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ABSTRACT: The authors present a patient with posttraumatic choroidal neovascular membrane (CNVM) treated with PDT resulting in regression of the CNVM.
Indian Journal of Ophthalmology 07/2005; 53(2):131-2. · 1.02 Impact Factor
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ABSTRACT: We report a case of Type 2A idiopathic parafoveal telangiectasis treated by Photodynamic Therapy (PDT), resulting in retinal pigment epithelial (RPE) atrophy corresponding to the size of the laser spot used. This raises a doubt regarding the safety of photodynamic therapy in CNVM secondary to type 2A parafoveal telangiectasis.
Indian Journal of Ophthalmology 04/2005; 53(1):61-3. · 1.02 Impact Factor
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ABSTRACT: Choroidal neovascular membrane, a known complication of choroidal osteoma causing visual loss when located subfoveally, can be successfully treated with transpupillary thermo therapy.
Indian Journal of Ophthalmology 01/2005; 52(4):329-30. · 1.02 Impact Factor
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ABSTRACT: To elucidate the effect of discontinuation of corticosteroids in patients with atypical severe central serous chorioretinopathy (CSC) on retinal reattachment, resolution of retinal pigment epithelium (RPE) leaks, and improvement in visual acuity (VA).
Prospective, noncomparative, observational case series.
Twenty-four eyes of 17 patients who were being treated with corticosteroids for atypical severe CSC. Of these 17 patients, 16 were treated inappropriately with corticosteroids for their ocular condition; presumably, these patients' conditions were misdiagnosed, and they were thought to have choroiditis, Harada's syndrome, or similar entities, and not central serous chorioretinopathy.
Observation or laser photocoagulation.
Reattachment of the retina, obliteration of RPE leaks on fundus fluorescein angiography, and improvement in Snellen VA.
Discontinuation of corticosteroids resulted in reattachment of the retina in 21 eyes (87.5%), with median time to reattachment of 49 days (range, 32-400); only 3 eyes required laser photocoagulation. Fundus fluorescein angiography showed obliteration of RPE leaks at a median period of 75 days (range, 32-400) in the observed eyes; the median VA improved from 20/80 to 20/30. The mean follow-up was 16.5 months.
Discontinuation of corticosteroids in atypical CSC helped in obliteration of RPE leaks and retinal reattachment in 87.5% of the eyes without laser treatment, and improvement in VA was observed.
Ophthalmology 10/2004; 111(9):1708-14. · 5.45 Impact Factor
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ABSTRACT: A rare case of bronchial carcinoid tumour metastasis to the ciliary body and the choroid with clinical, diagnostic and histopathological correlation is reported.
Indian Journal of Ophthalmology 07/2004; 52(2):160-2. · 1.02 Impact Factor
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ABSTRACT: To analyze the clinical and histopathological features of retinoblastoma presenting as orbital cellulitis.
Retrospective analysis of case records and review of the histopathology of four patients with retinoblastoma presenting as orbital cellulitis.RES U LTS On histopathological examination, all eyes showed anterior segment involvement with extensive necrosis. One case had a well-differentiated tumor and one showed extraocular extension of the tumor.
Advanced necrotic retinoblastoma with anterior segment involvement may often present as orbital cellulitis.
Orbit 07/2004; 23(2):93-8.
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ABSTRACT: Nm23 is a metastasis-suppressor protein. Decreased nm23 protein contributes to aggressiveness in many tumors. Nm23 immunoreactivity was studied in retinoblastoma and correlated with differentiation and invasiveness.
Immunohistochemistry was performed on 73 formalin-fixed, paraffin-embedded specimens of retinoblastoma. Western blot was conducted to confirm the immunohistochemical study. Prognostic features such as differentiation, invasion of choroid, optic nerve, and orbit, and metastasis were analyzed.
Intense nm23 immunoreactivity was seen in 61% of the retinoblastomas with no invasion and faint nm23 immunoreactivity was seen in 85% of the retinoblastomas with invasion (p < 0.001). Poorly differentiated retinoblastoma showed decreased nm23 immunoreactivity compared to well-differentiated retinoblastomas (p = 0.02). An inverse correlation was observed between invasion of choroid, optic nerve, orbit, and metastasis, and nm23 immunoreactivity. Western blot assays of fresh tumor extracts confirmed the immunohistochemical findings.
