Padmaja Kumari Rani

L V Prasad Eye Institute, Bhaganagar, Telangana, India

Are you Padmaja Kumari Rani?

Claim your profile

Publications (52)98.94 Total impact

  • Padmaja Kumari Rani · Jay Chhablani · Archana Bhargava
    Jama Ophthalmology 06/2015; 133(6):e1568. DOI:10.1001/jamaophthalmol.2015.68 · 3.83 Impact Factor
  • Jay Chhablani · Ashraya Nayaka · Padmaja Kumari Rani · Subhadra Jalali
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate changes in choroidal thickness (CT) in inherited retinal diseases and its relationship with age, spherical equivalent, visual acuity, and macular thickness. Retrospective analysis of 51 eyes with features of retinal dystrophy of 26 subjects, who underwent enhanced depth imaging using spectral domain (SD) optical coherence tomography (OCT), were included. The CT measurements were made at the fovea and at 5 points with an interval of 500 microns in both directions, nasal and temporal from the fovea and were compared with age-matched healthy subjects. Step-wise regression was used to find the relationship between age, spherical equivalent, best-corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal CT. Disease distribution was as follows: Stargardt's disease 18 eyes (9 subjects); Best disease 5 eyes (3 subjects); cone-rod dystrophy 26 eyes (13 subjects); and Bietti's crystalline dystrophy 2 eyes (1 subject). Mean subfoveal CT was 266.33 ± 76 microns. On regression analysis, no significant correlation was found between subfoveal CT and any other variable such as age (P = 0.9), gender (P = 0.5), CMT (P = 0.1), spherical equivalent (P = 0.3) and BCVA (P = 0.6). While comparing with age-matched healthy subjects, no significant statistical difference was noted (P < 0.05) among all age groups. Our study reports quantitative changes in CT in various common inherited retinal diseases seen in Indian populations. To validate changes in choroid, a longitudinal study with larger sample size is warranted.
    Indian Journal of Ophthalmology 05/2015; 63(5):391-3. DOI:10.4103/0301-4738.159862 · 0.93 Impact Factor
  • Taraprasad Das · Rajiv Raman · Kim Ramasamy · Padmaja Kumari Rani
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    Middle East African journal of ophthalmology 04/2015; 22(2):174-8. DOI:10.4103/0974-9233.154391
  • Devendra Phalak · Padmaja Kumari Rani · Divya Balakrishnan · Subhadra Jalali
    [Show abstract] [Hide abstract]
    ABSTRACT: A premature infant who developed central retinal vein obstruction in one eye during laser therapy for high-risk prethreshold retinopathy of prematurity is described. Systemic investigations were done to detect the cause of such an acute and unreported episode. Acquired deficiency of protein C levels was detected. Premature infants are at risk of thromboembolic episodes due to deranged hematological parameters. Acquired protein C deficiency possibly precipitated acute retinal vein occlusion during laser therapy in this infant. Intravitreal bevacizumab was used successfully to treat the episode of retinal venous occlusion. Retinal vein obstruction during laser treatment for retinopathy of prematurity is reported for the first time. Copyright 2014, SLACK Incorporated.
    Journal of Pediatric Ophthalmology & Strabismus 12/2014; 51 Online:e72-4. DOI:10.3928/01913913-20141120-01 · 0.73 Impact Factor
  • Source
    Laxmi Gella · Rajiv Raman · Padmaja Kumari Rani · Tarun Sharma
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To report the appearance of diabetic retinopathy lesions using spectral domain optical coherence tomography (SD-OCT). Materials and Methods: A total of 287 eyes of 199 subjects were included. All the subjects underwent complete ophthalmic examination including SD-OCT. Results: The appearance of various lesions of diabetic retinopathy and the retinal layers involved were reported. In subjects with macular edema the prevalence of incomplete PVD was 55.6%. Conclusion: SD-OCT brings new insights into the morphological changes of the retina in diabetic retinopathy.
