AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5...AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.展开更多
AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profile...AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.展开更多
AIM：To evaluate the role of bone marrow-derived stem cells in the treatment of advanced dry age-related macular degeneration（AMD）using multifocal electroretinogram（mf-ERG）and fundus autofluorescence imaging.METH...AIM：To evaluate the role of bone marrow-derived stem cells in the treatment of advanced dry age-related macular degeneration（AMD）using multifocal electroretinogram（mf-ERG）and fundus autofluorescence imaging.METHODS：Thirty patients（60 eyes）with bilateral central geographic atrophy（GA）were recruited.Worse eye of each patient received autologous bone marrow-derived hematopoietic stem cells（BM-HSCs）（group 1）and the fellow eye with better visual acuity served as control（group2）.The effect of stem cell therapy was determined in terms of visual acuity,amplitude and implicit time in mf-ERG and size of GA on fundus autofluorescence imaging.These tests were performed at presentation and first,third and sixth month follow up.Adverse events（if any）were also monitored.RESULTS：At 6mo follow-up there was no statistically significant improvement in median log MAR best corrected visual acuity（BCVA）in either group.Mf-ERG revealed significant improvement in amplitude and implicit time in the intervention group.A significant decrease was also noted in greatest linear dimension（GLD）of GA in the eyes receiving stem cells[6.78±2.60 mm at baseline to 6.56±2.59 mm at 6mo（P=0.021）].However,no such improvement was noted in the control group.CONCLUSION：Electrophysiological and anatomical improvement in the intervention group sheds light on the therapeutic role of BM-HSCs.Further studies are required to determine the stage of disease at which the maximal benefit can be achieved and to standardize the dose andfrequency of stem cell injection.展开更多
AIM： To elucidate the mechanism of multidrug resistance in retinoblastoma, and to acquire more insights into in vivo drug resistance.METHODS： Three anticancer drug resistant Y79 human RB cells were generated against...AIM： To elucidate the mechanism of multidrug resistance in retinoblastoma, and to acquire more insights into in vivo drug resistance.METHODS： Three anticancer drug resistant Y79 human RB cells were generated against vincristine, etoposide or carboplatin, which are used for conventional chemotherapy in RB. Primary cultures from enucleated eyes after chemotherapy（PCNC） were also prepared. Their chemosensitivity to chemotherapeutic agents（vincristine, etoposide and carboplatin） were measured using MTT assay. Western blot analysis was performed to evaluate the expression of p53, Bcl-2 and various multidrug resistant proteins in retinoblastoma cells.RESULTS： Following exposure to chemotherapeutic drugs, PCNC showed less sensitivity to drugs. No significant changes observed in the p53 expression, whereas Bcl-2 expression was found to be increased in the drug resistant cells as well as in PCNC. Increased expression of P-glycoprotein（P-gp） was observed in drug resistant Y79 cells; however there was no significant change in the expression of P-gp found between primary cultures of primarily enucleated eyes and PCNC. Multidrug resistance protein 1（Mrp-1） expression was found to be elevated in the drug resistant Y79 cells as well as in PCNC. No significant change in the expression of lung resistance associatedprotein（Lrp） was observed in the drug resistant Y79 cells as well as in PCNC.CONCLUSION： Our results suggest that multidrug resistant proteins are intrinsically present in retinoblastoma which causes treatment failure in managing retinoblastoma with chemotherapy.展开更多
· AIM: To describe a new surgical technique for managing dislocated sclerotic cataractous lens.· METHODS: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre a...· AIM: To describe a new surgical technique for managing dislocated sclerotic cataractous lens.· METHODS: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port23 G pars plana vitrectomy and perfluorocarbon liquid(PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL,Fluid Air Exchange was done in all the cases and surgery completed uneventfully.·RESULTS: Best corrected visual acuity(BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up.·CONCLUSION: Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser.展开更多
INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration...INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration cytology(FNAC)as a diagnostic modality for RB has been controversial,mainly due to concerns of tumor dissemination and extra-ocular spread[1-2].Although the majority of RB cases can be diagnosed without the need for any invasive procedure,in展开更多