Decreased nm23 immunoreactivity was seen in poorly differentiated retinoblastomas and in retinoblastomas with invasiveness. These findings may lay the groundwork for further studies to better understand the molecular mechanisms and provide a more accurate prediction of invasion and metastasis of retinoblastoma.
Ocular Immunology and Inflammation 06/2004; 12(2):127-35. · 1.25 Impact Factor
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Retina 05/2004; 24(2):317-8. · 2.81 Impact Factor
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ABSTRACT: To study the clinical and histopathological characteristics of uveal melanomas in Asian Indians and compare them with other ethnic groups.
One hundred and three enucleated eyes with clinical diagnosis of uveal melanoma were retrospectively studied (1987-2001) and the clinical and pathological features analysed.
Uveal melanomas constituted 0.02% of outpatients in a referral eye hospital in India over a 12-year period. The patients were predominantly males. Uveal melanomas tended to occur in the younger age. The mean age was 45.7 +/- 14.2 years. Melanoma involved the choroid in 90 (87.37%) patients, and both choroid and ciliary body in 13 (12.62%) patients. Mean basal diameter of the tumour was 13.43 +/- 5.32 mm. Mixed cell type was more common.
Uveal melanomas are rare in the Asian Indians compared to those in the West. They occur in younger persons, have a greater mean basal diameter than that of Caucasians and are predominantly of the mixed cell type.
Indian Journal of Ophthalmology 04/2004; 52(1):41-4. · 1.02 Impact Factor
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Manisha Agarwal, Mahesh P Shanmugam,
Lekha Gopal,
Nitin Shetty,
Muna Bhende,
Lingam Gopal,
Tarun Sharma,
Sandeep Thakur,
Rajiv Raman,
S H M Nizamuddin,
K R Moorthy
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ABSTRACT: To evaluate the efficacy of transpupillary thermotherapy (TTT) in choroidal neovasularisation (CNVM) secondary to age related macular degeneration (AMD).
Retrospective, non-randomized study of 28 eyes of 28 patients with subfoveal CNVM (classic, occult or mixed) secondary to AMD.
Fifteen patients (53.57%) maintained their pre-treatment vision, 2 (7.14%) patients showed improvement of more than 2 lines and 11 (39.28%) patients showed deterioration of vision by >2 lines. Angiographic and clinical regression of CNVM was noted in 19 patients (67.8%) on an average follow up of 15.32 +/- 3.31 months.
TTT leads to stabilisation of vision in 60% of treated eyes with CNVM due to AMD.
Indian Journal of Ophthalmology 04/2004; 52(1):45-9. · 1.02 Impact Factor
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Lingam Gopal,
Anand A Ramaswamy,
Hajib N Madhavan,
Rajani R Battu,
Tarun Sharma, Mahesh P Shanmugam,
Pramod S Bhende,
Muna Bhende,
Dhanashree Ratra,
Nitin S Shetty,
Madhav K Rao
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ABSTRACT: To report the clinical and microbiological profile of endophthalmitis caused by Acinetobacter calcoaceticus.
A retrospective study of case series of Acinetobacter calcoaceticus endophthalmitis. Outcome measures included ability to sterilise the eye, anatomical result (clear media and attached retina) and visual recovery (visual acuity > 6/60).
Of the 20 cases studied, 10 were cases of postoperative endophthalmitis, 3 were posttraumatic, 6 were endogenous and one was bleb-related endophthalmitis. Specific features of interest observed were relative chronicity of presentation and absence of any obvious predisposing factor in endogenous endophthalmitis cases. All cases could be sterilised except one, which needed evisceration. Cases with postoperative endophthalmitis had better anatomical outcome (7/10 with attached retina and clear media) and visual outcome (4/10 regained vision > 6/18). Higher smear positivity was seen in vitreous samples (72.2%) compared to aqueous samples (37.5%). Culture positivity was higher from the vitreous cavity compared to aqueous. The organism was sensitive to ciprofloxacin in a high percentage (88.9%) of cases.
Visual recovery in Acinetobacter calcoaceticus endophthalmitis is modest. Ciprofloxacin is the antibiotic of choice.
