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Agrawal P, Tiwari A, Chowdhury SK, Vohra M, Gour A, Waghmare N, Bhutani U, Kamalnath S, Sangwan B, Rajput J, Raj R, Rajendran NP, Kamath AV, Haddadin R, Chandru A, Sangwan VS, Bhowmick T. Kuragel: A biomimetic hydrogel scaffold designed to promote corneal regeneration. iScience 2024; 27:109641. [PMID: 38646166 PMCID: PMC11031829 DOI: 10.1016/j.isci.2024.109641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024] Open
Abstract
Cornea-related injuries are the most common cause of blindness worldwide. Transplantation remains the primary approach for addressing corneal blindness, though the demand for donor corneas outmatches the supply by millions. Tissue adhesives employed to seal corneal wounds have shown inefficient healing and incomplete vision restoration. We have developed a biodegradable hydrogel - Kuragel, with the ability to promote corneal regeneration. Functionalized gelatin and hyaluronic acid form photo-crosslinkable hydrogel with transparency and compressive modulus similar to healthy human cornea. Kuragel composition was tuned to achieve sufficient adhesive strength for sutureless integration to host tissue, with minimal swelling post-administration. Studies in the New Zealand rabbit mechanical injury model affecting corneal epithelium and stroma demonstrate that Kuragel efficiently promotes re-epithelialization within 1 month of administration, while stroma and sub-basal nerve plexus regenerate within 3 months. We propose Kuragel as a regenerative treatment for patients suffering from corneal defects including thinning, by restoration of transparency and thickness.
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Affiliation(s)
| | - Anil Tiwari
- Pandorum Technologies Pvt., Ltd, Bangalore, India
- Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | | | - Mehak Vohra
- Pandorum Technologies Pvt., Ltd, Bangalore, India
| | - Abha Gour
- Pandorum Technologies Pvt., Ltd, Bangalore, India
- Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | | | | | - S. Kamalnath
- Pandorum Technologies Pvt., Ltd, Bangalore, India
| | | | - Jyoti Rajput
- Pandorum Technologies Pvt., Ltd, Bangalore, India
| | - Ritu Raj
- Pandorum Technologies Pvt., Ltd, Bangalore, India
| | | | | | - Ramez Haddadin
- Feinberg School of Medicine Northwestern University, Chicago, IL, USA
| | - Arun Chandru
- Pandorum Technologies Pvt., Ltd, Bangalore, India
| | | | - Tuhin Bhowmick
- Pandorum Technologies Pvt., Ltd, Bangalore, India
- Pandorum International Inc, San Francisco, CA, USA
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2
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Mondal M, Vohra M, Sangwan J, Verma S, Coulson-Thomas VJ, Chandru A, Bhowmick T, Sangwan VS, Acharya M, Tiwari A. In vitro Assay to Examine the Function of Tears on Corneal Epithelial Cells. Bio Protoc 2024; 14:e4910. [PMID: 38213327 PMCID: PMC10777051 DOI: 10.21769/bioprotoc.4910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
Tears contain numerous secreted factors, enzymes, and proteins that help in maintaining the homeostatic condition of the eye and also protect it from the external environment. However, alterations to these enzymes and/or proteins during pathologies such as mechanical injury and viral or fungal infections can disrupt the normal ocular homeostasis, further contributing to disease development. Several tear film components have a significant role in curbing disease progression and promoting corneal regeneration. Additionally, several factors related to disease progression are secreted into the tear film, thereby serving as a valuable reservoir of biomarkers. Tears are readily available and can be collected via non-invasive techniques or simply from contact lenses. Tears can thus serve as a valuable and easy source for studying disease-specific biomarkers. Significant advancements have been made in recent years in the field of tear film proteomics, lipidomics, and transcriptomics to allow a better understanding of how tears can be utilized to gain insight into the etiology of diseases. These advancements have enabled us to study the pathophysiology of various disease states using tear samples. However, the mechanisms by which tears help to maintain corneal homeostasis and how they are able to form the first line of defense against pathogens remain poorly understood and warrant detailed in vitro studies. Herein, we have developed an in vitro assay to characterize the functional importance of patient isolated tears and their components on corneal epithelial cells. This novel approach closely mimics real physiological conditions and could help the researchers gain insight into the underlying mechanisms of ocular pathologies and develop new treatments. Key features • This method provides a new technique for analyzing the effect of tear components on human corneal epithelial cells. • The components of the tears that are altered in response to diseases can be used as a biomarker for detecting ocular complications. • This procedure can be further employed as an in vitro model for assessing the efficacy of drugs and discover potential therapeutic interventions.
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Affiliation(s)
- Moumita Mondal
- Eicher-Shroff Center for Stem Cell Research, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Mehak Vohra
- Pandorum technologies Pvt. Ltd., Bangalore, India
| | - Jyoti Sangwan
- Eicher-Shroff Center for Stem Cell Research, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Sudhir Verma
- Department of Zoology, Deen Dayal Upadhyaya College, New Delhi, India
- College of Optometry, University of Houston, Houston, TX, USA
| | | | - Arun Chandru
- Pandorum technologies Pvt. Ltd., Bangalore, India
| | | | - Virender S. Sangwan
- Eicher-Shroff Center for Stem Cell Research, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
- Department of Cornea, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Manisha Acharya
- Department of Cornea, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Anil Tiwari
- Eicher-Shroff Center for Stem Cell Research, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
- Department of Cornea, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
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Donthineni PR, Deshmukh R, Ramamurthy C, Sangwan VS, Mehta JS, Basu S. Management of cataract in dry eye disease: Preferred practice pattern guidelines. Indian J Ophthalmol 2023; 71:1364-1372. [PMID: 37026268 DOI: 10.4103/ijo.ijo_2807_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.
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Affiliation(s)
- Pragnya R Donthineni
- Shantilal Sanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rashmi Deshmukh
- Refractive and Cataract Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Chitra Ramamurthy
- Cataract and IOL Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Virender S Sangwan
- Department of Cornea and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Jodhbir S Mehta
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore
| | - Sayan Basu
- Shantilal Sanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Rao AT, Gupta A, Chauhan T, Basu S, Batra N, Sharma N, Sangwan VS, Gupta V, Mukherjee S. Efficacy and safety of 0.05% micellar nano-particulate (MNP) cyclosporine ophthalmic emulsion in the treatment of moderate-to-severe keratoconjunctivitis sicca: a 12-week, multicenter, randomized, active-controlled trial. BMC Ophthalmol 2023; 23:121. [PMID: 36973703 PMCID: PMC10041473 DOI: 10.1186/s12886-023-02838-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Keratoconjunctivitis sicca or dry eye disease (DED) is a multifactorial disorder underpinned by a complex inflammatory cycle. Introduction of topical cyclosporine has been a significant advance in the management of DED. In recent years advancements in formulation technology have led to development of micellar nano-particulate (MNP) cyclosporine formulations that promise better penetration into ocular target tissues and potential for reduced ocular surface irritation.
Methods
We compared two dosing regimes of a proprietary MNP cyclosporine emulsion with the widely marketed topical cyclosporine formulation Restasis™ in a multicenter parallel-group randomised trial in patients with DED. Patients were randomised to one of 3 treatment groups with 90 patients eligible for the per protocol analysis: 30 in the higher dose test arm A; 32 in the lower dose test arm B; and 28 in the Restasis™ control arm C. All scored efficacy endpoints were tested for significance by comparing the mean change in scores from baseline in the test groups with that in the control group at 12 weeks, using the Student’s t test. Wilcoxon’s rank sum test was used to test individual symptom scores and clinician’s global evaluation of treatment grades.
Results
Corneal fluorescein staining score, the primary efficacy endpoint, decreased by 6.8 ± 4.0, 5.7 ± 3.9, and 4.6 ± 3.6 points in the 3 groups respectively, indicating superior efficacy in test arm A in comparison to control arm C (p = 0.0026). Schirmer’s tear test, conjunctival lissamine staining score, ocular surface disease index, and individual dry eye symptom scores also favoured higher dose MNP cyclosporine over Restasis™. The study failed to differentiate the treatment arms in terms of clinician’s global evaluation of treatment, use of tear substitutes, best corrected visual acuity or safety and toleration.
Conclusion
The results indicate that the dose of 1 drop of a 0.05% w/v ophthalmic emulsion of MNP cyclosporine administered topically twice daily yields better outcomes at 12 weeks than the lower dose tested in the study, and is more efficacious than an equivalent dose of Restasis™, the active control used in the study.