Azuara-Blanco et al.(1)in their multicentric“EAGLE”study have done a remarkable work in comparing efficacy of clear lens extraction(CLE)vs.laser peripheral iridotomy(LPI)in 155 eyes having newly diagnosed primary an...Azuara-Blanco et al.(1)in their multicentric“EAGLE”study have done a remarkable work in comparing efficacy of clear lens extraction(CLE)vs.laser peripheral iridotomy(LPI)in 155 eyes having newly diagnosed primary angle closure(PAC)with ocular hypertension(IOP≥30 mmHg)and 263 eyes with early to moderate primary angle closure glaucoma(PACG).The authors reported better quality of life scores and a mean intraocular pressure lower by 1 mmHg in eyes which underwent CLE as compared to LPI at 36 months follow-up.The conclusion of the study was that CLE has a greater efficacy and is more cost effective as compared to the current standard of care(LPI followed by topical therapy)and should therefore be considered as the first line therapy in management of PAC disease(PAC and PACG).展开更多
Central insulin resistance, the diminished cellular sensitivity to insulin in the brain, has been implicated in diabetes mellitus, Alzheimer’s disease and other neurological disorders. However, whether and how centra...Central insulin resistance, the diminished cellular sensitivity to insulin in the brain, has been implicated in diabetes mellitus, Alzheimer’s disease and other neurological disorders. However, whether and how central insulin resistance plays a role in the eye remains unclear. Here, we performed intracerebroventricular injection of S961, a potent and specific blocker of insulin receptor in adult Wistar rats to test if central insulin resistance leads to pathological changes in ocular structures. 80 mg of S961 was stereotaxically injected into the lateral ventricle of the experimental group twice at 7 days apart, whereas buffer solution was injected to the sham control group. Blood samples, intraocular pressure, trabecular meshwork morphology, ciliary body markers, retinal and optic nerve integrity, and whole genome expression patterns were then evaluated. While neither blood glucose nor serum insulin level was significantly altered in the experimental or control group, we found that injection of S961 but not buffer solution significantly increased intraocular pressure at 14 and 24 days after first injection, along with reduced porosity and aquaporin 4 expression in the trabecular meshwork, and increased tumor necrosis factor α and aquaporin 4 expression in the ciliary body. In the retina, cell density and insulin receptor expression decreased in the retinal ganglion cell layer upon S961 injection. Fundus photography revealed peripapillary atrophy with vascular dysregulation in the experimental group. These retinal changes were accompanied by upregulation of pro-inflammatory and pro-apoptotic genes, downregulation of anti-inflammatory, anti-apoptotic, and neurotrophic genes, as well as dysregulation of genes involved in insulin signaling. Optic nerve histology indicated microglial activation and changes in the expression of glial fibrillary acidic protein, tumor necrosis factor α, and aquaporin 4. Molecular pathway architecture of the retina revealed the three most significant pathways involved being inflammation/cell stress, insulin signaling, and extracellular matrix regulation relevant to neurodegeneration. There was also a multimodal crosstalk between insulin signaling derangement and inflammation-related genes. Taken together, our results indicate that blocking insulin receptor signaling in the central nervous system can lead to trabecular meshwork and ciliary body dysfunction, intraocular pressure elevation, as well as inflammation, glial activation, and apoptosis in the retina and optic nerve. Given that central insulin resistance my lead to neurodegenerative phenotype in the visual system, targeting insulin signaling may hold promise for vision disorders involving the retina and optic nerve.展开更多
AIM:To ascertain the pattern of investigations at first contact in uveitic patients and evaluate compliance to treatment.METHODS:An observational study comprised of 201 uveitic patients presenting for the first time t...AIM:To ascertain the pattern of investigations at first contact in uveitic patients and evaluate compliance to treatment.METHODS:An observational study comprised of 201 uveitic patients presenting for the first time to our centre from January 2019 to June 2020.Detailed information regarding systemic investigations undertaken by specialists at the time of first contact and the cost of these investigations were reviewed on the first visit to our centre.Compliance with the treatment was determined and reasons behind non-compliance were evaluated on the first follow-up in patients who had no improvement in clinical signs and symptoms.RESULTS:The mean age of the study group was 35.35±14.1y and gender composition was 59.7%males and 40.3%females.Anterior uveitis