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Sharma S, Belenje A, Takkar B, Narula R, Rathi VM, Tyagi M, Rani PK, Narayanan R, Kaur I. Tear Protein Markers for Diabetic Retinopathy and Diabetic Macular Edema - Towards an Early Diagnosis and Better Prognosis. Semin Ophthalmol 2024:1-11. [PMID: 38643349 DOI: 10.1080/08820538.2024.2342266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Diabetic eye disease is a highly prevalent and sight-threatening disorder. It is a disease of neuro-vascular unit of the retina, if left untreated can cause blindness. Therapeutic approaches followed for its treatment can only restrict the progression of the disease with highly variable results. There is no known biomarker for an early diagonsis of this disease, therefore by the time it is detected it goes beyond repair. This creates a massive demand for development of such biomarkers that help detect disease in its earlier stages. METHODS PUBMED (https://pubmed.ncbi.nlm.nih.gov/) was searched for articles relevant to the topic published till November 2023. The search was made using keywords such as Diabetic Retinopathy, inflammation, tear, biomarker, proteomics etc. The studies providing relevant information to prove the importance of biomarker discovery were chosen. After compiling the data, the manuscript writing was planned under relevant headings and sub-headings. RESULTS The review provides a comprehensive overview of all the tear protein biomarker studies in the field of DR and DME. Briefly, their potential in other diseases is also elucidated. While there are many studies pertaining to DR biomarkers, the identified markers lack validations which has restricted their usage in clinics. In case of DME, there was no such study towards biomarker discovery for its diagnosis and prognosis. CONCLUSIONS The review highlights major studies and their lacunae in the field of biomarkers discovery for DR and DME.
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Affiliation(s)
- Sarmeela Sharma
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
- Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Akash Belenje
- Anant Bajaj Retina Institute, LV Prasad Eye Institue, Hyderabad, India
| | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institue, Hyderabad, India
| | - Ritesh Narula
- Anant Bajaj Retina Institute, LV Prasad Eye Institue, Hyderabad, India
| | | | - Mudit Tyagi
- Anant Bajaj Retina Institute, LV Prasad Eye Institue, Hyderabad, India
| | | | - Raja Narayanan
- Anant Bajaj Retina Institute, LV Prasad Eye Institue, Hyderabad, India
| | - Inderjeet Kaur
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
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Upadhyaya A, Padhy SK, Takkar B. Pattern Macular Dystrophy Caused by CTNNA1 Gene Mutation. Ophthalmol Retina 2024:S2468-6530(24)00107-6. [PMID: 38573304 DOI: 10.1016/j.oret.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Affiliation(s)
| | | | - Brijesh Takkar
- LV Prasad Eye Institute, Anant Bajaj Retina Institute, Hyderabad, India
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Sangani P, Temple S, Bhandary S, Narayanan R, Johnson E, Das AV, Ali MH, Takkar B. Macular Pigment Assessment in Indian Population Using Degree of Polarization Threshold: Impact of Diet on Macular Pigment Density. Transl Vis Sci Technol 2024; 13:20. [PMID: 38517446 PMCID: PMC10981160 DOI: 10.1167/tvst.13.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose To determine macular pigment (MP) density scores in healthy Indians and examine correlations with demographic and lifestyle variables. Methods We observed 484 Indians without an ocular pathology. Body mass index (BMI) and self-reported lifestyle factors (sunglasses usage, physical activity, and smoking) were noted. MP density was assessed as the threshold of perception of the shadow of their macular pigments on their retina using a new MP assessment tool (MP-eye). Lutein and zeaxanthin intake was assessed using a prevalidated questionnaire regionally designed for the Indian diet. Clusters of participants were created for statistical analysis based on MP-eye scores secondarily to detect any relevant effects in very low, low, medium, and high ranges of MPs. Results Data analyzed included 235 males and 249 females with mean age of 36.1 ± 12.9 years (range, 14-72). The median MP-eye score was 6 (range, 0-10, with 10 being high). Most were non-smokers (413, 85.3%) and did not use sunglasses (438, 90.5%), and 314 (64.9%) had low physical activity. Diabetes was present in 62 participants (12.8%) and hypertension in 53 (10.9%). Advancing age (r = -0.209; P < 0.000) and BMI (r = -0.094; P = 0.038) had weak negative correlation with MP-eye scores. Hypertension was less prevalent (7/88) in the cluster with the highest median MP-eye score (P = 0.033). Dietary intake of MPs and other lifestyle factors did not correlate significantly with MP-eye score overall or when analyzed in clusters. Conclusions MP-eye scores of an Indian population were normally distributed. Higher age, high BMI, and presence of hypertension were weakly associated with lower MP-eye scores. The impact of diet on MPs requires further evaluation. Translational Relevance This normative regional database enables risk stratification of macular degeneration.
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Affiliation(s)
- Payal Sangani
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
| | - Shelby Temple
- School of Optometry, Aston University, Birmingham, United Kingdom
- School of Biological Sciences, The University of Bristol, Bristol, United Kingdom
- Azul Optics, Bristol, United Kingdom
| | - Shashank Bhandary
- Suven Clinical Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | - Anthony Vipin Das
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
| | - Md Hasnat Ali
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
- Department of Computational Biostatistics and Data Science, LV Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
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Venugopal R, Das AV, Takkar B, Stewart MW, Narayanan R. Real-world experience of full-thickness traumatic macular hole among young patients. Int J Retina Vitreous 2024; 10:20. [PMID: 38383490 PMCID: PMC10882818 DOI: 10.1186/s40942-024-00539-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To describe the demographics, clinical, and imaging characteristics, and visual outcomes in young patients with full-thickness traumatic macular hole (TMH). METHODS This retrospective hospital-based study included patients with full-thickness TMH who presented between August 2010 and June 2021. Demographic data, clinical findings, and imaging characteristics were extracted from an electronic medical record system. Regression analyses were performed to determine significant associations among variables and to identify predictors of visual outcomes. RESULTS 144 (0.005%) patients among 2,834,616 were diagnosed with Full thickness TMH. The majority of them were male (89.58%; odds ratio [OR] = 6.71) and the holes were unilateral. The mean age at presentation was 23.37 ± 8.19 years. Ball were the most common cause of injuries (22.22%), followed by stick (14.58%) and firecracker (12.50%). The mean LogMAR visual acuity (VA) at presentation was 1.18 ± 0.72, with 25.69% of eyes having VA < 20/400. The mean minimum hole diameter was 619.34 ± 336.16 μm. Sub-retinal fluid was present in 44.44%, followed by intraretinal fluid in 34.03% of eyes. Macular holes closed after vitrectomy in 66.67% of eyes, with mean final VA of 1.07 ± 0.85. Baseline VA was a strong predictor of final VA (R2 = 0.677; p = 0.000168). CONCLUSION Traumatic macular hole is a unilateral condition with significant visual impairment that is mainly seen in males during the third decade of life. Surgery is successful in most cases but improvements in VA are modest.
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Affiliation(s)
- Ragukumar Venugopal
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India.
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Gaur N, Takkar B, Chandra P, Puri S, Satpathy G, Sharma YR. Clinical Profile, Antibiotic Resistance and Outcomes in Bacterial Endophthalmitis: Coagulase-Negative Staphylococcus Endophthalmitis as Compared to Other Organisms. Cureus 2024; 16:e53532. [PMID: 38314390 PMCID: PMC10838384 DOI: 10.7759/cureus.53532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND To evaluate the clinical profile, outcomes and antibiotic resistance in bacterial endophthalmitis. METHODS This was a post-hoc analysis of a study conducted at a tertiary centre, where 60 consecutive cases of culture-proven bacterial endophthalmitis were included prospectively. Group 1 included coagulase-negative Staphylococcus endophthalmitis (CNSE), while group 2 included the remaining cases. Clinical features, antibiotic resistance and visual outcomes were compared. Visual acuity >3/60 at six months of follow-up was defined as a good visual outcome. RESULTS Group 1 had 31 cases, while group 2 had 29. Group 2 included 12 gram-positive and 17 gram-negative isolates. Among the groups, group 2 had more patients with presenting visual acuity below hand motions close to the face (25 vs. 12, p<0.001), poor visual outcomes (26 vs. 3, p<0.001) and retinal detachment (RD) (10 vs. 2, p=0.007). Pseudomonas was most commonly resistant to antibiotics, and ceftazidime (p=0.005) and cefazolin (p=0.009) resistance were higher in group 2 isolates. In group 1, five isolates were resistant to any one of the antibiotics, whereas in group 2, 13 isolates were resistant to any one of the antibiotics (p=0.024). CONCLUSIONS In the current study, eyes in the group of endophthalmitis caused by CNSE achieved better visual acuities at the last follow-up compared to eyes with endophthalmitis caused by other bacteria. Antibiotic resistance in isolates other than CNSE is a cause of concern.
