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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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Regani H, Chandra P, Kumawat D, Chawla R, Agarwal R, Vohra R. Role of additional posterior barrage laser in type 1 zone 2 retinopathy of prematurity: A randomized trial. Indian J Ophthalmol 2023; 71:3460-3464. [PMID: 37870007 PMCID: PMC10752333 DOI: 10.4103/ijo.ijo_2992_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: 11/11/2022] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose The efficacy of additional barrage laser posterior to ridge in advanced stage 3 or stage 4 retinopathy of prematurity (ROP) is established, but its role in early stages is not defined. The objective was to study the efficacy of additional posterior barrage laser in type I zone 2 disease. Methods In a randomized trial, patients with type I zone 2 ROP were recruited between February 2016 and May 2017. One eye of each baby was randomized into study and control groups, respectively. Laser photocoagulation anterior to ridge was given in the control group, and additional posterior barrage laser was performed in the study group. The outcome measures were time to complete ridge regression and final cycloplegic refraction at 3 months post-laser. Results Forty patients (40 eyes per group) completed the required follow-up. The mean birth weight and gestational age were 1357 ± 338 g and 29.72 ± 2.57 weeks, respectively. The mean post-conceptional age during laser was 36.67 ± 3.23 weeks. The number of eyes achieving ridge regression in control and study groups was 8/40 (20%) and 27/40 (67%) at 2 weeks (P = 0.001) and 39/40 (97%) and 40/40 (100%) at 4 weeks (P = 0.4). The mean time to complete ridge regression was 3.74 ± 1.17 weeks and 2.62 ± 0.91 weeks in control and study groups, respectively (P < 0.001). The mean spherical equivalent at 12 weeks in control and study groups was -1.9 ± 2.3 Diopters and -2.4 ± 2.6 Diopters, respectively (P = 0.41). Conclusions Additional posterior barrage laser leads to significantly faster regression of type 1 zone 2 ROP without increasing induced myopia and thereby might be a useful adjunct to conventional treatment in selected cases. Trial registration number CTRI/2018/05/013779.
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Affiliation(s)
- Harika Regani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Neonatology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
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Kumar P, Chandra P, Agarwal R, Chawla R, Vohra R. Response to: 'Deep learning synthetic angiograms for individuals unable to undergo contrast-guided laser treatment in aggressive retinopathy of prematurity'. Eye (Lond) 2023; 37:2836. [PMID: 37500751 PMCID: PMC10482974 DOI: 10.1038/s41433-023-02401-6] [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] [Received: 12/05/2022] [Revised: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Prashant Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Kumar P, Chandra P, Agarwal R, Chawla R, Vohra R. Role of fluorescein angiography guided laser treatment in aggressive retinopathy of prematurity. Eye (Lond) 2023; 37:2130-2134. [PMID: 36329165 PMCID: PMC10333195 DOI: 10.1038/s41433-022-02302-0] [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: 05/19/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare disease regression in cases of Fluorescein Angiography (FA) guided laser vs. conventional laser treatment in infants with Aggressive retinopathy of prematurity (AROP). METHODS 60 eyes of 30 infants of AROP were randomized into two groups. In both the group's FA was done once. Montage of the fundus, FA images was created and the vascular area, avascular areas, and skip areas after laser treatment were demarcated and measured. In group 1, FA-guided laser treatment was done whereas in group 2 they were lasered without seeing FA. Infants were followed up every week to look for skip areas and disease regression. RESULTS The mean vascular retinal area in group 1 and group 2 on fundus images was 302.7 sq. mm and 245.8 sq. mm respectively, while the same on FA was 285.2 sq. mm and 221.3 sq. mm respectively, suggesting overestimation of the vascular area on fundus imaging compared to FA which enabled more objective estimation of avascular loop areas. Retinal skip areas in group 1 and group 2 after 1st laser were 18.7 sq. mm and 73.1 sq. mm respectively (P = 0.001), after 2nd laser was 3.7 sq. mm and 19.2 sq. mm (P = 0.003), which suggests FA-guided laser led to significantly fewer skip areas. Infants had regression in 4.1 ± 0.3 wks and 4.2 ± 0.4 wks in groups 1 and 2, respectively. CONCLUSION FA-guided laser ensured lesser skip areas and more complete laser treatment, though regression was similar in both groups.
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Affiliation(s)
- Prashant Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Parappil H, Gaffari M, Ahmed J, Skaria S, Rijims M, Chandra P, Babu KTS. Oral Dextrose gel use in asymptomatic hypoglycemic newborns decreases NICU admissions and parenteral dextrose therapy: A retrospective study. J Neonatal Perinatal Med 2023; 16:111-117. [PMID: 36872799 DOI: 10.3233/npm-221170] [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: 03/06/2023]
Abstract
BACKGROUND Neonatal hypoglycemia is one of the most common causes of admission to neonatal intensive care unit requiring intravenous dextrose therapy. Administration of IV dextrose and transfer to the NICU may interfere with parent-infant bonding, breastfeeding, and has financial implications. OBJECTIVE Retrospective study to evaluate the effect of dextrose gel supplementation for asymptomatic hypoglycemia in reducing NICU admissions and intravenous dextrose therapy. METHOD A retrospective study conducted for eight months each before and after introduction of dextrose gel in the management of asymptomatic neonatal hypoglycemia. Asymptomatic hypoglycemic infants were given only feeds in pre dextrose gel period and dextrose gel along with feeds in the dextrose gel period. Rates of admission to NICU and the need of IV dextrose therapy were evaluated. RESULTS High risk characteristics (Prematurity, Large for Gestational Age, small for Gestational Age, Infants of diabetic mother etc.) were equally distributed among both the cohorts. Primary outcome results showed significant reduction in NICU admissions from 396/1801(22%) to 329/1783 (18.5%) (odds ratio, 95% CI 1.24(1.05-1.46, p 0.008). There was significant reduction in IV dextrose therapy requirement from 277/1405 (15.4%) to 182/1454 (10.2%) (odds ratio, 95% CI 1.59(1.31- 1.95, p < 0.001).Babies discharged on predominant breast feeding showed significant improvement from 237/396(59.8%) in the pre dextrose gel period to 240/329 (72.9%) (odds ratio, 95% CI 0.82(0.73-0.90, p < 0.001) in dextrose gel period. CONCLUSIONS Dextrose gel supplementation with feeds reduced NICU admissions, the need for parenteral dextrose therapy, avoided maternal separation and promoted breastfeeding.