Trial registration
This trial was registered in the Clinical Trials Registry of India on 29/03/2019, and was assigned registration number CTRI/2019/03/018319.
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Tavakkoli F, Eleiwa TK, Elhusseiny AM, Damala M, Rai AK, Cheraqpour K, Ansari MH, Doroudian M, H Keshel S, Soleimani M, Djalilian AR, Sangwan VS, Singh V. Corneal stem cells niche and homeostasis impacts in regenerative medicine; concise review. Eur J Ophthalmol 2023:11206721221150065. [PMID: 36604831 DOI: 10.1177/11206721221150065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The limbal stem cells niche (LSCN) is an optimal microenvironment that provides the limbal epithelial stem cells (LESCs) and strictly regulates their proliferation and differentiation. Disturbing the LSCN homeostasis can lead to limbal stem cell dysfunction (LSCD) and subsequent ocular surface aberrations, such as corneal stromal inflammation, persistent epithelial defects, corneal neovascularisation, lymphangiogenesis, corneal opacification, and conjunctivalization. As ocular surface disorders are considered the second main cause of blindness, it becomes crucial to explore different therapeutic strategies for restoring the functions of the LSCN. A major limitation of corneal transplantation is the current shortage of donor tissue to meet the requirements worldwide. In this context, it becomes mandatory to find an alternative regenerative medicine, such as using cultured limbal epithelial/stromal stem cells, inducing the production of corneal like cells by using other sources of stem cells, and using tissue engineering methods aiming to produce the three-dimensional (3D) printed cornea. Limbal epithelial stem cells have been considered the magic potion for eye treatment. Epithelial and stromal stem cells in the limbal niche hold the responsibility of replenishing the corneal epithelium. These stem cells are being used for transplantation to maintain corneal epithelial integrity and ultimately sustain optimal vision. In this review, we summarised the characteristics of the LSCN and their current and future roles in restoring corneal homeostasis in eyes with LSCD.
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Affiliation(s)
- Fatemeh Tavakkoli
- Department of Community Health, College of Health Technology, Cihan University, Erbil, Iraq.,SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India.,Centre for Genetic Disorders, Banaras Hindu University, Varanasi, India
| | - Taher K Eleiwa
- Department of Ophthalmology, Benha University, Benha, Egypt
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mukesh Damala
- SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India.,School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Amit K Rai
- Centre for Genetic Disorders, Banaras Hindu University, Varanasi, India
| | - Kasra Cheraqpour
- Translational Eye Research Center, Farabi Eye Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Ansari
- Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad Medical Center, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Doroudian
- Department of Cell and Molecular Biology, Faculty of Biological Sciences, 145440Kharazmi University, Tehran, Iran
| | - Saeed H Keshel
- Department of Tissue Engineering and Applied Cell Sciences, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology, 159636Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali R Djalilian
- Department of Ophthalmology, 159636Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Vivek Singh
- SSR Stem Cell Biology Laboratory, Brien Holden Eye Research Centre, Centre for Ocular Regeneration, Hyderabad Eye Research Foundation, L.V. Prasad Eye Institute, Hyderabad, India
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Sabhapandit S, Murthy SI, Sharma N, Sangwan VS. Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome. Clin Ophthalmol 2022; 16:3547-3557. [PMID: 36274679 PMCID: PMC9579814 DOI: 10.2147/opth.s385782] [Citation(s) in RCA: 2] [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] [Received: 08/10/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
Peripheral ulcerative keratitis (PUK) is an inflammatory, necrotic condition in the peripheral cornea which may end in corneal perforation and visual morbidity if not treated adequately. PUK can occur due to infectious or non-infectious causes. Early cases need medical therapy, both locally and systemically (for some cases). However, advanced PUK may necessitate surgical removal of inciting cause of the pathology and maintaining tectonic stability. Such surgical treatment, including corneal transplantations, may be used in an emergency setting or for visual rehabilitation following preliminary stabilization of the affected cornea. The outcome of these surgeries need to be analyzed to understand the long-term visual prognosis of such eyes. This is an attempt to analyze surgical modalities in the management of PUK and their outcomes.
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Affiliation(s)
- Swapnali Sabhapandit
- Institute of Ophthalmic Sciences, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India,Correspondence: Swapnali Sabhapandit, Institute of Ophthalmic Sciences, Asian Institute of Gastroenterology Hospitals, Mindspace Road, Gachibowli, Hyderabad, 500032, India, Tel +91 8790622699, Email
| | - Somasheila I Murthy
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Namrata Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Singh A, Murthy SI, Gandhi A, Sangwan VS. Reply. Cornea 2022; 41:e16. [PMID: 35439793 DOI: 10.1097/ico.0000000000003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Aastha Singh
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Arpan Gandhi
- Microbiology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Shanbhag SS, Sangwan VS, Singh A, Donthineni PR, Basu S, Srinivasan B, Agarwal S, Iyer G. Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India. Front Med (Lausanne) 2021; 8:643955. [PMID: 34513854 PMCID: PMC8429498 DOI: 10.3389/fmed.2021.643955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of rare, severe immunological blistering skin reactions which are triggered by medication intake or infections. The acute phase is characterized by necrolysis of the skin and desquamation of mucosa, primarily oral and ocular, with significant mortality rates. The chronic phase is characterized by multi-organ sequelae with increased rates of morbidity and reduced quality of life for patients who have survived the acute phase. Since the primary goal in the acute phase is saving the life of the patient, ocular involvement is often missed and a significant proportion of patients present to an ophthalmologist with the chronic ocular sequelae. In India, chronic ocular sequelae and low vision are observed in two-thirds of patients who present in the chronic phase of SJS/TEN. In the chronic phase of ocular involvement, there are definite windows of opportunity which if targeted with specific interventions such as scleral lenses and mucous membrane grafts can help reduce the incidence of corneal blindness and improve the quality of life for patients with SJS/TEN. Over the last decade, several studies from India have advanced the understanding of the natural course of ocular involvement in SJS/TEN and the outcomes of timely interventions in the chronic phase of the disease. We present an overview of the epidemiology of ocular complications of SJS/TEN in India, the specific challenges faced in the management of ocular complications in the acute stage and recent advances in management of the chronic ocular complications of the disease.
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Affiliation(s)
| | - Virender S Sangwan
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Aastha Singh
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | - Sayan Basu
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.,Center for Ocular Regeneration, LV Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Bhaskar Srinivasan
- CJ Shah Cornea Services/Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Shweta Agarwal
- CJ Shah Cornea Services/Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Geetha Iyer
- CJ Shah Cornea Services/Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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Singh A, Murthy SI, Gandhi A, Sangwan VS. "Doughnut" Amniotic Membrane Transplantation With Penetrating Keratoplasty for Vernal Keratoconjunctivitis With Limbal Stem Cell Disease. Cornea 2021; 40:914-916. [PMID: 33214419 DOI: 10.1097/ico.0000000000002553] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Severe vernal keratoconjunctivitis (VKC) can cause ocular surface disease including partial or complete limbal stem cell deficiency (LSCD), especially in early-onset and severe limbal form of VKC. We report a novel technique of doughnut amniotic membrane transplantation (AMT) along with penetrating keratoplasty (PK) for management of partial LSCD and corneal scarring in a case of severe VKC. METHODS Case report. RESULTS A 17-year-old boy, with onset of disease at 8 years of age, and development of partial LSCD and corneal scarring over a period of 9 years despite therapy, presented with profound visual loss due to dense bilateral corneal scarring. After the active allergy subsided, he underwent modified AMT (doughnut AMT) with simultaneous PK in his left eye. Histopathology of the excised button revealed conjunctival phenotype and dense corneal scarring up to the posterior stroma. At 1-year follow up, his best spectacle-corrected visual acuity was maintained at 20/30 in the operated eye, the graft was clear, and the ocular surface was stable. CONCLUSIONS Severe VKC can cause ocular surface disease including LSCD with corneal scarring, especially in early-onset limbal form of VKC. The modified technique of AMT (doughnut AMT) along with PK can successfully visually rehabilitate and address partial LSCD in such patients.
