Jeewan S Titiyal

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (169)362.78 Total impact

  • Manpreet Kaur · Suman Sahu · Namrata Sharma · Jeewan S. Titiyal

    No preview · Article · Feb 2016 · Journal of refractive surgery (Thorofare, N.J.: 1995)
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    ABSTRACT: Purpose: To evaluate the time to donor lenticule apposition in cases of Descemet stripping automated endothelial keratoplasty (DSAEK) using microscope-integrated intraoperative optical coherence tomography (iOCT). Methods: Thirty eyes of 27 patients planned to undergo Descemet stripping automated endothelial keratoplasty were enrolled in this prospective study. In group I (n = 10), continuous intracameral positive pressure was maintained for 8 minutes. In group II (n = 10) and group III (n = 10), external corneal massage was initiated simultaneously with positive intracameral air pressure. The external corneal massage was continued till complete resolution of interface fluid; the positive intracameral pressure was maintained for 8 minutes in group II and for 5 minutes in group III. The host-donor relationship was continuously monitored with the iOCT. The main outcome measure was time to complete donor lenticule apposition. Results: In group I, the interface fluid persisted after 8 minutes of positive intracameral pressure in all eyes (10/10); hence an external corneal massage was required to achieve optimal donor adherence. In groups II and III, all eyes (20/20) had complete resolution of the interface fluid at the end of 3 minutes. In 100% of the eyes (30/30), the grafts were attached after anterior chamber decompression as seen on the iOCT. In all cases, the donor lenticules were adhered in the postoperative period. Conclusions: iOCT helps in understanding that the donor lenticule is well apposed within 1 to 3 minutes with the technique of simultaneous positive intracameral pressure and external corneal massage. This knowledge minimizes the waiting time for graft apposition and prevents prolonged intraocular pressure elevation.
    No preview · Article · Jan 2016 · Cornea
  • Manpreet Kaur · Jeewan S Titiyal · Namrata Sharma · Rohan Chawla
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    ABSTRACT: A 29-year-old man presented with acute onset pain, redness and diminution of vision in the right eye 5 days after implantation of an implantable collamer lens (ICL). A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken and intravitreal antibiotics (vancomycin 1 mg/0.1 ml+piperacillin-tazobactam 225 mg/0.1 mL) were administered. The vitreous culture revealed presence of methicillin-resistant Staphylococcus epidermidis. There was minimal improvement after 48 h; hence the ICL was explanted and repeat injection of intravitreal antibiotics administered. Following this, the endophthalmitis resolved and the patient achieved a corrected distance visual acuity of 20/25 4 weeks later. A repeat implantation of ICL was performed 9 months after the first surgery, following which the patient regained uncorrected distance visual acuity of 20/20. To our knowledge, this is the first case in which an ICL was re-implanted after successful resolution of endophthalmitis.
    No preview · Article · Nov 2015 · Case Reports
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    ABSTRACT: Purpose: To compare the equivalence of gatifloxacin 0.3% with a combination of fortified cefazolin sodium 5% and tobramycin sulfate 1.3% eye drops in the treatment of nonperforated bacterial corneal ulcers. Methods: In randomized, controlled, equivalence clinical trials, microbiologically proven cases of nonperforated bacterial corneal ulcers were enrolled and were allocated randomly to one of the 2 treatment groups. Group A was given combination therapy (fortified cefazolin sodium 5% and tobramycin sulfate 1.3%) and group B was given monotherapy (gatifloxacin 0.3%). The primary outcome measure was the percentage of corneal ulcers that healed at 3 months of follow-up. Results: Out of 204 patients enrolled, 103 patients were randomized to group A, whereas 101 patients were randomized to group B. The mean ± SD of ulcer size in groups A and B were 4.35 ± 1.36 and 4.18 ± 1.31 mm, respectively (P = 0.376). The most common bacterial isolate was coagulase-negative Staphylococcus (51.5% in group A and 45.5% in group B). Worsening of the ulcer was seen in 27.2% (28/103) of the cases in group A and in 21.8% (22/101) of the cases in group B. The percentage healing difference was calculated to be 5.4% (90% confidence interval, -4.5 to 15.3). No serious events attributable to therapy were reported in any group. Conclusions: Using the prespecified definition of equivalence of ±20%, this trial found evidence that gatifloxacin monotherapy was equivalent to combination therapy with cefazolin and tobramycin for the treatment of nonperforated bacterial corneal ulcers.
