Tanuj Dada’s research while affiliated with All India Institute of Medical Sciences Bhopal and other places

Précis Cognitive impairment in multiple domains was observed in primary open angle glaucoma patients as compared to age and gender matched healthy controls. Objective Evaluation of cognitive impairment in individuals with Primary Open Angle Glaucoma (POAG). Methods In this case-control study, individuals with POAG (cases, n=70) were compared with age- and sex-matched healthy individuals (controls, n=70) using detailed ophthalmological evaluation, cognitive assessment and serum cortisol level. A multitude of tests were employed to comprehensively assess various domains of cognitive function: Addenbrooke Cognitive Examination (ACE-III; attention/orientation, memory, language, verbal fluency, and visuospatial skills), Post Graduate Institute Memory Scale (PGIMS; verbal and non verbal memory), Wisconsin Card Sorting Test (WCST; nonverbal executive functions), Go No-Go task (GNG; inhibitory control), and Trail Making Test (TMT; attention and working memory). Results Intraocular pressure and cup disc ratio were significantly higher ( P <0.001) while retinal nerve fibre layer (RNFL) thickness and mean deviation were significantly lower in cases as compared to controls. Cases had significantly lower scores on ACE-III and PGIMS ( P <0.001) and longer test completion time in TMT-A ( P =0.001). The performance of cases was also significantly worse on most parameters of the WCST and GNG tasks. Serum cortisol level was significantly higher in cases (11.75±7.41 mcg/dl) compared to controls (7.93±2.39 mcg/dl; P =0.02). A significant correlation was observed between serum cortisol level and WCST correct response ( P =0.04), WCST error response ( P =0.002) and total time taken in TMT-A ( P =0.03).Visual field mean deviation also exhibited a significant correlation with serum cortisol level ( P <0.001) and total time taken on WCST ( P =0.03) and TMT-A ( P =0.03). Conclusion Individuals with POAG exhibited higher cognitive impairment and raised serum cortisol levels than age-matched healthy controls. Early recognition and management of cognitive impairment are pivotal for enhancing the quality of life and implementing comprehensive glaucoma care.

Aims/Purpose: Prostaglandin analogues used in glaucoma therapy act on prostaglandin F (FP) receptor to enhance the uveoscleral outflow, however they do not have affinity for prostaglandin E3 (EP3) receptors which are extensively present in iris‐ciliary body‐trabecular meshwork. Ricinoleic acid (RA) derived from the castor oil used as labor inducer as it causes EP3 receptor agonism and release of prostaglandins. This property of dual agonism, makes it an ideal candidate for ocular hypotensive therapy. Therefore, this study was designed to study the interaction RA with FP and EP3 receptor. Methods: The three‐dimensional structure modeling and docking was performed for FP and E3 receptor with ricinoleic acid and their respective positive controls. To study interaction of RA with FP and EP3 receptor, calcium binding and cAMP release assay were performed in ovarian, kidney, corneal epithelial and trabecular meshwork cell lines. The variable concentration of RA were compared to the positive and negative controls. The ovarian and trabecular meshwork cells supernatant were assessed for the levels of PGF2alpha using ELISA. Results: The in‐silico study showed RA higher binding affinity for EP3 receptor as compared to its natural (PGE2) and synthetic ligand (Misoprostol). The RA had comparatively less affinity for FP receptor compared to controls. In calcium release and cAMP assay, RA variable doses (10‐1000nM) were able to increase the release of calcium and decrease the cAMP levels in dose dependent manner. The dose response of RA for the EP3 agonism was significantly higher than latanoprost, and travoprost. The EP3 agonism by RA caused the release of PGF2alpha at lower levels, which plateaued after the 200nM dose. Conclusions: The study shows that at lower doses RA had higher interaction with EP3 but comparable affinity for FP receptors. The release of prostaglandin by EP3 agonism might be responsible for its dual agonism. The compound can be tested further for its hypotensive properties in glaucoma.

Précis Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction. Purpose To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG). Methods A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80 y) and were randomised into two groups (“A”: BANG performed in the high-flow regions and “B”: BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15 mm Hg and ≥6 mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success). Results AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48 y and male: female (14:1) and group B age: 64.6±7.08 y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43 mm Hg); group B (17.60±5.42 mm Hg)] ( P =0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98 mm Hg); group B (13.13±2.29 mm Hg)] ( P =0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P =0.021). Survival in Kaplan-Meier analysis was higher in group B ( P =0.021). Complications were comparable in both groups. Conclusion Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.

Purpose: This study aims to analyze the outcomes of cases of abandoned cataract surgeries referred to a tertiary eye center. Methods: This retrospective observational case series includes eleven cases referred to a tertiary eye center following abandoned cataract surgeries. The preoperative factors, intraoperative management, and postoperative outcomes were recorded and analyzed. Results: The mean age of presentation was 56.8 ± 13.7 years, and the median time from the primary surgery to presentation at the tertiary eye center was four days (range: two hours to four weeks). There was an association with hypermature cataracts in 36.3% (4/11) of cases, diabetes in 36.3% (4/11) of cases, and pseudo-exfoliation syndrome in 18.2% (2/11) of cases. The primary cataract surgery was aborted after making an incision and without initiating capsulorhexis in 45.5% (5/11) of cases. Descemet's membrane detachment and corneal edema were present in nearly half (45.5%) of the cases. Conclusion: A thorough preoperative assessment, early identification of intraoperative complications, timely referral by the primary surgeon, and appropriate and prompt intervention by the second surgeon are essential for improving visual outcomes.

There is an annual epidemic of viral conjunctivitis at the onset of the monsoon (rainy) season in North India. This affects a large population, with many patients developing ocular symptoms and then getting better without any treatment as there is no specific therapy for adenoviral infections. However, this creates a dangerous situation for patients with operated trabeculectomy with a filtering bleb as conjunctivitis can lead to blebitis and bleb-related endophthalmitis with super-added bacterial/fungal infections. While the viral infection is self-limiting and most patients get well without treatment, urgent medical attention is required if patients with operated trabeculectomy develop this condition. It is important to educate all patients with operated glaucoma about the outbreak of conjunctivitis and explain the danger signs (like redness, sensitivity to light, vision decrease and pain, which require immediate medical attention and initiation of broad-spectrum antibiotics if a delay is anticipated in visiting the hospital.

Purpose To assess real-time intraoperative pachymetry changes occurring during corneal cross-linking (CXL) using microscope-integrated optical coherence tomography (Mi-OCT) and compare accuracy of various modalities of pachymetry assessment. Methods This was a cross-sectional observational comparative study including 45 consecutive patients with progressive keratoconus planned for CXL. Mi-OCT (RESCAN 700) was used to measure central corneal thickness (CCT) during four stages of CXL: before epithelial debridement, after debridement, after riboflavin instillation, and after ultraviolet irradiation. Scheimpflug imaging, anterior segment OCT (AS-OCT), and ultrasound pachymetry were used to assess CCT preoperatively. All data were entered into Excel software (Microsoft Corporation) and analyzed. Results The CCT significantly decreased after each step of CXL as measured on Mi-OCT ( P < .0001). Mi-OCT overestimated the CCT significantly by 1.12 times on average (range: 1.02 to 1.43) compared to ultrasound pachymetry ( P = .0004). CCT measured using Scheimpflug imaging and anterior segment OCT was statistically comparable to ultrasound pachymetry. Conclusions Mi-OCT provides a real-time assessment of CCT during CXL. However, because it overestimates the pachymetry, ultrasound pachymetry remains the gold standard for decision-making during CXL. [ J Refract Surg . 2024;40(12):e934–e940.]