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Affiliation(s)
- Aastha Singh
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India; and
| | - Arpan Gandhi
- Ocular Histopathology Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Department of Cornea, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Singh A, Sangwan VS. Mini-Review: Regenerating the Corneal Epithelium With Simple Limbal Epithelial Transplantation. Front Med (Lausanne) 2021; 8:673330. [PMID: 34124103 PMCID: PMC8195332 DOI: 10.3389/fmed.2021.673330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Simple limbal epithelial transplantation (SLET) is an ingenious, low cost and effective technique of limbal stem cell transplantation (LSCT) that is increasingly being undertaken in practice across the world. Since it was first described a decade ago, the technique has been performed in a variety of cases of limbal stem cell deficiency (LSCD) and has underwent several innovative modifications. Published literature on SLET has progressively increased over time and successful outcomes in various clinical scenarios have been reported. This concise review attempts to present a crisp account of SLET covering the indications and contraindications of performing the procedure; detailed account of pre-operative work up and preparation; surgical technique and its modifications; post-operative course, care and possible complications as well as published outcomes of surgery from across the world. Comparative analysis of various techniques of LSCT have been discussed and common concerns of surgeons practising or those who are planning to start practising SLET have been addressed. The authors hope that the pragmatic insights and pearls given at the end of the review will aid the surgeons in performing this technique to provide maximum benefit to patients suffering from the potentially blinding condition of LSCD.
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Affiliation(s)
- Aastha Singh
- Department of Cornea, Anterior Segment and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Department of Cornea, Anterior Segment and Uveitis, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Abstract
A 23-year-old man presented with congestion, peripheral corneal vascularization, an elevated ridge-like epithelial line and cellular infiltration around limbal transplants, 15 months after undergoing living-related simple limbal epithelial transplantation (SLET) for total limbal stem cell deficiency. A diagnosis of acute allograft rejection was made and he was treated with intravenous methylprednisolone, topical and oral prednisolone as well as systemic cyclosporine and azathioprine, leading to reversal of the signs. Similar findings were noted during a later rejection episode. An epithelial rejection line and cellular infiltration of limbal transplants are easily identifiable clinical signs of allograft rejection post SLET.
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Affiliation(s)
- Jayesh Vazirani
- Center for Excellence in Cornea and Ocular Surface Disorders, Excel Eye Care, Ahmedabad, Gujarat, India
| | - Sayan Basu
- Centre for Ocular Regeneration; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Singh A, Acharya M, Sangwan VS. Commentary: Impact of COVID-19 on ocular surface health. Indian J Ophthalmol 2021; 69:1066-1067. [PMID: 33913833 PMCID: PMC8186629 DOI: 10.4103/ijo.ijo_720_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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Aastha Singh
- Cornea and Anterior Segment Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Manisha Acharya
- Cornea and Anterior Segment Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Cornea and Anterior Segment Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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13
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Tibrewal S, Rath S, Ganesh S, Sangwan VS. Lateral Rectus Muscle Injury During Double-Headed Pterygium Surgery: A Rare Complication. J Pediatr Ophthalmol Strabismus 2020; 57:e96-e99. [PMID: 33320270 DOI: 10.3928/01913913-20201103-01] [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] [Received: 06/21/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Abstract
A 43-year-old man developed double vision, esotropia, and abduction limitation after excision of a doubleheaded pterygium. Exploration during strabismus surgery 4 months later revealed a partially severed lateral rectus muscle and extensive conjunctival scarring. Direct injury to the lateral rectus muscle during pterygium surgery is extremely rare. Prevention and management strategies are discussed. [J Pediatr Ophthalmol Strabismus. 2020;57:e96-e99.].
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Singh G, Mathur U, Sangwan VS. Vernal Keratoconjunctivitis spectrum in two generations of a family. Indian J Ophthalmol 2020; 68:1644-1645. [PMID: 32709799 PMCID: PMC7640810 DOI: 10.4103/ijo.ijo_1716_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Garima Singh
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Umang Mathur
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Sabherwal S, Chaku D, Mathur U, Sangwan VS, Majumdar A, Gandhi A, Dubey S, Sood I. Are high-efficiency particulate air (HEPA) filters and laminar air flow necessary in operating rooms to control acute post-operative endophthalmitis? Indian J Ophthalmol 2020; 68:1120-1125. [PMID: 32461444 PMCID: PMC7508147 DOI: 10.4103/ijo.ijo_1493_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the five-year incidence of acute post-operative endophthalmitis following cataract surgery, between centers with and without laminar air flow and high-efficiency particulate air (HEPA) filters in operating rooms. Methods Retrospective analysis of medical records of patients operated in a single network of a tertiary and four secondary hospitals across north India. Cases of endophthalmitis were identified from the records between January 2013 and June 2018. Protocols and consumables were standardized across all hospitals. The only infrastructural difference being the presence of laminar air flow and high energy particulate air filters in operating rooms of the tertiary center. The type of surgery, along with the demographic and socio-economic details, were captured and analyzed, using z-test for proportions and logistic regression. Results Out of 88,297 cataract surgeries conducted, 36 cases of endophthalmitis were reported. The incidence of endophthalmitis across the network was estimated to be 0.041%, (95% CI: 0.027 to 0.054). There was no statistically significant difference between the incidence of POE at the tertiary (0.042%) and secondary centers (0.039%). Certain risk factors for high endophthalmitis incidence were identified, namely patients undergoing small incision cataract surgery and belonging to lower socio-economic status. However, for both factors the difference was not statistically significant. Conclusion The five-year incidence of acute post-operative endophthalmitis in our network was found comparable to the best reported in literature. Incidence at secondary centers, without laminar air flow and high energy particulate air filters was found comparable to that in the tertiary center having these facilities.
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Affiliation(s)
- Shalinder Sabherwal
- Department of Community Ophthalmology and Public Health Research, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Deepali Chaku
- Department of Community Ophthalmology and Public Health Research, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Umang Mathur
- Executive Medical Director and Head Cornea and Anterior Segment Services, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Director of Innovations and Technology, Head Glaucoma Services and Head Quality Resource Center, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Atanu Majumdar
- Bio-Statistician, Head Glaucoma Services and Head Quality Resource Center, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Arpan Gandhi
- Head Lab Services, Head Glaucoma Services and Head Quality Resource Center, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Suneeta Dubey
- Medical Superintendent, Head Glaucoma Services and Head Quality Resource Center, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Ishaana Sood
- Department of Community Ophthalmology and Public Health Research, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Gupta N, Farooqui JH, Dziasko MA, Daniels JT, Mathur U, Sangwan VS. Reappearance of limbal pigmentation post-simple limbal epithelial transplant. Indian J Ophthalmol 2020; 68:927-929. [PMID: 32317494 PMCID: PMC7350484 DOI: 10.4103/ijo.ijo_155_19] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
We report the repigmentation at the limbus in patients who underwent simple limbal epithelial transplant (SLET) for uniocular chemical injury. The first case is of an 8-year-old child who presented with grade 4 chemical injury, with limbal stem cell deficiency (LSCD) corresponding to 6 o' clock till 11 o' clock. He was managed by amniotic membrane graft in the acute stage and SLET after 6 months of the initial injury. The second case is of a 15-year-old female who presented with lime injury, which had resulted in 6 o' clock of limbal involvement (10 o' clock till 4 o' clock). The patient was managed on similar lines with amniotic membrane graft (AMG) in the acute phase and SLET after 6 months of injury. The ocular surface was stable in both the patients post-SLET. The effected limbus showed pigmentation at 8 months of follow-up which eventually became distinct and remained stable. We speculate that the pigmentation at limbus could be attributed to proliferation and movement of melanocytes from limbal biopsy in SLET. These may be capable of supporting the proliferation of limbal epithelial cells and modulation of corneal wound healing.