was observed in 45.3%of patients,intermediate uveitis in 31.8%of patients,posterior uveitis in 14.9%of patients and panuveitis in 8.0%of patients.Association with a systemic disease was evident in 17.9%of patients.When compared with standard guidelines and uveitis patterns,systemic investigations were identified to be relevant only in 38.3%of patients.Non-compliance to treatment was documented in 22.4%of patients.Common reasons for non-compliance were inadequate counselling by the treating physician about treatment in 26.7%of patients and a busy schedule at work/school in 22.2%of patients.CONCLUSION:Significant number of investigations performed at first contact is found to be contrary to standard guidelines and are not contributory to the care.About a quarter of patients in this study are found to be non-compliant with the treatment.Compliance is more challenging to achieve in school-going children and working adults.The availability of comprehensive,periodically updated,evidence-based guidelines on the role of investigations and the use of trained counsellors may help to channelize proper evaluation and improve compliance to treatment,respectively,in patients with uveitis.展开更多
AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients under...AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.展开更多
BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the fi rst point of care for detecting posterior segment and orbital pathologies in cases of paediatric oc...BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the fi rst point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids.RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80(65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage(8.19%), retinal detachment(6.55%), choroidal detachment(4.91%), posteriorly dislocated clear lens(0.81%) and retained intraocular foreign body(5.73%). Non-traumatic cases constituted around 42(34.42%) eyes, which included corneal ulcer(7.37%), retinoblastoma(6.55%), endophthalmitis(4.91%), extraocular muscle cysticercosis(4.91%), orbital cellulitis(4.09%), periocular haemorrhage(2.45%), proptosis(1.63%), paediatric cataract(1.63%) and cryptophthalmos(0.81%). No adverse events of performing the ultrasound was noted.CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of signifi cant posterior segment and orbital diseases.展开更多
Dear Editor,We read with interest the article ＂Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification＂ by Demircan et al. The authors describe the intra...Dear Editor,We read with interest the article ＂Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification＂ by Demircan et al. The authors describe the intraoperative and post-operative outcomes of phacoemulsification in terms of cumulative dissipated energy （CDE）, total ultrasound （US） time, torsional US time, total fluid use, percentage change in central corneal thickness and endothelial cell count in the two groups. A comparative evaluation has been made between the two groups involving the Kelman mini-flared tip and the Intrepid balanced phaco tip using the Infiniti Ozil IP Vision system （Alton Laboratories Inc., Fort Worth, TX, USA） as hasbeen explicitly mentioned in the article under the ＂Methods＂ section. However,展开更多
AIM： To study the various morphological patterns of fundus autofluorescence （FAF） images in patients with age-related macular degeneration （AMD） in Indian population.METHODS： Totally 179 eyes of 104 patients wit...AIM： To study the various morphological patterns of fundus autofluorescence （FAF） images in patients with age-related macular degeneration （AMD） in Indian population.METHODS： Totally 179 eyes of 104 patients with clinical diagnosis of AMD were recruited into the study. Autofluorescence images were captured using confocal scanning laser ophthalmoscope and the patterns of FAF were classified.RESULTS： Of 179 eyes, 27 （15.08%） were early AMD, 58 （32.41%） were intermediate AMD, 94 eyes （52.51%） were late AMD. Of 94 eyes with late AMD, 79 （84.04%） were neovascular AMD and 15 （15.96%） were central geographic atrophy. In eyes with early and intermediate AMD, 9 patterns of FAF were noted. Six patterns （normal, minimal change, focal increased, patchy increased, linear, reticular） were similar to that in the published classification. Two patterns （lacelike and speckled） described in the published classification were not found. Three new patterns （focal hypo-fluorescence, patchy hypo-fluorescence, mixed focal hypo-fluorescence and hyper-fluorescence） were detected. In eyes with neovascular AMD, 6 morphological patterns of FAF were noted. Two patterns （mixed hypo-fluorescence and hyper-fluorescence, central hypo-fluorescence with hyper-fluorescent rim） were similar to that in published classification. Two patterns （normal, near normal or normal background fluorescence in the centre of hypo-fluorescent area） described in the published classification were not found. Four new patterns （minimal change, hypo-fluorescent patch, central hypo-fluorescence with surrounding reticular, bull’s eye） were recognized. In eye with central geographic atrophy 5 morphological patterns were noted and these were similar to that in published classification.CONCLUSION： Phenotypic differences in the pattern of FAF exist in the study population compared to existing classification systems.展开更多