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Affiliation(s)
- Nripen Gaur
- Ophthalmology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
| | - Brijesh Takkar
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, IND
| | - Parijat Chandra
- Vitreo-retinal Services, Ophthalmology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Somya Puri
- Ophthalmology, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
| | - Gita Satpathy
- Microbiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Yog R Sharma
- Vitreo-retinal Services, Ophthalmology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Upadhyaya A, Kiri H, Natarajan R, Hansraj S, Padhy SK, Takkar B, Padhi TR, Jalali S, Parameswarappa DC. Outcomes of vitreoretinal surgery in eyes with retinitis pigmentosa without retinal detachment. Graefes Arch Clin Exp Ophthalmol 2024; 262:441-448. [PMID: 37861848 DOI: 10.1007/s00417-023-06274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE Outcomes of retinal detachment (RD) have been discussed in detail in many reports of patients with retinitis pigmentosa (RP). This study tries to understand the outcomes of vitreoretinal (VR) surgery for indications other than RD in the eyes with RP. METHODS This is a retrospective study that includes clinical data from January 2013 to December 2021. Patients with RP who were treated with a VR surgical intervention were included in the study. The primary outcome of the study was to assess the changes in best-corrected visual acuity. RESULTS Forty-four eyes of 40 patients with RP were included in the study. Nearly half of the eyes (43%, 19/44) presented from 1 month to 1 year after the onset of diminished vision, with or without floaters. The mean ± standard deviation (SD) best-corrected visual acuity (BCVA) at presentation was 1.30 ± 0.79 logMAR (20/400 ± 20/125). The major surgical indications were vitreous opacities (43.2%, 19/44) and subluxated/dislocated cataractous lenses (25%, 11/44). The median follow-up duration was 8 months (interquartile range (IQR): 1.5-27). Approximately 77% (34/44) of the eyes had improvement in vision. The mean postoperative BCVA at the last follow-up was 0.95 ± 0.73 logMAR (p-value: 0.03). CONCLUSIONS Most eyes with RP recovered well after VR surgical interventions, with short-term improvements in visual acuity. It may be crucial to address the vitreous opacities and membranes as they hinder the residual central island of vision in RP. However, appropriate counselling is required regarding the progressive nature of retinal neuronal degeneration.
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Affiliation(s)
- Abhishek Upadhyaya
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hardik Kiri
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramya Natarajan
- Department of Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Saarang Hansraj
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Standard Chartered - LVPEI Academy for Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Vitreoretina and Uveitis Services, Anant Bajaj Retina Institute, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, Anant Bajaj Retina Institute, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India
| | - Deepika C Parameswarappa
- Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad, Telangana, 500 034, India.
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Ajmani U, Takkar B, Rani PK, Chhablani J, Sahoo NK. Optical coherence tomography characteristics and factors affecting visual acuity in diabetic papillopathy. Eur J Ophthalmol 2024:11206721231225989. [PMID: 38193207 DOI: 10.1177/11206721231225989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To analyse baseline imaging characteristics and factors affecting poor visual acuity in diabetic papillopathy. METHODS This was a retrospective, observational study conducted at a tertiary eye care centre in eyes with a diagnosis of diabetic papillopathy. Demographic data including age, gender, duration of diabetes, type of diabetes, HbA1c values and other systemic co-morbidities were recorded. Baseline best corrected visual acuity (BCVA), and various imaging characteristics were noted. RESULTS 37 eyes of 22 patients with diagnosis of diabetic papillopathy were included [mean age of 46.6 ± 13.5 years, five (22.7%) females and 17 (77.3%) males]. Bilateral involvement was seen in 15 (68.2%) patients. The mean baseline BCVA was 0.51 ± 0.49 logMAR (Snellen equivalent 20/60). Two eyes (5.4%) had features of concurrent mild NPDR, 9 eyes (24.3%) had moderate NPDR, 10 eyes (27.03%) had severe NPDR while 16 (43.2%) other had PDR. All eyes had optic disc edema while 4 had disc pallor at presentation. Telangiectatic vessels/ neovascularisation of disc was present in 17 eyes (45.9%) detected either clinically or on optical coherence tomography (OCT) angiography. 11 (29.7%) eyes had a peripapillary cuff of subretinal fluid accompanying the disc edema. Sixteen eyes (43.2%) had centre involving macular edema seen on OCT. In eyes with a macular edema, the mean central macular thickness was 407.4 ± 71.42 microns at baseline. On assessing the baseline factors that contribute to the final visual acuity, presenting visual acuity was the only variable found to be statistically significant. CONCLUSION Although described to have good visual outcome, eyes presenting with poor visual acuity tend to have worse vision on follow up. This may aid in prognosticating and guiding management plan.
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Affiliation(s)
- Udit Ajmani
- Department of Retina and Vitreous, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Vijayawada, India
| | - Brijesh Takkar
- Department of Retina and Vitreous, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Padmaja Kumari Rani
- Department of Retina and Vitreous, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Niroj Kumar Sahoo
- Department of Retina and Vitreous, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Vijayawada, India
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Kadam Y, Thaku P, Das AV, Narayanan R, Senthil S, Takkar B. Hemi-retinal vein occlusion: Characterizing a rare retinal vasculopathy. Indian J Ophthalmol 2024:02223307-990000000-00071. [PMID: 38189486 DOI: 10.4103/ijo.ijo_1712_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/20/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To characterize hemi-retinal vein occlusion (HRVO) in patients presenting to a multi-tier ophthalmology hospital network. METHODS This retrospective, hospital-based study analyzed 2,834,616 new patients between August 2010 and June 2021. Patients with a clinical diagnosis of HRVO in at least one eye were included as cases. Data were collected using an electronic medical record system. Data were compared to the findings noted in branch RVO (BRVO) and central RVO (CRVO) patients. RESULTS HRVO constituted 0.9% (n = 191) of all the retinal vein occlusions (RVOs), with the mean age being 60.55 ± 10.14 years. Most patients were male (125, 65.45%) with unilateral (92.67%) affliction. Majority presented during the sixth (31.41%) or seventh (32.46%) decade of life. Most patients reported mild (37.07%) or moderate (27.32%) visual impairment, with vision < 20/200 being less common in HRVO (25.8%) and BRVO (17.2%) compared to CRVO (44.1%) (P < 0.00001). Glaucoma was diagnosed and treated in 49 (23.90%) eyes, which was much higher than CRVO (11.45%) and BRVO (5.04%) (P < 0.001), though neovascular glaucoma was much less than CRVO (2.9% vs. 9.2%) (P = 0.0037). On follow-up, HRVO eyes (12.2%) had lesser vision loss compared to CRVO eyes (13.7%) (this difference does not look very significant to me), though BRVO had the least (9.1%) vision loss. CONCLUSION HRVO is a rare RVO, presenting more in males. It causes less-severe visual impairment compared to CRVO. Large majority of patients with HRVO do not have identifiable systemic risk factors other than age. Preexisting glaucoma was more associated with HRVO compared to other RVOs.
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Affiliation(s)
- Yogita Kadam
- Department of EyeSmart EMR and AEye, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
| | - Pratima Thaku
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR and AEye, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, Hyderabad, Telangana, India
- Anant Bajaj Retina Institute, Hyderabad, Telangana, India
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Venugopal R, Das AV, Takkar B, Narayanan R. Clinical Profile, Demographic Distribution and Risk Factors of Parafoveal Telangiectasia: An Electronic Medical Record-Driven Big Data Analytics from a Multitier Eye Care Network. Semin Ophthalmol 2024; 39:102-108. [PMID: 37610827 DOI: 10.1080/08820538.2023.2249536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To describe the demographics and clinical profile of parafoveal telangiectasia (PFT) and compare risk factors for diabetic retinopathy (DR) among PFT and non-PFT patients. METHODS This cross-sectional hospital-based study included 2,834,616 new patients presenting to a multi-tier ophthalmology hospital network in India between August 2010 and June 2021. Patients with a clinical diagnosis of PFT in at least one eye were included as cases. The data were collected using an electronic medical record system. RESULTS Overall, 2,310 (0.081%) patients were diagnosed with PFT. Most of the patients were female (62.42%) with (odds ratio [OR] = 2.08), and had bilateral (84.85%) affliction. The most common age group at presentation was during the sixth decade of life with 825 (35.71%) patients. The overall prevalence was higher in patients from an upper socio economic status (0.242%) presenting from the metropolitan geography (0.113%; OR = 2.37). Systemic history of diabetes mellitus (DM) with a mean duration of 122.03 ± 95.59 months was seen in 849 (36.75%) and hypertension in 609 (26.36%) patients. Of the 4,270 eyes, 2,441 (57.17%) eyes had a visual impairment of mild or no visual impairment (<20/70) followed by moderate visual impairment (>20/70-20/200) in 1022 (23.93%) eyes. The risk of sight threatening diabetic retinopathy (STDR) among PFT patients was higher (OR = 1.43) compared to non-PFT cohort. Choroidal neovascular membrane (CNVM) was observed in 481 (11.26%) eyes. CONCLUSION PFT is more common in females and is predominantly bilateral. PFT is more common in upper socio economic status and majority of the eyes had mild or moderate visual impairment. Diabetes and Hypertension are associated risk factors in PFT.
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Affiliation(s)
- Ragukumar Venugopal
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Raja Narayanan
- Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, India
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
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Brar AS, Ramachandran S, Takkar B, Narayanan R, Mandal S, Padhy SK. Characterization of retinal hemorrhages delimited by the internal limiting membrane. Indian J Ophthalmol 2024; 72:S3-S10. [PMID: 38131534 PMCID: PMC10833172 DOI: 10.4103/ijo.ijo_266_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
Clinically, hemorrhages at the vitreoretinal interface have been termed as 'pre-retinal' in location. However, there is a careful distinction to be made between sub-hyaloid and sub-internal limiting membrane (ILM) planes of blood collection. In the past half-century, a body of literature has accrued on sub-internal limiting membrane hemorrhage. We characterize the etiopathological, clinical, anatomical, and imaging characteristics of this entity (often misconstrued as sub-hyaloid hemorrhage). Management decisions are briefly described, and a unifying term of sub-internal limiting membrane macular hemorrhage is proposed to aid in further research.