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Affiliation(s)
- Nidhi Gupta
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Javed H Farooqui
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | | | | | - Umang Mathur
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Virender S Sangwan
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Das S, Mohamed A, Sangwan VS. Clinical course and outcomes in patients with Mooren ulcer who had cataract surgery. J Cataract Refract Surg 2019; 43:1044-1049. [PMID: 28917404 DOI: 10.1016/j.jcrs.2017.05.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/07/2017] [Accepted: 05/21/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To report outcomes of cataract surgery in patients with Mooren ulcer. SETTING L.V. Prasad Eye Institute, Hyderabad, India. DESIGN Retrospective case series. METHODS The medical records of patients with Mooren ulcer who had cataract surgery between 2000 and 2015 were assessed. The main outcome measures were the role of preoperative immunosuppression and disease inactivity, cataract surgery safety, visual outcomes, and postoperative ulcer recurrence. RESULTS Of 22 patients (26 eyes), the mean corneal ulceration was 6.8 clock hours ± 2.9 (SD). Corticosteroids were the most commonly used (84.6% of the 26 eyes) preoperative immunosuppression agents and 38.5% of the 26 eyes were under maintenance immunosuppression. The median disease inactivity before surgery was 7 months. Cataract surgery was extracapsular in 10 patients, small incision in 3 patients, and phacoemulsification in 13 patients. Twenty-two eyes had scleral incisions. The median follow-up was 6 months (interquartile range, 10 months). The median corrected distance visual acuity (CDVA) improved from 1.48 logarithm of minimum angle of resolution (logMAR) before surgery to 0.30 and 0.35 logMAR at 1 month and at the last follow-up after surgery, respectively (P ≤ .0001). Mooren ulcer recurred in 5 eyes between 3 months and 7 years after surgery. No disease activity was seen in the immediate postoperative period. No significant risk factors for disease recurrence were noted. CONCLUSIONS With adequate immunosuppression, cataract surgery in eyes with Mooren ulcer was safe and CDVA improved significantly with no disease reactivation immediately after surgery. No proven role of maintenance immunosuppression was observed. The type of cataract surgery had no influence on ulcer reactivation. Patients with a disease-free interval of 6 months or more before surgery and those who had scleral incisions had favorable outcomes.
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Affiliation(s)
- Shilpa Das
- From the Prof. Brien Holden Eye Research Centre (Das), Ophthalmic Biophysics (Mohamed), and the Cornea, Ocular Immunology and Uveitis Service, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- From the Prof. Brien Holden Eye Research Centre (Das), Ophthalmic Biophysics (Mohamed), and the Cornea, Ocular Immunology and Uveitis Service, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- From the Prof. Brien Holden Eye Research Centre (Das), Ophthalmic Biophysics (Mohamed), and the Cornea, Ocular Immunology and Uveitis Service, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.
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Abstract
BACKGROUND: Contact lenses (CLs) remain the mainstay in improving vision in patients having keratoconus. With corneal collagen cross-linking (CXL) performed worldwide, whether the same CLs can be used or needs replacement needed to be assessed and considered. AIMS: The aim of this study was to evaluate the changes in CL fitting following CXL. SETTINGS AND DESIGN: This is a retrospective study conducted at a tertiary center. SUBJECTS AND METHODS: We analyzed the medical records of patients who underwent CXL and used CL. Data collected included demographics, pre- and post-CXL refraction, corneal topography, anterior-segment examination, and CL [rigid gas permeable(RGP)] fitting details and duration between CXL and RGP fitting. STATISTICAL ANALYSIS: Descriptive analysis and paired t-test were used to compare the pre- and post-CXL data on refraction, visual acuity, and CL parameters. The statistical significance was kept at P < 0.05. RESULTS: Thirty-four eyes (keratoconus = 32, pellucid marginal degeneration = 1, and post-LASIK ectasia = 1) of 27 patients who used CL before and after undergoing CXL were analyzed. Mean duration between CXL and RGP lens use was 2.53 months. Mean sphere and cylinder post-CXL was −4.11 ± 4.32 D and −3.54 ± 2.51 D, respectively. A mean change of 0.75 ± 3.72 D sphere and 0.71 ± 3.39 D cylinder was noted post-CXL. The post-CXL best spectacle-corrected visual acuity (CVA) was 0.52 ± 0.36 and with RGP lens it was 0.09 ± 0.18. There was no significant difference in pre- and post-CXL RGP lens CVA (0.07 ± 0.09 and 0.09 ± 0.18, respectively; P = 0.556). Pre-CXL, 3-point-touch fitting was in 24 eyes (70.59%) and central fluorescein pooling was in 10 eyes (29.41%). Post-CXL, 30 eyes (88.24%) had 3-point-touch and central fluorescein pooling was found in four eyes (11.76%). One patient had CL intolerance after CXL. Of the 32 keratoconus eyes, 62.5% (n = 20 eyes) were prescribed new lenses; 37.5% (n = 12 eyes) continued using own lenses. CONCLUSIONS: There was no significant difference in refraction, topography indices, and RGP lens parameters pre- and post-CXL. However, changes in RGP lens fitting characteristics suggest a possible change in shape or apex location of the cornea after CXL. RGP lenses remain the best option to improve visual acuity after CXL in corneal ectasia.
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Affiliation(s)
| | | | - Varsha M Rathi
- Bausch and Lomb Contact Lens Clinic, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Bausch and Lomb Contact Lens Clinic, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mukesh Taneja
- Bausch and Lomb Contact Lens Clinic, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- Bausch and Lomb Contact Lens Clinic, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Sangwan VS, Gupta N, Singh A, MacNeil S. Cutting corners, or simplifying technology to reach more patients; using the body as its own incubator for epithelial regeneration. Indian J Ophthalmol 2019; 67:1261-1263. [PMID: 31332104 PMCID: PMC6677077 DOI: 10.4103/ijo.ijo_632_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/06/2023] Open
Affiliation(s)
- Virender S Sangwan
- Cornea, Anterior Segment and Uveitis, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi, India
| | - Nidhi Gupta
- Cornea, Anterior Segment and Uveitis, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi, India
| | - Aastha Singh
- Cornea, Anterior Segment and Uveitis, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi, India
| | - Sheila MacNeil
- Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, United Kingdom
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20
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Tyagi M, Agarwal K, Reddy Pappuru RR, Dedhia C, Agarwal H, Nayak S, Panchal B, Kaza H, Basu S, Pathengay A, Murthy S, Sangwan VS. Sympathetic Ophthalmia after Vitreoretinal Surgeries: Incidence, Clinical Presentations and Outcomes of a Rare Disease. Semin Ophthalmol 2019; 34:157-162. [PMID: 31055985 DOI: 10.1080/08820538.2019.1610464] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: To evaluate clinical presentation, course and outcomes in patients without a history of penetrating ocular trauma who developed Sympathetic Ophthalmia (SO) following vitreoretinal surgeries Methods: Retrospective review of clinical records of all patients diagnosed and treated as S.O was done . All cases without a previous history of trauma were included and were analyzed with respect to clinical presentations, anatomic and visual outcomes. Results: 175 cases of sympathetic ophthalmia were diagnosed and treated till June 2017. 16 of these cases had undergone a pars plana vitrecomy (PPV) in the past and had no history of prior ocular trauma. SO after vitreoetinal surgeries accounted for 9.14 percent of all cases of SO .In the same duration, till 2017,a total 41365 PPV were done. Thus 0.038 percent of PPV cases developed a SO . 10 patients were males and 6 were females. The median age at presentation was 45.7 years. The time interval from surgery to diagnosis of sympathetic ophthalmia ranged from 22 days to 4 years after undergoing a surgery. The mean visual acuity in the sympathizing eye was 1.26 logMAR (snellens equivalent of 20/320) which improved to 0.62 logMAR(snellens equivalent of 20/80) after treatment. The most common anterior segment finding was non granulomatous anterior uveitis, seen in 8 cases (50%) while neurosensory detachments were the most common posterior segment presentation (10 cases, 62.5%).12 patients had undergone more than 1 surgery (mean number of surgeries was 1.88). 10 patients had undergone a sutureless PPV (6 cases of 23 gauge and 4 cases of 25 gauge vitrectomy) while 4 patients had undergone a 20 gauge vitrectomy where all sclerotomies were sutured after surgery All patients were treated with systemic steroids and immunosuppresants and 15 out of 16 patients showed significant improvement in the final visual acuity in the sympathizing eye Conclusions: Sympathetic ophthalmia after vitreoretinal surgeries is a rare but potentially sight threatening disease occurring in 0.038 percent of all cases of Pars Plana Vitrectomy. Presence of inflammation in the fellow eye after a vitreoretinal surgery in the other eye should alert the surgeon to possibility of sympathetic ophthalmia.