    No preview · Article · Oct 2015 · Cornea
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    ABSTRACT: Purpose: To evaluate the efficacy and safety of intracameral amphotericin B (ICAMB) in the management of fungal keratitis. Methods: In total, 45 eyes with smear-confirmed fungal keratitis with hypopyon were randomized into three treatment groups: Group I (topical antifungal treatment + oral antifungal); Group II (topical antifungal treatment + ICAMB + oral antifungal); and Group III (topical antifungal treatment + drainage of hypopyon + ICAMB + oral antifungal). The main outcome measures were treatment success rate, time to heal, visual acuity gain, and presence of complications. Results: There were no differences in the treatment success rates (p = 0.66), time to healing (p = 0.18), or mean final visual acuity (logMAR) (p = 0.8) between the three groups. The major complication observed was increased incidence of cataract in group III (40%), though it was statistically insignificant. Conclusions: ICAMB does not offer any benefit over topical antifungal therapy when performed alone or associated with drainage of hypopyon.
    Full-text · Article · Sep 2015 · Ocular immunology and inflammation
  • Jeewan S Titiyal · Manpreet Kaur · Namrata Sharma
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    ABSTRACT: To describe the technique of femtosecond laser-assisted cataract surgery for management of posterior polar cataracts. The technique was performed in 25 eyes of 20 patients with posterior polar cataract and nuclear sclerosis grades II to III. A hybrid pattern of three cylinders (2, 4, and 6 mm) and three chops (6 mm in length) was used for nucleotomy. Block by block emulsification of the pre-chopped nucleus was done from the center outward, with the remaining outer rings acting as a protective cushion. Manual hydrodissection and hydrodelineation were avoided. There were no cases with posterior capsular tear in this series and the phacoemulsification procedure could be completed uneventfully with implantation of intraocular lens in the bag in all of the eyes. The postoperative uncorrected Snellen visual acuity was 20/25 or greater in all cases. The technique of femtosecond laser-assisted cataract surgery with a hybrid pattern of cylinder and chop is safe and effective in managing cases of posterior polar cataract, specifically for higher grades of nuclear sclerosis. [J Refract Surg. 2015;31(X):XX-XX.]. Copyright 2015, SLACK Incorporated.
    No preview · Article · Sep 2015 · Journal of refractive surgery (Thorofare, N.J.: 1995)
  • Manpreet Kaur · Namrata Sharma · Jeewan S Titiyal

    No preview · Article · Jul 2015 · Journal of Cataract and Refractive Surgery
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    ABSTRACT: Descemet stripping automated endothelial keratoplasty is being performed in increasing number of cases each year. An adequate scleral rim on all sides is mandatory for the donor cornea to be mounted on the artificial anterior chamber for microkeratome-assisted dissection. Occasionally, the scleral rim may however be inadequate. The primary cause of inadequate scleral rim is poorly trained technicians in in-situ excision technique. Hence, we devised a novel technique for performing successful microkeratome-assisted dissection in donor corneas with inadequate scleral rim. A surrogate scleral rim was obtained from the donor tissue not fit for optical keratoplasty. It was then glued to the optical grade donor cornea that had an inadequate scleral rim either focally or circumferentially. The combination was then used for a successful microkeratome-assisted dissection followed by endothelial keratoplasty. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    No preview · Article · Jun 2015 · The British journal of ophthalmology
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    ABSTRACT: To compare the outcomes of phacoemulsification with toric intraocular lens implantation versus phacoemulsification with monofocal intraocular lens implantation followed by photorefractive keratectomy (PRK) for correction of pre-existing astigmatism. Randomized controlled trial, six month study. Setting: Institutional Study population: Sixty eyes of 52 patients with age related senile cataract and regular corneal astigmatism ranging from 1.50 to 3.00 D, enrolled and randomly allocated in two groups based on computer generated random number table. Group 1 patients underwent phacoemulsification with toric intraocular lens (IOL) implantation and Group 2 patients underwent phacoemulsification with monofocal IOL implantation followed by PRK three months later. