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Kumar Menia N, Handa S, Markan A, Thakur U, Agarwal A, Gupta V. Intermediate Uveitis with Cystoid Macular Edema as Presentation of Retained Caterpillar Hair in the Vitreous Cavity. Ocul Immunol Inflamm 2024:1-4. [PMID: 38713820 DOI: 10.1080/09273948.2024.2345282] [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: 10/31/2023] [Accepted: 04/16/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE To report an unusual case of retained caterpillar hair in the vitreous cavity presenting as recurrent Intermediate Uveitis with cystoid macular edema. METHOD Case Report. RESULTS A 40-year-old male presented to our uveitis clinic with recurrent episodes of redness and diminution of vision in his left eye for 3 years. He was diagnosed and treated elsewhere as a case of recurrent intermediate uveitis and was referred to our center for a second opinion to initiate immunosuppressive therapy. A detailed history revealed that a caterpillar had fallen into his left eye 3 years back, followed by severe irritation, pain, and redness. He received topical antibiotics and corticosteroids, and retained caterpillar hair was removed from the ocular surface. During the last 3 years, the patient had multiple episodes of inflammation despite being treated with oral and topical corticosteroids. At the current visit, a meticulous clinical examination at our centre revealed multiple, migrated, retained caterpillar hair in the vitreous cavity. The patient was diagnosed with Ophthalmia Nodosa (Type V) and managed with surgical intervention (vitreous surgery). The case highlights an unusual presentation of ON and the role of pars plana vitrectomy in its successful management. CONCLUSION We highlight a rare and unusual presentation of ophthalmia nodosa and its successful management.
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Affiliation(s)
- Nitin Kumar Menia
- Ophthalmology, All India Institute of Medical Sciences, Jammu, India
- Advanced Eye Center, PGIMER, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Center, PGIMER, Chandigarh, India
| | | | | | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
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Agarwal A, Menia NK, Markan A, Sallam AB, Habib A, Mansour A, Iovino C, Peiretti E, Demirel S, Tawfiq MA, Hanout M, Gupta V, Ghazi N, Sengupta S. Outcomes after giant peripheral retinotomy and anterior flap retinectomy for rhegmatogenous retinal detachments with advanced proliferative vitreoretinopathy using small gauge vitrectomy. Indian J Ophthalmol 2024:02223307-990000000-00174. [PMID: 38622862 DOI: 10.4103/ijo.ijo_2840_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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/19/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To analyze the visual and anatomical outcomes for eyes with rhegmatogenous retinal detachment (RRD) and advanced proliferative vitreoretinopathy (PVR) undergoing giant peripheral retinotomy (GPR) using 25-gauge pars plana vitrectomy (PPV). METHODS In this retrospective multi-center study, patients with RRD with either anteroposterior or circumferential retinal shortening and advanced PVR requiring more than 90-degree GPR with/without relaxing retinotomy were included. Subjects of either gender, any age group, and with complete surgical notes were included. Outcome measures of the study included anatomical success (i.e. complete retinal re-attachment) at 6 months using survival analysis, visual outcomes, and post-operative complications. RESULTS Forty-one eyes of 41 patients (33 males) with a mean age of 44.9 ± 21.4 years were included. At 6 months follow-up, anatomical success was seen in 29 eyes (70.7%) with a cumulative re-attachment rate of 66% (95% confidence interval = 48 = 79%). All re-detachments occurred at ≤6 months with a peak at 4-6 months (n = 9). Twenty-three eyes (56%) achieved ambulatory vision (5/200) or better. Direct perfluorocarbon liquid-silicone oil exchange was performed in 20 eyes. Intra-operative complications included persistent retinal folds (2 eyes), subretinal air (1 eye), and subretinal bleed (1 eye). Eleven eyes (26.8%) developed secondary glaucoma (2 eyes required a drainage device), and hypotony of ≤6 mmHg was noted in 3 eyes (7.3%). Corneal decompensation was noted in 8 eyes (19.5%), and 3 eyes (7.3%) underwent re-surgery for re-RRD. CONCLUSION After GPR using small gauge PPV, two-thirds achieve anatomical success, and over half have ambulatory vision, but overall post-operative complications can occur in more than half of the eyes.