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Affiliation(s)
- H Parappil
- Department of Neonatology, Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar.,Department of Pediatrics, Weill Cornell Medical College, Doha, State of Qatar
| | - M Gaffari
- Department of Neonatology, Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar
| | - J Ahmed
- Department of Neonatology, Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar
| | - S Skaria
- Department of Nursing, Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar
| | - M Rijims
- Department of Pharmacy Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar
| | - P Chandra
- Department of Statistics, Hamad Medical Corporation Doha, State of Qatar
| | - K T S Babu
- Department of Neonatology, Women wellness and Research Centre, Hamad Medical Corporation, Doha, State of Qatar
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Nisha KL, Ganapathy S, Puthumangalathu Savithri S, Idaguri M, Mohanachandran P, Vinekar A, Chandra P, Kulkarni S, Dogra M. A Novel Method to Improve Inter-Clinician Variation in the Diagnosis of Retinopathy of Prematurity Using Machine Learning. Curr Eye Res 2023; 48:60-69. [PMID: 36322485 DOI: 10.1080/02713683.2022.2139847] [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: 11/06/2022]
Abstract
PURPOSE Inter-clinician variation could cause uncertainty in disease management. This is reported to be high in Retinopathy of Prematurity (ROP), a potentially blinding retinal disease affecting premature infants. Machine learning has the potential to quantify the differences in decision-making between ROP specialists and trainees and may improve the accuracy of diagnosis. METHODS An anonymized survey of ROP images was administered to the expert(s) and the trainee(s) using a study-designed user interface. The results were analyzed for repeatability as well as to identify the level of agreement in the classification. "Ground truth" was prepared for each individual and a unique classifier was built for each individual using the same. The classifier allowed the identification of the most important features used by each individual. RESULTS Correlation and disagreement between the expert and the trainees were visualized using the Dipstick™ diagram. Intra-clinician repeatability and reclassification statistics were assessed for all. The repeatability was 88.4% and 86.2% for two trainees and 92.1% for the expert, respectively. Commonly used features differed for the expert and the trainees and accounted for the variability. CONCLUSION This novel, automated algorithm quantifies the differences using machine learning techniques. This will help audit the training process by objectively measuring differences between experts and trainees. TRANSLATIONAL RELEVANCE Training for image-based ROP diagnosis can be more objectively performed using this novel, machine learning-based automated image analyzer and classifier.
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Affiliation(s)
- K L Nisha
- National Institute of Technology Calicut, Calicut, India
| | | | | | | | | | | | - Parijat Chandra
- Dr R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Mangat Dogra
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yadav KK, Chouhan N, Thubstan R, Norlha S, Hariharan J, Borwankar C, Chandra P, Dhar VK, Mankuzhyil N, Godambe S, Sharma M, Venugopal K, Singh KK, Bhatt N, Bhattacharyya S, Chanchalani K, Das MP, Ghosal B, Godiyal S, Khurana M, Kotwal SV, Koul MK, Kumar N, Kushwaha CP, Nand K, Pathania A, Sahayanathan S, Sarkar D, Tolamati A, Koul R, Rannot RC, Tickoo AK, Chitnis VR, Behere A, Padmini S, Manna A, Joy S, Nair PM, Jha KP, Moitra S, Neema S, Srivastava S, Punna M, Mohanan S, Sikder SS, Jain A, Banerjee S, . K, Deshpande J, Sanadhya V, Andrew G, Patil MB, Goyal VK, Gupta N, Balakrishna H, Agrawal A, Srivastava SP, Karn KN, Hadgali PI, Bhatt S, Mishra VK, Biswas PK, Gupta RK, Kumar A, Thul SG, Kalmady R, Sonvane DD, Kumar V, Gaur UK, Chattopadhyay J, Gupta SK, Kiran AR, Parulekar Y, Agrawal MK, Parmar RM, Reddy GR, Mayya YS, Pithawa CK. Commissioning of the MACE gamma-ray telescope at Hanle, Ladakh, India. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v123/i12/1428-1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Russell A, Chandra P, Robson M, Narayanan P, Joseph S, Mukherjee P, Aghi M, Otañez M, Dutta M, Bhojani U, Pathak P, John S. Implementing FCTC Article 17 Through Participatory Research With Bidi Workers in Tamil Nadu, India. Nicotine Tob Res 2022; 24:1714-1719. [PMID: 35349705 PMCID: PMC9597000 DOI: 10.1093/ntr/ntac075] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The exploitation, poor conditions, and precarity in the bidi (hand-rolled leaf cigarette) industry in India make it ripe for the application of the FCTC's Article 17, "Provision of support for economically viable alternative activities". "Bottom-up", participatory approaches give scope to explore bidi rollers' own circumstances, experiences, and aspirations. METHODS A team of six community health volunteers using a participatory research orientation developed a questionnaire-based semi-structured interview tool. Forty-six bidi rolling women were interviewed by pairs of volunteers in two northern Tamil Nadu cities. Two follow-up focus groups were also held. A panel of 11 bidi rollers attended a workshop at which the findings from the interviews and focus groups were presented, further significant points were made and possible alternatives to bidi rolling were discussed. RESULTS Bidi workers are aware of the adverse impact of their occupation on them and their families, as well as the major risks posed by the product itself for the health of consumers. However, they need alternative livelihoods that offer equivalent remuneration, convenience, and (in some cases) dignity. Alternative livelihoods, and campaigns for better rights for bidi workers while they remain in the industry, serve to undercut industry arguments against tobacco control. Responses need to be diverse and specific to local situations, i.e. "bottom-up" as much as "top-down", which can make the issue of scaling up problematic. CONCLUSION Participatory approaches involving bidi workers themselves in discussions about their circumstances and aspirations have opened up new possibilities for alternative livelihoods to tobacco. IMPLICATIONS Progress with the FCTC's Article 17 has generally been slow and has focussed on tobacco cultivation rather than later stages in the production process. The bidi industry in India is ripe for the application of an alternative livelihoods approach. This study is one of the first to use participatory methods to investigate the circumstances, experiences, and aspirations of bidi workers themselves.
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Affiliation(s)
- Andrew Russell
- Department of Anthropology, Durham University, Durham, UK
| | - P Chandra
- D Arul Selvi Rehabilitation Trust, Tirupattur, India
| | - Mary Robson
- Institute for Medical Humanities, Durham University, Durham, UK
| | | | - Stanley Joseph
- Praxis Institute for Participatory Practices, New Delhi, India
| | | | - Mira Aghi
- Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Marty Otañez
- Anthropology Department, University of Colorado, Denver, CO, USA
| | - Madhumita Dutta
- Department of Geography, Ohio State University, Columbus, OH, USA
| | | | | | - Sushil John
- Low Cost Effective Care Unit, CMC Vellore, Vellore, India
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Mohan J, Mehta A, Chandra P, Mohanan P, Abdullakutty J, Oomman A, Porwal S, Sharma K, Charantimath M, Banerjee S, Kumar S, Novel G. Translating novel evidence into practice: Consensus for intensive therapy with high dose potent statin to improve outcomes in acute coronary syndrome. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vinekar A, Azad R, Dogra MR, Jalali S, Bhende P, Chandra P, Venkatapathy N, Kulkarni S. Preferred practice guidelines for retinopathy of prematurity screening during the COVID-19 pandemic. World J Clin Pediatr 2022; 11:215-220. [PMID: 35663008 PMCID: PMC9134152 DOI: 10.5409/wjcp.v11.i3.215] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/17/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature. India has the largest number of surviving preterm births born annually. ROP blindness can be largely prevented if there is a robust screening program which detects treatment requiring disease in time. ROP treatment must be provided within 48 h of reaching this threshold of treatment making it a relative emergency. During the severe acute respiratory syndrome-coronavirus disease 2019 pandemic in 2020 ROP screening was disrupted throughout the world due to lockdowns and restriction of movement of these infants, their families, specialists and healthcare workers. The Indian ROP Society issued guidelines for ROP screening and treatment in March 2020, which was aimed at preserving the chain-of-care despite the potential limitations and hazards during the (ongoing) pandemic. This preferred practice guideline is summarized in this manuscript.