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual cylinder, contrast sensitivity, glare acuity, pain score and higher order aberrations. At six months 53.3% eyes in toric IOL and 60% eyes in monofocal IOL with PRK group attained UDVA of 20/20. Median residual refractive cylinder value was higher in toric IOL group [toric IOL = -0.5, monofocal IOL with PRK = 0 (p = 0.02)]. Mean root mean square value of total aberrations (5 mm pupil) was higher in monofocal IOL with PRK eyes [toric IOL= 1.02 ± 0.44, monofocal IOL with PRK = 1.28 ± 0.5 (p = 0.04)]. Mean contrast sensitivity values were comparable. Mean toric IOL rotation was 1.3 ± 2.1 degrees. Mean glare acuity was better in toric IOL eyes [toric IOL = 0.46 ± 0.16, monofocal IOL with PRK = 0.73 ± 0.12 (p < 0.001)]. Median postoperative pain scores were higher in monofocal IOL with PRK eyes. PRK yields lesser residual cylinder compared to toric IOL. However, causes greater post-operative pain, corneal aberrations and poor glare acuity. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · American Journal of Ophthalmology
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    ABSTRACT: To evaluate aetiology, demographic profile, clinical features and outcomes in cases of peripheral ulcerative keratitis (PUK). Seventy-six eyes of 65 consecutive patients with PUK were evaluated in this prospective interventional study over an 18 month period, which were followed for 3 years. The main outcome measures were sociodemographic profile, aetiology, clinical features, management strategies and outcome. Sixty per cent (39/65) of cases were men and mean age was 45.5±17.9 years. Two-thirds (43/65) of the patients were from rural areas with majority (48/65) belonging to low socioeconomic status. Unilateral disease was present in 83% of patients (54/65) with nasal involvement in 60.5% (46/76) cases. The most common aetiology was Mooren's ulcer (31.5% cases (24/76 eyes)) followed by infection and systemic collagen vascular disease. Meibomian gland dysfunction (17/76: 22.3%) was the most common extraocular association and complicated cataract (12/76:15.7%) was the most common intraocular abnormality. In mild and moderate cases, no significant visual improvement was observed (p=0.085 and p=0.156) as compared with the pretreatment status. Surgical treatment was successful in maintaining anatomical integrity in 83.3% (30/36) eyes. Recurrence of the disease was seen in one eye in moderate disease and three eyes in severe disease. Mooren's ulcer followed by collagen vascular diseases and infection are important causes of PUK in developing countries. Surgical intervention in perforated cases had good anatomical success and visual prognosis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    No preview · Article · May 2015 · The British journal of ophthalmology
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    ABSTRACT: To compare the results of microkeratome-assisted sutureless anterior lamellar keratoplasty (SALK) with and without phacoemulsification. In this retrospective comparative interventional case series, patients with superficial anterior corneal opacity were divided into 2 groups. Eyes in group 1 (n = 6) had associated cataract and underwent SALK with phacoemulsification surgery (SALK triple). Eyes in group 2 (n = 6) did not have cataract and underwent only anterior lamellar keratoplasty. A 200-μm microkeratome head was used for host and donor cut. Fibrin glue was applied at the graft-host junction. Visual acuity, refractive error, topographic changes, and pachymetry were noted. Mean follow-up was 9 ± 2.7 months. The best spectacle-corrected visual acuity (BSCVA) improved significantly over the preoperative value in both the groups at 1 month, 6 months, and the last follow-up (P = 0.028). The mean gain in BSCVA was 8.8 ± 3.4 lines and 6.8 ± 5.2 lines, respectively, for groups 1 and 2 at the last follow-up, with no statistically significant difference in the BSCVA of both groups at the last follow-up (P = 0.80). There was no statistical difference at the last follow-up between the 2 groups with respect to spherical equivalent (P = 0.6), cylinder (P = 0.81), topographic astigmatism (P = 0.75), and graft thickness (P = 0.81). One patient in group 1 underwent graft rejection, which completely reversed with treatment. No cases of graft dislocation, infection, epithelial ingrowth, vascularization, or recurrence of primary pathology were noted in either group. SALK triple is an effective surgery for early visual rehabilitation of patients with superficial anterior corneal opacity and concomitant cataract.