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Affiliation(s)
- Anand Singh Brar
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sohini Mandal
- Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanta Kumar Padhy
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Brar AS, Parameswarappa DC, Takkar B, Narayanan R, Jalali S, Mandal S, Fujinami K, Padhy SK. Gene Therapy for Inherited Retinal Diseases: From Laboratory Bench to Patient Bedside and Beyond. Ophthalmol Ther 2024; 13:21-50. [PMID: 38113023 PMCID: PMC10776519 DOI: 10.1007/s40123-023-00862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
This comprehensive review provides a thorough examination of inherited retinal diseases (IRDs), encompassing their classification, genetic underpinnings, and the promising landscape of gene therapy trials. IRDs, a diverse group of genetic conditions causing vision loss through photoreceptor cell death, are explored through various angles, including inheritance patterns, gene involvement, and associated systemic disorders. The focal point is gene therapy, which offers hope for halting or even reversing the progression of IRDs. The review highlights ongoing clinical trials spanning retinal cell replacement, neuroprotection, pharmacological interventions, and optogenetics. While these therapies hold tremendous potential, they face challenges like timing optimization, standardized assessment criteria, inflammation management, vector refinement, and raising awareness among vision scientists. Additionally, translating gene therapy success into widespread adoption and addressing cost-effectiveness are crucial challenges to address. Continued research and clinical trials are essential to fully harness gene therapy's potential in treating IRDs and enhancing the lives of affected individuals.
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Affiliation(s)
- Anand Singh Brar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, 751024, India
| | - Deepika C Parameswarappa
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Raja Narayanan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Subhadra Jalali
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Sohini Mandal
- Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Kaoru Fujinami
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, 152-8902, Japan
| | - Srikanta Kumar Padhy
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, 751024, India.
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12
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Takkar B, Tyagi M. Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery. Ophthalmol Retina 2023; 7:1126. [PMID: 37831038 DOI: 10.1016/j.oret.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Brijesh Takkar
- Anant Baja Retina Institute, L V Prasad Eye Institute, Hyderabad, India; Indian Health Outcomes, Public Health and Economics Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Anant Baja Retina Institute, L V Prasad Eye Institute, Hyderabad, India
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Ramachandran S, Chavan K, Padhi TR, Takkar B, Karande S, Kelgaonkar A, Panda KG, Padhy SK. Central retinal artery occlusion following pediatric blunt ocular trauma. Indian J Ophthalmol 2023; 71:3626-3632. [PMID: 37991294 PMCID: PMC10788753 DOI: 10.4103/ijo.ijo_3337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. METHODOLOGY The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. RESULTS A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. CONCLUSION CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.
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Affiliation(s)
- Sivaranjan Ramachandran
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Kasturi Chavan
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Tapas R Padhi
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Brijesh Takkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayali Karande
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Krushna G Panda
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikanta K Padhy
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
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14
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Das AV, Venugopal R, Takkar B, Sharma S, Balakrishnan N, Narayanan R, Parameswarappa D, Padhy SK. Clinical profile and demographic distribution of Stargardt disease phenotypes: An Electronic medical record-driven big data analytics from a multitier eye care network. Indian J Ophthalmol 2023; 71:3407-3411. [PMID: 37787244 PMCID: PMC10683681 DOI: 10.4103/ijo.ijo_3290_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/19/2023] [Accepted: 06/06/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To describe the demographics and clinical profile of Stargardt disease in patients presenting a multitier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study was performed among 2,834,616 new patients presenting between August 2010 and June 2021 in our network. Patients with a clinical diagnosis of Stargardt disease in at least one eye were included as cases. The data were collected using an electronic medical record system. Results Overall, 1,934 (0.069%) patients were diagnosed with Stargardt disease. Most of the patients were male (63.14%). The most common age group at presentation was during the second decade of life, with 626 (31.87%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.077%), in those presenting from the urban geography (0.079%), and in students (0.197%). Systemic history of hypertension was seen in 56 (2.85%) patients, while diabetes mellitus was seen in (2.49%) patients. Of the 3,917 eyes, 1,910 (48.76%) eyes had moderate visual impairment (>20/70-20/200) followed by severe visual impairment (>20/200 to 20/400) in 646 (16.49%) eyes. The most commonly associated retinal signs were retinal flecks in 1,260 (32.17%) eyes, followed by RPE changes in 945 (24.13%) eyes. The most documented investigations were autofluorescence (39.85%), followed by optical coherence tomography (23.90). Cataract surgery was the commonest performed surgical intervention in (0.66%) eyes, followed by intravitreal injection in 4 (0.10%) eyes. The family history of parent consanguinity marriage was reported by 212 (10.79%) patients. Conclusion Stargardt disease was seen more commonly in males presenting during the second decade of life. It is predominantly a bilateral disease, with the majority of the eyes having moderate visual impairment.
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Affiliation(s)
- Anthony Vipin Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ragukumar Venugopal
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sumant Sharma
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neelima Balakrishnan
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deepika Parameswarappa
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Palan P, Bhopalka AK, Takkar B. Intraoperative optical coherence tomography-guided management of optic-disc-pit maculopathy. BMJ Case Rep 2023; 16:e254884. [PMID: 37669826 PMCID: PMC10481729 DOI: 10.1136/bcr-2023-254884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Affiliation(s)
- Parth Palan
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Econimics (IHOPE) Research Centre, Hyderabad, India
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16
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Sheemar A, Goel P, Thakur PS, Takkar B, Kaur I, Rani PK, Tyagi M, Basu S, Venkatesh P. Diabetes, Diabetic Retinopathy, and Inflammatory Disorders. Ocul Immunol Inflamm 2023:1-14. [PMID: 37159104 DOI: 10.1080/09273948.2023.2203742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This review summarizes the impact of systemic and ocular inflammatory disorders on diabetes mellitus (DM) and diabetic retinopathy (DR). Local inflammation is a key pathology in diabetic retinopathy (DR) and is also an evolving target for clinical therapy. The legacy effects of local inflammation at the intracellular level make DR a persistent self-driven vicious process. Ocular inflammation is accompanied as well as incited by systemic inflammation due to diabetes mellitus (DM) itself. Over the years, a multitude of studies have evaluated the impact of systemic inflammatory disorders (SIDs, like rheumatoid arthritis, lupus, psoriasis, etc.) and anti-inflammatory drugs prescribed for managing them on manifestations of DM. Recent studies have indicated increased insulin resistance to be a result of chronic inflammation, and the anti-inflammatory drugs to have a protective effect towards DM. Very few studies have evaluated the impact of SIDs on DR. Furthermore, the evidence from these studies is conflicting, and while local anti-inflammatory therapy has shown a lot of clinical potential for use in DR, the results of systemic anti-inflammatory therapies have been inconsistent. The impact of local ocular inflammation due to uveitis on DR is a crucial aspect that has not been evaluated well at present. Initial pre-clinical studies and small-sized clinical reports have shown a strong and positive relationship between the presence of uveitis and the severity of DR as well as its progression, while larger cross-sectional patient surveys have refuted the same. The long term impact of ocular inflammation due to uveitis on DR needs to be studied while adjusting for confounders.
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Affiliation(s)
- Abhishek Sheemar
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pallavi Goel
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Inderjeet Kaur
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Padmaja K Rani
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Uveitis Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Soumyava Basu
- Uveitis Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Pradeep Venkatesh
- Dr. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Das T, Padakandla SR, Shivaji S, Jayasudha R, Takkar B. Intraocular Microbiome in Diabetes and Diabetic Retinopathy: A Pilot Study. Ophthalmol Ther 2023; 12:1109-1126. [PMID: 36719607 PMCID: PMC10011241 DOI: 10.1007/s40123-023-00660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The objective of this study was to compare the microbiome in the aqueous humour and gut of people with diabetes mellitus (DM) with and without diabetic retinopathy (DR). METHODS This was a prospective controlled study. The study included 17 people undergoing intraocular surgery in their naïve eyes. Stool samples were obtained in the perioperative period; aqueous humour samples of sufficient quantity were obtained in 12 people during intraocular surgery. Dietary information was obtained using a previously validated questionnaire. The gut and aqueous humour samples were assessed for microbiome using 16S rRNA gene sequencing coupled with QIIME and R software. RESULTS Aqueous humour was analysed in 12 people: 4 each healthy controls, people with DM, and people with DR. There were minor differences at the phyla levels, but the aqueous humour microbiomes of healthy controls, DM, and DR formed three distinct clusters on heat map analysis with discriminatory genera. This genera-level clustering was more apparent for the intraocular than the gut microbiome. In people with DM and DR, we identified genera unique to the eye or the gut. There was a consistent reduction in the abundance of anti-inflammatory bacteria in people with DR than DM. CONCLUSIONS There is a difference in intraocular and gut microbiome regardless of disease or health. Our preliminary findings indicate distinctive features of the intraocular microbiome in people with DR compared with those without it. While this distinctiveness appears more evident in aqueous humour than in the gut, it needs further confirmation with larger studies.