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Affiliation(s)
- Aniruddha Agarwal
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nitin Kumar Menia
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jammu, India
| | - Ashish Markan
- Department of Ophthalmology, Eye7 Chaudhary Eye Center, New Delhi, India
| | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed Habib
- Department of Ophthalmology, Ain Shams University, Vitreoretinal Service, Al Mashreq Eye Hospital, Cairo, Egypt
| | - Ahmed Mansour
- Department of Ophthalmology, Ain Shams University, Vitreoretinal Service, Al Mashreq Eye Hospital, Cairo, Egypt
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Enrico Peiretti
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Sibel Demirel
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | | | - Mostafa Hanout
- Princess Margaret Cancer Center/University Health Network, Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Nicola Ghazi
- The Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (UAE)
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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Markan A, Tripathi M, Chaudhary R, Gupta P. Multimodal imaging in a case of Kranenburg syndrome. BMJ Case Rep 2023; 16:e256751. [PMID: 37899081 PMCID: PMC10619104 DOI: 10.1136/bcr-2023-256751] [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: 10/31/2023] Open
Affiliation(s)
- Ashish Markan
- Department of Ophthalmology, Eye7 Chaudhary Eye Centre, New Delhi, Delhi, India
| | - Manasi Tripathi
- Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rahil Chaudhary
- Department of Ophthalmology, Eye7 Chaudhary Eye Centre, New Delhi, Delhi, India
| | - Pawan Gupta
- Department of Ophthalmology, Eye7 Chaudhary Eye Centre, New Delhi, Delhi, India
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Markan A, Dogra M, Katoch D, Tomar M, Mittal H, Singh R. Endogenous Endophthalmitis in COVID-19 Patients: A Case Series and Literature Review. Ocul Immunol Inflamm 2023:1-7. [PMID: 37043623 DOI: 10.1080/09273948.2023.2192273] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE To report outcomes in cases of endogenous endophthalmitis (EE) following COVID-19 infection. MATERIAL AND METHODS In a retrospective study, patients with EE, who had a recent history of COVID-19 infection requiring hospital admission were recruited. Necessary demographic details, details of ocular examination, and microbiological details were collected. RESULTS Six patients (10 eyes), with a mean age of 48 + 19.80 years were included. The mean duration of onset of ocular symptoms from the time of diagnosis of COVID was 28.16 + 16.15 days. 8 eyes required surgical intervention, whereas 2 eyes were managed conservatively. Three patients were positive for Candida albicans, two patients were positive for Aspergillus fumigatus, and one patient was a presumed bacterial EE. The majority of the eyes had favorable functional and anatomical outcomes during the post-operative period. CONCLUSION High-dose corticosteroid therapy in the management of moderate and severe COVID-19 infection may be associated with EE, predominantly fungal.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Tomar
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitisha Mittal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Chandra K, Singh R, Dogra M. Microscope integrated OCT (Mi-OCT) guided retrieval of intrastromal corneal foreign body. GMS Ophthalmol Cases 2023; 13:Doc09. [PMID: 37034412 PMCID: PMC10073981 DOI: 10.3205/oc000217] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Introduction To describe the role of microscope integrated optical tomography (Mi-OCT) in removal of intrastromal corneal foreign body. Methodology A young male presented with trauma to the right eye with sugarcane stick. Ocular examination revealed two sugarcane particles, approximately 3.5 mm in greatest dimension, embedded in the corneal stroma. For removal of foreign body, Mi-OCT was switched on and the area of interest was focused. Sugarcane particles appeared as hyperreflective structures embedded in the corneal stroma with everted edges of the overlying corneal epithelium and anterior stroma. Results Both the sugarcane particles were removed successfully under real time images provided by Mi-OCT without causing any inadvertent damage to the corneal stroma. Conclusion Mi-OCT can be used as an adjunct in emergency surgical procedures like removal of intrastromal corneal foreign bodies with accurate precision.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Chandra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- *To whom correspondence should be addressed: Mohit Dogra, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India, Phone: +91 9814108019, E-mail:
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Abstract
This report highlights the association of tacrolimus use with acute macular neuroretinopathy (AMN). A 27-year-old woman, a known case of diffuse proliferative membranous glomerulonephritis, developed abnormal body movements, loss of consciousness, and blurring of vision in the left eye, after 3 months of starting tacrolimus. Blood investigations revealed anemia, thrombocytopenia, raised urea and creatinine levels, and raised LDH levels. A diagnosis of tacrolimus induced hemolytic uremic syndrome (HUS) with posterior reversible encephalopathy syndrome (PRES) was made. Ocular examination revealed a reddish-brown petaloid retinal lesion, which was better appreciated on red-free imaging as dark grey area pointing towards the fovea. OCT-A and SD-OCT revealed flow voids in deep retinal plexus, and disruption of ellipsoid and interdigitation zone, respectively, findings consistent with AMN. To the best of our knowledge, it is the first report of association of tacrolimus with AMN.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikitha Ayyadurai
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Kishore A, Agarwal A, Akella M, Singh A, Goyal S, Roy M, Singh M, Singh M. Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India. Indian J Ophthalmol 2022; 70:4238-4243. [PMID: 36453323 PMCID: PMC9940582 DOI: 10.4103/ijo.ijo_781_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 To report the demographic profile of patients registered through e-Sanjeevani OPD seeking teleophthalmology services. Methods This was a cross-sectional data analysis of patients with ocular complaints registered through the e-Sanjeevani platform at a tertiary care center. It was a doctor-to-doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient's age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion e-Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment.