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Affiliation(s)
- Mudit Tyagi
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Komal Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Rajeev R Reddy Pappuru
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Chintan Dedhia
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Hitesh Agarwal
- a Uveitis and Ocular Immunology Services , Smt Kanuri Santhamma Center for Vitreo-Retina Diseases L. V. Prasad Eye Institute , Hyderabad , India
| | - Sameera Nayak
- b Uveitis and Retina services, KVC Campus , L.V. Prasad Eye Institute , Vijayawada , India
| | - Bhavik Panchal
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Hrishikesh Kaza
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Soumyava Basu
- d Uveitis and Retina Services, MTC Campus , L. V. Prasad Eye Institute , Bhubaneshwar , India
| | - Avinash Pathengay
- c Uveitis and Retina Services, GMRV Campus , L.V .Prasad Eye Institute , Visakhapatnam , India
| | - Somasheila Murthy
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
| | - Virender S Sangwan
- e Uveitis and Ocular Immunology Services , Tej Kohli Cornea Institute, L. V. Prasad Eye Institute , Hyderabad , India
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Affiliation(s)
- Manisha Singh
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, India
| | - Neha Kapoor
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, India
| | - Virender S Sangwan
- Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, India
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22
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Sahu SK, Mittal SK, Foulsham W, Li M, Sangwan VS, Chauhan SK. Mast Cells Initiate the Recruitment of Neutrophils Following Ocular Surface Injury. Invest Ophthalmol Vis Sci 2019; 59:1732-1740. [PMID: 29610857 PMCID: PMC5885762 DOI: 10.1167/iovs.17-23398] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose The purpose of this study was to investigate the contribution of mast cells to early neutrophil recruitment during ocular inflammation. Methods In a murine model of corneal injury, the epithelium and anterior stroma were removed using a handheld motor brush. Cromolyn sodium (2% in PBS) eye drops were administered topically for mast cell inhibition. In vitro, bone marrow–derived mast cells were cultured alone or with corneal tissue. The frequencies of CD45+ inflammatory cells, CD11b+Ly6G+ neutrophils, and ckit+FcεR1+ mast cells in the cornea were assessed by flow cytometry. mRNA expression of CXCL2 was evaluated by real-time PCR and protein expression by ELISA. β-Hexosaminidase assays were performed to gauge mast cell activation. Results Neutrophil infiltration of the cornea was observed within 1 hour of injury, with neutrophil frequencies increasing over subsequent hours. Concurrent expansion of mast cell frequencies at the cornea were observed, with mast cell activation (assessed by β-hexosaminidase levels) peaking at 6 hours after injury. Evaluation of CXCL2 mRNA and protein expression levels demonstrated augmented expression by injured corneal tissue relative to naïve corneal tissue. Mast cells were observed to constitutively express CXCL2, with significantly higher expression of CXCL2 protein compared with naïve corneal tissue. Culture with harvested injured corneas further amplified CXCL2 expression by mast cells. In vivo, mast cell inhibition was observed to decrease CXCL2 expression, limit early neutrophil infiltration, and reduce inflammatory cytokine expression by the cornea. Conclusions Our data suggest that mast cell activation after corneal injury amplifies their secretion of CXCL2 and promotes the initiation of early neutrophil recruitment.
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Affiliation(s)
- Srikant K Sahu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.,L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sharad K Mittal
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - William Foulsham
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Mingshun Li
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.,Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Virender S Sangwan
- L.V. Prasad Eye Institute, Bhubaneswar, Odisha, India.,L.V. Prasad Eye Institute, Hyderabad, India
| | - Sunil K Chauhan
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
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23
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Ramachandran C, Sangwan VS, Ortega I, Bhatnagar U, Mulla SMA, McKean R, MacNeil S. Synthetic biodegradable alternatives to the use of the amniotic membrane for corneal regeneration: assessment of local and systemic toxicity in rabbits. Br J Ophthalmol 2018; 103:286-292. [PMID: 30337329 DOI: 10.1136/bjophthalmol-2018-312055] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/19/2018] [Accepted: 09/17/2018] [Indexed: 11/04/2022]
Abstract
AIM The aim of this study was to assess the local and systemic response to poly-lactic co-glycolic acid (PLGA) 50:50 membranes, developed as synthetic biodegradable alternatives to the use of human donor amniotic membrane in the treatment of limbal stem cell deficiency. METHODS PLGA membranes of 2 cm diameter and 50 µm thickness were placed on one eye of rabbits and secured in place using fibrin glue and a bandage contact lens, suturing the eye close with a single stitch. Control animals were treated identically, with the absence of the membranes. Plain and microfabricated electrospun membranes (containing micropockets which roughly emulate the native limbal niche) were examined over 29 days. All animals were subjected to a detailed gross and histopathological observation as well as a detailed examination of the eye. RESULTS Application of the membranes both with and without microfabricated pockets did not adversely affect animal welfare. There was complete degradation of the membranes by day 29. The membranes did not induce any significant local or systemic toxicity. Conjunctival congestion and corneal vascularisation were noted in a few control and PLGA-treated animals. Intraocular pressure was normal and the retinal status was unaltered. The ocular surface was clear and intact in all animals by the end of 29 days. CONCLUSION Membranes of 50:50 PLGA can be safely applied to rabbit corneas without inducing any local or systemic toxicity and these break down completely within 29 days.
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Affiliation(s)
- Charanya Ramachandran
- Sudhakar and Sreekanth Ravi Stem Cell Laboratory, LV Prasad Eye Institute, Kallam Anji Reddy campus, LV Prasad Marg, Hyderabad, Telangana, India
| | - Virender S Sangwan
- Sudhakar and Sreekanth Ravi Stem Cell Laboratory, LV Prasad Eye Institute, Kallam Anji Reddy campus, LV Prasad Marg, Hyderabad, Telangana, India
| | - Ilida Ortega
- School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | | | | | - Rob McKean
- The Electrospinning Company Ltd, Rutherford Appleton Laboratory, Oxford, UK
| | - Sheila MacNeil
- Department of Materials Science and Engineering, Kroto Research Institute, North Campus, University of Sheffield, Sheffield, UK
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Geetha Sravani N, Mohamed A, Sangwan VS. Response to Modabber and Harissi-Dagher's Letter: "Type 1 Boston Keratoprosthesis for Limbal Stem Cell Deficiency in Epidermolysis Bullosa". Ocul Immunol Inflamm 2018; 27:287. [PMID: 29648915 DOI: 10.1080/09273948.2018.1451051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- N Geetha Sravani
- a Ophthalmic Biophysics , L V Prasad Eye Institute , Hyderabad , India
| | - Ashik Mohamed
- a Ophthalmic Biophysics , L V Prasad Eye Institute , Hyderabad , India
| | - Virender S Sangwan
- b Tej Kohli Cornea Institute, L V Prasad Eye Institute , Hyderabad , India.,c Centre for Ocular Regeneration, L V Prasad Eye Institute , Hyderabad , India
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25
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Islam MM, Buznyk O, Reddy JC, Pasyechnikova N, Alarcon EI, Hayes S, Lewis P, Fagerholm P, He C, Iakymenko S, Liu W, Meek KM, Sangwan VS, Griffith M. Biomaterials-enabled cornea regeneration in patients at high risk for rejection of donor tissue transplantation. NPJ Regen Med 2018; 3:2. [PMID: 29423280 PMCID: PMC5792605 DOI: 10.1038/s41536-017-0038-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 07/17/2017] [Revised: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
The severe worldwide shortage of donor organs, and severe pathologies placing patients at high risk for rejecting conventional cornea transplantation, have left many corneal blind patients untreated. Following successful pre-clinical evaluation in mini-pigs, we tested a biomaterials-enabled pro-regeneration strategy to restore corneal integrity in an open-label observational study of six patients. Cell-free corneal implants comprising recombinant human collagen and phosphorylcholine were grafted by anterior lamellar keratoplasty into corneas of unilaterally blind patients diagnosed at high-risk for rejecting donor allografts. They were followed-up for a mean of 24 months. Patients with acute disease (ulceration) were relieved of pain and discomfort within 1–2 weeks post-operation. Patients with scarred or ulcerated corneas from severe infection showed better vision improvement, followed by corneas with burns. Corneas with immune or degenerative conditions transplanted for symptom relief only showed no vision improvement overall. However, grafting promoted nerve regeneration as observed by improved touch sensitivity to near normal levels in all patients tested, even for those with little/no sensitivity before treatment. Overall, three out of six patients showed significant vision improvement. Others were sufficiently stabilized to allow follow-on surgery to restore vision. Grafting outcomes in mini-pig corneas were superior to those in human subjects, emphasizing that animal models are only predictive for patients with non-severely pathological corneas; however, for establishing parameters such as stable corneal tissue and nerve regeneration, our pig model is satisfactory. While further testing is merited, we have nevertheless shown that cell-free implants are potentially safe, efficacious options for treating high-risk patients. A biomaterial implant supports the regeneration of severely damaged corneas in patients at high risk for rejecting conventional transplantation. An international team from Canada, China, India, Sweden, Ukraine and United Kingdom used mini-pigs to confirm the safety of implanting cell-free corneas made from recombinant human collagen and a synthetic lipid, before examining the effects of implantation on human vision in seven patients. The implants were well-tolerated and led to significant vision improvement in patients with damaged corneas due to infection. Furthermore, within two weeks of surgery the implants had relieved pain. Over two years, sensitivity to touch improved, suggesting an ability to promote nerve regeneration. This study supports the use of animal models to test biomaterials designed for medical applications and describes a safe and promising option for treating patients that not treatable by conventional corneal transplantation.