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Affiliation(s)
- Taraprasad Das
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
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Hathibelagal AR, Bhutia P, Das M, Babu H, Jalali S, Takkar B, Paremeswarappa DC, Ballae Ganeshrao S. Tablet-based 'ON/OFF' pathway test can distinguish between rod- and cone-dominated diseases. Ophthalmic Physiol Opt 2023; 43:231-238. [PMID: 36416095 DOI: 10.1111/opo.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The photopic ON pathway defect is associated with nocturnal vision loss. However, the measurement of ON function to detect a rod-dominated disease (rods affected more than cones) has not been explored. We evaluated whether the psychophysical evaluation of ON/OFF pathways can be used to distinguish cone-dominated from rod-dominated diseases. METHODS Thirty-seven patients with inherited retinal diseases were tested using the 'EyeSpeed' [iOS application] on an iPad. The test displayed a random number (1-3) of light or dark targets on a black-and-white noise background. Participants responded on a touch screen indicating the correct number of targets displayed. The outcome variables-reaction time, accuracy and performance index (speed [1/reaction time] * accuracy) to both light and dark targets were assessed for diagnostic ability using standard receiver-operating characteristic (ROC) analysis. RESULTS Mean ± standard deviation age and visual acuity for the cone- and rod-dominated groups were 25.15 ± 11.74 years, 0.80 ± 0.25 logMAR and 28.3 ± 14.29 years, 0.48 ± 0.26 logMAR, respectively. The median reaction time to light targets in rod-dominated disease [interquartile range] was 5.28 s [3.17], significantly greater than for patients with cone-dominated disease (2.07 s [0.93]; Mann-Whitney U test, p < 0.001). Amongst all of the outcome variables evaluated, the reaction time to light targets (criterion of ≥2.98 s) exhibited the highest area under the ROC curve (area = 0.89 ± 0.11; p < 0.001), with a sensitivity and specificity of 82.4% and 85% respectively. CONCLUSIONS Reaction time to light targets using the ON/OFF pathway paradigm is a valid marker to differentiate between rod- and cone-dominated retinal dystrophies. ON pathway function measured using a tablet-based test could act as a supplemental test in the diagnosis of challenging photoreceptor-specific inherited retinal diseases.
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Affiliation(s)
- Amithavikram R Hathibelagal
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Phuntsok Bhutia
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Mritunjoy Das
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Helna Babu
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.,Professor Brien Holden Eye Research Center, L V Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India.,Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India.,Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Deepika C Paremeswarappa
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Shonraj Ballae Ganeshrao
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Aggarwal D, Mitra S, Kalra P, Bagga B, Mishra D, Takkar B. Case Report: Poor Outcome Despite Aggressive Management in Pythium insidiosum Endophthalmitis. Am J Trop Med Hyg 2023; 108:27-30. [PMID: 36509056 PMCID: PMC9833092 DOI: 10.4269/ajtmh.22-0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/27/2022] [Indexed: 12/15/2022] Open
Abstract
Pythium insidiosum is a parasitic oomycete that can cause keratitis and closely resembles fungus, both clinically and morphologically. It requires a trained microbiologist for its differentiation from fungal filaments and has poor response to antifungal therapy. We present a case of primary isolation of the organism from the vitreous cavity in a case of endophthalmitis. The infection spread quickly and involved all the ocular tissues. The eye had poor visual outcome despite a sequence of rapidly completed retinal and corneal surgeries along with initiation of anti-Pythium therapy.
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Affiliation(s)
- David Aggarwal
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (LVPEI), Hyderabad, India
| | | | | | | | - Dilip Mishra
- Department of Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
| | - Brijesh Takkar
- Anant Bajaj Retina Institute, L V Prasad Eye Institute (LVPEI), Hyderabad, India
- Indian Health Outcomes, Public Health, and Economics Research Centre, LVPEI, Hyderabad, India
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Achanta DSR, Mohamed A, Chaurasia S, Senthil S, Mandal AK, Takkar B, Mishra DK, Edward DP, Ramappa M. Objectively measuring anterior segment alterations in the eyes of mucopolysaccharidoses: Its utility in early diagnosis of glaucoma. Indian J Ophthalmol 2022; 70:4180-4185. [PMID: 36453310 PMCID: PMC9940542 DOI: 10.4103/ijo.ijo_1300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Our study aimed to evaluate the utility of the anterior segment morphometry for objectively assessing anterior segment architectural changes of corneal clouding in the mucopolysaccharidoses (MPS) cohort and to investigate whether these measurements correlate with the slit-lamp findings on the cornea and early diagnosis of glaucoma. Methods This retrospective study involved 70 eyes of 35 children with cloudy cornea due to MPS variants. Anterior segment architectural alterations were measured using anterior segment imaging and biometry in MPS children and compared with controls. Results Mean age of the cohort at the time of assessment was 7.9 ± 4.5 years. Males constituted two-thirds of the cohort. Variants of MPS with cloudy cornea were as follows: Type I (62%), Type IV (11%), and Type VI (22%). Morphometric measurements were available in 22 eyes of 11 MPS children and an age-matched healthy control group. There were significant differences between MPS cohort and controls in refraction in Diopters (5.03 ± 0.39 and 0.01 ± 0.04; P < 0.0001), axial length (AXL) in mm (21.39 ± 0.28 and 23.04 ± 0.28; P = 0.0002), average keratometry in Diopters (40.67 ± 0.44 and 42.83 ± 0.44; P < 0.0001), anterior chamber depth (ACD) in mm (2.92 ± 0.07 and 3.65 ± 0.07; P < 0.0001), and intraocular pressure (IOP) in mmHg (25.2 ± 2.0 and 14.1 ± 2.3; P = 0.0003). Secondary glaucoma was observed in 28% of the MPS cohort. Conclusion The anterior segment morphometry in the cloudy cornea due to MPS provides an objective measurement of anterior segment architectural changes, thus diagnosing early-onset secondary glaucoma. These findings highlight that cloudy cornea due to MPS variants merits close monitoring throughout life.
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Affiliation(s)
- Divya Sree Ramya Achanta
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India,Jasti V Ramanamma Children’s Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India,Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India,Jasti V Ramanamma Children’s Eye Care Center, L V Prasad Eye Institute, Hyderabad, India,The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
| | | | - Brijesh Takkar
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India,Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India,Indian Health Outcomes, Public Health & Economics Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, India
| | - Deepak Paul Edward
- Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Muralidhar Ramappa
- Centre for Rare Eye Diseases and Ocular Genetics, L V Prasad Eye Institute, Hyderabad, India,Jasti V Ramanamma Children’s Eye Care Center, L V Prasad Eye Institute, Hyderabad, India,The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India,Correspondence to: Dr. Muralidhar Ramappa, Head, Centre for Rare Eye Diseases and Ocular Genetics Consultant, The Cornea Institute and Jasti V Ramanamma Children’s Eye Care Center, L V Prasad Eye Institute, Hyderabad, Telangana, India. E-mail:
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21
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Murthy SI, Takkar B, Bhate M, Mishra DK, Sheba E, Sharma S. Herpes Simplex Virus Anterior Uveitis in a Child Presenting as a Hypopyon in a White Eye. Ocul Immunol Inflamm 2022; 30:1992-1994. [PMID: 34114937 DOI: 10.1080/09273948.2021.1921225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To report a rare ocular presentation of unilateral anterior uveitis with hypopyon in a 5-year-old child, suspected as masquerade. METHODS Retrospective report. RESULTS A 5-year-old boy presented with hypopyon-uveitis. Detailed systemic work-up was negative for masquerade and uveitis entities. He was started on oral and topical steroids but had reactivation on taper. Real-time polymerase chain reaction (PCR) test of aqueous fluid was positive for herpes simplex virus (HSV)-1 DNA. The inflammation resolved completely on oral acyclovir and topical corticosteroids. He subsequently underwent pars plana lensectomy, primary posterior capsulotomy and vitrectomy for complicated cataract. Post-operatively, vision improved to 20/400 with aphakic correction. Maintenance oral acyclovir was stopped after 3 months with no reactivation and amblyopia therapy was continued. CONCLUSION This is a rare presentation of hypopyon uveitis due to HSV-1 in a child. The role of real-time PCR in establishing the diagnosis is crucial in such cases of diagnostic dilemma.
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Affiliation(s)
- Somasheila I Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Manjushree Bhate
- Jasti V Ramanamma Children's Eye Care Center, L V Prasad Eye Institute, Hyderabad, India
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, India
| | - Esther Sheba
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, India
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22
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Sheemar A, Gaur N, Thakur PS, Sharma P, Takkar B, Khanduja S. Optical Coherence Tomography Features of Ocular Cysticercosis: A Review of Literature With Observer Variation. Ophthalmic Surg Lasers Imaging Retina 2022; 53:446-454. [PMID: 35951713 DOI: 10.3928/23258160-20220629-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ocular cysticercosis is a sparsely reported condition, requiring urgent management. The gold standard for diagnosis is an in toto extraction of the cyst with subsequent histopathology. The procedure can be demanding in contrast to the frequently adopted practice of in vivo cyst lysis. The latter, however, obviates a conventional biopsy. We reviewed published optical coherence tomography (OCT) images of ocular cysticercosis for their suitability to surrogate a conventional biopsy and identified commonly reported features. We also used triple masking and ascertained the observer agreement on identification of these features. We found that the features of the parasite are much more clearly discernible as compared with features of the involved ocular tissue itself. The hyperreflective cyst wall and scolex and the hyporeflective cyst cavity had the highest frequency and observer agreement among all the analyzed features, suggesting their use for diagnosis. We could match many of the OCT features with the previously reported histopathological findings, supporting the role of OCT as a diagnostic adjunct and a substitute for conventional biopsy. Conversely, features of the ocular tissue could be judged poorly with low observer agreement, suggesting poor prognostic ability of OCT. [Ophthalmic Surg Lasers Imaging Retina 2022;53:446-454.].