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Affiliation(s)
- Ashish Markan
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alisha Kishore
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Correspondence to: Dr. Amit Agarwal, Department of Telemedicine, First Floor, PGIMER, Chandigarh, India. E-mail:
Prof. Meenu Singh, Department of Telemedicine, First Floor, PGIMER, Chandigarh, India. E-mail:
| | - Madhuri Akella
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aruna Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goyal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manaswita Roy
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Correspondence to: Dr. Amit Agarwal, Department of Telemedicine, First Floor, PGIMER, Chandigarh, India. E-mail:
Prof. Meenu Singh, Department of Telemedicine, First Floor, PGIMER, Chandigarh, India. E-mail:
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Markan A, Takkar A, Dogra M, Tigari B. Multimodal imaging in a case of optic disc drusen with peripapillary choroidal neovascular membrane. BMJ Case Rep 2022; 15:e253245. [PMID: 36357107 PMCID: PMC9660690 DOI: 10.1136/bcr-2022-253245] [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: 11/12/2022] Open
Affiliation(s)
- Ashish Markan
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Takkar
- Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Basavaraj Tigari
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Dogra M, Ayyadurai N, Singh R. A hybrid 26G needle drainage technique in scleral buckling: A mini scleral cut-down. Indian J Ophthalmol 2022; 70:3603-3606. [PMID: 36190054 PMCID: PMC9789871 DOI: 10.4103/ijo.ijo_760_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: 11/05/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of hybrid 26-gauge needle drainage in scleral buckling for rhegmatogenous retinal detachment (RRD). Methods In this retrospective study, we included patients who underwent scleral buckling surgery along with subretinal fluid (SRF) drainage using the 'Hybrid 26G needle drainage technique'. Pre-operative assessment included the best corrected visual acuity (BCVA), lens status, and extent of retinal detachment. Intra-operative surgical details such as the height of retinal detachment, number of attempts required to drain the fluid, amount of fluid drained, adequacy of break buckle relationship, and any intra-operative or post-operative complications were noted. Post-operatively, the final visual outcome and retina status were assessed at 3 months of follow-up. Results A total of 10 eyes with primary RRD and proliferative vitreoretinopathy C1 or less were included. Pre-operatively, the mean BCVA was 2.43 ± 1.01 logMAR units, which improved significantly to 0.679 ± 0.45 logMAR units (p value < 0.05) at 3 months of follow-up. Regarding the extent of RRD, five eyes (50%) had a total detachment, two eyes (20%) had a sub-total detachment, and three eyes (30%) had an inferior detachment. Four eyes had shallow detachment, four had a moderate detachment, and two eyes had bullous detachment. Complete drainage of SRF (>75%) was achieved in five patients, and a partial but adequate drainage (50-75%) was achieved in the rest of the five patients. In none of the patients, inadequate or dry tap was encountered. No intra-operative complications were encountered. The retina was attached in eight out of ten eyes at 1 week and at a 1-month follow-up period. Two patients required pars plana vitrectomy for persistent SRF. The retina was attached in all the patients at 3 months of follow-up. Conclusion The 'Hybrid needle drainage' technique is a safe and effective technique for SRF drainage in scleral buckling surgery.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Correspondence to: Dr. Ashish Markan, Senior Resident, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikitha Ayyadurai
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- Ashish Markan
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parshant Singla
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Gupta N, Dogra M, Sharma A, Singh R. Oral valganciclovir in human immunodeficiency virus-positive patients suffering from cytomegalovirus retinitis at a tertiary care hospital in North India. Indian J Ophthalmol 2022; 70:2472-2475. [PMID: 35791137 PMCID: PMC9426123 DOI: 10.4103/ijo.ijo_2787_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: 11/15/2022] Open
Abstract
Purpose: To study clinical efficacy of valganciclovir in cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)-positive-positive patients in a tertiary care clinic in a developing nation. Methods: In a retrospective study, systemic and ocular records of HIV patients suffering from CMVR and treated with valganciclovir, were analyzed. Primary outcome measures were involvement of the other eye, incidence of retinal detachment, systemic involvement, and mortality encountered. Secondary outcome measures included change in BCVA. Results: Out of nine patients who were included, two patients developed CMVR in the other eye and only one patient (11.11%) developed retinal detachment during the course of the study. No patient developed any systemic manifestations or had mortality during the course of the study. The change in BCVA was not statistically significant. Conclusion: Use of oral valganciclovir showed good outcome and was found to be a better alternative compared to the use of intravitreal ganciclovir in the literature. Introduction of valganciclovir at an affordable price in developing nations can decrease disease burden.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Mittal H, Singla P, Singh R. Pneumatic retinopexy as an approach to retinal detachment in a 30-weeks pregnant lady. BMJ Case Rep 2022; 15:e249746. [PMID: 35537773 PMCID: PMC9092137 DOI: 10.1136/bcr-2022-249746] [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] [Accepted: 04/26/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ashish Markan
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitisha Mittal