Dear Editor,We read with interest the article by Gao et al on fungal endophthalmitis associated with fungal keratitis in 27 eyes of 27 patients. They have reported[1] that multiple surgeries including penetrating kera...Dear Editor,We read with interest the article by Gao et al on fungal endophthalmitis associated with fungal keratitis in 27 eyes of 27 patients. They have reported[1] that multiple surgeries including penetrating keratoplasty （PKP）, pars plana vitrectomy （PPV）, intracameral or intravitreal antifungals, cataract extraction and evisceration resulted in a final visual acuity better than counting fingers in 55.6% eyes. Most common causative fungal pathogens in their study were Fusarium （44%）, Aspergillus （22%）, and Alternaria （7%）.展开更多
Self-inflicted eye injuries in psychotic patients are not uncommon, it has been well described in the literature, earlier report date back to the mid-19th century, but it was there in ancient time as well. In developi...Self-inflicted eye injuries in psychotic patients are not uncommon, it has been well described in the literature, earlier report date back to the mid-19th century, but it was there in ancient time as well. In developing countries, because of poor health care system, it seems many cases go undiagnosed and unreported.展开更多
Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tert...Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.展开更多
Ischemic optic neuropathies could be a result of inflammatory and non inflammatory small vessel disease and have been classified as arteritic and non-arteritic anterior ischemic optic neuropathy respectively. This rev...Ischemic optic neuropathies could be a result of inflammatory and non inflammatory small vessel disease and have been classified as arteritic and non-arteritic anterior ischemic optic neuropathy respectively. This review has been intended to elucidate the epidemiology, etiology, pathogenesis, clinical picture and management of NAION and the literature search was completed using the published data in Pubmed, Medline, and Ovid over the last five decades.展开更多
Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,...Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,if given within the correct window period post laser therapy.展开更多
We report a case where unilateral iridofundal coloboma(IFC)was observed with asymmetric retinopathy of prematurity(ROP).Associated ocular abnormalities with IFC are present in nearly 15%of the cases;however its implic...We report a case where unilateral iridofundal coloboma(IFC)was observed with asymmetric retinopathy of prematurity(ROP).Associated ocular abnormalities with IFC are present in nearly 15%of the cases;however its implications on course of ROP have not been reported thus far.IFC,damaging in its own respect,may be protective against disease progression in ROP.展开更多
BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracamera l injection of 2%hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in...BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracamera l injection of 2%hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontroll ed primary open-angle glaucoma in a prospective randomized manner. PATIENTS AND METHODS: Thirty consecutive eyes with primary open-angle glaucoma scheduled fo r trabeculectomy were randomized to conventional trabeculectomy without HPMC inj ection (group I; n=15) or to intracameral injection of 2%HPMC during trabeculec tomy (group II; n=15). All patients were observed serially on days 1, 3, 5, 7, a nd 14 and months 1, 3, and 6 postoperatively. The main outcome measure was resto ration of anterior chamber depth to preoperative level with IOP of less than 21m mHg with no additional antiglaucoma medication or surgery. RESULTS: The anterior chamber depth decreased from 2.5 ±0.53 to 1.5 ±0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 ±0.43 to 2.5 ±0.36 mm on postopera tive day 1 in group II (P=.04). Overall, the IOP decreased to 5.0 ±2.8 mm Hg in group I (87%reduction) and 9.0 ±4.6 mm Hg in group II (70%reduction). Two ey es developed postoperative flat anterior chamber and related complications in gr oup I, whereas none of the eyes in group II developed such complications. CONCLU SIONS: Intracameral injection of 2%HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallo w anterior chamber depth following trabeculectomy.展开更多
文摘AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.