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23
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Thakur PS, Aggarwal D, Takkar B, Shivaji S, Das T. Evidence Suggesting the Role of Gut Dysbiosis in Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2022; 63:21. [PMID: 35877085 PMCID: PMC9339698 DOI: 10.1167/iovs.63.8.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Gut dysbiosis has been identified and tested in human trials for its role in diabetes mellitus (DM). The gut-retina axis could be a potential target for retardation of diabetic retinopathy (DR), a known complication of DM. This study reviews the evidence suggesting gut dysbiosis in DR. Methods The published literature in the past 5 years was reviewed using predetermined keywords and articles. The review intended to determine changes in gut microbiome in DR, the hypothesized mechanisms linking to the gut-retina axis, its predictive potential for progression of DR, and the possible therapeutic targets. Results The gut microbiota of people with DM differ from those without it, and the gut microbiota of people with DR differ from those without it. The difference is more significant in the former (DM versus no DM) and less significant in the latter (DM without DR versus DM with DR). Early research has suggested mechanisms of the gut-retina axis, but these are not different from known changes in the gut microbiome of people with DM. The current evidence on the predictive value of the gut microbiome in the occurrence and progression of DR is low. Therapeutic avenues targeting the gut-retina axis include lifestyle changes, pharmacologic inhibitors, probiotics, and fecal microbiota transplantation. Conclusions Investigating the therapeutic utility of the gut ecosystem for DM and its complications like DR is an emerging area of research. The gut-retina axis could be a target for retardation of DR but needs longitudinal regional studies adjusting for dietary habits.
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Affiliation(s)
- Pratima Singh Thakur
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - David Aggarwal
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India.,https://orcid.org/0000-0001-5779-7645
| | - Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.,https://orcid.org/0000-0003-0376-4658
| | - Taraprasad Das
- Anant Bajaj Retina Institute-Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,https://orcid.org/0000-0002-1295-4528
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24
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Takkar B, Sheemar A, Jayasudha R, Soni D, Narayanan R, Venkatesh P, Shivaji S, Das T. Unconventional avenues to decelerated diabetic retinopathy. Surv Ophthalmol 2022; 67:1574-1592. [PMID: 35803389 DOI: 10.1016/j.survophthal.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/07/2023]
Abstract
Diabetic retinopathy (DR) is an important microvascular complication of diabetes mellitus (DM), causing significant visual impairment worldwide. Current gold standards for retarding the progress of DR include blood sugar control and regular fundus screening. Despite these measures, the incidence and prevalence of DR and vision-threatening DR remain high. Given its slowly progressive course and long latent period, opportunities to contain or slow DR before it threatens vision must be explored. This narrative review assesses the recently described unconventional strategies to retard DR progression. These include gut-ocular flow, gene therapy, mitochondrial dysfunction-oxidative stress, stem cell therapeutics, neurodegeneration, anti-inflammatory treatments, lifestyle modification, and usage of phytochemicals. These therapies impact DR directly, while some of them also influence DM control. Most of these strategies are currently in the preclinical stage, and clinical evidence remains low. Nevertheless, our review suggests that these approaches have the potential for human use to prevent the progression of DR.
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Affiliation(s)
- Brijesh Takkar
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India; Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India.
| | - Abhishek Sheemar
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Raja Narayanan
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India; Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Pradeep Venkatesh
- Dr. RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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25
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Ramamurthy S, Parameswarappa DC, Padhy SK, Takkar B. Exudative maculopathy in presumed X-linked retinoschisis with review of literature. Indian J Ophthalmol 2022; 70:2706-2708. [PMID: 35791214 PMCID: PMC9426173 DOI: 10.4103/ijo.ijo_2090_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Srikanta K Padhy
- Indian Health Outcomes, Public Health and Health Economics research centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Anant Bajaj Retina institute; Indian Health Outcomes, Public Health and Health Economics research centre (IHOPE), LV Prasad Eye Institute, Hyderabad, India
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26
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Parameswarappa DC, Das AV, Thakur PS, Takkar B, Multani PK, Padhy SK, Doctor MB, Agarwal K, Jalali S. Retinitis pigmentosa in Laurence-Moon-Bardet-Biedl syndrome in India: Electronic medical records driven big data analytics: Report II. Indian J Ophthalmol 2022; 70:2533-2538. [PMID: 35791150 PMCID: PMC9426086 DOI: 10.4103/ijo.ijo_2268_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: To describe the clinical presentation and demographic distribution of retinitis pigmentosa (RP) in Laurence–Moon–Bardet–Biedl (LMBB) syndrome patients. Methods: This is a cross-sectional observational hospital-based study wherein 244 patients with RP in LMBB syndrome presenting to our hospital network between March 2012 and October 2020 were included. An electronic medical record database was used for data retrieval. Results: There were 244 patients in total, with a hospital-based prevalence rate of 0.010% or 1000/100,000 population. The mean and median age of patients was 15.22 ± 7.56 and 14 (IQR: 10–18.5) years, respectively, with the majority being in the age group of 11–20 years (133/244 patients; 54.50%). Males were more commonly affected (164 patients; 67.21%), and the majority (182 patients; 74.59%) were students. All 244 patients (100%) complained of defective central vision at presentation. More than one-fourth of the patients had severe visual impairment to blindness at presentation. Prominent retinal feature at presentation was diffuse or widespread retinal pigment epithelial degeneration in all patients. Conclusion: Patients with RP in LMBB syndrome present mainly in the first to second decade of life with severe visual acuity impairment to blindness early in life. It is important to rule out LMBB syndrome in early-onset RP with central visual acuity impairment. On the contrary, all patients diagnosed or suspected with LMBB syndrome systemic features at physician clinic should also be referred for ophthalmic evaluation, low vision assessment, rehabilitation, and vice versa.
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Affiliation(s)
| | - Anthony V Das
- Department of eyeSmart EMR and AEye; Standard Charted Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pratima S Thakur
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases; Standard Charted Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases; Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Prabhjot K Multani
- Retina and Uveitis Department, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Srikant K Padhy
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Mariya B Doctor
- Department of Standard Charted Eye Care Education, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases, Hyderabad, Telangana, India
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27
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Parameswarappa DC, Takkar B, Padhy SK, Kannabiran C. Commentary: Decoding genetic retinal diseases research in India. Indian J Ophthalmol 2022; 70:2550-2551. [PMID: 35791154 PMCID: PMC9426148 DOI: 10.4103/ijo.ijo_937_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Deepika C Parameswarappa
- Srimati Kanuri Santhamma Center for Vitreo . Retinal Diseases, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Center for Vitreo - Retinal Diseases, Anant Bajaj Retina Institute; Indian Health Outcomes, Public Health and Economics Research, Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta K Padhy
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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28
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Padhy SK, Parameswarappa DC, Agarwal K, Takkar B, Behera S, Panchal B, Ramappa M, Padhi TR, Jalali S. Clinical and visual electrophysiological characteristics of vitelliform macular dystrophies in the first decade of life. Indian J Ophthalmol 2022; 70:2516-2525. [PMID: 35791148 PMCID: PMC9426046 DOI: 10.4103/ijo.ijo_2186_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate patterns of pediatric vitelliform macular dystrophy (PVMD). Methods: This is a retrospective analysis of Indian children with vitelliform macular dystrophy (VMD) presenting within the first decade of life. Records were evaluated for clinical findings, family screening, and investigative findings including optical coherence tomography (OCT), fundus autofluorescence (FAF), full-field electroretinogram (ERG) and electrooculogram (EOG). Electrophysiology was scrutinized and audited for acquisition and interpretation errors. Findings on follow-up were also recorded. Results: 46 eyes of 24 patients were included. Mean age at presentation was 7.17 ± 2.17 years. Mean follow-up duration was 1.55 ± 1.69 years. Best disease was the commonest type of VMD detected (21 patients), while autosomal recessive bestrophinopathy was seen in three cases. Mean logMAR BCVA was 0.364 which decreased to 0.402 on follow-up. Hyperopia was noted in 29 out of 46 eyes (mean being +3.87 D, range ebing +0.75 to +8.75 D). Four eyes of four children had choroidal neovascular membrane at presentation, while another child developed while in follow-up. Solid type subretinal deposit was the commonest OCT finding (n = 29/38) and central hyper FAF was the commonest pattern (n = 18/32). EOG was available for review in 32 eyes, but was unreliable in 11 eyes. Seven eyes demonstrated complete absence of light rise on EOG. Conclusion: PVMD can present in advanced forms. Progression to complications with loss of visual acuity can happen within the first decade of life. EOG shows grossly suppressed waveforms in the light phase in a large number of such children.
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Affiliation(s)
- Srikanta Kumar Padhy
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Komal Agarwal
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases; The Centre of Excellence for Rare Eye Diseases; Indian Health Outcomes, Public Health and Economics (IHOPE) Research Centre, Hyderabad, Telangana, India
| | - Shashwat Behera
- Vitreoretina and Uveitis Services, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, GMR Varalalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Muralidhar Ramappa
- The Centre of Excellence for Rare Eye Diseases; Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, Mithu Tulasi Chanrai Campus, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Subhadra Jalali
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases; Jasti V Ramanamma Children's Eye Care Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
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29
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Neveu MM, Padhy SK, Ramamurthy S, Takkar B, Jalali S, Cp D, Padhi TR, Robson AG. Ophthalmological Manifestations of Oculocutaneous and Ocular Albinism: Current Perspectives. Clin Ophthalmol 2022; 16:1569-1587. [PMID: 35637898 PMCID: PMC9148211 DOI: 10.2147/opth.s329282] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
Albinism describes a heterogeneous group of genetically determined disorders characterized by disrupted synthesis of melanin and a range of developmental ocular abnormalities. The main ocular features common to both oculocutaneous albinism (OCA), and ocular albinism (OA) include reduced visual acuity, refractive errors, foveal hypoplasia, congenital nystagmus, iris and fundus hypopigmentation and visual pathway misrouting, but clinical signs vary and there is phenotypic overlap with other pathologies. This study reviews the prevalence, genetics and ocular manifestations of OCA and OA, including abnormal development of the optic chiasm. The role of visual electrophysiology in the detection of chiasmal dysfunction and visual pathway misrouting is emphasized, highlighting how age-associated changes in visual evoked potential (VEP) test results must be considered to enable accurate diagnosis, and illustrated further by the inclusion of novel VEP data in genetically confirmed cases. Differential diagnosis is considered in the context of suspected retinal and other disorders, including rare syndromes that may masquerade as albinism.