    Oman Journal of Ophthalmology 09/2014; 7(3):126-9. DOI:10.4103/0974-620X.142594
  • Source
    Jay Chhablani · Padmaja Kumari Rani · Annie Mathai · Subhadra Jalali · Igor Kozak
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and objective To assess the efficacy of navigated laser (Navilas®) treatment for central serous chorioretinopathy. Materials and methods Prospective study included 16 eyes of 15 subjects with nonresolving central serous chorioretinopathy. Fluorescein-angiography guided Navilas® treatment was performed. Pre- and posttreatment best-corrected visual acuity, pre- and posttreatment central macular thickness, number of leaks on fluorescein angiography, and various treatment parameters were analyzed. Pain experience was evaluated using the visual analog pain scale. Results Sixteen eyes from 15 subjects (mean age 42.2±9.9 years) were analyzed. Mean duration of symptoms was 11.45±6.6 months. Average number of leaks per eye was 2.8 and one laser spot per leak was performed. There was complete resolution of subretinal fluid in 15 out of 16 eyes at 2 months. Average visual analog pain scale score was 0.63±1.41. Conclusion Navilas® without a contact lens achieved resolution of subretinal fluid with a single laser spot for each single leak and minimum iatrogenic damage.
    Clinical ophthalmology (Auckland, N.Z.) 08/2014; 8:1543-7. DOI:10.2147/OPTH.S67025
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To assess the prevalence of blindness and visual impairment (VI), their associated causes and underlying risk factors in three tribal areas of Andhra Pradesh, India and compare this data in conjunction with data from other countries with low and middle income settings. Methods Using a validated Rapid Assessment of Avoidable Blindness methodology, a two stage sampling survey was performed in these areas involving probability proportionate to size sampling and compact segment sampling methods. Blindness, VI and severe visual impairment (SVI) were defined as per the WHO guidelines and Indian definitions. Results Based on a prior enumeration, 7281 (97.1%) subjects were enrolled (mean age = 61.0+/−7.9 years). Based on the presenting visual acuity (PVA), the prevalences of VI, SVI and blindness were 16.9% (95% CI: 15.7–18.1), 2.9% (95% CI: 2.5–3.4), and 2.3% (95% CI: 1.9–2.7), respectively. When based on the Pinhole corrected visual acuity (PCVA), the prevalences were lower in VI (6.2%, 95% CI: 5.4–6.9), SVI (1.5%, 95% CI: 1.2–1.9) and blindness (2.1%, 95% CI: 1.7–2.5). Refractive error was the major cause of VI (71.4%), whereas, cataract was the major cause of SVI and blindness (70.3%). Based on the PVA, the odds ratio (OR) of blindness increased in the age groups of 60–69 years (OR = 3.8, 95% CI: 2.8, 5.1), 70–79 years (OR = 10.6, 95% CI: 7.2, 15.5) and 80 years and above (OR = 30.7, 95% CI: 19.2, 49). The ORs were relatively higher in females (OR = 1.3, 95% CI: 1.0, 1.6) and illiterate subjects (OR = 4.3, 95% CI: 2.2, 8.5), but lower in those wearing glasses (OR = 0.2, 95% CI: 0.1, 0.4). Conclusions This is perhaps the first study to assess the prevalence of blindness and VI in these tribal regions and the majority of the causes of blindness and SVI were avoidable (88.5%). These findings may be useful for planning eye care services in these underserved regions.
    PLoS ONE 07/2014; 9(7):e100644. DOI:10.1371/journal.pone.0100644 · 3.23 Impact Factor
  • Source
    Fatma J Omar · Sheela Devi Sethu · Padmaja Kumari Rani · Geng Ning · George Kabona
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Diabetes and its related microvascular complications like Diabetic retinopathy are showing an alarming rise in developing countries like Zanzibar. Objective of the present study is to evaluate the impact of integrating eye screening for all subjects attending the diabetes clinic at Mnazi Mmoja Hospital in Zanzibar and to estimate the prevalence of visual impairment and diabetic retinopathy among the subjects. Methods This is a cross sectional study involving 356 randomly selected patients who had attended the diabetes clinic between July and August 2012. All subjects underwent comprehensive eye examination including fundus evaluation after dilatation by a cataract surgeon and an ophthalmologist, independently. Data was collected using the designated questionnaire and analysed using the SPSS software. Blindness and visual impairment was defined as presenting VA <3/60 and <6/18 to 6/60 in the better eye respectively and DR was graded using the International classification of Diabetic Retinopathy severity grading scale. Results A total of 356/967 subjects were recruited in a duration of 2 months; 176 (49.4%) were male and the mean age was 52.21 (SD 15.3). Targeted eye screening of diabetics showed that 231/356 (65%) of the subjects had eye problems, including potentially blinding conditions that required immediate intervention in contrast to the existing self reported referral where only 10% of an average of 200 diabetics underwent eye checkup in a year. The prevalence of visual impairment was 20.2%; 95% CI: 16.4-24.7 and blindness in 9.3%; 95% CI: 6.7 -12.7. The prevalence of DR was 28.3% and sight-threatening DR was reported in 9%. Among the DR cases, 30% had sight threatening DR including 28% macular edema, 2% severe NPDR and PDR. Multivariate analysis showed a higher risk for any DR in older subjects >50 years (OR: 2.19; 95% CI: 1.14 – 4.25) and in females (OR: 1.92; 95% CI: 1.07 – 3.44). Conclusion Opportunistic DR screening model achieved higher yield of identification of visual impairment and DR compared to the yield of 10% of existing self reported Diabetic eye screening model at Zanzibar. Integration of eye screening at diabetes clinics helps in early identification and provision of appropriate treatment for reducing blindness due to diabetes.