文摘AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.
文摘AIM：To evaluate the role of bone marrow-derived stem cells in the treatment of advanced dry age-related macular degeneration（AMD）using multifocal electroretinogram（mf-ERG）and fundus autofluorescence imaging.METHODS：Thirty patients（60 eyes）with bilateral central geographic atrophy（GA）were recruited.Worse eye of each patient received autologous bone marrow-derived hematopoietic stem cells（BM-HSCs）（group 1）and the fellow eye with better visual acuity served as control（group2）.The effect of stem cell therapy was determined in terms of visual acuity,amplitude and implicit time in mf-ERG and size of GA on fundus autofluorescence imaging.These tests were performed at presentation and first,third and sixth month follow up.Adverse events（if any）were also monitored.RESULTS：At 6mo follow-up there was no statistically significant improvement in median log MAR best corrected visual acuity（BCVA）in either group.Mf-ERG revealed significant improvement in amplitude and implicit time in the intervention group.A significant decrease was also noted in greatest linear dimension（GLD）of GA in the eyes receiving stem cells[6.78±2.60 mm at baseline to 6.56±2.59 mm at 6mo（P=0.021）].However,no such improvement was noted in the control group.CONCLUSION：Electrophysiological and anatomical improvement in the intervention group sheds light on the therapeutic role of BM-HSCs.Further studies are required to determine the stage of disease at which the maximal benefit can be achieved and to standardize the dose andfrequency of stem cell injection.
基金the support of Department of Biotechnology, Govt. of India
文摘AIM： To elucidate the mechanism of multidrug resistance in retinoblastoma, and to acquire more insights into in vivo drug resistance.METHODS： Three anticancer drug resistant Y79 human RB cells were generated against vincristine, etoposide or carboplatin, which are used for conventional chemotherapy in RB. Primary cultures from enucleated eyes after chemotherapy（PCNC） were also prepared. Their chemosensitivity to chemotherapeutic agents（vincristine, etoposide and carboplatin） were measured using MTT assay. Western blot analysis was performed to evaluate the expression of p53, Bcl-2 and various multidrug resistant proteins in retinoblastoma cells.RESULTS： Following exposure to chemotherapeutic drugs, PCNC showed less sensitivity to drugs. No significant changes observed in the p53 expression, whereas Bcl-2 expression was found to be increased in the drug resistant cells as well as in PCNC. Increased expression of P-glycoprotein（P-gp） was observed in drug resistant Y79 cells; however there was no significant change in the expression of P-gp found between primary cultures of primarily enucleated eyes and PCNC. Multidrug resistance protein 1（Mrp-1） expression was found to be elevated in the drug resistant Y79 cells as well as in PCNC. No significant change in the expression of lung resistance associatedprotein（Lrp） was observed in the drug resistant Y79 cells as well as in PCNC.CONCLUSION： Our results suggest that multidrug resistant proteins are intrinsically present in retinoblastoma which causes treatment failure in managing retinoblastoma with chemotherapy.
文摘· AIM: To describe a new surgical technique for managing dislocated sclerotic cataractous lens.· METHODS: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port23 G pars plana vitrectomy and perfluorocarbon liquid(PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL,Fluid Air Exchange was done in all the cases and surgery completed uneventfully.·RESULTS: Best corrected visual acuity(BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up.·CONCLUSION: Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser.