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parshant Singla
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Markan A, Gupta N, Tigari B, Singh R, Dogra M. Intraoperative optical coherence tomography (I-OCT) assisted passage of the encircling element during retinal detachment surgery. GMS Ophthalmol Cases 2022; 12:Doc10. [PMID: 35465300 PMCID: PMC9006424 DOI: 10.3205/oc000197] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To describe the role of microscope integrated optical tomography (Mi-OCT) in passage of the encircling element during retinal detachment surgery. Materials and methods: Mi-OCT was switched on while passing scleral anchoring sutures to secure the encircling element. The depth of the suture tract was seen in real time while the needle was passed through the sclera. The amount of scleral intend achieved was assessed using Mi-OCT at the end of the surgery. Results: The depth of needle tract through the sclera and the amount of scleral indentation achieved while tying the sutures could be successfully analyzed using Mi-OCT. Conclusion: Mi-OCT can be used as an adjunct while training vitreoretinal fellows and trainees in surgical procedures like passage of scleral sutures for anchoring the encircling element.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nikita Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Basavaraj Tigari
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India,*To whom correspondence should be addressed: Mohit Dogra, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Vidya Path, Sector 12, 160012 Chandigarh, India, Phone: +91 9814108019, E-mail:
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Markan A, Ayyadurai N, Singh SR, Katoch D. Intraoperative haemorrhagic choroidal detachment during MicroIncision Vitrectomy Surgery (MIVS): a unique mechanism. BMJ Case Rep 2022; 15:e245307. [PMID: 35217551 PMCID: PMC8883204 DOI: 10.1136/bcr-2021-245307] [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] [Accepted: 09/23/2021] [Indexed: 11/03/2022] Open
Abstract
Haemorrhagic choroidal detachment (HCD) is a dreaded intraoperative complication of ophthalmic surgery, despite being rare. Multiple systemic and ocular risk factors of HCD have been reported. Acute hypotony during surgery is considered one of the most important precipitating factors. We herein describe a series of events during pars plana vitrectomy surgery for management of rhegmatogeneous retinal detachment which lead to localised HCD. We believe that the pathogenesis of localised HCD is related to compressive decompressive forces during the final tie of the encircling element after fluid air exchange.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Nikitha Ayyadurai
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Markan A, Neupane S, Agrawal R, Gupta V. Newer therapeutic agents for retinal diseases. Expert Review of Ophthalmology 2022. [DOI: 10.1080/17469899.2022.2030709] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Swechya Neupane
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Sen Hospital, Novena, Singapore
| | - Vishali Gupta
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Markan A, Singh SR, Dogra M. Commentary: Utility of a smartphone-assisted direct ophthalmoscope camera for a general practitioner in screening of diabetic retinopathy at a primary health care center. Indian J Ophthalmol 2021; 69:3148-3149. [PMID: 34708759 PMCID: PMC8725082 DOI: 10.4103/ijo.ijo_2387_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Simar R Singh
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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17
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Jayakumar K, Bansal S, Markan A, Agarwal A, Bansal R, Mahajan S, Agrawal R, Gupta V. Reversibility of retinochoroidal vascular alteration in patients with obstructive sleep apnea after continuous positive air pressure and surgical intervention. Indian J Ophthalmol 2021; 69:1850-1855. [PMID: 34146042 PMCID: PMC8374762 DOI: 10.4103/ijo.ijo_3150_20] [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: 12/31/2022] Open
Abstract
Purpose The aim of this work was to study various retinochoroidal parameters in patients with obstructive sleep apnea syndrome (OSAS) and the effect of interventions on these parameters at 6 months follow-up. Methods A total of 36 patients were recruited prospectively from the otorhinolaryngology clinics of a large tertiary center between September 2018 to March 2020. The subjects were divided into three groups depending upon intervention chosen for OSAS: Group A (surgery, i.e., uvulopalatopharyngoplasty), group B (medical therapy, i.e., continuous positive air pressure) and group C (no intervention). Various retinochoroidal parameters which were studied included retinal thickness (RT), choroidal thickness (CT), choroidal vascularity index (CVI), arteriovenous ratio (AVR), capillary density index (CDI) in superficial and deep retina, at baseline and 6 months of follow-up after the intervention. Results In group A, CT increased significantly at 6 months (332.76 ± 86.41 um) compared to baseline (306.28 ± 78.19) (P = 0.0004). Similarly, CDI at both superficial and deep capillary plexus increased significantly at 6 months (superficial CDI: 0.65 ± 0.04, deep CDI: 0.38 ± 0.01) compared to baseline (superficial CDI: 0.62 ± 0.03, deep CDI: 0.36 ± 0.02) (P = 0.004 and 0.002 respectively). In group B, CT increased significantly at 6 months (361.38 ± 78.63 um) compared to baseline (324.21 ± 76.97 um) (P = 0.008). Also, CVI showed a significant decrease at 6 months (65.74 ± 1.84%) compared to baseline (67.36 ± 1.57%) (P = 0.019). In group C, all except CDI in deep capillary plexus showed a significant decrease at 6 months (0.35 ± 0.01) compared to baseline (0.36 ± 0.02) (P = 0.003). Conclusion OSAS alters various retinochoroidal parameters and timely intervention in patients with OSAS can prevent these alterations. Also, these retinochoroidal parameters could serve as one of the markers to monitor the disease progression.