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Affiliation(s)
- Anand Vinekar
- Pediatric Retina, Narayana Nethralaya Eye Institute, Bangalore 560010, India
| | - Rajvardhan Azad
- Department of Ophthalmology, Regional Institute of Ophthalmology, IGIMS, Patna 800014, India
| | - Mangat Ram Dogra
- Department of Ophthalmology, Grewal Eye Institute, Chandigarh 160009, India
| | - Subhadra Jalali
- Department of Retina, LV Prasad Eye Institute, Hyderabad 500034, India
| | - Pramod Bhende
- Department of Retina, Sankara Nethralaya, Chennai 600006, India
| | - Parijat Chandra
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi 110023, India
| | | | - Sucheta Kulkarni
- Department of Ophthalmology, H.V.Desai Eye Hospital, Pune 411028, India
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Dolma Y, Thuileiphy T, Ningthoujam O, Chandra P. Improving compliance for e-learning among ophthalmic nurses using quality improvement methodology. Indian J Ophthalmol 2022; 70:1058-1059. [PMID: 35225575 PMCID: PMC9114575 DOI: 10.4103/ijo.ijo_3095_21] [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] [Indexed: 11/11/2022] Open
Affiliation(s)
- Yangchen Dolma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - T Thuileiphy
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Onita Ningthoujam
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract
Preterm babies with retinopathy of prematurity (ROP) can become blind if they do not receive appropriate timely intervention. The presence of cataract in these individuals in addition to visual deprivation amblyopia, also delays proper screening, adequate treatment, and makes follow-up assessment difficult. Anatomical differences in these infants and amblyopia management, especially in unilateral cataract, are other important concerns, and hence, management of these cases with cataract and ROP is challenging. In this review, studies where ROP cases were associated with cataract, were evaluated with a focus on preterm individuals less than 6 months age. Preterm babies are at increased risk of developing cataract because of systemic factors. In addition, those with ROP may have cataract associated with retinal detachment or treatment received. The type of cataract, risk factors, and pathophysiology associated with each cause varies. This review highlights these different aspects of cataract in ROP including causes, pathophysiology, types of cataracts, and management. The management of these cases is critical in terms of the timing of cataract surgery and the challenges associated with surgery and posterior segment management for ROP. Anatomical differences, preoperative retina status, pupillary dilatation, neovascularization of iris in aggressive posterior ROP, fundus examination, amblyopia, and follow-up are various important aspects in the management of the same. The preoperative workup, intraoperative challenges, postoperative care, and rehabilitation in these individuals are discussed.
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Affiliation(s)
- Sudarshan Khokhar
- Cataract and Refractive Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Abhidnya Surve
- Cataract and Refractive Service; Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Saurabh Verma
- Cataract and Refractive Service; Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shorya Azad
- Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Parijat Chandra
- Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chirakshi Dhull
- Cataract and Refractive Service; Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajpal Vohra
- Vitreoretinal, Uvea and ROP Service; Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Kumari A, Surve A, Azad SV, Chawla R, Chandra P, Thukral A, Vohra R, Kumar A. An Observational Study of Different Treatment Practices for Aggressive Posterior Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2021; 58:370-376. [PMID: 34228562 DOI: 10.3928/01913913-20210423-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate risk factors and outcomes of preferred practice for infants with aggressive posterior retinopathy of prematurity (APROP) at a tertiary eye center in India. METHODS This was an observational study of infants with APROP where patients were divided into three groups after 2 weeks of initial treatment depending on the treatment received: anti-VEGF only, laser only, and combination of anti-VEGF injection followed by laser within 2 weeks of anti-VEGF injection (combined group). All infants were evaluated for risk factors and followed up at 1, 2, 4, 8, and 12 weeks to determine treatment outcomes in terms of regression, vascular re-growth, progression, and recurrence of the disease. RESULTS Sixty eyes of 31 infants were included in the study, with 26 eyes in the anti-VEGF only group, 19 eyes in the laser-only group, and 15 eyes in the combined group. Infants in the combined group presented late with lower birth weight (BW), smaller gestational age (GA), and a history of longer duration of ventilatory support. After 3 months of follow-up, regression occurred in 73.08% in the anti-VEGF only group, 89.5% in the laser-only group, and 86.66% in the combined group (P = .07). Zone of vascularization was greater in the anti-VEGF only group and the combined group compared to the laser-only group. Disease recurrence was seen in 27% in the anti-VEGF group, none in the laser-only group, and 13.33% in the combined group (P < .001). However, progression to stage 4 ROP requiring surgery was noted in 2 eyes in the laser-only group. CONCLUSIONS Infants with APROP who have a lower GA or BW or require longer ventilatory support are possibly a subset best suited for planned combination therapy. A combination of anti-VEGF therapy followed by laser treatment within 2 weeks allows for early regression, a stable course, lower recurrence, and a larger area of retinal vascularization. [J Pediatr Ophthalmol Strabismus. 2021;58(6):370-376.].
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Thomas D, Madathil S, Thukral A, Sankar MJ, Chandra P, Agarwal R, Deorari A. Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity. Indian Pediatr 2021. [PMID: 34016801 PMCID: PMC8549580 DOI: 10.1007/s13312-021-2321-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. Objective To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal ROP), CHOP-ROP (children’s Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. Study design Ambispective observational. Setting Tertiary care neonatal intensive care unit in India. Participants Neonates less than 32 weeks or less than 1500 g born between July, 2013 to June, 2019 (N=578), who underwent ROP screening. Primary outcome Sensitivity, specificity and time from alarm to treatment by each algorithm. Results The sensitivity and specificity of WINROP was 85% and 36%, for CHOP-ROP it was 54% and 71%, and for ROPScore it was 73% and 67%, respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates with type 1 ROP underwent treatment at median gestation of 9 weeks and median time from alarm to treatment by WINROP, CHOP-ROP and ROPScore was 7, 7 and 3 weeks, respectively. Conclusion WINROP, CHOP-ROP and ROPScore were not sensitive enough to replace the gestational age, weight and risk factor-based screening criteria for type 1 ROP.
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Kumar V, Naik A, Kumawat D, Sundar D, Chawla R, Chandra P, Kumar A. Multimodal imaging of eyes with metamorphopsia after vitrectomy for rhegmatogenous retinal detachment. Indian J Ophthalmol 2021; 69:2757-2765. [PMID: 34571630 PMCID: PMC8597520 DOI: 10.4103/ijo.ijo_3658_20] [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] [Indexed: 12/04/2022] Open
Abstract
Purpose: To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI). Methods: In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI). Results: Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM. Conclusion: POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.