    BMC Ophthalmology 06/2014; 14(1):81. DOI:10.1186/1471-2415-14-81 · 1.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose:To compare the laser spot quality between the conventional slit lamp pattern laser (PASCAL) and the navigated pattern laser (NAVILAS) for panretinal photocoagulation (PRP). Methods:Prospective randomized interventional trial of 73 eyes (61 patients) with high-risk proliferative diabetic retinopathy. Eyes underwent PRP using 30ms pulse duration with either PASCAL (16 eyes) or NAVILAS laser (21 eyes); or 100 ms pulse duration with either PASCAL (16 eyes) or NAVILAS laser (20 eyes). Fundus color images of all quadrants were taken five minutes after treatment. Laser burn size (major and minor diameter and area), ellipticity (ratio of minor to major axis) were analyzed across the retina. Treatment time and pain were compared between both groups. Results:The burn size variation in navigated laser 30 ms, 100 ms and conventional pattern 30 ms and single spot 100 ms laser was 22%, 24%, 21% and 35%, respectively. The variation of the laser burn area near the arcade for NAVILAS and for PASCAL was 29% and 22%, respectively (p<0.01). Closer to the equator, burns from the NAVILAS showed even smaller variation of 15% compared to 25% with PASCAL (p<0.005). Laser spots from PASCAL exhibited an increasing elliptical shape towards the periphery while NAVILAS laser spots tended to be more uniform all over the retina. Average treatment duration and pain experience was less with navigated laser compared to pattern laser (p= <0.05). Conclusions:Navigated laser treatment achieves more uniform laser burns with less pain during shorter treatment duration in comparison to conventional pattern laser.
    Investigative ophthalmology & visual science 05/2014; 55(6). DOI:10.1167/iovs.14-13936 · 3.66 Impact Factor
  • Satyanarayana Sristi · Sethu Sheeladevi · Padmaja Kumari Rani
    [Show abstract] [Hide abstract]
    ABSTRACT: To ascertain the knowledge, attitudes and practices (KAP) of the general population and of persons with diabetes about diabetes and diabetic retinopathy in rural southern India. 380 people with diabetes (Group 1) and 380 people from the general population (Group II) aged ≥ 40 years were randomly enrolled from rural villages in Andhra Pradesh, southern India. A KAP questionnaire was used to document the Knowledge, Attitude and Practices. Scores were given to each question on a continuous scale — minimum 60 % in each section was taken as the correct knowledge, a positive attitude and good practices. Univariable and multivariable linear regression analysis was used to determine the factors positively influencing the knowledge, attitude and practices among the subjects. The mean score of knowledge (P < 0.001), attitude (P < 0.001) and practices (P < 0.001) was significantly higher among persons with diabetes. Among the persons in Group I, 28.2 %, 36.1 % and 40.3 % had the correct knowledge, a positive attitude and good practices, respectively, whereas the scores of the Group II were comparatively low. In Group I, 58.2 % (221) never had a dilated examination and there was no statistically significant difference between males and females (P 0.24) in terms of a dilated eye examination. Among those who had dilated eye examination 92.5 % (147) had dilated examination only once although 46.3 % had diagnosed diabetes for more than 5 years. In the multiple linear regression analysis education of the subjects is the main influencing factor for correct knowledge (P < 0.001) and a positive attitude (P < 0.001) in both the groups. Targeted health education programs needs to be organised and targeted for both communities and practitioners to increase the awareness resulting in positive practices.