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Affiliation(s)
- Kalaivani Jayakumar
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Bansal
- Otorhinolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Markan
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reema Bansal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sarakshi Mahajan
- School of Medicine, St Joseph Mercy Hospital, Oakland, Pontiac, Michigan, USA
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital; Singapore Eye Research Institute, Singapore
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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18
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Bansal R, Markan A, Gautam N, Guru RR, Lakshmi PVM, Katoch D, Agarwal A, Singh MP, Suri V, Mohindra R, Sahni N, Bhalla A, Malhotra P, Gupta V, Puri GD. Retinal Involvement in COVID-19: Results From a Prospective Retina Screening Program in the Acute and Convalescent Phase. Front Med (Lausanne) 2021; 8:681942. [PMID: 34249972 PMCID: PMC8264127 DOI: 10.3389/fmed.2021.681942] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: To detect retinal involvement in coronavirus disease 2019 (COVID-19) patients in acute and convalescent phase by their fundus screening. Methods: In a prospective, cross-sectional, observational study (July–November 2020), 235 patients (142 acute and 93 convalescent phase) underwent fundus screening in a tertiary care center in North India. For convalescent phase, “hospitalized” patients (73) were screened at least 2 weeks after hospital discharge, and “home-isolated” patients (20) were screened 17 days after symptom onset/COVID-19 testing. Results: None in acute phase showed any retinal lesion that could be attributed exclusively to COVID-19. Five patients (5.38%) in convalescent phase had cotton wool spots (CWSs) with/without retinal hemorrhage, with no other retinal finding, and no visual symptoms, seen at a median of 30 days from COVID-19 diagnosis. Conclusions: CWSs (and retinal hemorrhages) were an incidental finding in COVID-19, detected only in the convalescent phase. These patients were much older (median age = 69 years) than the average age of our sample and had systemic comorbidities (diabetes mellitus, hypertension, etc.). We propose the term “COVID-19 retinopathy” to denote the presence of CWSs at the posterior pole, occasionally associated with intraretinal hemorrhages, in the absence of ocular inflammation in patients with a history of COVID-19 disease.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Gautam
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Ranjan Guru
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mini P Singh
- Department of Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeru Sahni
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G D Puri
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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19
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Markan A, Singh R. Course of lipaemia retinalis in acquired generalised lipodystrophy. BMJ Case Rep 2021; 14:14/6/e242109. [PMID: 34130976 DOI: 10.1136/bcr-2021-242109] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ashish Markan
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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20
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Markan A, Aggarwal K, Gupta V, Agarwal A. Bacillary layer detachment in tubercular choroidal granuloma: A new optical coherence tomography finding. Indian J Ophthalmol 2021; 68:1944-1946. [PMID: 32823426 PMCID: PMC7690492 DOI: 10.4103/ijo.ijo_1434_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/30/2022] Open
Affiliation(s)
- Ashish Markan
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Markan A, Bansal R, Gautam N, Ahuja C, Agarwal A, Katoch D, Gupta V. Longitudinal analysis of cotton wool spots in COVID-19 with high-resolution spectral domain optical coherence tomography and optical coherence tomography angiography. Clin Exp Ophthalmol 2021; 49:392-395. [PMID: 33665913 PMCID: PMC8014087 DOI: 10.1111/ceo.13919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/19/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin Gautam
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Ahuja
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Abstract
A 47-year-old man presented to our retina clinic with gradual onset diminution of vision in his right eye for the last 3 months. Anterior segment evaluation was normal in both eyes. Fundus evaluation showed the presence of leopard spot appearance in the right eye with inferior exudative retinal detachment. Multimodal imaging was done to evaluate retinal pigment epithelium function, choroidal thickness, choroidal vascularity and scleral thickness. Multimodal imaging showed increased choroidal thickness, choroidal congestion on indocyanine green angiography and peripheral choroidal detachment with normal sclera thickness in our patient, thus pointing towards a diagnosis of uveal effusion syndrome type 3.