文摘INTRODUCTION The diagnosis of retinoblastoma(RB)is usually made by clinical examination and imaging modalities such as B-scan ultrasonography of the eye,CT scan and MRI of the orbits.The role of fine needle aspiration cytology(FNAC)as a diagnostic modality for RB has been controversial,mainly due to concerns of tumor dissemination and extra-ocular spread[1-2].Although the majority of RB cases can be diagnosed without the need for any invasive procedure,in
文摘Azuara-Blanco et al.(1)in their multicentric“EAGLE”study have done a remarkable work in comparing efficacy of clear lens extraction(CLE)vs.laser peripheral iridotomy(LPI)in 155 eyes having newly diagnosed primary angle closure(PAC)with ocular hypertension(IOP≥30 mmHg)and 263 eyes with early to moderate primary angle closure glaucoma(PACG).The authors reported better quality of life scores and a mean intraocular pressure lower by 1 mmHg in eyes which underwent CLE as compared to LPI at 36 months follow-up.The conclusion of the study was that CLE has a greater efficacy and is more cost effective as compared to the current standard of care(LPI followed by topical therapy)and should therefore be considered as the first line therapy in management of PAC disease(PAC and PACG).
基金supported by a grant from All India Institute of Medical Sciences,New Delhi (to RD and TD)Indian Council of Medical Research,Senior Research Fellowship Grant (3/1/2(24)/oph-2009-NCD-II,to MAF)+1 种基金Feldstein Medical Foundation Research Grant (to KCC)unrestricted fund from Research to Prevent Blindness to NYU Langone Health Department of Ophthalmology (to KCC)。
文摘Central insulin resistance, the diminished cellular sensitivity to insulin in the brain, has been implicated in diabetes mellitus, Alzheimer’s disease and other neurological disorders. However, whether and how central insulin resistance plays a role in the eye remains unclear. Here, we performed intracerebroventricular injection of S961, a potent and specific blocker of insulin receptor in adult Wistar rats to test if central insulin resistance leads to pathological changes in ocular structures. 80 mg of S961 was stereotaxically injected into the lateral ventricle of the experimental group twice at 7 days apart, whereas buffer solution was injected to the sham control group. Blood samples, intraocular pressure, trabecular meshwork morphology, ciliary body markers, retinal and optic nerve integrity, and whole genome expression patterns were then evaluated. While neither blood glucose nor serum insulin level was significantly altered in the experimental or control group, we found that injection of S961 but not buffer solution significantly increased intraocular pressure at 14 and 24 days after first injection, along with reduced porosity and aquaporin 4 expression in the trabecular meshwork, and increased tumor necrosis factor α and aquaporin 4 expression in the ciliary body. In the retina, cell density and insulin receptor expression decreased in the retinal ganglion cell layer upon S961 injection. Fundus photography revealed peripapillary atrophy with vascular dysregulation in the experimental group. These retinal changes were accompanied by upregulation of pro-inflammatory and pro-apoptotic genes, downregulation of anti-inflammatory, anti-apoptotic, and neurotrophic genes, as well as dysregulation of genes involved in insulin signaling. Optic nerve histology indicated microglial activation and changes in the expression of glial fibrillary acidic protein, tumor necrosis factor α, and aquaporin 4. Molecular pathway architecture of the retina revealed the three most significant pathways involved being inflammation/cell stress, insulin signaling, and extracellular matrix regulation relevant to neurodegeneration. There was also a multimodal crosstalk between insulin signaling derangement and inflammation-related genes. Taken together, our results indicate that blocking insulin receptor signaling in the central nervous system can lead to trabecular meshwork and ciliary body dysfunction, intraocular pressure elevation, as well as inflammation, glial activation, and apoptosis in the retina and optic nerve. Given that central insulin resistance my lead to neurodegenerative phenotype in the visual system, targeting insulin signaling may hold promise for vision disorders involving the retina and optic nerve.