    International Journal of Diabetes in Developing Countries 03/2014; 35(1):33-38. DOI:10.1007/s13410-014-0219-6 · 0.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To describe the outcomes and clinicomicrobiological profile of 11 years of a protocol-based management in neonatal endogenous endophthalmitis. Methods: This was a retrospective interventional study of endogenous endophthalmitis in 31 eyes of 26 neonates. The protocol for active infection included systemic antimicrobials, vitreous and/or aqueous tap, and intravitreal antimicrobials under topical or general anesthesia along with core vitrectomy in selected cases. Blood, urine, umbilicus, aqueous, and vitreous samples underwent microbiological evaluation. Retinopathy of prematurity screening and treatment were done when indicated. Primary outcome was anatomic status assessed by comprehensive eye examination and by fundus photography whenever possible. Results: Twenty-one of 26 babies (81%) were preterm. Two types of presentations included those with a fulminant appearance (24 eyes) and those with focal retinitis detected during routine screening (7 eyes). Vitreous culture was positive in 12/20 eyes (60%). Pseudomonas aeruginosa ( 8 ) was the most common isolate. Incorrect initial diagnosis was common. Treatment included intravitreal injections in 26 eyes, 10 of which also underwent vitrectomy. Twenty-four of the 26 patients (92%) received parenteral antimicrobials and 17 had evidence of systemic infection. All eyes with a fulminant presentation developed phthisis, while all focal fungal cases were salvaged. Conclusions: Neonatal endogenous endophthalmitis has 2 distinct presentations. Focal retinal infections have good visual and anatomical outcomes while fulminant nosocomial cases do poorly. Management under topical anesthesia can be an alternative strategy for sick babies that cannot undergo surgery under general anesthesia due to systemic morbidity. Awareness about early diagnostic signs may help early referral.
    European journal of ophthalmology 11/2013; 24(3). DOI:10.5301/ejo.5000395 · 1.06 Impact Factor
  • Deepthi Reddy · Padmaja Kumari Rani · Subhadra Jalali · Harsha Laxmana Rao
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To estimate prevalence and risk factors for diabetic retinopathy (DR) in diabetic patients with Non-Arteritic Anterior Ischemic Retinopathy (NA-AION). Methods: This was a retrospective chart review of patients with diabetes diagnosed with NA-AION. Patients with clinical anomalies affecting the optic nerve, diabetic papillopathy, and features suggestive of arteritic AION (raised erythrocyte sedimentation rate/positive temporal artery biopsy) were excluded. Clinical diagrams, notes, and fundus photographs, if available, were evaluated for optic disc edema, optic disc atrophy, presence or absence of small discs, retinal vessel abnormalities, presence of DR, and the presence of sight-threatening DR (STDR). Results: A total of 153 eyes of 109 subjects were included in the study. 82 subjects (75.2%) were men. Mean age of the subjects was 55 ± 9 years. 58 subjects (53.7%) had hypertension and 21 (19.3%) were insulin-dependent. 80 subjects (52.3%) had a duration of diabetes of five years or greater. DR with NA-AION was seen in 46 eyes (30.1%, 95% CI: 22.7 to 37.4) and STDR with NA-AION was seen in 20 eyes (13.1%, 95% CI: 7.7 to 18.5). Logistic regression analysis revealed the duration of diabetes to be significantly associated with both the presence of DR (OR: 1.07, 95% CI: 1.01 to 1.14, p = 0.02) and STDR (OR 1.08, 95% CI: 1.02-1.15, p = 0.01). Conclusions: Prevalence of DR and STDR in eyes with NA-AION was 30.1% and 13.1%, respectively. Duration of diabetes was an important risk factor for both presence and severity of DR in subjects with NA-AION.