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Affiliation(s)
- Ashish Markan
- Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bruttendu Moharana
- Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Pujari A, Chawla R, Markan A, Shah P, Kumar S, Hasan N, Sharma A, Kumar A. Age-related changes in macular vessels and their perfusion densities on optical coherence tomography angiography. Indian J Ophthalmol 2021; 68:494-499. [PMID: 32057011 PMCID: PMC7043186 DOI: 10.4103/ijo.ijo_521_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 To evaluate age-related changes in macular vessels and their perfusion densities using optical coherence tomography angiography (OCTA). Methods A total of 108 eyes of 54 healthy subjects between the age group of 11 to 60 years having unaided visual acuity of 20/20 were studied on spectral domain OCTS using 3 * 3 mm macula protocol. These subjects were divided into 5 groups; Group 1: 11-20 years, Group 2: 21-30 years, Group 3: 31-40 years, Group 4: 41-50 years, and Group 5: 51-60 years. An early treatment diabetic retinopathy study (ETDRS) grid overlay at the macula was used to calculate changes in different quadrants of the superficial retinal plexus. Results A total of 98 eyes of 49 patients were considered for the final analysis. The vessel density values decreased from the second to the sixth decade in all four quadrants (except the third decade, where a slight increase was noted). The total vessel density decreased from 168 ± 78 mm-1 (group 1) to 131.47 ± 18.32 mm-1 (group 5). A similar reduction pattern in perfusion density was seen in each quadrant from the second to the sixth decade. The total perfusion density reduced from 309 ± 15.63% (group 1) to 283.05 ± 45.23% (group 5). The foveal avascular zone area was 0.18 ± 0.09 mm2 in group 1, 0.33 ± 0.13 mm2 in group 2, 0.30 ± 0.10 mm2 in group 3, 0.38 ± 0.05 mm2 in group 4, and 0.46 ± 0.06 mm2 in group 5. Conclusion In our population, macular vessel density appears to decrease noticeably from the fourth decade onwards but a statistically significant decrease was observed only from the fifth decade onwards. However, it was not uniform along with all the quadrants. Similarly, the percentage of perfusion density dropped from the fourth decade but these values also varied among the different quadrants.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Shah
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suneel Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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24
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Abstract
Intrachoroidal cavitation (ICC) is a morphological feature outlined by optical coherence tomography and is characterized by presence of a hyporeflective space beneath the unaltered retinal pigment epithelium. It can be peripapillary or macular in location. Macular ICCs are reported in both myopic and non-myopic eyes. We report a case of full thickness macular hole with retinal incarceration into the macular ICC in a patient with pathological myopia. The term “Peripapillary sink hole” has been described in the literature. We propose the use of term “Macular sink hole” for our case owing to similar findings in the macula.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Agarwal A, Aggarwal K, Handa S, Markan A, Gupta V. Subretinal Hemorrhage Complicating Retinal Angiomatous Proliferation in Tubercular Retinal Vasculitis. Ocul Immunol Inflamm 2020; 30:397-401. [PMID: 32976040 DOI: 10.1080/09273948.2020.1803363] [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: 10/23/2022]
Abstract
PURPOSE To report a patient with submacular hemorrhage due to retinal angiomatous proliferation (RAP) in tubercular retinal vasculitis (TRV). METHODS Case report. RESULTS We report a 33-year-old Asian Indian patient of TRV presenting with capillary non-perfusion areas, submacular hemorrhage and venous loops. The patient presented with sudden onset decrease in vision in the right eye. Multimodal imaging revealed presence of retinal vascular anastomosis and stage 2 RAP. Systemic examination was within normal limits. Laboratory evaluation revealed positive Mantoux and interferon gamma release assay. He underwent right eye intravitreal injection of recombinant tissue plasminogen activator (12.5µg/0.1ml) with 100% sulphur hexafluoride (SF6) tamponade. The patient had successful displacement of the submacular hemorrhage with some improvement in visual acuity. CONCLUSION This case highlights that rare vascular alterations such as RAP can develop in subjects with ocular tuberculosis.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sabia Handa
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Markan
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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26
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Agarwal A, Invernizzi A, Markan A, Testi I, Keane PA, Agrawal R, Nguyen QD, Pavesio C, Gupta V. Imaging in Tubercular Choroiditis: Current Concepts. Ocul Immunol Inflamm 2020; 28:1223-1238. [PMID: 32976732 DOI: 10.1080/09273948.2020.1817500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/23/2022]
Abstract
PURPOSE Ocular tuberculosis has protean clinical manifestations. Because of its varied clinical presentation, multimodal imaging is very important to characterize the disease activity, presence of inflammation, determining therapeutic response, and detection of complications. METHODS Narrative review. RESULTS In this review, various imaging modalities employed in the management of ocular tuberculosis including fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have been reviewed. Not only do these imaging tools complement each other in providing a comprehensive assessment of the pathology, they also help in gaining valuable insights regarding the evolution of the disease. CONCLUSIONS Fundus imaging plays a vital role in the diagnosis and management of patients with posterior uveitis due to tuberculosis. Fundus imaging may have a useful role in defining clinical endpoints for ocular tuberculosis in the future.