文摘AIM:To ascertain the pattern of investigations at first contact in uveitic patients and evaluate compliance to treatment.METHODS:An observational study comprised of 201 uveitic patients presenting for the first time to our centre from January 2019 to June 2020.Detailed information regarding systemic investigations undertaken by specialists at the time of first contact and the cost of these investigations were reviewed on the first visit to our centre.Compliance with the treatment was determined and reasons behind non-compliance were evaluated on the first follow-up in patients who had no improvement in clinical signs and symptoms.RESULTS:The mean age of the study group was 35.35±14.1y and gender composition was 59.7%males and 40.3%females.Anterior uveitis was observed in 45.3%of patients,intermediate uveitis in 31.8%of patients,posterior uveitis in 14.9%of patients and panuveitis in 8.0%of patients.Association with a systemic disease was evident in 17.9%of patients.When compared with standard guidelines and uveitis patterns,systemic investigations were identified to be relevant only in 38.3%of patients.Non-compliance to treatment was documented in 22.4%of patients.Common reasons for non-compliance were inadequate counselling by the treating physician about treatment in 26.7%of patients and a busy schedule at work/school in 22.2%of patients.CONCLUSION:Significant number of investigations performed at first contact is found to be contrary to standard guidelines and are not contributory to the care.About a quarter of patients in this study are found to be non-compliant with the treatment.Compliance is more challenging to achieve in school-going children and working adults.The availability of comprehensive,periodically updated,evidence-based guidelines on the role of investigations and the use of trained counsellors may help to channelize proper evaluation and improve compliance to treatment,respectively,in patients with uveitis.
文摘AIM： To evaluate the causes and associations of missed retinal breaks（MRBs） and posterior vitreous detachment（PVD） in patients with rhegmatogenous retinal detachment（RRD）.METHODS： Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and191 patients were included for analysis of PVD,depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations.RESULTS： Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs（P =0.033） with the odds of missing a retinal break being1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy（PVR） and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae,pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD.Traumatic RRDs were rarely associated with PVD. CONCLUSION： Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
文摘BACKGROUND: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the fi rst point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.METHODS: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids.RESULTS: Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80(65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage(8.19%), retinal detachment(6.55%), choroidal detachment(4.91%), posteriorly dislocated clear lens(0.81%) and retained intraocular foreign body(5.73%). Non-traumatic cases constituted around 42(34.42%) eyes, which included corneal ulcer(7.37%), retinoblastoma(6.55%), endophthalmitis(4.91%), extraocular muscle cysticercosis(4.91%), orbital cellulitis(4.09%), periocular haemorrhage(2.45%), proptosis(1.63%), paediatric cataract(1.63%) and cryptophthalmos(0.81%). No adverse events of performing the ultrasound was noted.CONCLUSION: First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of signifi cant posterior segment and orbital diseases.
文摘Dear Editor,We read with interest the article ＂Comparison of 45-degree Kelman and 45-degree balanced phaco tip designs in torsional microcoaxial phacoemulsification＂ by Demircan et al. The authors describe the intraoperative and post-operative outcomes of phacoemulsification in terms of cumulative dissipated energy （CDE）, total ultrasound （US） time, torsional US time, total fluid use, percentage change in central corneal thickness and endothelial cell count in the two groups. A comparative evaluation has been made between the two groups involving the Kelman mini-flared tip and the Intrepid balanced phaco tip using the Infiniti Ozil IP Vision system （Alton Laboratories Inc., Fort Worth, TX, USA） as hasbeen explicitly mentioned in the article under the ＂Methods＂ section. However,
文摘AIM： To study the various morphological patterns of fundus autofluorescence （FAF） images in patients with age-related macular degeneration （AMD） in Indian population.METHODS： Totally 179 eyes of 104 patients with clinical diagnosis of AMD were recruited into the study. Autofluorescence images were captured using confocal scanning laser ophthalmoscope and the patterns of FAF were classified.RESULTS： Of 179 eyes, 27 （15.08%） were early AMD, 58 （32.41%） were intermediate AMD, 94 eyes （52.51%） were late AMD. Of 94 eyes with late AMD, 79 （84.04%） were neovascular AMD and 15 （15.96%） were central geographic atrophy. In eyes with early and intermediate AMD, 9 patterns of FAF were noted. Six patterns （normal, minimal change, focal increased, patchy increased, linear, reticular） were similar to that in the published classification. Two patterns （lacelike and speckled） described in the published classification were not found. Three new patterns （focal hypo-fluorescence, patchy hypo-fluorescence, mixed focal hypo-fluorescence and hyper-fluorescence） were detected. In eyes with neovascular AMD, 6 morphological patterns of FAF were noted. Two patterns （mixed hypo-fluorescence and hyper-fluorescence, central hypo-fluorescence with hyper-fluorescent rim） were similar to that in published classification. Two patterns （normal, near normal or normal background fluorescence in the centre of hypo-fluorescent area） described in the published classification were not found. Four new patterns （minimal change, hypo-fluorescent patch, central hypo-fluorescence with surrounding reticular, bull’s eye） were recognized. In eye with central geographic atrophy 5 morphological patterns were noted and these were similar to that in published classification.CONCLUSION： Phenotypic differences in the pattern of FAF exist in the study population compared to existing classification systems.