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Affiliation(s)
- Vinod Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Naik
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dheepak Sundar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Kaur R, Sachan A, Thukral A, Chandra P. Impact of COVID-19 pandemic lockdowns on retinopathy of prematurity services at a tertiary eye care center in India. Indian J Ophthalmol 2021; 69:2903-2904. [PMID: 34571682 PMCID: PMC8597536 DOI: 10.4103/ijo.ijo_1600_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: 11/07/2022] Open
Affiliation(s)
- Ramandeep Kaur
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anusha Sachan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
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Madathil S, Thomas D, Chandra P, Agarwal R, Sankar MJ, Thukral A, Deorari A. 'NOPAIN-ROP' trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial. BMJ Open 2021; 11:e046235. [PMID: 34531205 PMCID: PMC8449965 DOI: 10.1136/bmjopen-2020-046235] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP). DESIGN Open-label randomised trial. SETTING Tertiary care institution. PARTICIPANTS Preterm infants who underwent laser photocoagulation for ROP. INTERVENTIONS Infants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase. MAIN OUTCOME MEASURES Proportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure. RESULTS A total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine. CONCLUSIONS Fentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings. TRIAL REGISTRATION NUMBER CTRI/2018/03/012878.
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Affiliation(s)
- Shamnad Madathil
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Deena Thomas
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Parijat Chandra
- Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ramesh Agarwal
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - M Jeeva Sankar
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Anu Thukral
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
| | - Ashok Deorari
- Paediatrics, All India Institute of Medical Sciences, New Delhi, New Delhi, India
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Dolma Y, Rajput A, Joji A, Chandra P. Improving surgical scrub time in the eye operation theatre using quality improvement methodology. Indian J Ophthalmol 2021; 69:1972-1973. [PMID: 34146079 PMCID: PMC8374773 DOI: 10.4103/ijo.ijo_1006_21] [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] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yangchen Dolma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Asha Rajput
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anie Joji
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Rani D, Kumar A, Chandra P, Chawla R, Hasan N, Agarwal D. Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial. Indian J Ophthalmol 2021; 69:320-325. [PMID: 33463583 PMCID: PMC7933851 DOI: 10.4103/ijo.ijo_1720_20] [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: 11/24/2022] Open
Abstract
Purpose: To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM). Methods: 68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months. Results: 68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group. Conclusion: 3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.
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Affiliation(s)
- Deeksha Rani
- 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
| | - Parijat Chandra
- 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
| | - Nasiq Hasan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.
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Affiliation(s)
- Komal Agarwal
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand Vinekar
- Department of Pediatric Retina, Narayana Nethralaya Eye Institute, New Delhi, India
| | - Parijat Chandra
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Tapas Ranjan Padhi
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Sameera Nayak
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Kode Venkatadri Chowdhary Campus, Vijaywada, Andhra Pradesh, India
| | - Sushma Jayanna
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Granthi Mallikarjun Rao Varalaksmi Campus, Visakhapatnam, Andhra Pradesh, India
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Srimati Kanuri Santhamma Center for Vitreo-Retina Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Kumar V, Samdani A, Chandra P, Kumar A. Ultra‐wide field imaging of retinal haemangioma in retinitis pigmentosa. Clin Exp Optom 2021; 100:96-97. [DOI: 10.1111/cxo.12437] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Asha Samdani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India,
| | - Parijat Chandra
- 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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Kumawat D, Sachan A, Shah P, Chawla R, Chandra P. Aggressive posterior retinopathy of prematurity: a review on current understanding. Eye (Lond) 2021; 35:1140-1158. [PMID: 33514899 PMCID: PMC8115681 DOI: 10.1038/s41433-021-01392-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023] Open
Abstract
A review of literature was performed, focused on the etiopathogenesis of aggressive posterior retinopathy of prematurity (APROP), the characteristic and atypical clinical features, management strategies, anatomical and visual outcomes. Characteristically APROP has zone I/posterior zone II involvement with prominent plus disease, featureless junction, large vascular loops, flat extra-retinal fibrovascular proliferation, and a rapidly progressive course. The risk factors for APROP are extreme prematurity (birth weight ≤1000 gram and/or gestational age ≤28 weeks), dysregulated oxygen supplementation, intrauterine growth retardation, sepsis, and thrombocytopenia. The uncommon presentations include small zone I disease, a hybrid disease with additional ridge tissue, and APROP in bigger babies with birth weight greater than 1500 g. Laser photocoagulation role is limited by the resultant visual field loss and high refractive error. Although anti-vascular endothelial growth factor injection allows peripheral retinal vascularization; reactivation of disease, systemic absorption of the drug and long-term safety are the chief concerns. Early vitrectomy is required when tractional retinal detachment develops. The visual outcome depends upon the morphology and vascular development of the macula. With the limited yet emerging new understanding of the pathophysiology, a multifaceted rational and individualized treatment strategy is suggested for APROP. Best practices in neonatal intensive care may prevent the occurrence of APROP. Further studies need to be performed for the prevention and safe, effective management of APROP.
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Affiliation(s)
- Devesh Kumawat
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anusha Sachan
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Shah
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- grid.413618.90000 0004 1767 6103Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chandra P, Kumar V, Takkar B, Kumawat D. Silicone Oil Opacification after Prolonged Intraocular Retention. J Ophthalmic Vis Res 2021; 16:300-302. [PMID: 34055268 PMCID: PMC8126750 DOI: 10.18502/jovr.v16i2.9096] [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] [Received: 02/26/2019] [Accepted: 01/24/2021] [Indexed: 11/26/2022] Open
Abstract
This is a Photo Essay and does not have an abstract. Please download the PDF or view the article HTML.
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Affiliation(s)
- Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Sachan A, Chandra P, Agarwal R, Vohra R, Chawla R, Sankar MJ, Kumawat D, Kumar A. Profile of Retinopathy of Prematurity in Outborn and Inborn Babies at a Tertiary Eye Care Hospital. Indian Pediatr 2020; 57:1020-1022. [PMID: 32533682] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the profile of retinopathy of prematurity (ROP) among outborn and inborn babies at a tertiary-care centre. METHODOLOGY In a prospective observational study from 2015-2016, outborn and inborn babies eligible for ROP screening were evaluated for ROP profile and treatment results. RESULTS 532 outborns and 38 inborns had ROP. Respi-ratory distress, sepsis and apnea were present in 81.3%, 51.5% and 36.2% of outborns with ROP and 68.4%, 39.4% and 36.8% of inborns with ROP. Type 1 ROP was noted in 49.2% eyes of outborns with ROP and 36.8% eyes of inborns with ROP. Type 1 ROP regressed with laser in 97.3% and 100% eyes of outborn and inborn with ROP, respectively. Stage 4, 5 and sequelae were noted in 5.2%, 22.8% and 4.6% eyes of outborns with ROP, respectively, but none in inborns. CONCLUSIONS Quality neonatal care and timely screening ensured lesser ROP-related morbidity in inborns as compared to outborns.