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Affiliation(s)
- Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan , Milan, Italy
| | - Ashish Markan
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Ilaria Testi
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Pearse A Keane
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Rupesh Agrawal
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK.,Department of Ophthalmology, Singapore Eye Research Institute, Singapore , Singapore.,Department of Ophthalmology, Tan Tock Seng Hospital, Singapore , Singapore
| | - Quan Dong Nguyen
- Byers Eye Institute, Department of Ophthalmology, Stanford University , Palo Alto, CA, USA
| | - Carlos Pavesio
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust , London, UK
| | - Vishali Gupta
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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27
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Markan A, Kumar A, Vira J, Gupta V, Agarwal A. Advances in the tools and techniques of vitreoretinal surgery. Expert Review of Ophthalmology 2020. [DOI: 10.1080/17469899.2020.1810018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ashish Markan
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Kumar
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jayesh Vira
- Department of Ophthalmology, Sankara Eye Hospital, Coimbatore, India
| | - Vishali Gupta
- Department of Ophthalmology, Sankara Eye Hospital, Coimbatore, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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28
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Markan A, Agarwal A, Arora A, Bazgain K, Rana V, Gupta V. Novel imaging biomarkers in diabetic retinopathy and diabetic macular edema. Ther Adv Ophthalmol 2020; 12:2515841420950513. [PMID: 32954207 PMCID: PMC7475787 DOI: 10.1177/2515841420950513] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 04/10/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022] Open
Abstract
Diabetic retinopathy is one of the major microvascular complications of diabetes mellitus. The most common causes of vision loss in diabetic retinopathy are diabetic macular edema and proliferative diabetic retinopathy. Recent developments in ocular imaging have played a significant role in early diagnosis and management of these complications. Color fundus photography is an imaging modality, which is helpful for screening patients with diabetic eye disease and monitoring its progression as well as response to treatment. Fundus fluorescein angiography (FFA) is a dye-based invasive test to detect subtle neovascularization, look for areas of capillary non-perfusion, diagnose macular ischemia, and differentiate between focal and diffuse capillary bed leak in cases of macular edema. Recent advances in retinal imaging like the introduction of spectral-domain and swept source-based optical coherence tomography (OCT), fundus autofluorescence (FAF), OCT angiography, and ultrawide field imaging and FFA have helped clinicians in the detection of certain biomarkers that can identify disease at an early stage and predict response to treatment in diabetic macular edema. This article will summarize the role of different imaging biomarkers in characterizing diabetic retinopathy and their potential contribution in its management.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Atul Arora
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Krinjeela Bazgain
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vipin Rana
- Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Professor of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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29
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Markan A, Jain M, Singh R. Secondary intrachoroidal cavitation in a case of iridofundal coloboma. Med Hypotheses 2020; 143:110085. [PMID: 32721794 DOI: 10.1016/j.mehy.2020.110085] [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] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
Intrachoroidal cavitation is a morphological entity usually described in high myopic eyes. It is usually seen in peripapillary location, though macular location has also been reported. It has been associated with optic disc tilting and posterior staphyloma. We report a case of a 27 year old female who presented to us with recent onset scotoma in her visual field. On examination she had a fundal coloboma with intercalary membrane detachment with intrachoroidal cavitation at the edge of the coloboma. We hypothetise that this intrachoroidal cavitation is a secondary phenomenon and is responsible for recent onset scotoma in her visual field.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mayur Jain
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30
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Pujari A, Kumar S, Markan A, Chawla R, Damodaran S, Kumar A. Buckling surgery on a goat's eye: A simple technique to enhance residents' surgical skill. Indian J Ophthalmol 2019; 67:1327-1328. [PMID: 31332123 PMCID: PMC6677078 DOI: 10.4103/ijo.ijo_1779_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/10/2022] Open
Abstract
Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suneel Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sourav Damodaran
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kumar V, Dubey D, Kumawat D, Markan A, Chandra P, Chandra M, Kumar A. Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial. Br J Ophthalmol 2019; 104:1271-1276. [DOI: 10.1136/bjophthalmol-2019-315095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/17/2019] [Accepted: 11/30/2019] [Indexed: 11/04/2022]
Abstract
AimTo study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).MethodsIn a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months).ResultsSixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62).ConclusionsILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment.Trial registration numberCTRI2018/04/012978.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Markan A, Chawla R, Gupta V, Tripathi M, Sharma A, Kumar A. Photoreceptor evaluation after successful macular hole closure: an adaptive optics study. Ther Adv Ophthalmol 2019; 11:2515841419868132. [PMID: 31432003 PMCID: PMC6685118 DOI: 10.1177/2515841419868132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/28/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: To study photoreceptor changes after a successful macular hole surgery using adaptive optics. Materials and Methods: Three patients who underwent a successful macular hole surgery were studied. Cone density, spacing, and number of nearest neighbors were analyzed at 2° and 4° of eccentricity in all four quadrants using adaptive optics. Results: All three patients gained a visual acuity better than logMAR 0.477 (Snellen equivalent 6/18) at 6 months following successful macular hole surgery. Following successful closure of the macular hole, photoreceptors were appreciated at 2° and 4° of eccentricity from the center. However, as compared with the fellow normal eye, cell density was reduced significantly in the inferior (12,929.33 ± 2047.50 versus 23,839.67 ± 3711.16 cells/mm2 at 2°) and temporal quadrant (13,890 ± 3424.26 versus 22,578.67 ± 5651.34 cells/mm2 at 2°), and intercell spacing was increased significantly in inferior (9.6 ± 0.92 versus 7.14 ± 0.545 µm) and nasal quadrant (8.83 ± 0.39 versus 7.49 ± 0.42 µm). Number of nearest neighbors was unaffected after the hole closure. Conclusion: Postoperative recovery of vision after successful closure of the hole occurs because of the migration or shifting of cells from parafoveal retina toward the center. Cells nearest to the hole margin (at 2° eccentricity) appear to shift more as compared with cells which are further away.