    No preview · Article · Apr 2015 · Cornea
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    ABSTRACT: To evaluate the safety and efficacy of collagen cross-linking (CXL) in the treatment of keratoconus. A prospective randomized sham-controlled clinical trial was undertaken and 43 eyes with moderate to severe keratoconus were randomized into two groups that is the treatment (n = 23) and the sham (n = 20) group. CXL was performed with riboflavin (0.1 in 20 % dextran) followed by UVA radiation (365 nm, 3 mW/cm(2), 30 min). In the sham group, only riboflavin was administered without UVA radiation. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intraocular pressure, corneal thickness, keratometry, endothelial count, confocal microscopy were evaluated at baseline and at 1 week, 1, 3, and 6 months. In cases where CXL was done, UDVA improved by mean 0.11 ± 0.06 logMAR units at 6 months (P = 0.01). The refractive cylinder and spherical equivalent decreased by mean of 0.62 D (P = 0.01) and 0.5 D (P = 0.19), respectively. Ultrasonic central corneal thickness decreased by mean 22.7 ± 10.3 μm (P = 0.01). The maximum and minimum keratometry decreased by mean of 1.2 ± 0.8 D (P = 0.01) and 0.83 ± 1.2 D (P = 0.39), respectively. The specular count and intraocular pressure did not show any significant change. In the sham group, no significant change was observed in any parameter. Confocal analysis showed that the epithelial healing was complete at 1 week after crosslinking. The sub-epithelial plexus showed loss of nerve plexus at 1 month, regeneration of nerve fibers which started at 3 months and was complete at 6 months. The anterior stroma showed loss of keratocytes with honeycomb oedema and apoptotic bodies till 3 months. The regeneration of keratocytes started at 3 months and was complete at 6 months of follow-up. Collagen cross-linking is an effective procedure to halt progression in keratoconus. The confocal microscopic changes correlate with the outcomes in the treatment and the sham groups.
    No preview · Article · Feb 2015 · International Ophthalmology
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    ABSTRACT: To evaluate the occurrence of localized incision-site Descemet membrane detachment (DMD) during and after phacoemulsification and to study its relationship with phacoemulsification parameters. Forty-three, consecutive uneventful cases of phacoemulsification through 2.8-mm clear corneal incision were included in this prospective study. Preoperatively, the grade of cataract was assessed. The phacoemulsification parameters noted were phacoemulsification time, aspiration time, cumulative dissipated energy (CDE), ultrasound time, and total fluid volume. Anterior segment optical coherence tomography (AS-OCT) was performed on postoperative days 1 and 7 to study the course of the incision-site DMD. Fourteen of 43 cases (32%) showed localized incision-site DMD either intraoperatively or on AS-OCT on the first postoperative day. Of these, nine cases were detected intraoperatively, and six cases were detected on AS-OCT on the first postoperative day. All cases were of planar type and resolved spontaneously. A single case showed a concurrent DMD involving central cornea, which resolved without any surgical intervention. The occurrence of DMD was significantly higher in those with the total ultrasound time greater than 60 sec (P=0.038) (odds ratio: 7.639). The CDE was higher in cases with DMD; however, the result was not statistically significant (P=0.062). Torsional equivalent in level-3, total torsional time, equivalent torsional time, aspiration time, and the total fluid volume were comparable (P>0.05) between cases with and without incision-site DMD. Postphacoemulsification incision-site DMD may occur in up to one third of cases and is associated with increase in the total ultrasound time.