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Affiliation(s)
- Anusha Sachan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India. Correspondence to: Dr Parijat Chandra, Professor, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110 029, India.
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - M Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
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Sachan A, Chandra P, Agarwal R, Vohra R, Chawla R, Sankar MJ, Kumawat D, Kumar A. Profile of Retinopathy of Prematurity in Outborn and Inborn Babies at a Tertiary Eye Care Hospital. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shah PR, Sachan A, Chandra P. Retrolental Hemorrhage in Berger's Space After Intravitreal Bevacizumab Injection for Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2020; 57:e71-e73. [PMID: 33090229 DOI: 10.3928/01913913-20200817-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
A preterm neonate with type 1 retinopathy of prematurity in posterior zone II presented with hemorrhage in Berger's space immediately after intravitreal bevacizumab injection. The authors report a rare case of successful self-resolution and discuss the need for proper injection technique to prevent this complication. [J Pediatr Ophthalmol Strabismus. 2020;57:e71-e73.].
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Agarwal D, Chawla R, Varshney T, Shaikh N, Chandra P, Kumar A. Managing vitreoretinal surgeries during COVID-19 lockdown in India: Experiences and future implications. Indian J Ophthalmol 2020; 68:2126-2130. [PMID: 32971623 PMCID: PMC7727968 DOI: 10.4103/ijo.ijo_2140_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 02/06/2023] Open
Abstract
Purpose: The study aims to describe the clinical and demographic profile of patients who required vitreoretinal surgeries during the novel coronavirus disease-2019 (COVID-19) lockdown in India. It also reports our operating protocols and initial experience while performing vitreoretinal surgeries during COVID-19 times at a government tertiary eye care hospital. Methods: This is a retrospective cross-sectional observational study of patients requiring emergent/urgent vitreoretinal surgeries between March 25, 2020 and May 31, 2020. A modified working protocol focussing on the enforcement of standard COVID-19 precautions, OT sterilization, and formation of dedicated infection control and disease surveillance committee was adopted. Patients underwent standard vitreoretinal procedures under general/local anesthesia. Relevant demographic and clinical data were recorded and analyzed. Surveillance data of healthcare workers (HCW) was also analyzed. Results: Eighty six patients were considered for vitreoretinal surgery in this period. Finally, 83 patients underwent surgery. The mean age of the patients was 38.4 ± 20.1 years (Range, 1 month - 75 years). Majority of them were males (66%) and adults (82.6%). Majority of them came from nearby hotspot areas. Most common indications were acute retinal detachment (38.5%) and diabetic vitrectomies (22.9%). Trauma-related cases (14.4%) were less. Surgery was deferred in 3 patients who turned out to be COVID-19 positive. 4 HCWs were quarantined but none of them developed COVID-19 disease. Conclusion: During COVID-19 lockdown, vitreoretinal surgeries were most commonly performed for retinal detachment and diabetic complications. Proper implementation of infection control protocols helps in delivering adequate patient care while ensuring the safety of caregivers during this pandemic.
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Affiliation(s)
- Divya Agarwal
- 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
| | - Toshit Varshney
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nawazish Shaikh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- 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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Senjam SS, Chandra P. Retinopathy of prematurity: Addressing the emerging burden in developing countries. J Family Med Prim Care 2020; 9:2600-2605. [PMID: 32984093 PMCID: PMC7491791 DOI: 10.4103/jfmpc.jfmpc_110_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/18/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations.
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Affiliation(s)
- Suraj Singh Senjam
- Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Vitreoretina and ROP Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Elsayed E, Abuyaqoub S, Almallahi N, Alam F, Saleh R, Chandra P, Almulla N, Al Kahlout M, Hamed M, Abdulla N, Al Emadi S. FRI0061 THE ADVERSE OBSTETRIC OUTCOMES WHEN RHEUMATOID ARTHRITIS IS CONTROLLED DURING PREGNANCY: IS THE DISEASE ITSELF A PROBLEM? DATA FROM A CASE-CONTROL COHORT OF 190 PREGNANCIES AT A MULTI-NATIONALITY SPECIALIZED CENTER IN QATAR. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6073] [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: 11/03/2022]
Abstract
Background:Rheumatoid arthritis is implicated in causing adverse pregnancy outcomes including high rates of prematurity and low birth weight. But little is known about the impact of the disease when it’s controlled as most of the information is extracted from retrospective data.Objectives:To examine the adverse obstetric outcomes after controlling disease during pregnancy. We also took into account many confounders that might affect the outcome.Methods:This is an ongoing Case-Control Prospective Cohort. It is implemented in a tertiary center where cases are recruited from a single specialized pregnancy and rheumatic disease clinic to ensure standardized management. These cases were fulfilling the ACR 2010 classification criteria for rheumatoid arthritis. Disease activity was measured using CDAI once before pregnancy and once in each trimester. We excluded subjects with chronic morbidities or twin pregnancy. Data were collected in pre-specified data sheets. Routine blood tests in addition to C-reactive protein were obtained. Cases were recruited at different disease activity stages, but treatment was escalated to reach remission as possible by the third trimester. Data were analyzed using SPSS software for descriptive and comparative analyses.Results:Since 2017 we have recruited 215 subjects. A total of 190 completed pregnancies were analyzed in this report (114 controls and 76 cases). Five subjects were excluded as their disease was not controlled by 27 weeks of gestation. Baseline characteristics of age, baseline BMI and anemia were similar. Exposure to passive smoking was significantly higher in the control group. There was no statistical difference in the incidence of gestational diabetes, pre-eclampsia and infections. Rates of abortions and cesarean sections were significantly higher in the cases group. The incidence of PROM & low birth weight was not statistically different. Three cases of IUFD were reported among controls versus none in the cases (Table 1). Prematurity rate was numerically higher in the control group but did not reach a statistical difference. Congenital anomalies and NICU admission rates were comparable between the groups. But the incidence of neonatal morbidities was significantly higher in the control group (p. value 0.006), but the majority of morbidities were due to jaundice that resolved with phototherapy. we have evaluated the incidence of group B streptococcal Agalactae as a possible contributor to morbidities but it was similar between the groups. All cases were on DMARDs during pregnancy. Hydroxychloroquine was the most commonly used (55%) followed by sulfasalazine (40%). Steroid was used for variable duration in pregnancy in 23 cases. In most of them, it was tapered and stopped by the end of pregnancy. Biologics were used in 15 cases with few adverse outcomes including: abortion (1 case), PROM (1), maternal UTI (1), repeated URT infection (1) and neonatal bronchiolitis (1).Table 1.Birth OutcomesBirth OutcomeCases (n)Controls (n)P.valueAbortion910.001IUFD030.18PROM180.09Cesarean20170.02LBW680.68Premature8250.74Conclusion:From this ongoing cohort we conclude that controlled RA during pregnancy carries low risk of adverse obstetric outcomes in spite the regular use of DMARDs. Although these results are reassuring, further regression models are required after recruiting more subjects.References:[1]Johanna M. W. Hazes. (2011). Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.Rheumatology, 50:1955-1968Disclosure of Interests:None declared
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Sen P, Wu WC, Chandra P, Vinekar A, Manchegowda PT, Bhende P. Retinopathy of prematurity treatment: Asian perspectives. Eye (Lond) 2020; 34:632-642. [PMID: 31664193 PMCID: PMC7093470 DOI: 10.1038/s41433-019-0643-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/20/2019] [Accepted: 07/05/2019] [Indexed: 01/04/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.