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Affiliation(s)
- M Mirazul Islam
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,2Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA USA
| | - Oleksiy Buznyk
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Jagadesh C Reddy
- 4Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India
| | - Nataliya Pasyechnikova
- Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Emilio I Alarcon
- 5Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON Canada
| | - Sally Hayes
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | - Philip Lewis
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | - Per Fagerholm
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Chaoliang He
- 8Key Laboratory of Polymer Eco-materials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, China
| | - Stanislav Iakymenko
- Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine, Odessa, Ukraine
| | - Wenguang Liu
- 9School of Materials Science and Engineering, Tianjin University, Tianjin, China
| | - Keith M Meek
- 6School of Optometry and Vision Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.,7Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, Cardiff, UK
| | | | - May Griffith
- 1Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,4Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, India.,10Department of Ophthalmology and Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Canada
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Affiliation(s)
- N Geetha Sravani
- a Ophthalmic Biophysics , L V Prasad Eye Institute , Hyderabad , India
| | - Ashik Mohamed
- a Ophthalmic Biophysics , L V Prasad Eye Institute , Hyderabad , India
| | - Virender S Sangwan
- b Tej Kohli Cornea Institute , L V Prasad Eye Institute , Hyderabad , India.,c Centre for Ocular Regeneration , L V Prasad Eye Institute , Hyderabad , India
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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Kaliki S, Mohammad FA, Tahiliani P, Sangwan VS. Reply. Am J Ophthalmol 2017; 179:205-206. [PMID: 28477844 DOI: 10.1016/j.ajo.2017.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
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Rathi VM, Mandathara PS, Dumpati S, Sangwan VS. Change in vault during scleral lens trials assessed with anterior segment optical coherence tomography. Cont Lens Anterior Eye 2017; 40:157-161. [DOI: 10.1016/j.clae.2017.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/24/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Shah R, Puranik C, Mohamed A, Sangwan VS. Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up. BMJ Case Rep 2017; 2017:bcr-2016-217372. [PMID: 28179383 DOI: 10.1136/bcr-2016-217372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
An 11-year-old girl presented to our tertiary eye care centre with a 9-month-old history of lime injury in the left eye in 1999 with vision of counting fingers close to the face. She initially underwent superficial keratectomy with amniotic membrane graft in 1999. Subsequently, cultivated limbal epithelial transplantation was performed in 2001 which improved her vision to 20/400. Following development of pannus and symblepharon in the left eye, she underwent pannus resection and conjunctival limbal autograft in 2002 and, a month later, optical penetrating keratoplasty (PK) following which her vision improved to 20/125. She was under regular follow-up, underwent exotropia correction and subsequent levator palpebrae superioris resection for ptosis and was maintaining good vision. On her last follow-up 14 years after PK in 2016, her vision in the left eye was 20/40 with lipid keratopathy and her right eye showed no signs of focal limbal stem cell deficiency.
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Affiliation(s)
- Ritu Shah
- L V Prasad Eye Institute, Tej Kohli Cornea Institute, Hyderabad, Telangana, India
| | - Charuta Puranik
- L V Prasad Eye Institute, Tej Kohli Cornea Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- L V Prasad Eye Institute, Centre for Ocular Regeneration, Hyderabad, Telangana, India
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Kaliki S, Mohammad FA, Tahiliani P, Sangwan VS. Concomitant Simple Limbal Epithelial Transplantation After Surgical Excision of Ocular Surface Squamous Neoplasia. Am J Ophthalmol 2017; 174:68-75. [PMID: 27832940 DOI: 10.1016/j.ajo.2016.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the surgical outcomes of ocular surface squamous neoplasia (OSSN) following wide excisional biopsy with and without primary simple limbal epithelial transplantation (p-SLET). DESIGN Nonrandomized clinical study with historical controls. METHODS setting: Single-institutional study. PATIENTS Eight patients who underwent wide excisional biopsy of OSSN without p-SLET (historical controls) and 7 patients with p-SLET (cases). INTERVENTION Wide excisional biopsy, p-SLET. MAIN OUTCOME MEASURES Limbal stem cell deficiency (LSCD). RESULTS The tumor features of cases vs historical controls, including mean number of limbal clock hours affected by OSSN (6 vs 4; P = .12), mean tumor basal dimension (13 mm vs 8 mm; P = .11), and mean number of clock hours of corneoscleral limbal dissection owing to wide tumor excision (8 vs 7; P = .12), were comparable. The occurrence of partial LSCD in historical controls vs cases was 75% vs 0% (P = .007) at a mean follow-up period of 12 months in both groups. Of these 6 historical controls that developed LSCD, pannus was noted in 1 (13%) and pseudopterygium extending onto the cornea in 5 (63%) patients. The mean number of clock hours of LSCD was 3 (median, 2; range, 2-6) in these historical controls. The mean time interval between surgical excision of OSSN and onset of LSCD was 8 weeks (median, 6 weeks; range, 6-12 weeks). CONCLUSION Corneoscleral limbal dissection of ≥6 clock hours during wide excision of OSSN can cause LSCD. Concomitant p-SLET after surgical excision of OSSN prevents LSCD in cases requiring extensive corneoscleral limbal dissection.
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Affiliation(s)
- Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India.
| | - Faraz Ali Mohammad
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Prerana Tahiliani
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
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Rathi VM, Taneja M, Murthy SI, Bagga B, Vaddavalli PK, Sangwan VS. Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes. Indian J Ophthalmol 2016; 64:140-4. [PMID: 27050350 PMCID: PMC4850810 DOI: 10.4103/0301-4738.179715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best-corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Prefirst PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.
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Affiliation(s)
- Varsha M Rathi
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Abstract
Context: This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease. Aims: We report our experience with patients having keratoglobus at a tertiary eye care center in India. Settings and Design: Retrospective study. Materials and Methods: We analyzed adults and pediatric patients (<16 years) with keratoglobus, seen during 2008–2012. The age, gender, consanguinity, presenting ocular signs, ocular and systemic associations, visual acuity, corneal topography, and surgeries were documented. Results: Forty-eight patients (mean age 22 ± 15 years, 31 males) having keratoglobus were analyzed. 21 patients (42 eyes) were <16 years. Twelve eyes (16 events) had positive history of trauma. The presenting clinical signs were corneal scars/scars of tear repair (15 eyes), hydrops, healed and acute (14 eyes) and corneal or globe rupture (9 eyes). Best-corrected visual acuity was >20/40 in 6/42 (14.3%) pediatric eyes and 15/53 (28.30%) adults. Visual acuity ranging from counting of fingers to no light perception was noted in 20/53 (37.74%) adults and 21/42 (50%) pediatric patients; 13/20 (65%) with blue sclera and 8/22 eyes (36.37%) without blue sclera. Vernal keratoconjunctivitis was present in one pediatric patient. Choroidal osteoma, retinitis pigmentosa, and retinal detachment were present in adults. Surgeries performed were corneal tear repair (5 eyes), tissue adhesive application (2 eyes), descematopexy (4 eyes) and penetrating keratoplasty (PK - 8 eyes: Three had post-PK glaucoma, graft failure-one eye, 4 patients wore scleral lens - prosthetic replacement of the ocular surface ecosystem). Conclusions: About 50% of pediatric eyes (65% having blue sclera) had no functional vision. Trivial trauma was responsible for corneal rupture indicating need for protective glasses. About 50% patients had post-PK glaucoma though grafts were clear.