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Affiliation(s)
- Magella M Neveu
- Department Electrophysiology, Moorfields Eye Hospital, London, EC1V 2PD, UK.,Institute of Ophthalmology, University College London, London, UK
| | | | | | - Brijesh Takkar
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Subhadra Jalali
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Deepika Cp
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Tapas Ranjan Padhi
- Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, India
| | - Anthony G Robson
- Department Electrophysiology, Moorfields Eye Hospital, London, EC1V 2PD, UK.,Institute of Ophthalmology, University College London, London, UK
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30
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Takkar B, Sahoo NK, Tyagi M, Dave VP. Observations on Six Rare Cases of Chorioretinitis Sclopetaria. Nepal J Ophthalmol 2022; 14:152-161. [DOI: 10.3126/nepjoph.v14i1.33047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Chorioretinitis sclopetaria (CS) is a rare consequence of ocular injury. Its association with open globe injury (OGI) and retinal detachment (RD) is controversial. This study evaluates patterns of chorioretinitis sclopetaria and its association with open globe injury and retinal detachment.
Case: This is an electronic review of records of a tertiary eye care institute of south India with descriptive analysis of six cases. Cases where fundus findings of chorioretinitis sclopetaria were available were included. Information regarding mode of injury, visual outcomes, follow up and causes of poor visual outcomes were obtained. Presence of open globe injury, retinal detachment, vitreous hemorrhage (VH) and orbital foreign body (FB) was also noted. Ultrasound scans of the eyeball were reviewed for presence of signs of chorioretinitis sclopetaria.
Observations: All the injured patients were male (age range 23-52 years). Bullet and blast injuries were the modes of injury. The duration since injury to the last follow up ranged from 0.25 to 12 years. The final visual acuity was <20/200 in 3/6 cases. Open globe injury and retinal detachment was noted in one case each, while 3/5 cases had orbital foreign body. Extensive facial and neuro-surgery were required in 2/6 cases. Sonography showed signs of chorioretinitis sclopetaria in 2/3 cases where scans were available for review.
Conclusions: Though manifestations of chorioretinitis sclopetaria evolve with time with visual improvement, final visual acuity is generally poor. Cases of chorioretinitis sclopetaria may have accompanying retinal detachment or open globe injury. Sonography should be evaluated with a high degree of suspicion for chorioretinitis sclopetaria in typical cases.
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Garg G, Venkatesh P, Chawla R, Takkar B, Temkar S, Damodaran S. Normative data of retinal arteriolar and venular calibre measurements determined using confocal scanning laser ophthalmoscopy system - Importance and implications for study of cardiometabolic disorders. Indian J Ophthalmol 2022; 70:1657-1663. [PMID: 35502046 PMCID: PMC9333006 DOI: 10.4103/ijo.ijo_2162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To determine and validate retinal vascular caliber measurements by using the confocal scanning laser ophthalmoscopy system. Retinal vasculature changes are often regarded as clinical markers for systemic disease. Methods: It was a prospective observational study conducted on 600 eyes of 300 normal subjects with no systemic or ocular illness from January 1, 2016 to June 30, 2017 in a tertiary referral eye center. Non-mydriatic infrared reflectance, blue reflectance, and blue peak blue autofluorescence fundus imaging were done on the confocal scanning laser ophthalmoscopy system. The dimensions of the retinal vessels were measured using inbuilt calipers at 1800 mm from the center of the optic disc. Internal and external dimensions were measured. Observer variation and its comparison using Image J software were assessed. Results: The median age was 29 years (18–50 years). Mean internal and external diameters for arterioles were 85.1 ± 12.4 mm and 105.0 ± 12.0 mm, and for venules were 133.8 ± 16.6 mm and 145.4 ± 16.1 mm, respectively. The mean internal and external wall thicknesses were 19.7 ± 8.0 mm and 11.0 ± 5.6 mm, and wall thickness-to-lumen ratios were 0.3 ± 0.1 and 0.1 ± 0.1, respectively. Arteriolar-to-venular ratio for lumen and vessel was 0.66 ± 0.1 and 0.74 ± 0.1, respectively. There was no statistically significant difference between age groups. Both inter- and intra-observer reproducibility was >95%. The Bland–Altman plot showed that the difference between measurements using both confocal scanning laser ophthalmoscopy and Image J software lies within the limits of agreement approximately 95% of the time. Conclusion: This is the first effort to develop a normative database by using a simple non-invasive confocal scanning laser ophthalmoscopy system with high observer reproducibility.
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Affiliation(s)
- Gaurav Garg
- Department of Retina and Uvea Services, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Department of Retina and Uvea Services, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Department of Retina and Uvea Services, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Department of Vitreo-Retina Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Shreyas Temkar
- Department of Retina and Uvea Services, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sourav Damodaran
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Jayanna S, Agarwal K, Doshi V, Reddy RU, Ali H, Dogra A, Takkar B, Agarwal H, Padhi TR, Chittabhathini S, Jalali S. A retrospective analysis of ultra-widefield photograph (Optos) documentation of retinopathy of prematurity at a tertiary eye care outpatient setup: the Indian Twin Cities ROP Study, report number 11. J AAPOS 2022; 26:68.e1-68.e6. [PMID: 35339696 DOI: 10.1016/j.jaapos.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To demonstrate the usefulness of ultrawide-field fundus (UWF) photography for documentation in retinopathy of prematurity (ROP). METHODS The medical records of infants with ROP who underwent at least one sitting of UWF fundus photography in addition to binocular indirect ophthalmoscopy (BIO) from April 2018 to September 2020 were analyzed retrospectively. BIO was conducted by a trained ROP specialist, and final diagnosis and treatment were based solely on BIO findings. All fundus photographs were captured on Optos UWF camera (Dunfermline, UK) in a flying baby position. Demographic details and fundus findings on BIO and fundus photographs were analyzed. RESULTS Of the 187 infants who met inclusion criteria for successful imaging, 22 (11.7%) had findings that were discordant with BIO. Although no posterior disease was missed, 4 infants who received treatment would not have been treated based solely on UWF photography findings. Of the 60 babies whose images did not meet the inclusion criteria for successful imaging, 41 had ROP that required intervention. CONCLUSIONS In our patient cohort, UWF photography proved useful in documenting the initial and follow-up findings of preterm babies with ROP.
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Affiliation(s)
- Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virangi Doshi
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rakshi Ugandhar Reddy
- Department of Optometry, Brien Holden School of Optometry, L V Prasad Eye Institute, Hyderabad, India
| | - Hasnat Ali
- Department of Biostatistics, L V Prasad Eye Institute, Hyderabad, India
| | - Avantika Dogra
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hitesh Agarwal
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas Ranjan Padhi
- Vitreoretinal and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | | | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Murthy SI, Takkar B, Mishra DK. Rapidly Progressing Fungal Keratitis with Endophthalmitis Post-Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Am J Trop Med Hyg 2022; 106:tpmd211054. [PMID: 35245897 PMCID: PMC9128680 DOI: 10.4269/ajtmh.21-1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Somasheila I. Murthy
- Cornea Service, The Cornea Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt Kannuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research, Hyderabad, India
| | - Dilip Kumar Mishra
- Ophthalmic Pathology Service, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
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Paritala A, Takkar B, Gaur N, Soni D, Ali MH, Rathi A. Correlation of vitreous chamber depth with ocular biometry in high axial myopia. Indian J Ophthalmol 2022; 70:914-920. [PMID: 35225543 PMCID: PMC9114555 DOI: 10.4103/ijo.ijo_1201_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The proportion of axial length (AL) occupied by vitreous chamber depth (VCD), or VCD:AL, consistently correlates to ocular biometry in the general population. Relation of VCD:AL to ocular biometry in high myopia is not known. The purpose of this study is to evaluate the relation of VCD and VCD:AL to ocular biometry of highly myopic eyes. METHODS This was a cross-sectional retrospective study of records of 214 myopic eyes (<-1 D SE, aged 20-40 years) attending the refractive surgery services. High axial myopia was defined as AL >26.5 mm. Eyes with posterior staphyloma and myopic maculopathy were excluded. Records were assessed for measurements of AL, central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white diameter (WTW), and vitreous chamber depth (VCD). Groups were formed based on increasing AL, while the sum of CCT, ACD, and LT was recorded as anterior segment depth (AS). The main outcome measure was the correlation of VCD and VCD:AL to ocular biometry. A comparison was also performed based on of degree of axial myopia. RESULTS Mean age of the patients was 27.0 ± 5.2 years. VCD showed a very strong correlation with AL (R = 0.98, P < 0.001) but did not correlate to any anterior parameter. VCD:AL showed moderate negative relation with AS (R = -0.43, P < 0.001) and ACD (R = -0.3, P < 0.001), while it had a weakly negative relation with LT (R = -0.18, P = 0.006). VCD:AL showed strong negative relation (R > ~0.7) with AS in all individual groups of AL. Among anterior parameters, WTW showed the most consistent relation with ocular biometry. CONCLUSION VCD:AL is a better correlate of ocular biometry in high myopia as compared to VCD. However, the correlation is weaker than that noted by previous studies done on the general population. Longitudinal studies of VCD:AL in the younger age group is recommended.