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Affiliation(s)
- Parveen Sen
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Wei-Chi Wu
- Chang Gung Memorial Hospital Taoyuan, Taoyuan, Taiwan
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Vinekar
- Paediatric Retina Department, Narayana Nethralaya, Bangalore, India
| | | | - Pramod Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
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Kumawat D, Kumar V, Sahay P, Nongrem G, Chandra P. Bilateral asymmetrical partial heterochromia of iris and fundus in Waardenburg syndrome type 2A with a novel MITF gene mutation. Indian J Ophthalmol 2020; 67:1481-1483. [PMID: 31436206 PMCID: PMC6727726 DOI: 10.4103/ijo.ijo_181_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/22/2022] Open
Abstract
A 3-year-old girl presented with bilateral asymmetrical partial heterochromia of iris and fundus. The parents also complained of bilateral hearing loss in the child. Suspecting an auditory-pigmentary syndrome, systemic and genetic evaluation was performed. The child had profound sensory-neural hearing loss. Targeted gene sequencing revealed a novel nonsense variation in exon 9 of the MITF gene (chr3:70008440A>T) that was pathogenic for Waardenburg syndrome (WS) type 2A. This case highlights the characteristics of the iris and fundus hypochromia, which may provide a clue toward the diagnosis of WS.
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Affiliation(s)
- Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Grisilda Nongrem
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chandra P, Kumawat D, Agarwal D, Chawla R. Combined Vitrectomy and Anti-VEGF Treatment for Stage 4 Retinopathy of Prematurity With Extensive Neovascular Proliferation. J Pediatr Ophthalmol Strabismus 2020; 57:61-66. [PMID: 31972043 DOI: 10.3928/01913913-20191030-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/03/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the role of combined vitrectomy and intravitreal anti-vascular endothelial growth factor (VEGF) injection for stage 4 retinopathy of prematurity (ROP) with extensive neovascular proliferation. METHODS In a retrospective interventional study at a tertiary eye care center, 15 eyes (9 infants) with advanced stage 4 ROP underwent 25-gauge vitrectomy combined with intravitreal 0.625 mg of bevacizumab (n = 12) or 0.25 mg of ranibizumab (n = 3) injection and were followed up until 65 weeks' postconceptional age (PCA). The perinatal history, tractional retinal detachment (TRD) characteristics (zone, stage, and presence of "plus" disease), treatment details, and anatomical outcomes were reviewed. The main outcome measures were fibrovascular tissue and TRD regression and final macular status. RESULTS Mean gestational age and birth weight were 28.5 ± 1.2 weeks and 1,167 ± 185 g, respectively. Thirteen eyes had zone I disease and 2 eyes had zone II disease. Thirteen eyes were stage 4A and 2 eyes were stage 4B ROP. The morphology was aggressive posterior ROP in 10 eyes. The mean PCA at surgery was 37.8 ± 2.3 weeks. Lensectomy was also performed in 2 eyes. Rapid fibrovascular tissue regression was seen in 14 eyes within 2 weeks, followed by TRD regression and macular vascularization, although 2 eyes had macular pucker formation. Persistent vitreous bleeding was present in 1 eye, which needed lavage, and eventually the TRD regressed. Disease reactivation was noted in 1 eye at 5 weeks and was managed with repeat intravitreal anti-VEGF injection. CONCLUSIONS Anti-VEGF treatment combined with vitrectomy leads to rapid disease regression in advanced stage 4 ROP with extensive neovascular proliferation. [J Pediatr Ophthalmol Strabismus. 2020;57(1):61-66.].
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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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Jain S, Kumar V, Salunkhe N, Tewari R, Chandra P, Kumar A. Swept-Source OCT Analysis of the Margin of Choroidal Coloboma: New Insights. Ophthalmol Retina 2019; 4:92-99. [PMID: 31678052 DOI: 10.1016/j.oret.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE To study the retinal architecture and vitreoretinal interface at the edge of choroidal coloboma using swept-source OCT. DESIGN Prospective observational case series at a tertiary eye care center. PARTICIPANTS Patients with choroidal coloboma treated at an ophthalmology department and fulfilling the inclusion criteria of the study. METHODS Swept-source OCT was carried out in 30 eyes of 20 patients with choroidal coloboma. MAIN OUTCOME MEASURES The primary objective was to describe the OCT features at the margin of the coloboma. RESULTS Swept-source OCT of the coloboma margin revealed new features in addition to the previously described findings. Two types of transition from normal retina into intercalary membrane (ICM) were noted: abrupt (73.33%) and gradual (26.67%). Outer retinal layers (interdigitation zone and ellipsoid zone) terminated at a variable distance before the retinal pigment epithelium in 56.67% of eyes. Cystic spaces in the ICM (46.67%), schisis-like spitting of the ICM (30%), and breaks in the ICM (6.67%) were seen as well. Subclinical retinal detachment (RD) was also noted in 1 eye. The peculiar features noted at the vitreoretinal interface included vitreous attachment at the coloboma margin (23.33%), vitreous condensation (6.67%), and hill like projections of ICM into the vitreous cavity (26.67%). In the region of the coloboma, sclera and Tenon's capsule could also be analyzed as a hyperreflective lamellar structure and an irregularly arranged less hyperreflective structure. CONCLUSIONS Swept-source OCT of the coloboma margin revealed various new features in addition to those described previously. The detection of subclinical RD or early termination of outer retinal layers in selected cases may be helpful in guiding new management protocols.
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Affiliation(s)
- Shreyans Jain
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Nitesh Salunkhe
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Balakrishnan S, Narasimhan S, Chandra P. Pattern analysis of FDG pet in atypical parkinsonism - An innovative approach. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Goel S, Kumar A, Ravani RD, Chandra P, Chandra M, Kumar V. Comparison of ranibizumab alone versus ranibizumab with targeted retinal laser for branch retinal vein occlusion with macular edema. Indian J Ophthalmol 2019; 67:1105-1108. [PMID: 31238421 PMCID: PMC6611316 DOI: 10.4103/ijo.ijo_1364_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/09/2022] Open
Abstract
Purpose: To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ). Methods: 33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months. Results: Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 μm, P < 0.001 vs. 253.75 ± 137.9 μm, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively). Conclusion: UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.