Indian Journal of Ophthalmology 12/2003; 51(4):335-40. · 1.02 Impact Factor
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Lingam Gopal,
Candace M D'Souza,
Muna Bhende,
Shika Fogla,
Dhanasree Ratra,
Nitin S Shetty,
Tarun Sharma, Mahesh P Shanmugam,
Pramod Bhende,
Rajani R Bhattu,
Sengamedu S Badrinath
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ABSTRACT: To compare the implant and explant techniques of scleral buckling.
This prospective, randomized clinical study compared the two techniques of scleral buckling. Variables such as size and extent of the buckle, duration of the surgery, complications, and anatomical and visual outcome were studied. The height of the buckle as measured by ultrasonography was also studied.
No significant difference was found between the two groups for total duration of the surgery, complications, anatomical results, visual outcome, and buckle height. For the 1- to 2-quadrant buckles, duration of the surgery up to initiation of subretinal fluid drainage was found to be significantly shorter for the explant group. Serial ultrasonography showed significant reduction in buckle height over 6 months in both groups to an equal degree.
Scleral buckling seems to be equally effective whether performed as an implant or explant.
Retina 11/2003; 23(5):636-40. · 2.81 Impact Factor
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Retina 07/2003; 23(3):428; discussion 428. · 2.81 Impact Factor
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ABSTRACT: The loss of Fas is believed to enhance metastatic spread in diverse human tumors. We studied the expression of Fas by immunohistochemistry in retinoblastomas and correlated the results clinicopathologically.
Archival specimens of 76 retinoblastomas were included in this study. The tumors were divided into three groups: Group A (n = 21) comprising tumors with no invasion; Group B (n = 46) tumors with invasion of choroid (diffuse), optic nerve (post-laminar), and orbit; and Group C (n = 9) tumors with both invasion and metastasis. Sections were immunostained with monoclonal antibody CD95 (APO-1/Fas) and the immunoreactivity was assessed.
Negative immunoreactivity of Fas was observed in Group B and Group C tumors (p < 0.001). Poorly differentiated retinoblastomas showed a decreased Fas expression (p = 0.006).
Decreased expression of Fas is seen in aggressive tumors and tumors that are poorly differentiated. This preliminary observation deserves further investigation, which may then shed more light on the immune escape mechanisms of this tumor and thus enable novel therapeutic strategies.
Ocular Immunology and Inflammation 06/2003; 11(2):107-13. · 1.25 Impact Factor
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Tarun Sharma,
Sourav Sinha,
Nitant Shah,
Lingam Gopal, Mahesh P Shanmugam,
Pramod Bhende,
Muna Bhende,
Nitin S Shetty,
Rajat Agrawal,
Dhanashree Deshpande,
Jyotirmay Biswas,
B Sukumar
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ABSTRACT: To report the clinical characteristics of, discuss the surgical options for, and analyze the factors affecting the anatomic and visual outcome of intraocular cysticercosis.
Retrospective, noncomparative, interventional case series.
Forty-five eyes of 44 Indian patients with posterior segment intraocular cysticercosis.
The charts of 45 eyes, in which intraocular cysticercosis was removed by vitreoretinal surgery (either transscleral or transvitreal), were reviewed.
These included the postoperative retinal status and the best-corrected Snellen visual acuity.
Intraocular cysticercosis was present in the vitreous cavity of 27 eyes (60%) and in the subretinal space of 18 eyes (40%). Anterior segment inflammation was seen in 13 eyes (28.8%) and vitreous inflammation in 38 eyes (84.4%). Retinal detachment was observed in 22 eyes (48.8%), with proliferative vitreoretinopathy in 13 eyes (59.09%). Subretinal cysts anterior to the equator (4 eyes) were removed transsclerally, whereas subretinal cysts posterior to the equator and intravitreal cysts (41 eyes) were removed transvitreally. The mean follow-up was 10.5 months. At the last follow-up, the retina was attached in 39 eyes (86.6%); visual acuity of >/=5/200 was achieved in 67.5%.
Current vitreoretinal surgical techniques enable removal of intraocular cysticercosis in all cases, with reattachment of the retina in 86.6% and recovery of ambulatory vision in approximately 67% of cases.
