: To report the incidence of, and to estimate the long-term risk and predisposing factors and the surgical outcomes for, retinal detachment (RD) after pediatric cataract surgery. Design: Retrospective consecutive interventional case series. Participants: During the study period 1996 to 2007 at a tertiary eye care institute, 481 eyes of 295 children aged below 16 years with no other ocular and systemic anomalies who underwent lensectomy, posterior capsulorrhexis, and anterior vitrectomy combined with primary intraocular lens implantation were included. The median follow-up was 66 months. Methods: Kaplan-Meier estimates and Cox proportional hazard regression model were used for estimating cumulative risk and hazard ratio (HR), respectively. Difference between measured preoperative axial length and age-matched mean axial length (prior studies) was calculated, and was defined as age-adjusted axial length difference (ALD) (minus and plus denotes myopia and hypermetropia, respectively). Main Outcome Measures: Cumulative risk and potential risk factors for RD. Results: Of the total, 12 eyes of 9 children developed RD after cataract surgery, with a median time of 70 months. The overall risk of RD was 5.5% at 10 years after cataract surgery. All 9 children were male. The multi-adjusted HR associated with increased risk of RD was 12.42 (95% confidence interval [CI], 2.91-53.01; P = 0.001) for eyes of children with intellectual disability and 21.93 (95% CI, 2.95-162.80; P = 0.003) for eyes of children with age-adjusted ALD < -1 mm (myopic). Retinal break associated with induction of posterior vitreous detachment was the most common (8 eyes) cause of RD. No surgical intervention was done in 2 eyes. Scleral buckle and vitrectomy combined with belt buckle were performed in 4 and 6 eyes, respectively. At final follow-up, 5 and 9 eyes had a visual acuity better than or equal to 6/18 and 6/60, respectively. Conclusions: A 5.5% risk for RD is estimated for the first 10 years after cataract surgery in children with no known ocular and systemic anomalies. The risk significantly increases in a male, myopic, and intellectual disabled child. We emphasize the need for regular and long-term follow-up after pediatric cataract surgery. © 2017 American Academy of Ophthalmology.


Raman R.,Shri Bhagwan Mahavir Vitreoretinal Services
Cutaneous and ocular toxicology | Year: 2010

To report the clinical presentation and course of internal ophthalmoplegia after retinal laser photocoagulation in three patients. We report three cases in which internal ophthalmoplegia occurred after retinal laser photocoagulation. All patients underwent detailed clinical examination and anterior segment and fundus photography. Denervation supersensitivity testing with 0.125% pilocarpine was done in two cases. Pupil graphs were recorded in third case at presentation and at follow up. All three cases showed dilated pupils with loss of accommodation after undergoing retinal photocoagulation, of which two cases were documented to have denervation supersensitivity. On follow up, one case showed complete accommodation recovery and partial pupil recovery over a follow up of 10 months. Another case nearing presbyopic age had no recovery in accommodation and had partial pupil recovery after 20 months. Isolated internal ophthalmoplegia is a rare complication of retinal laser photocoagulation. It has been reported to be a transient phenomenon. Our case series shows the slow recovery pattern with only partial recovery until a follow up of 20 months, documented by pupil graphs.


Rishi E.,Shri Bhagwan Mahavir Vitreoretinal Services | Rishi P.,Shri Bhagwan Mahavir Vitreoretinal Services | Koundanya V.V.,Shri Bhagwan Mahavir Vitreoretinal Services | Sahu C.,Shri Bhagwan Mahavir Vitreoretinal Services | And 2 more authors.
Eye (London, England) | Year: 2016

METHODS: Retrospective interventional case series. Case records of 143 consecutive eyes presenting with post-traumatic endophthalmitis between 1997 and 2007 were reviewed. Univariate and multivariate analysis were done to analyze factors associated with adverse outcomes.RESULTS: Mean age at presentation was 9.2 years (median 8 years, range: 2 months to 18 years). Broomstick and hypodermic needle were most common causes for injuries. Common presenting features were cataract (n=51), hypopyon (n=45) and retinal detachment (n=29). Corneal abscess (n=21; OR: 5, CI: 1.4-18.7) and retinal detachment (n=29, OR: 5, CI: 1.6-11.3) were independent risk factors for poor outcome (P=0.04 and 0.012, respectively). Gram-positive bacteria were isolated in 54% (n=31) of culture-positive cases. Forty-nine (34%) patients had ambulatory vision at final visit. Patients who received treatment within 24 h were 3.6 and 9 times more likely to have better anatomical outcome than those treated at 2-7 days, or >7 days, respectively (P=0.0001). Patients undergoing early vitrectomy were 27 times more likely to have better outcome (P=0.0001).CONCLUSION: Post-traumatic endophthalmitis in children is more common in boys <10 years of age and most often caused by injury with organic matter. Corneal abscess and retinal detachment are associated with poor outcome. E. fecalis is the most common causative organism. Early vitrectomy results in better outcomes.PURPOSE: The purpose of this study was to describe clinical features, risk factors, causative organisms, treatment options, and outcomes of post-traumatic endophthalmitis in children and adolescents.


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.


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.

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