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Affiliation(s)
- Siddhi Goel
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Raghav D Ravani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mahesh Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract
A preterm infant with zone 1 aggressive posterior retinopathy of prematurity developed infectious endophthalmitis after intravitreal injection of ranibizumab. Urgent empirical intravitreal therapy with vancomycin, ceftazidime, and dexamethasone along with intravenous therapy with amikacin and meropenem helped in early resolution. Vascularization/activity of disease subsided on follow-up, media cleared, and laser photocoagulation was completed. Later the disease reactivated, developed vitreous membranes and central retinal traction, for which 25-gauge lens-sparing vitrectomy was performed. Emergent treatment helped in salvaging the eye from both aggressive ROP disease and devastating endophthalmitis. Rationale approach to such a case is being discussed.
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Affiliation(s)
- Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Azimeera
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Chandra P, Tewari R, Salunkhe N, Kumawat D, Chaurasia AK, Gupta V. Short-term incidence and management of glaucoma after successful surgery for stage 4 retinopathy of prematurity. Indian J Ophthalmol 2019; 67:917-921. [PMID: 31124515 PMCID: PMC6552587 DOI: 10.4103/ijo.ijo_33_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/28/2023] Open
Abstract
Purpose: The purpose of this study is to describe the short-term incidence, clinical features, and management of glaucoma in children after successful surgery for stage 4 retinopathy of prematurity (ROP). Methods: The retrospective study included all eyes undergoing successful surgery for stage 4 ROP with good outcomes at a tertiary eye care center between June 2014 and June 2016. Cases developing postoperative glaucoma underwent examination under anesthesia for measurement of intraocular pressures (IOP), corneal diameters, Retcam-assisted fundus imaging, and gonioscopy. Outcomes of glaucoma management were evaluated. Results: Hundred eyes of 70 babies underwent successful surgery for stage 4 ROP (with postoperative attached retina, and minimal sequelae) with minimum follow-up of 15 months. Six eyes (6%) developed postoperative glaucoma. Of these, four eyes had undergone lens-sparing vitrectomy and two were managed with lensectomy and vitrectomy (LV). Median time duration for development of glaucoma after primary vitreous surgery was 17.5 weeks. Two cases could be managed with topical IOP-lowering agents alone, whereas four required filtering surgeries (trabeculotomy with trabeculectomy and 0.04% mitomycin C [MMC] application). Average IOP decreased from 25 ± 2.36 to 12.2 ± 2.05 mmHg at 12 months from glaucoma diagnosis. Conclusion: Glaucoma is a potential adverse event following successful vitreous surgery for stage 4 ROP. A combined trabeculotomy–trabeculectomy along with MMC gives favorable outcome.
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Affiliation(s)
- Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Salunkhe
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abadh K Chaurasia
- 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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Bhayana AA, Kumawat D, Kumar V, Chandra M, Chandra P, Sihota R, Kumar A. Interocular asymmetry in choroidal thickness in healthy Indian population using swept-source optical coherence tomography. Indian J Ophthalmol 2019; 67:1252-1253. [PMID: 31238487 PMCID: PMC6611235 DOI: 10.4103/ijo.ijo_8_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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)
- Amber Amar Bhayana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ramanjit Sihota
- 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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Chandra P, Kumawat D, Tewari R, Sinha R. Surgical outcomes of immediate sequential bilateral vitreoretinal surgery for advancing retinopathy of prematurity. Indian J Ophthalmol 2019; 67:903-907. [PMID: 31124512 PMCID: PMC6552586 DOI: 10.4103/ijo.ijo_741_18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP. Methods: In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status. Results: The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20–68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease. Conclusion: ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.
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Affiliation(s)
- Parijat Chandra
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Renu Sinha
- Department of Ocular Anaesthesia, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Purpose To compare the outcomes of conventional laser photocoagulation versus additional posterior barrage laser in advanced stage 3 retinopathy of prematurity (ROP). Methods A total of 20 infants with bilateral symmetric zone 2 stage 3 advancing ROP were treated with conventional laser treatment followed by randomization of one eye to receive additional posterior retinal laser treatment. Disc-fovea and inter-arcade distance was measured. The patients were followed up prospectively for 3 months. Structural and functional outcomes and safety profile were analyzed. Results 18/20 (90%) eyes in the study group and 19/20 (95%) eyes in the control group achieved regression of disease. Faster and complete regression was observed at 4 weeks after posterior laser compared to the control group (P = 0.024). Disc-fovea and inter-arcade distance was comparable in both groups. Conclusion Additional posterior barrage laser is a safe technique that led to faster and more complete regression in eyes with advancing ROP. Final regression profile was comparable in both treatment modalities.
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Affiliation(s)
- Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajvardhan Azad
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
A safe technique for entry incisions and closure in stage 5 retinopathy of prematurity (ROP) surgery is being described. Three 23G clear corneal incisions are made which allow for safe and snug entry of 25G calibrated infusion and 25G instruments for performing lensectomy, membrane removal and vitrectomy. At the end of surgery, air is injected and corneal entries are hydrated for sutureless closure. The technique was performed in 50 eyes of 36 children with stage 5 ROP. The hybrid technique ensured safe entry and exit with stable anterior chamber during surgery. None of the cases developed retinal breaks during surgical entry nor had any complications such as hypotony, flat anterior chamber, hyphaema or corneal edema in post operative period. Clear corneal entry using 23G incisions for 25G instrument access is a safe and effective technique for performing lensectomy and vitrectomy with sutureless closure in cases with stage 5 ROP.
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Affiliation(s)
- Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
We report a case of retinopathy of prematurity (ROP) in an infant with oculocutaneous albinism (OCA), with the challenges faced in diagnosis, and subsequent management. Poor fundus contrast and blanching of retinal vessels on indentation caused significant visualization problems in detection of ridge and extraretinal vessel proliferation. Careful examination revealed zone 2 Stage 3 ROP with preplus disease in both eyes. Laser photocoagulation was attempted, but laser uptake was poor. The disease regressed over 3-week close follow-up. ROP along with OCA is a rare finding. There is a need for high index of suspicion and caution while screening and managing such babies.