    No preview · Article · Feb 2015 · Eye & Contact Lens Science & Clinical Practice
  • Digvijay Singh · Rohit Saxena · Rajesh Sinha · Jeewan S Titiyal
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    ABSTRACT: To study changes in near and distance stereoacuity after laser in situ keratomileusis (LASIK). A prospective interventional study was conducted at an apex tertiary care ophthalmology center in India. Near and distance stereoacuity was tested in 40 patients (80 eyes) who underwent LASIK for myopic correction and got unaided vision of 0.67 or better in each eye. Stereoacuity was tested with best spectacle correction before LASIK, and post-LASIK stereoacuity was tested with unaided eye near and distance Randot tests. Forty patients (80 eyes) had a mean (±SD) pre-LASIK refractive error of -4.70 (±1.72) DS OD and -4.59 (±1.58) DS OS and a mean (±SD) anisometropia of 0.55 (±0.51) DS. The median pre-LASIK near stereoacuity was 70 arcsec and distance stereoacuity was 200 arcsec, both of which improved after LASIK to 30 and 60 arcsec, respectively (p < 0.001, both). Amount of refractive error was not associated with stereoacuity but anisometropia of greater than or equal to 1 diopter had significantly worse distance stereoacuity in both the pre-LASIK and post-LASIK period. The post-LASIK near stereoacuity and distance stereoacuity were strongly associated (r = 0.706, p < 0.001) unlike the change in stereoacuity. Near and distance stereoacuity shows significant improvement after LASIK. Stereoacuity is associated with the degree of anisometropia but not the amount of refractive error corrected.
    No preview · Article · Feb 2015 · Optometry and vision science: official publication of the American Academy of Optometry
  • Tarun Arora · Sourabh Sharma · Namrata Sharma · Jeewan S Titiyal
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    ABSTRACT: A 17-year-old boy, presented with a 2-year history of bilateral, recurrent ocular surface mass. Dermatological evaluation revealed the presence of multiple hypopigmented macules over his body. Skin biopsy showed features typical of epidermodysplasia verruciformis. Topical mitomycin C (0.02%) was administered in both eyes for 6 weeks (three 1-week cycles over 6 weeks). While the mass in the left eye regressed, the mass in the right eye was excised under guidance of intraoperative frozen section. Triple-freeze thaw cryotherapy of the surrounding conjunctiva along with placement of amniotic membrane graft was performed. Postoperative mitomycin C (0.02%) was administered for another 6 weeks (three 1-week cycles over 6 weeks) in both eyes. At 4 years of follow-up, no recurrence has been noted. 2015 BMJ Publishing Group Ltd.
    No preview · Article · Jan 2015 · Case Reports
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    ABSTRACT: The aim of this study was to detect fungal hyphae in a corneal scraping sample using a cost-effective assembly of smartphone and pocket magnifier. In this case report, a tissue sample was obtained by conventional corneal scraping from a clinically suspicious case of mycotic keratitis. The smear was stained with Gram stain, and a 10% potassium hydroxide mount was prepared. It was imaged using a smartphone coupled with a compact pocket magnifier and integrated light-emitting diode assembly at point-of-care. Photographs of multiple sections of slides were viewed using smartphone screen and pinch-to-zoom function. The same slides were subsequently screened under a light microscope by an experienced microbiologist. The scraping from the ulcer was also inoculated on blood agar and Sabouraud dextrose agar. Smartphone-based digital imaging revealed the presence of gram-positive organism with hyphae. Examination under a light microscope also yielded similar findings. Fusarium was cultured from the corneal scraping, confirming the diagnosis of mycotic keratitis. The patient responded to topical 5% natamycin therapy, with resolution of the ulcer after 4 weeks. Smartphones can be successfully used as novel point-of-care, cost-effective, reliable microscopic screening tools.