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Affiliation(s)
- Anusha Paritala
- Smt. Kanuri Santhamma Centre for Vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Centre for Vitreoretinal diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana; Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Nripen Gaur
- Department of Ophthalmology, AIIMS-Bilaspur, India
| | - Deepak Soni
- Department of Ophthalmology, AIIMS-Bhopal, India
| | - Mohammad Hasnat Ali
- Clinical Epidemiology and Bio-Statistics, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Anubha Rathi
- The Cornea Institute, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
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Takkar B, Belenje A, Agarwal K, Tyagi M, Aggarwal V, Padhi T, Narayanan R. Jet stream related iatrogenic retinal breaks during vitreo-retinal surgery. Indian J Ophthalmol 2022; 70:902-907. [PMID: 35225540 PMCID: PMC9114574 DOI: 10.4103/ijo.ijo_1918_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Nayak S, Das T, Parameswarappa D, Sharma S, Jakati S, Jalali S, Narayanan R, Basu S, Tyagi M, Dave VP, Pappuru RR, Pathengay A, Kaza H, Rani PK, Behera S, Sahoo NK, Kapoor A, Agrawal H, Agarwal K, Takkar B, Raval VR. Sight-threatening intraocular infection in patients with COVID-19 in India. Indian J Ophthalmol 2021; 69:3664-3676. [PMID: 34827019 PMCID: PMC8837282 DOI: 10.4103/ijo.ijo_1474_21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital. Methods We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes. Results The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5-72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7-63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi. Conclusion Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.
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Affiliation(s)
- Sameera Nayak
- Vitreo-Retina and Uvea Services, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Vijayawada, Andhra Pradesh, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | | | - Savitri Sharma
- Jhaveri Microbiology Centre and Saroja A Rao Immunology Laboratory, Hyderabad, Telangana, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Soumyava Basu
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Avinash Pathengay
- Uvea Services, L V Prasad Eye Institute, GMR Varalakshmi Campus, Vishakhapatnam, Andhra Pradesh, India
| | - Hrishikesh Kaza
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Shashwat Behera
- Vitreo-Retina and Uvea Services, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Vijayawada, Andhra Pradesh, India
| | - Niroj Kumar Sahoo
- Vitreo-Retina and Uvea Services, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Vijayawada, Andhra Pradesh, India
| | - Aditya Kapoor
- Vitreo-Retina and Uvea Services, L V Prasad Eye Institute, Kode Venkatadri Chowdary Campus, Vijayawada, Andhra Pradesh, India
| | - Hitesh Agrawal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Komal Agarwal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Vishal Ramesh Raval
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
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Nanda R, Sahu S, Takkar B, Padhy SK. Postvitrectomy full-thickness macular hole and retinal detachment in a case of polypoidal choroidal vasculopathy. BMJ Case Rep 2021; 14:e246503. [PMID: 34772684 PMCID: PMC8593717 DOI: 10.1136/bcr-2021-246503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ridham Nanda
- Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Suman Sahu
- Ophthalmology, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Brijesh Takkar
- Ophthalmology, LV Prasad Eye Institute, Hyderabad, India
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Padhy SK, Takkar B, Kelgaonkar A, Sahu S. Retinal pigment epithelial step sign: optical coherence tomography clue for diagnosing retained subretinal perfluorocarbon liquid. BMJ Case Rep 2021; 14:e244464. [PMID: 34764110 PMCID: PMC8586882 DOI: 10.1136/bcr-2021-244464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Srikanta Kumar Padhy
- Ophthalmology, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, Odisha, India
| | - Brijesh Takkar
- Ophthalmology, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Anup Kelgaonkar
- Ophthalmology, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, Odisha, India
| | - Suman Sahu
- Ophthalmology, LV Prasad Eye Institute Bhubaneswar Campus, Bhubaneswar, Odisha, India
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Sheemar A, Soni D, Takkar B, Basu S, Venkatesh P. Inflammatory mediators in diabetic retinopathy: Deriving clinicopathological correlations for potential targeted therapy. Indian J Ophthalmol 2021; 69:3035-3049. [PMID: 34708739 PMCID: PMC8725076 DOI: 10.4103/ijo.ijo_1326_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 11/22/2022] Open
Abstract
The role of inflammation in diabetic retinopathy (DR) is well-established and dysregulation of a large number of inflammatory mediators is known. These include cytokines, chemokines, growth factors, mediators of proteogenesis, and pro-apoptotic molecules. This para-inflammation as a response is not directed to a particular pathogen or antigen but is rather directed toward the by-products of the diabetic milieu. The inflammatory mediators take part in cascades that result in cellular level responses like neurodegeneration, pericyte loss, leakage, capillary drop out, neovascularization, etc. There are multiple overlaps between the inflammatory pathways occurring within the diabetic retina due to a large number of mediators, their varied sources, and cross-interactions. This makes understanding the role of inflammation in clinical manifestations of DR difficult. Currently, mediator-based therapy for DR is being evaluated for interventions that target a specific step of the inflammatory cascade. We reviewed the role of inflammation in DR and derived a simplified clinicopathological correlation between the sources and stimuli of inflammation, the inflammatory mediators and pathways, and the clinical manifestations of DR. By doing so, we deliberate mediator-specific therapy for DR. The cross-interactions between inflammatory mediators and the molecular cycles influencing the inflammatory cascades are crucial challenges to such an approach. Future research should be directed to assess the feasibility of the pathology-based therapy for DR.
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Affiliation(s)
- Abhishek Sheemar
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis Service, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pradeep Venkatesh
- Dr.R.P.Centre for Ophthalmic Sciences, All India Institute of Medical Science, New Delhi, India
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Abstract
The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban-rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people's participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.
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Affiliation(s)
- Padmaja K Rani
- Smt. Kanuri Santhamma Center for Vitreo-retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreo-retinal Diseases; Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India, Telangana
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreo-retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Thakur PS, Aggarwal D, Takkar B. Management of a misidentified and misnumbered intraocular glass foreign body with an endoscope in a case of endophthalmitis. BMJ Case Rep 2021; 14:e244569. [PMID: 34610955 PMCID: PMC8493899 DOI: 10.1136/bcr-2021-244569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/03/2022] Open
Abstract
An endoscope is a useful adjunct for the retinal surgeon to overcome haze of a compromised anterior segment. It allows early surgery in trauma and infections which translates to better results. Intraocular glass foreign body is a challenging condition, demanding highly skilled surgical expertise. We present endoscopic removal of an intraocular foreign glass body in a badly traumatised and infected eye. The surgical challenge was accentuated by an imaging misdiagnosis of 'twin metallic foreign bodies'.
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Affiliation(s)
- Pratima Singh Thakur
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - David Aggarwal
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health, and Economics Research (IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, India
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Das T, Takkar B, Sivaprasad S, Thanksphon T, Taylor H, Wiedemann P, Nemeth J, Nayar PD, Rani PK, Khandekar R. Recently updated global diabetic retinopathy screening guidelines: commonalities, differences, and future possibilities. Eye (Lond) 2021; 35:2685-2698. [PMID: 33976399 PMCID: PMC8452707 DOI: 10.1038/s41433-021-01572-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/28/2021] [Accepted: 04/21/2021] [Indexed: 02/04/2023] Open
Abstract
Diabetic retinopathy (DR) is a global health burden. Screening for sight-threatening DR (STDR) is the first cost-effective step to decrease this burden. We analyzed the similarities and variations between the recent country-specific and the International Council of Ophthalmology (ICO) DR guideline to identify gaps and suggest possible solutions for future universal screening. We selected six representative national DR guidelines, one from each World Health Organization region, including Canada (North America), England (Europe), India (South- East Asia), Kenya (Africa), New Zealand (Western Pacific), and American Academy of Ophthalmology Preferred Practice Pattern (used in Latin America and East Mediterranean). We weighed the newer camera and artificial intelligence (AI) technology against the traditional screening methodologies. All guidelines agree that screening for DR and STDR in people with diabetes is currently led by an ophthalmologist; few engage non-ophthalmologists. Significant variations exist in the screening location and referral timelines. Screening with digital fundus photography has largely replaced traditional slit-lamp examination and ophthalmoscopy. The use of mydriatic digital 2-or 4-field fundus photography is the current norm; there is increasing interest in using non-mydriatic fundus cameras. The use of automated DR grading and tele-screening is currently sparse. Country-specific guidelines are necessary to align with national priorities and human resources. International guidelines such as the ICO DR guidelines remain useful in countries where no guidelines exist. Validation studies on AI and tele-screening call for urgent policy decisions to integrate DR screening into universal health coverage to reduce this global public health burden.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.