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Affiliation(s)
- Parijat Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nitesh Salunkhe
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Devesh Kumawat
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ruchir Tewari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Vanathi M, Kumawat D, Singh R, Chandra P. Iatrogenic Crystalline Lens Injury in Pediatric Eyes Following Intravitreal Injection for Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2019; 56:162-167. [PMID: 31116863 DOI: 10.3928/01913913-20190211-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the occurrence of lens injury during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in infants with retinopathy of prematurity (ROP). METHODS ROP cases presenting to a tertiary care center with cataract following intravitreal injection were retrospectively studied from June 2017 to May 2018. The indication, setting, and method of injection were noted. Ultrasound biomicroscopy (UBM) details were recorded. The main measures were morphology of cataract, posterior capsular defect, and intraocular lens (IOL) placement. RESULTS Three children (mean age: 14 ± 8.6 months, two male and one female) received injection elsewhere under topical anesthesia in the neonatal intensive care unit (NICU) for type 1 ROP (stage 3 in zone I or II with significant plus disease) 9 to 18 months earlier. All cases developed cataract caused by intravitreal needle damaging the posterior capsule. In one case, a dense zonular cataract was present and peripheral dehiscence of the posterior capsule became evident only during lens aspiration. The second and third cases had a central posterior subcapsular cataract. Preexisting central dehiscence of the posterior capsule was noted on UBM and confirmed during surgery. A multi-piece IOL was securely placed in all cases. At last follow-up (median: 6 months; range: 3 to 6 months), the IOL was stable and centered in all cases with a clear visual axis. CONCLUSIONS The increasing occurrence of cataract in treatment-requiring ROP following intravitreal anti-VEGF injections being given by practitioners in the NICU setting under topical anesthesia that hinders optimal visualization and technique is a significant concern. [J Pediatr Ophthalmol Strabismus. 2019;56(3):162-167.].
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Kumawat D, Jayaraman N, Sahay P, Chandra P. Multicoloured lenticular opacities in a case of cerulean cataract. BMJ Case Rep 2019; 12:12/4/e230167. [DOI: 10.1136/bcr-2019-230167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Khokhar S, Chandra P, Gupta Y, Kumawat D, Dhull C. Bilateral Total Cataract After Intravitreal Bevacizumab Injection in Aggressive Posterior Retinopathy of Prematurity. J Pediatr Ophthalmol Strabismus 2019; 56:e28-e30. [PMID: 30907975 DOI: 10.3928/01913913-20190219-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/18/2019] [Indexed: 11/20/2022]
Abstract
The authors report a rare occurrence of bilateral cataract in eyes with aggressive posterior retinopathy of prematurity after bilateral administration of intravitreal bevacizumab in a neonate, with no evidence of lens touch. Although the exact mechanism of cataractogenesis is unclear, the possibility of local drug toxicity needs to be investigated. [J Pediatr Ophthalmol Strabismus. 2019;56:e28-e30.].
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Manasa S, Kakkar P, Kumar A, Chandra P, Kumar V, Ravani R. Comparative Evaluation of Standard ILM Peel With Inverted ILM Flap Technique In Large Macular Holes: A Prospective, Randomized Study. Ophthalmic Surg Lasers Imaging Retina 2019; 49:236-240. [PMID: 29664979 DOI: 10.3928/23258160-20180329-04] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/03/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the outcomes of inverted internal limiting membrane (ILM) flap technique (IFT) with the standard ILM peel (SIP) for large macular holes (MHs). PATIENTS AND METHODS This is a prospective, randomized study in which 100 patients with idiopathic MHs with minimum linear dimension of 600 μm or greater were recruited. Group 1 underwent SIP and group 2 underwent IFT. Best-corrected visual acuity (BCVA), type of MH closure, and multifocal electroretinogram (mfERG) were evaluated at presentation, 1 week, 1 month, and 3 months postoperatively. RESULTS Mean postoperative BCVA was 0.86 ± 0.19 in group 1 and 0.67 ± 0.3 in group 2 at 3 months postoperatively (P = .001). Type 1 closure was observed in 34.04% of patients in group 1 and in 62.79% of patients in group 2 (P = .02). mfERG showed improvement in both groups. CONCLUSION IFT provides superior outcomes compared to SIP and, hence, could be considered as the surgical modality of choice in large MH. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:236-240.].
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Bhayana AA, Kumar V, Tayade A, Chandra M, Chandra P, Kumar A. Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography. Indian J Ophthalmol 2019; 67:252-255. [PMID: 30672480 PMCID: PMC6376823 DOI: 10.4103/ijo.ijo_668_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/30/2022] Open
Abstract
Purpose: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. Methods: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19–60 years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness were excluded. Twelve radial line scans were obtained centered on the fovea that were used to calculate choroidal and retinal thickness in 9 early treatment diabetic retinopathy study (ETDRS) zones. Results: The mean age of all the subjects was 28.70 ± 11.28 years; mean axial length was 23.63 ± 1.96 mm, and mean spherical equivalent was − 0.92 ± 3.08 D. The mean subfoveal choroidal thickness was 299.10 ± 131.2 μ and mean foveal thickness was 239.92 ± 48.16 μ. A negative correlation was found between subfoveal choroidal thickness and age (r = −0.0961, P = 0.1392) and axial length (r = −0.3166, P < 0.001). A statistically significant positive correlation was found between subfoveal choroidal thickness and refractive error (r = 0.2393, P = 0.0002). Conclusion: This study provides normative database for subfoveal choroidal thickness and foveal thickness using swept-source optical coherence tomography. The choroidal thickness measured with swept-source platform is slightly higher than that reported with spectral domain platforms.
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Affiliation(s)
- Amber A Bhayana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Tayade
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Chandra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Parijat Chandra
- 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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Deorari A, Chandra P. Quality improvement: A new paradigm in health care. Apollo Med 2019. [DOI: 10.4103/am.am_20_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chandra P, Kumawat D, Sahay P, Alam T, Bhari A. Ocular auto-stimulation and its morbidity in stage 5 retinopathy of prematurity. Indian J Ophthalmol 2019; 67:912-916. [PMID: 31124514 PMCID: PMC6552578 DOI: 10.4103/ijo.ijo_2116_18] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the characteristics and morbidity due to ocular auto-stimulation (OAS) in stage 5 Retinopathy of Prematurity (ROP). Methods: Stage 5 ROP cases presenting to ROP clinic of a tertiary care centre from January 2017 to December 2017 were recruited. Eye-pressing was elicited on history from parents and categorized as infrequent (performed <50% of waking time) or frequent (≥50% of time). B-scan ultrasonography was performed for configuration of retinal detachment (open or closed funnel). Keratometry was performed in eyes undergoing vitrectomy under general anaesthesia using automated hand-held keratometer. The outcome measures were the presence and characteristics of OAS, enophthalmos, corneal opacity and keratometry values. Results: Out of 93 eyes of 49 babies, 78.5% (n = 73) had OAS. Gestational age, birth weight, sex, retinal funnel configuration, and visual function did not significantly affect OAS. However, post-conceptional age was significantly greater in eyes with OAS (95% CI: 63.1 to 69.9 weeks) than those without OAS (95% CI: 52.4 to 63.4 weeks) (P = 0.018). OAS occurred frequently in 32.8% (n = 24/73) eyes, more commonly in eyes with light followability. Keratometry did not differ significantly with the presence of OAS (P = 0.88). Enophthalmos, corneal opacity, posterior synechiae were noted in 79.5% (58/73), 21.9% (16/73), and 28.8% (21/73) eyes with OAS, respectively. Enophthalmos occurred significantly in eyes with OAS (P = 0.001), while corneal opacity and posterior synechiae did not (P = 0.071 and 0.91, respectively). Conclusion: OAS and its resultant morbidity are common occurrences in stage 5 ROP. The post-conceptional age and residual visual function may govern the characteristics of OAS.
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