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Affiliation(s)
- Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Assistant Professor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vinay Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manasi Tripathi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Markan A, Azmira K, Dada T, Gupta V. Supracapsular fixation for repositioning Ahmed glaucoma valve in case with tube-endothelial touch. Eur J Ophthalmol 2019; 30:212-216. [PMID: 30832506 DOI: 10.1177/1120672119834491] [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: 11/17/2022]
Abstract
A new technique of correcting tube-corneal touch is described in a case of Ahmed glaucoma valve implantation. This technique repositions the intracameral tube without externalization unlike the standard procedures which aim to correct tube-corneal touch. The technique makes use of a transscleral supracapsular anchor suture to facilitate repositioning of the tube within the ciliary sulcus. Feasible only in pseudophakic and aphakic patients, either a preexisting iridectomy or intraoperative iridectomy is an essential prerequisite to perform this procedure. The final positioning of the tube within the sulcus potentially prevents chronic rubbing of the iris by polypropylene suture as opposed to a transcameral suture.
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Affiliation(s)
- Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Kishan Azmira
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chawla R, Pujari A, Mittal K, Rakheja V, Markan A. Retinal Arteriovenous Malformation Assessment Using Swept-Source OCT Angiography. Ophthalmic Surg Lasers Imaging Retina 2018; 49:216-219. [PMID: 29554392 DOI: 10.3928/23258160-20180221-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
Swept-source optical coherence tomography angiography (SS-OCTA) is a promising new imaging modality for assessing retinal and choroidal vasculature. Faster scanning speed, large number of A-scan acquisition, and enhanced depth penetration has enhanced the detailed analysis of retinal layers. The authors discuss SS-OCTA features of a rare case of retinal arteriovenous malformation. Image analysis revealed the anomalous large-caliber vessels occupying up to the entire retinal thickness with associated echolucent changes in the inner retinal layers surrounding the retinal vessels, along with disruption of the outer retinal layers, including the inner/outer segments of photoreceptors beneath the large tortuous vessels outside the foveola in absence of any capillary nonperfusion areas or lack of significant macular edema. At the fovea, the outer retinal layers were intact due to a smaller caliber and less-deep extension of the anomalous vessels. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:216-219.].
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Affiliation(s)
- Deepa R Swamy
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Ashish Markan
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Shashwat Behera
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Amar Pujari
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Gupta V, Markan A, Somarajan BI, Sihota R, Gupta A, Gupta S, Sharma A. Phenotypic differences between familial versus non-familial Juvenile onset open angle glaucoma patients. Ophthalmic Genet 2017; 39:63-67. [PMID: 28910179 DOI: 10.1080/13816810.2017.1368088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/18/2022]
Abstract
AIM To evaluate phenotypic differences among familial and non-familial JOAG patients. METHODS First degree relatives of unrelated JOAG patients were screened for glaucoma and ocular hypertension. JOAG probands were grouped as familial or non-familial and phenotypic differences in terms of age of onset, gender, baseline untreated IOP, presence angle dysgenesis, and refractive error was compared between the two groups. RESULTS Out of 368 unrelated JOAG patients, 134 in whom all first degree relatives had been examined were included in the study. The non-familial JOAG (n = 96) had similar age of onset as familial JOAG (n = 38); (p = 0.076) but had greater male preponderance (p = 0.046), and had the higher baseline IOP (p = 0.044) compared to familial JOAG. However, on adjustment using the Bonferroni correction, the observed differences were not found to be significant. Both groups had similar proportion of patients with angle dysgenesis (p = 0.46) and high myopia (p = 0.72). CONCLUSIONS Non-familial JOAG were not found to be phenotypically different from the familial JOAG patients in this cohort.
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Affiliation(s)
- Viney Gupta
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Ashish Markan
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Bindu I Somarajan
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Ramanjit Sihota
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Amisha Gupta
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Shikha Gupta
- a Dr. Rajendra Prasad Centre for Ophthalmic Sciences , All India Institute of Medical Sciences , New Delhi , India
| | - Arundhati Sharma
- b Department of Anatomy , All India Institute of Medical Sciences , New Delhi , India
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Kumar A, Kakkar P, Ravani RD, Markan A. Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment. BMJ Case Rep 2017; 2017:bcr-2016-217671. [PMID: 28710187 DOI: 10.1136/bcr-2016-217671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/04/2022] Open
Abstract
Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).1â€"3 Shimada et al4 described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction.5 6 Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.
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Affiliation(s)
- Atul Kumar
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kakkar
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Dinesh Ravani
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
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