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Affiliation(s)
- Varsha M Rathi
- Cornea Services, L V Prasad Eye Institute, Kallam Anji Reddy Camus, Hyderabad, Telangana, India
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Affiliation(s)
| | | | - Virender S. Sangwan
- Tej Kohli Cornea Institute
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, India
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Vazirani J, Sangwan VS. Surgical Management of SJS Sequelae: Outcomes and Alternatives. Curr Ophthalmol Rep 2016. [DOI: 10.1007/s40135-016-0109-9] [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: 11/24/2022]
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Das S, Pasari AS, Sangwan VS. Vernal keratoconjunctivitis: culmination of management using immunosuppression, surgical and prosthetic therapy over quarter century. BMJ Case Rep 2016; 2016:bcr-2016-217759. [PMID: 27881591 DOI: 10.1136/bcr-2016-217759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old male patient presented in 1988 with active vernal keratoconjunctivitis. He was treated with topical mast cell stabilisers and corticosteroids. Chronic inflammation despite topical treatment necessitated oral immunosuppressants. Active disease came under control with this; however, the patient gradually developed limbal stem cell deficiency. He underwent bilateral pannus resection with amniotic membrane transplantation that resulted in improved ocular surface. In 2007, patient was found to have significant bilateral posterior subcapsular cataracts and underwent bilateral cataract surgery with intraocular lens implantation with good visual outcome. In 2016, he was provided with scleral lens prosthetic device, which further improved vision. At last follow-up, more than 25 years after his initial visit, his visual acuity was 20/25 in both eyes with a stable surface. With a comprehensive approach using immunosuppression, surgical therapy and scleral lens prosthetic device, chronic vernal keratoconjunctivitis can be well managed as illustrated in this case.
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Affiliation(s)
- Shilpa Das
- Department of Cornea, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anand S Pasari
- Department of Cornea, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Mishra DK, Veena U, Kaliki S, Kethiri AR, Sangwan VS, Ali MH, Naik MN, Singh V. Differential Expression of Stem Cell Markers in Ocular Surface Squamous Neoplasia. PLoS One 2016; 11:e0161800. [PMID: 27584160 PMCID: PMC5008752 DOI: 10.1371/journal.pone.0161800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
Ocular Surface Squamous Neoplasm (OSSN) is the neoplasia arising from the conjunctiva, cornea and limbus. OSSN ranges from mild, moderate, severe dysplasia, carcinoma in situ (CIS) to squamous cell carcinoma (SCC). Recent findings on cancer stem cells theory indicate that population of stem-like cell as in neoplasia determines its heterogeneity and complexity leading to varying tumor development of metastatic behavior and recurrence. Cancer stem cell markers are not much explored in the cases of OSSN. In the present study, we aim to evaluate the expression of stem cells using stem cell markers mainly p63, ABCG2, c-KIT (CD117) and CD44 in OSSN tissue, which could have prognostic significance. The present study tries for the first time to explore expression of these stem markers in the cases of OSSN. These cases are subdivided into two groups. One group comprises of carcinoma in situ (n = 6) and the second group comprises of invasive carcinoma (n = 6). The mean age at presentation was 52 years; with 53 years for CIS group and 52 years for SCC group. From each group section from the paraffin block were taken for the IHC staining of p63, c-Kit, ABCG2 and CD44. Our experiments show high expression of P63 and CD44 in the cases of CIN and SCC. Both CIS and SCC displayed positive staining with p63, with more than 80% cells staining positive. However minimal expression of c-kit in both CIN and SCC. But surprisingly we got high expression of ABCG2 in cases of carcinoma in situ as compared to that of invasive squamous cell carcinoma. More than 50% of cells showed CD44 positivity in both CIS and SCC groups. Our results show for the first time that these four stem cells especially the limbal epithelium stem cells play a vital role in the genesis of OSSN but we need to explore more cases before establishing its clinical and biological significance.
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Affiliation(s)
- Dilip Kumar Mishra
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Uppala Veena
- Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhinav Reddy Kethiri
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal University, Manipal, Karnataka, India
| | - Virender S. Sangwan
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammed Hasnat Ali
- Clinical Epidemiology and Bio-Statistics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Milind N. Naik
- The Operation Eyesight Universal Institute for Eye cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Singh
- Champalimaud Translational Centre for Eye Research and Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Prof. Brien Holden Eye Research Center, and Center for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Manipal University, Manipal, Karnataka, India
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Mohamed A, Ali MJ, Parel JMA, Augusteyn RC, Sangwan VS. In vitro biometry of a human spherophakia. Clin Exp Optom 2016; 100:189-191. [PMID: 27557888 DOI: 10.1111/cxo.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/14/2016] [Accepted: 05/05/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ashik Mohamed
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.,Ophthalmic Biophysics Laboratory, L V Prasad Eye Institute, Hyderabad, India.,Vision Cooperative Research Centre, Brien Holden Vision Institute, Kensington, New South Wales, Australia
| | - Mohammad J Ali
- Ophthalmic Plastic Surgery, L V Prasad Eye Institute, Hyderabad, India
| | - Jean-Marie A Parel
- Vision Cooperative Research Centre, Brien Holden Vision Institute, Kensington, New South Wales, Australia.,Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert C Augusteyn
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.,Vision Cooperative Research Centre, Brien Holden Vision Institute, Kensington, New South Wales, Australia.,Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Virender S Sangwan
- Ophthalmic Biophysics Laboratory, L V Prasad Eye Institute, Hyderabad, India.,Vision Cooperative Research Centre, Brien Holden Vision Institute, Kensington, New South Wales, Australia.,Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Abstract
A 28-year-old male farmer presented to our emergency service with bilateral painful visual loss for the past 7 days that occurred suddenly after alcohol consumption. Examination showed bilateral central corneal epithelial defects, 3+ stromal edema, and cortical cataracts. After treatment with oral and topical corticosteroids for 4 weeks the corneal edema had subsided completely with mild anterior stromal scarring. Rapid progression of cataract to intumescent stage warranted sequential cataract surgeries 1 and 2 months after first presentation. Postoperatively, visual acuity recovered to 20/20 and 20/30 in the right and left eye respectively. This case highlights the extremely rare presentation of bilateral alcohol-induced toxic endothelitis, which recovered after intensive corticosteroid therapy.
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Affiliation(s)
- Abhishek Ranjan
- a Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus , Hyderabad , India
| | - Somasheila I Murthy
- a Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus , Hyderabad , India
| | - Varsha M Rathi
- b Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care (GPR ICARE) , Hyderabad , India
| | - Virender S Sangwan
- a Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus , Hyderabad , India
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40
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Vazirani J, Mariappan I, Ramamurthy S, Fatima S, Basu S, Sangwan VS. Surgical Management of Bilateral Limbal Stem Cell Deficiency. Ocul Surf 2016; 14:350-64. [DOI: 10.1016/j.jtos.2016.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/10/2016] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
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Rathi VM, Dumpati S, Mandathara PS, Taneja MM, Sangwan VS. Scleral contact lenses in the management of pellucid marginal degeneration. Cont Lens Anterior Eye 2016; 39:217-20. [DOI: 10.1016/j.clae.2015.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/04/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022]
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Basu S, Sureka SP, Shanbhag SS, Kethiri AR, Singh V, Sangwan VS. Simple Limbal Epithelial Transplantation. Ophthalmology 2016; 123:1000-10. [DOI: 10.1016/j.ophtha.2015.12.042] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/13/2023] Open
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Nawani N, Vazirani J, Ojha H, Sangwan VS. Conjunctival pedicle flap in management of open globe injury with corneal tissue loss. BMJ Case Rep 2016; 2016:bcr-2015-213703. [PMID: 26976834 DOI: 10.1136/bcr-2015-213703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Accidental injury with scissors led to an open globe injury with iris prolapse and corneal tissue loss in the right eye of a 15-year-old girl. Attempts to suture the laceration normally, led to persistent aqueous leak, and tight suturing was leading to unacceptable distortion of the corneal contour. In the absence of donor tissue or tissue glue, a bulbar conjunctival pedicle flap was used to augment sutures placed without undue tension, and watertight closure of the globe was achieved. Postoperatively, the flap retracted, and excellent tectonic, cosmetic and refractive outcomes were achieved. A conjunctival pedicle flap can be a useful adjunct in the armamentarium of the corneal surgeon while dealing with open globe injuries with corneal tissue loss.