    Seminars in ophthalmology 10/2013; 30(2). DOI:10.3109/08820538.2013.833262 · 1.20 Impact Factor
  • Jay Chhablani · Padmaja Kumari Rani · Divya Balakrishnan · Subhadra Jalali
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To describe a case of choroidal ischemia in a neonate after single, bilateral, intravitreal bevacizumab (IVB) injection for severe zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). Methods: A six-week-old baby, born at a gestation age of 28 weeks and birth weight of 1.08 kg, presented at a postconceptional age of 34 weeks for ROP screening. On examination, both eyes revealed engorged iris new vessels with poorly dilating pupils. Retinal examination showed media haze, severe zone 1 APROP with confluent new vessels, severe plus disease, and early vitreous condensation at the edge of new vessels for 12 clock hours. The child was treated bilaterally, with single IVB injection before laser. After 16 hours, hypotony and exudative retinal detachment with patches of choroidal whitening suggestive of choroidal ischemia were seen. Results: The child was treated with topical steroids and cycloplegic drops and exudative retinal detachment resolved on the tenth day. Initial resolution of new vessels showed recurrence after two weeks and was treated with laser photocoagulation. Stable retinopathy status was noted up to six months follow-up. Conclusion: Choroidal ischemia secondary to a single IVB injection for the treatment of AP-ROP could be an unusual complication which raises the concern of its use as a monotherapy in neonates.
    Seminars in ophthalmology 10/2013; 29(4). DOI:10.3109/08820538.2013.835842 · 1.20 Impact Factor
  • Subhadra Jalali · Raj Anand · Padmaja Kumari Rani · Divya Balakrishnan
    [Show abstract] [Hide abstract]
    ABSTRACT: Context: Outcomes of various screening strategies in retinopathy of prematurity are not well reported. Aim: To assess the impact of a city-wide, ROP screening strategy, on the disease presentation and treatment outcome. Materials and Methods: A retrospective case-control study from a prospectively collected ROP data-base was analyzed. Cases (group 1a) included ROP babies that were screened directly in neonatal intensive care units, and controls (group 1b) were babies referred directly to the institute from other neonatal centers during the same period. Historical controls (group 2) were ROP cases seen in the years preceding establishment of this ROP program and database. Primary outcome measure was the risk of eyes presenting with stage 4 or worse ROP, and main secondary outcome measure was the final anatomic outcome. Results: Of the 643 cases screened, 322 eyes of 161 babies had ROP. The median age of 7.19 months at presentation for the 46 patients (92 eyes) in group 2 was higher than the median age of 1.29 months for the 115 patients (230 eyes) in group 1. Within the group 1, group 1a had lower median age at presentation than group 1b (0.91 months versus 2.30 months). The relative risk of an eye presenting in the stage 4 and 5 in group 2 was 4.7 times higher (95% confidence interval 3.07 -7.32) than in group 1. Eyes that could be given treatment in group 2 were significantly less (P < 0.0005) than in group 1. The relative risk of poor outcome in group 2 was 3.83 times higher (95% confidence interval 2.75 -5.34) than in group 1. Group 1a eyes had the best outcomes. Conclusion: Early screening before one month of age in neonatal centers detects the disease early where prompt treatment can lead to favorable outcomes. The study provides early results of a model strategy for ROP screening.
    Indian Journal of Ophthalmology 10/2013; 62(5). DOI:10.4103/0301-4738.118449 · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the characteristics and treatment outcomes of an unreported, late vitreous hemorrhage due to anterior hyaloidal fibrovascular proliferation in laser-regressed retinopathy of prematurity (ROP). Interventional case series. In the ongoing Indian Twin Cities ROP study database, consecutive cases with isolated late vitreous hemorrhage at least one year after laser-regressed disease were analyzed retrospectively. Anterior hyaloidal fibrovascular proliferation was diagnosed primarily using scleral depression. Anterior retinal cryopexy with adjunctive treatments was performed. The main outcome measure was clinical resolution of new vessels with no recurrent hemorrhage over a 1-year period. Vitreous hemorrhage, at two to eight years of age, developed in three eyes of three children out of 1,168 ROP lasered eyes. All had received laser for zone I disease as neonates, with no subsequent sequelae. Evaluation revealed filiform new vessels at the posterior vitreous base involving inferior 180° with absence of any other source of hemorrhage. All underwent anterior retinal cryopexy to the affected area. Simultaneous additional treatment, based on intraoperative findings, included one case each of peripheral laser photocoagulation, lens-sparing vitrectomy and intravitreal bevacizumab. All three showed successful regression and non-recurrence of vitreous hemorrhage with improvement of vision >20/40 at an intermediate follow-up of two years. Anterior hyaloidal fibrovascular proliferation is an unreported and rare cause of vitreous hemorrhage, appearing years after laser-regressed ROP. It has a good response to interventional treatment. Meticulous scleral depression of the vitreous base under anesthesia is useful to detect this rare source of vitreous hemorrhage.