- Regional Chair, International Agency for the Prevention of Blindness, South East Asia, Hyderabad, India.
| | - Brijesh Takkar
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Thamarangsi Thanksphon
- Former Director, Healthier Populations and Non-Communicable Disease, WHO Regional Office for South- East Asia Region, New Delhi, India
| | - Hugh Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Wiedemann
- Department of Ophthalmology, University Leipzig, Leipzig, Germany
| | - Janos Nemeth
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Regional Chair, International Agency for the Prevention of Blindness, Europe, Budapest, Hungary
| | - Patanjali D Nayar
- Regional Advisor, Disability & Injury Prevention and Rehabilitation, Healthier Populations and Non-Communicable Disease, WHO Regional Office for South- East Asia Region, New Delhi, India
| | - Padmaja Kumari Rani
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Rajiv Khandekar
- Department of Research, Ophthalmic epidemiology & Low Vision, King Khalid Eye Hospital, Riyadh, Kingdom of Saudi Arabia
- British Columbia Centre for Epidemiologic & International Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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Desai A, Kaza H, Takkar B, Choudhari N. Anterior migration of asteroid hyalosis due to aqueous misdirection: asteroids in the wrong orbit. BMJ Case Rep 2021; 14:e246441. [PMID: 34479911 PMCID: PMC8420702 DOI: 10.1136/bcr-2021-246441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Arjun Desai
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hrishikesh Kaza
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Nikhil Choudhari
- Glaucoma Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Ravani RD, Yadav S, Takkar B, Sen S, Kashyap S, Gupta D, Jassal M, Agrawal A, Mohanty S, Tandon R. Experimental evaluation of safety and efficacy of plasma-treated poly-ε-caprolactone membrane as a substitute for human amniotic membrane in treating corneal epithelial defects in rabbit eyes. Indian J Ophthalmol 2021; 69:2412-2416. [PMID: 34427233 PMCID: PMC8544092 DOI: 10.4103/ijo.ijo_2986_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate biocompatibility and safety of plasma-treated poly-ε-caprolactone (pPCL) membrane compared to the human amniotic membrane in the healing of corneal epithelial defects in an experimental model. Methods: This is a prospective, randomized animal study including 12 rabbits. Circular epithelial injury measuring 6 mm in diameter was induced over the central cornea of one eye in twelve rabbits. The rabbits were randomized into two groups; in group A, the defect was covered with human amniotic membrane, while in group B, an artificial membrane made of bio-polymer plasma-treated poly-ε-caprolactone was grafted. Six rabbits were euthanized after 1 month and the other six after 3 months and the corneal epithelium was evaluated histopathologically and with immunohistochemistry. Results: Light microscopy of the corneal tissue performed after 1 month and 3 months demonstrated similar findings with no significant complications in either group. Immunohistochemistry with anti-CK-3 antibody showed characteristic corneal phenotype in the healed epithelium. In eyes grafted with pPCL membrane, epithelial healing as estimated by a decrease in size of the defect was significantly better than the group treated with the human amniotic membrane at all time periods monitored (P < 0.05), except day 1 (P = 0.83). The percentage reduction in the size of the epithelial defect was also significantly more in the pPCL membrane group as compared to the human amniotic membrane at all time periods (P < 0.05 at all observations) post-implantation except day 1 (P = 0.73). Conclusion: Plasma-treated poly-ε-caprolactone membrane is safe, biocompatible, and effective in the healing of corneal epithelial defects in rabbits.
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Affiliation(s)
- Raghav D Ravani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saumya Yadav
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sen
- Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kashyap
- Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Gupta
- SMITA Research Labs, Department of Textile Technology, Indian Institute of Technology, New Delhi, India
| | - Manjeet Jassal
- SMITA Research Labs, Department of Textile Technology, Indian Institute of Technology, New Delhi, India
| | - Ashwini Agrawal
- SMITA Research Labs, Department of Textile Technology, Indian Institute of Technology, New Delhi, India
| | - Sujata Mohanty
- Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal D, Takkar B, Basu S. Macular infarction in presumed rickettsial retinitis with late vascular remodelling. BMJ Case Rep 2021; 14:e243188. [PMID: 34380679 PMCID: PMC8359509 DOI: 10.1136/bcr-2021-243188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/03/2022] Open
Abstract
A middle-aged man had been diagnosed as retinitis and treated with steroids previously. The patient had developed macular infarction in the course of illness. We diagnosed him to have rickettsial retinitis on the basis of clinical features and positive Weil-Felix test. The patient's condition improved after treatment with oral antibiotics. The vasculature of the infarcted macula showed partial reperfusion late in the course of follow-up.
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Affiliation(s)
- David Aggarwal
- Smt. Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
- Indian Health Outcomes, Public Health and Economics Research(IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Smt. Kanuri Santhamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
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Sagar P, Sodhi PS, Roy S, Takkar B, Azad SV. Pachychoroid neovasculopathy: A comparative review on pathology, clinical features, and therapy. Eur J Ophthalmol 2021; 32:11206721211036290. [PMID: 34325545 DOI: 10.1177/11206721211036290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There have been major changes in our understanding of choroidal diseases in the last decade owing to multiple retinal and choroidal imaging related advances. A major conceptual pivot is establishment of pachychoroid and its spectrum of clinical disorders: pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularization, peripapillary pachychoroid syndrome, and focal choroidal excavation. However, considerable overlaps in manifestations and therapeutics of these disorders make differentiation amongst them difficult. This review is focused on pathogenesis and clinical aspects of pachychoroid neovasculopathy (PNV). Since PNV was defined as a separate entity around 5 years ago, there have been numerous contrasting observations surrounding it. We review and summarize these studies, and also compare PNV with other disorders of the pachychoroid spectrum in detail. There are important differences between etiologies of neovascular age related macular degeneration and PNV. Yet the current treatment strategies for PNV have been extrapolated from the trials for the former. Future research needs to validate this assumption with long-term results.
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Affiliation(s)
- Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shivamogga, India
| | | | - Sangeeta Roy
- Department of Vitreo Retina, Susrut Eye Foundation and Research Centre, Kolkata, West Bengal, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, Hyderabad, Telangana, India
| | - Shorya Vardhan Azad
- Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Preetam R, Aggarwal D, Takkar B. Freely Mobile Ocular Worm Hiding Away From the Light. Am J Trop Med Hyg 2021; 105:1131. [PMID: 34252048 PMCID: PMC8592204 DOI: 10.4269/ajtmh.21-0521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Raghav Preetam
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - David Aggarwal
- Srimati Kanuri Santamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Brijesh Takkar
- Srimati Kanuri Santamma Centre for Vitreoretinal diseases, LV Prasad Eye Institute, Hyderabad, India.,Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, LV Prasad Eye Institute, Hyderabad, India
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48
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Gunna NT, Paritala A, Takkar B, Sheth J. Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula. BMJ Case Rep 2021; 14:14/5/e242121. [PMID: 34045204 DOI: 10.1136/bcr-2021-242121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. The patient was treated conservatively with spontaneous reversal of ocular ischaemic syndrome and complete regain of visual function.
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Affiliation(s)
- Nithin Teja Gunna
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anusha Paritala
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India .,Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Jenil Sheth
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Takkar B, Das T, Thamarangsi T, Rani PK, Thapa R, Nayar PD, Rajalakshmi R, Choudhury N, Hanutsaha P. Development of Diabetic retinopathy screening guidelines in South-East Asia region using the context, challenges, and future technology. Semin Ophthalmol 2021; 37:97-104. [PMID: 34003720 DOI: 10.1080/08820538.2021.1925308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To formulate guidelines for screening of diabetic retinopathy (DR) for the World Health Organization (WHO) South-East Asia Region (SEAR) aligned with the current infrastructure and human resources for health (HRH).Design: A consultative group discussion of technical experts of the International Agency for the Prevention of Blindness (IAPB) from SEAR.Participants: IAPB country chairs and DR technical experts from SEAR countries.Methods: Data related to DR in SEAR was collected from published literature on available DM and DR guidelines and the participating experts. The 10 SEAR countries (the Democratic Republic of Korea was not included for lack of sufficient data) were divided into 3 resource levels (low, medium, and high) based on gross national income/per capita, cataract service indicators (cataract surgical rate and cataract surgical service), current infrastructure and available HRH. Two countries each were assigned to low (Myanmar, Timor-Leste) and high resource (India, Thailand) levels, and the remaining 6 countries (Bangladesh, Bhutan, Indonesia, Maldives, Nepal, Sri Lanka) were assigned the medium resource level. The DR care system was divided into 3 levels of care (essential, recommended, and desirable) and 3 levels of service delivery (primary, secondary, and tertiary).Main outcome measures: Primary, secondary, and tertiary level guidelines for screening of DRResults: Nine WHO SEAR countries participated in the formulation of the new country-specific DR screening guidelines. The DR screening recommendations were: advocacy at the community level, visual acuity measurement, and non-mydriatic fundus photography at the primary level, comprehensive eye examination and retinal laser at the secondary level, and intravitreal therapy and vitrectomy at the tertiary level. The systemic care of DM and hypertension are recommended at all levels commiserating with their care capabilities.Conclusions: The DR guidelines for the SEAR region are the first region-specific and resource-aligned recommendations for comprehensive DR care in each country of the region. In the future, the new technological advances in retinal camera technology, teleophthalmology, and artificial intelligence should be included within the structure of the public DR care system.
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Affiliation(s)
- Brijesh Takkar
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Indian Health Outcomes, Public Health and Economics Research (IHOPE) Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Regional Chair, International Agency for Prevention of Blindness, Hyderabad, India
| | - Thaksaphon Thamarangsi
- Healthier Populations and Non-Communicable Disease, WHO Regional Office for South- East Asia Region, New Delhi, India
| | - Padmaja K Rani
- Srimati Kanuri Santamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Patanjali D Nayar
- Disability & Injury Prevention and Rehabilitation, Healthier Populations and Non-Communicable Disease, WHO Regional Office for South- East Asia Region, New Delhi, India
| | - Ramachandran Rajalakshmi
- Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | | | - Prut Hanutsaha
- Department of Ophthalmology, Mahidol University, Nakhon Pathom, Thailand
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Sud R, Sharma P, Takkar B, Khanduja S. Modified intraocular lens injector assisted rescue technique for failed viscoexpression in a case of intracameral cysticercosis. Indian J Ophthalmol 2021; 68:932-934. [PMID: 32317496 PMCID: PMC7350499 DOI: 10.4103/ijo.ijo_1488_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intracameral cysticercosis is a rare disease, and surgical management with viscoexpression is the preferred technique. We discuss a novel technique for removal of anterior chamber parasitic cysts and present it as an alternative to the conventional viscoexpression. Our technique uses a custom-made assembly combining an intraocular lens (IOL) cartridge with an aspiration cannula. We compare its utility with the preexisting surgical methods.
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Affiliation(s)
- Rouli Sud
- Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India
| | - Pallavi Sharma
- Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh; Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Sumeet Khanduja
- Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India
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