    Full-text · Article · Jan 2015 · Cornea
  • Srilathaa Gunasekaran · Namrata Sharma · Jeewan S Titiyal
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    ABSTRACT: A functional corneal graft 34 years after penetrating keratoplasty (PKP) is rare and even rarer is its survival after wound dehiscence. We present a case of a 69-year-old man who had presented to the emergency services in January 2012 with corneal wound dehiscence OS extending to 8 o'clock following blunt trauma. His vision was perception of light. The best corrected visual acuity (BCVA) of the patient prior to graft dehiscence was 20/30. The patient had undergone optical penetrating keratoplasty for healed keratitis in OS in 1978 followed by phacoemulsification with intraocular lens implantation in 2009. Suturing of the graft was performed under topical anaesthesia. At 18 months follow-up, the BCVA was 20/60 with clear graft centrally and specular count was 865 cells/mm(2). This case highlights that early and appropriate management of corneal graft dehiscence can achieve good functional outcome even 34 years following PKP. 2014 BMJ Publishing Group Ltd.
    No preview · Article · Dec 2014 · Case Reports
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    ABSTRACT: Purpose To compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular chemical burns. Methods In a retrospective, interventional, comparative case series, 55 eyes with grades III, IV and V chemical burns (Dua's classification) who presented within 3 weeks of injury were evaluated. Patients were treated with conventional medical (CM group, 20 eyes) management alone or combined with either UCS (UCS group, 17 eyes) or AMT (AMT group, 18 eyes). The parameters evaluated were time to epithelialisation, epithelial defect diameter, epithelial defect area, corneal clarity, tear break-up time (TBUT), Schirmer test and best-corrected vision. Results UCS and AMT groups showed early epithelialisation as compared with the CM group (Kaplan–Meier analysis=0.01). Mean time for healing of epithelial defect was 57.7±29.3, 27.4±19.0, 41.1±28.9 days in the CM, UCS and AMT groups, respectively (p=0.02). Mean TBUT at the last follow-up was 8.6±0.7, 10.3±1.1, 9.4±1.2 s in the CM, UCS and AMT groups, respectively (p=0.02). The mean Schirmer value at the last follow-up was 13.7±1.0, 16.9±3.0 and 13.2±1.5 mm in the CM, UCS and AMT groups, respectively (p=0.01). The visual outcomes and the occurrence of corneal vascularisation, symblepheron, ectropion and entropion were comparable in between the groups. Conclusions Our study suggests that the UCS therapy may be a better alternative to AMT in acute moderate to severe (grades III, IV and V) ocular chemical burns, as it avoids surgical manoeuvre in already inflamed eyes.
    No preview · Article · Nov 2014 · British Journal of Ophthalmology
  • Tarun Arora · Rajesh Sinha · Namrata Sharma · Jeewan S. Titiyal

    No preview · Article · Oct 2014
  • Tarun Arora · Namrata Sharma · Supriya Arora · Jeewan S Titiyal
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    ABSTRACT: A 25-year-old woman presented with redness, pain, and diminution of vision that occurred 2 weeks after microkeratome-assisted laser in situ keratomileusis (LASIK). On presentation, corneal edema, Descemet membrane folds, keratic precipitates, stromal infiltrates, and flap necrosis were observed. Delayed post-LASIK microbial keratitis was diagnosed. The patient had no history of ocular herpes. Culture and scraping showed no organisms. Immunofluorescence stain was positive for the herpes simplex virus antigen. The patient was started on oral valacyclovir, and progress was monitored through serial clinical photographs and anterior segment optical coherence tomography. Resolution began within 3 days of initiating treatment and was complete in 4 weeks.
    No preview · Article · Oct 2014 · Journal of Cataract and Refractive Surgery