文摘Dear Editor,We read with interest the article by Gao et al on fungal endophthalmitis associated with fungal keratitis in 27 eyes of 27 patients. They have reported[1] that multiple surgeries including penetrating keratoplasty （PKP）, pars plana vitrectomy （PPV）, intracameral or intravitreal antifungals, cataract extraction and evisceration resulted in a final visual acuity better than counting fingers in 55.6% eyes. Most common causative fungal pathogens in their study were Fusarium （44%）, Aspergillus （22%）, and Alternaria （7%）.
文摘Self-inflicted eye injuries in psychotic patients are not uncommon, it has been well described in the literature, earlier report date back to the mid-19th century, but it was there in ancient time as well. In developing countries, because of poor health care system, it seems many cases go undiagnosed and unreported.
文摘Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.
文摘Ischemic optic neuropathies could be a result of inflammatory and non inflammatory small vessel disease and have been classified as arteritic and non-arteritic anterior ischemic optic neuropathy respectively. This review has been intended to elucidate the epidemiology, etiology, pathogenesis, clinical picture and management of NAION and the literature search was completed using the published data in Pubmed, Medline, and Ovid over the last five decades.
文摘Successful management of a case of aggressive posterior retinopathy of prematurity(APROP)poorly responsive to laser therapy with intravitreal bevacizumab(IVB)is discussed.IVB is useful as rescue therapy in such cases,if given within the correct window period post laser therapy.
文摘We report a case where unilateral iridofundal coloboma(IFC)was observed with asymmetric retinopathy of prematurity(ROP).Associated ocular abnormalities with IFC are present in nearly 15%of the cases;however its implications on course of ROP have not been reported thus far.IFC,damaging in its own respect,may be protective against disease progression in ROP.
文摘BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracamera l injection of 2%hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontroll ed primary open-angle glaucoma in a prospective randomized manner. PATIENTS AND METHODS: Thirty consecutive eyes with primary open-angle glaucoma scheduled fo r trabeculectomy were randomized to conventional trabeculectomy without HPMC inj ection (group I; n=15) or to intracameral injection of 2%HPMC during trabeculec tomy (group II; n=15). All patients were observed serially on days 1, 3, 5, 7, a nd 14 and months 1, 3, and 6 postoperatively. The main outcome measure was resto ration of anterior chamber depth to preoperative level with IOP of less than 21m mHg with no additional antiglaucoma medication or surgery. RESULTS: The anterior chamber depth decreased from 2.5 ±0.53 to 1.5 ±0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 ±0.43 to 2.5 ±0.36 mm on postopera tive day 1 in group II (P=.04). Overall, the IOP decreased to 5.0 ±2.8 mm Hg in group I (87%reduction) and 9.0 ±4.6 mm Hg in group II (70%reduction). Two ey es developed postoperative flat anterior chamber and related complications in gr oup I, whereas none of the eyes in group II developed such complications. CONCLU SIONS: Intracameral injection of 2%HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallo w anterior chamber depth following trabeculectomy.