    International Ophthalmology 09/2013; DOI:10.1007/s10792-013-9843-2 · 0.55 Impact Factor
  • Sethu Sheeladevi · Jayanthi Mekala · Siddharth Pujari · Padmaja Kumari Rani
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To present results from a district-wide diabetes prevention programme involving health education for school children and the local community.Method: The model of health education that was utilized aimed to secure lifestyle changes and the identification of diabetes risk by school children (aged 9–12 years). The children acted as health messengers in their families as well as in the neighbouring community. Health education sessions were also held for school teachers, non-governmental organizations, primary health centre physicians, self-help groups and laypeople in the district. All were trained in diabetes risk assessment by using the standardized Indian diabetic risk score and were trained to estimate urine glucose.Results: Over a four-year period (2005–2009) the programme trained 8288 teachers and 119,743 schoolchildren in 679 schools and 30,915 people working in the health and development sectors. Trained school children reached out to 2.4 million people in over 500,000 families, covering 80% of the district population (3 million). The project identified 83,907 (3.5%) people as being at high risk of developing diabetes and these were counselled regarding risk reduction and lifestyle modifications. Among those identified with diabetes risk, 15,868 (19%) people were identified as having positive urine glucose. There were 10,522 (0.4%) people with known diabetes who were referred to identified diabetes care centres in the district.Conclusion: This child-to-family-based lifestyle change and health education intervention, along with community participation, offers a novel approach with substantial coverage of district populations in India.
    Health Education Journal 06/2013; 73(4):[Epub ahead of print]. DOI:10.1177/0017896913485471 · 0.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: In the developing world, more than 90% of glaucoma is undetected due to the lack of appropriate screening methods. The LV Prasad Eye Institute Glaucoma Epidemiology and Molecular Genetic Study (LVPEI-GLEAMS) is a population-based study which aims to estimate the prevalence of, along with clinical, systemic and genetic risk factors for glaucoma in a rural population sampled from the state of Andhra Pradesh, India. The study aims to develop community screening strategies to diagnose glaucoma. This article describes the methodology adopted in LVPEI-GLEAMS. Methods: A sample of 3833 participants aged 40 years and older has been estimated to be enrolled using a compact segment sampling method with probability proportionate to size. Each participant will undergo a complete medical history and comprehensive eye examination including slit lamp photography, imaging of anterior and posterior segment, frequency doubling technology and standard automated perimetry. Additionally, glycosylated hemoglobin will be measured and a genetic profile based on candidate gene analysis will be undertaken. Clinical, biochemical and genetic data will be stored in a computerized database and analyzed. The novelty of this study lies in the fact that it is conducted at a vision center (primary eye care center serving a population of 50,000) by a vision technician (high school educated rural youth trained in basic ophthalmic techniques for a year). Conclusion: Information from the diagnostic techniques of the study will be used to develop effective community-level screening strategies, and insights from risk factors associated with glaucoma will help develop appropriate detection and management strategies.