Ophthalmology 06/2003; 110(5):996-1004. · 5.45 Impact Factor
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Retina 05/2003; 23(3):428. · 2.81 Impact Factor
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ABSTRACT: To describe the clinical characteristics of retinal detachments in patients with Marfan syndrome and report the surgical outcome of vitreoretinal surgery.
Records relating to 53 eyes of 45 patients with Marfan syndrome who underwent surgery for rhegmatogenous retinal detachment were reviewed. Of the 53 eyes, 24 (45.3%) underwent scleral buckling as the first procedure and 29 (54.7%) underwent vitrectomy surgery with scleral buckle as the first procedure. Main outcome measures included clinical characteristics of retinal detachment, reattachment rates, and functional improvement in vision.
Characteristic findings included total retinal detachment in 40 (75.5%) eyes, atrophic holes in 24 (45.3%) eyes, more than four retinal breaks in 21 eyes (39.6%), preequatorial and postequatorial breaks in 20 (37.7%) eyes, giant retinal tears in six (11.3%) eyes, and proliferative vitreoretinopathy (posterior, anterior, or both) in nine (17%) eyes. In 30 (56.6%) eyes, retinal breaks were located only in the temporal half of the retina. Of the 24 eyes with myopia, 13 (54.2%) had a myopic correction greater than 7 diopters. At the median follow-up of 10.7 months, complete retinal reattachment was obtained in 87.6% and 86.2% of patients undergoing scleral buckling (including additional procedures such as vitrectomy) and vitrectomy surgery, respectively. In eyes with reattached retinas, a final visual acuity of 20/200 or better was obtained in 81% of the patients after scleral buckling and in 56% of the patients after vitrectomy surgery (P = 0.07).
Retinal detachment in Marfan syndrome is complete in 75% of the eyes. More than half (56%) the eyes had a retinal break only in the temporal half of the retina, and 83% had at least a break in the temporal half of the retina. Currently available vitreoretinal surgical techniques result in successful reattachment of the retina in approximately 86% of the eyes.
Retina 09/2002; 22(4):423-8. · 2.81 Impact Factor
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ABSTRACT: To report a case of choroidal metastasis of a gingival squamous cell carcinoma.
Interventional case report.
Review of the clinical history and pathologic findings.
A 59-year-old woman with a history of right gingival squamous cell carcinoma presented with sudden dimness of vision in the left eye of 4 weeks duration. Fundus examination of the left eye revealed a yellowish elevated subretinal lesion involving the optic disk and macula. Fine-needle aspiration biopsy of the choroidal lesion, left eye, revealed metastatic squamous carcinoma cells. The patient was referred to a radiation oncologist for further management.
Choroidal metastasis from gingival squamous cell carcinoma is rare, and it may develop from hematogeneous spread.
American Journal of Ophthalmology 06/2002; 133(5):713-5. · 4.22 Impact Factor
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Archives of Ophthalmology 05/2002; 120(4):522-3. · 3.71 Impact Factor
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ABSTRACT: To compare the efficacy of alkalinized bupivacaine with that of a mixture of nonalkalinized bupivacaine and lignocaine for local anesthesia in primary vitreoretinal surgery.
Through a prospective, double-blind, randomized, controlled clinical trial, 540 consecutive patients undergoing primary vitreoretinal surgery received either alkalinized 0.5% bupivacaine (group B) or a mixture of nonalkalinized 0.5% bupivacaine and 2% lignocaine (group BL), both of which were administered with hyaluronidase, for periocular anesthetic block. The periocular block involved two injections in the extraconal space-one in the lower temporal quadrant and the other in the medial periconal space. The efficacy of the block was graded from 0 to 5 depending on the adequacy of anesthesia and akinesia and the need for local supplementation.
Adequate anesthesia and akinesia (grade 5) were achieved in 72.2% of the patients in group B compared with 57.4% in group BL (P = 0.0003). Intraoperative supplementation was needed in 9.6% and 20.7% of the patients in groups B and BL, respectively (P = 0.0003). Postoperative analgesics were required in 7.4% of the patients in group B and in 15.2% of those in group BL (P = 0.004).
Alkalinized 0.5% bupivacaine provides better quality of anesthesia than does the mixture of nonalkalinized 0.5% bupivacaine and 2% lignocaine for patients undergoing primary vitreoretinal surgery.
Retina 05/2002; 22(2):202-7. · 2.81 Impact Factor