    Ophthalmic epidemiology 06/2013; 20(3):188-195. DOI:10.3109/09286586.2013.792938 · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To report serious adverse events and long-term outcomes of initial experience with intraocular bevacizumab in retinopathy of prematurity (ROP). METHODS: Consecutive vascularly active ROP cases treated with bevacizumab, in addition to laser and surgery, were analysed retrospectively from a prospective computerised ROP database. Primary efficacy outcome was regression of new vessels. Secondary outcomes included the anatomic and visual status. Serious systemic and ocular adverse events were documented. RESULTS: 24 ROP eyes in 13 babies, received single intraocular bevacizumab for severe stage 3 plus after failed laser (seven eyes), stage 4A plus (eight eyes), and stage 4B/5 plus (nine eyes). Drug was injected intravitreally in 23 eyes and intracamerally in one eye. New vessels regressed in all eyes. Vision salvage in 14 of 24 eyes and no serious neurodevelopmental abnormalities were noted up to 60 months (mean 30.7 months) follow-up. Complications included macular hole and retinal breaks causing rhegmatogenous retinal detachment (one eye); bilateral, progressive vascular attenuation, perivascular exudation and optic atrophy in one baby, and progression of detachment bilaterally to stage 5 in one baby with missed follow-up. One baby who received intracameral injection developed hepatic dysfunction. One eye of this baby also showed a large choroidal rupture. CONCLUSIONS: Though intraocular bevacizumab, along with laser and surgery salvaged vision in many otherwise progressive cases of ROP, vigilance and reporting of serious adverse events is essential for future rationalised use of the drug. We report one systemic and four ocular adverse events that require consideration in future use of the drug.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 12/2012; 98(4). DOI:10.1136/archdischild-2012-302365 · 3.86 Impact Factor
  • Ophthalmic Epidemiology 12/2012; · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: To characterize the electroretinographic response of the macula by multifocal electroretinography (mfERG) in patients with type 2 idiopathic macular telangiectasia (MacTel). METHODS: A prospective study of mfERG in patients with type 2 MacTel was conducted from April 2009 to November 2009. mfERGs were recorded using a visual evoked response imaging system (MonElec2, Metrovision, Perenchies, France). The International Society for Clinical Electrophysiology of Vision (ISCEV) guidelines were followed. Patients with type 2 MacTel confirmed by fundus fluorescein angiography without subretinal neovascularisation were included. For recording purposes, 61 stimulus hexagonal elements were used. The first-order kernel mfERG responses were analyzed. Individual mfERG responses for the hexagons were grouped into concentric rings centered on the fovea for analysis (< 2, 5-10, 10-15 and >15°). Student's t-test and Mann-Whitney U test and linear regression analysis was performed with STATA ver 11.1 (StataCorp, College Station , TX, USA). RESULTS: Twenty eight eyes of 14 patients and 20 eyes of ten normal controls were included in the study. The mean logMAR visual acuity of the patients was 0.51 (Snellen equivalent 20/63). The mean N1 amplitude (nv/deg(2)) of patients were significantly reduced compared to controls and were as follows: 8.91 ± 14.00 vs 43.44 ± 9.55 (p < 0.0001) in less than 2°, 9.24 ± 10.47 vs 22.00 ± 3.87 (p < 0.0001) in 5-10°, 8.57 ± 10.02 vs 15.24 ± 1.89 (p < 0.0001) in 10-15°, and 7.03 ± 6.52 vs 12.47 ± 2.62 in > 15° (p < 0.001). The mean P1 amplitude (nv/deg(2)) was also significantly reduced in patients compared to controls and was as follows: 27.66 ± 37.44 vs 96.20 ± 12.41 (p < 0.0001) in less than 2°, 22.61 ± 19.38 vs 53.78 ± 9.79 (p < 0.0001) in 5-10°, 18.75 ± 20.21 vs 35.22 ± 4.16 (p < 0.001) in 10-15°, and 17.10 ± 12.54 vs 25.71 ± 3.93 (p < 0.001). The implicit time of N1 and P1 were also delayed significantly in all the rings. The mean central foveal thickness assessed by optical coherence tomography (OCT) scan was 84.78 ± 45.12 μm. There was poor correlation between mfERG amplitudes or implicit times with either the visual acuity or OCT central thickness. CONCLUSION: mfERG showed significant reduction in amplitudes and implicit times of the waveforms in patients with type 2 MacTel in all the rings, suggesting a more generalized affection of the macula. The maximum reductions were seen in the <2(o) rings. Although there was poor correlation between the visual acuity and the amplitudes a of the waveforms, mfERG is a useful investigative modality for functional assessment of macula in type 2 MacTel patients.
    Albrecht von Graæes Archiv für Ophthalmologie 11/2012; DOI:10.1007/s00417-012-2191-5 · 2.33 Impact Factor

Publication Stats

373 Citations
98.94 Total Impact Points

Institutions

  • 2010–2015
    • L V Prasad Eye Institute
      • • Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases
      • • International Centre for Advancement of Rural Eye care, Kismatpur Campus
      Bhaganagar, Telangana, India
  • 2005–2010
    • Sankara Nethralaya
      Chennai, Tamil Nadu, India