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Affiliation(s)
| | - Jayesh Vazirani
- Cornea and Anterior Segment Service, Maheshwari Eye Care Hospital, Rajkot, Gujarat, India
| | - Hindukush Ojha
- Cornea and Anterior Segment Service, Nethra Jivan Eye Hospital, Dehradun, Uttarakhand, India
| | - Virender S Sangwan
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Affiliation(s)
- Ashik Mohamed
- a Prof Brien Holden Eye Research Centre , Hyderabad , India
| | - Virender S Sangwan
- b Cornea and Anterior Segment Services , L V Prasad Eye Institute , Hyderabad , India
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Narang P, Mohamed A, Mittal V, Sangwan VS. Cataract surgery in chronic Stevens-Johnson syndrome: aspects and outcomes. Br J Ophthalmol 2016; 100:1542-1546. [PMID: 26903523 DOI: 10.1136/bjophthalmol-2015-308041] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/27/2016] [Indexed: 11/04/2022]
Abstract
AIM To assess the outcome of cataract surgery in patients with chronic sequelae of Stevens-Johnson syndrome (SJS). METHODS Setting: Tertiary eye care centre in South India. DESIGN Retrospective, non-comparative, consecutive, interventional case series. Study period: March 2003 to May 2014. Of the 1662 consecutive patients with SJS, 32 patients (40 eyes) with chronic sequelae of SJS who underwent cataract surgery were included. The main outcome measures were best-corrected visual acuity (BCVA) and ocular surface stabilisation. The visual acuity was expressed with reference to the logMAR. RESULTS The study included 12 men (37.5%) and 20 women (62.5%). 8 patients (25%) had bilateral cataract surgeries. The median preoperative BCVA was 1.61 (IQR, 0.80 to 2.78) (only perception of light in three eyes). The median BCVA in the immediate postoperative period was 0.60 (IQR, 0.30 to 1.48) (perception of light in an eye) which was significantly different from the preoperative BCVA (p<0.0001). The median BCVA achieved was 0.30 (IQR, 0.00 to 0.80), suggesting further improvement. Median time taken to achieve this postoperatively was 1.5 months (IQR, 8 days to 3 months). The median BCVA during the last follow-up was 0.48 (IQR, 0.18 to 1.00). The preferred type of cataract surgery was phacoemulsification. Ocular surface condition remained stable in 35 eyes (87.5%). Ocular surface breakdown in four eyes (10%) was managed appropriately. CONCLUSION Cataract surgery outcome can be visually rewarding in chronic sequelae of SJS provided ocular surface integrity is adequately maintained preoperatively and postoperatively.
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Affiliation(s)
- Purvasha Narang
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Vikas Mittal
- Cornea and Anterior Segment Services, Sanjivni Eye Care, Ambala City, India
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease. Ocul Surf 2016; 14:168-88. [PMID: 26882981 DOI: 10.1016/j.jtos.2016.02.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [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: 06/20/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, USA
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA; Boston Foundation for Sight, USA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | | | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, USA
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA.
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Jain R, Sharma N, Basu S, Iyer G, Ueta M, Sotozono C, Kannabiran C, Rathi VM, Gupta N, Kinoshita S, Gomes JAP, Chodosh J, Sangwan VS. Stevens-Johnson syndrome: The role of an ophthalmologist. Surv Ophthalmol 2016; 61:369-99. [PMID: 26829569 DOI: 10.1016/j.survophthal.2016.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 01/03/2023]
Abstract
Stevens-Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. Acute SJS leads to the acute inflammation of the ocular surface and chronic conjunctivitis. If not properly treated, it causes chronic cicatricial conjunctivitis and cicatricial lid margin abnormalities. Persistent inflammation and ulceration of the ocular surface with cicatricial complications of the lids leads to chronic ocular sequelae, ocular surface damage, and corneal scarring. The destruction of the glands that secrete the tear film leads to a severe form of dry eye that makes the management of chronic SJS difficult. The option that is routinely used for corneal visual rehabilitation, keratoplasty, is best avoided in such cases. We describe the management strategies that are most effective during the acute and chronic stages of SJS. Although treatments for acute SJS involve immunosuppressive and immunomodulatory therapies, amniotic membrane transplantation is also useful. The options for visual rehabilitation in patients with chronic SJS are undergoing radical change. We describe the existing literature regarding the management of SJS and highlight recent advances in the management of this disorder.
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Affiliation(s)
- Rajat Jain
- Cornea, Ocular Surface and Anterior Segment Services, Department of Ophthalmology, drishtiCONE Eye Care, New Delhi, India
| | - Namrata Sharma
- Cornea and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sayan Basu
- Cornea and Anterior Segment Services, Department of Ophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Geetha Iyer
- C J Shah Cornea Services, Department of Ophthalmology, Dr. G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, Chennai, India
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Ophthalmology, Doshisha University, Kyotanabe, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chitra Kannabiran
- Department of Ophthalmology, Kallam Anji Reddy Molecular Genetics Laboratory, L V Prasad Eye Institute (LVPEI), Hyderabad, Telangana, India
| | - Varsha M Rathi
- Cornea Services, Department of Ophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nidhi Gupta
- Department of Ophthalmology, Dr. Shroff Charity Eye Hospital, Delhi, India
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - José A P Gomes
- Cornea and External Disease Service, Department of Ophthalmology, Federal University of Sao Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil; Advanced Ocular Surface Center (CASO), Department of Ophthalmology, Federal University of Sao Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Virender S Sangwan
- Department of Ophthalmology, Srujana Center for Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Nair D, Mohamed A, Sangwan VS. Outcome of cataract surgery following simple limbal epithelial transplantation for lime injury-induced limbal stem cell deficiency. BMJ Case Rep 2015; 2015:bcr-2015-212613. [PMID: 26698204 DOI: 10.1136/bcr-2015-212613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old woman presented to us after being diagnosed elsewhere with right eye total limbal stem cell deficiency resulting from a lime burn. She was advised to undergo limbal stem cell transplantation, but failed to immediately do so. Two years later, she underwent cultivated limbal epithelial transplantation (CLET). As she had severe loss of vision with persisting conjunctival nodule and symblepharon 2 years following surgery, an impression of failed CLET was formed. Subsequently, simple limbal epithelial transplantation (SLET) was performed. Nine months later, she developed a cataract in her right eye; the cataract was extracted and posterior chamber intraocular lens implanted. The unaided visual acuity improved from light perception at presentation to 20/60 at 1-week postoperatively. At 5 months follow-up, the patient continued to maintain 20/60 visual acuity in her right eye. This case describes the outcome of cataract surgery following SLET, emphasising the need to perform cataract surgery in complicated cataracts for a better visual prognosis.
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Affiliation(s)
- Dhanyasree Nair
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender S Sangwan
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis--A Comprehensive Review and Guide to Therapy. I. Systemic Disease. Ocul Surf 2015; 14:2-19. [PMID: 26549248 DOI: 10.1016/j.jtos.2015.10.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/01/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023]
Abstract
The intent of this review is to comprehensively appraise the state of the art with regard to Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to the ocular surface complications and their management. SJS and TEN represent two ends of a spectrum of immune-mediated, dermatobullous disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. The widespread keratinocyte death seen in SJS/TEN is rapid and irreversible, and even with early and aggressive intervention, morbidity is severe and mortality not uncommon. We have divided this review into two parts. Part I summarizes the epidemiology and immunopathogenesis of SJS/TEN and discusses systemic therapy and its possible benefits. We hope this review will help the ophthalmologist better understand the mechanisms of disease in SJS/TEN and enhance their care of patients with this complex and often debilitating disease. Part II (April 2016 issue) will focus on ophthalmic manifestations.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Sayan Basu
- LV Prasad Eye Institute, Hyderabad, India
| | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, Aurora, CO
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA; Boston Foundation for Sight, Boston, MA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | - Chie Sotozono
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, Miami, FL
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
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50
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Abstract
Scleral lenses are large diameter lenses which rest over the sclera, unlike the conventional contact lenses which rest on the cornea. These lenses are fitted to not touch the cornea and there is a space created between the cornea and the lens. These lenses are inserted in the eyes after filling with sterile isotonic fluid. Generally, scleral contact lenses are used for high irregular astigmatism as seen in various corneal ectatic diseases such as keratoconus, pellucid marginal degeneration, or/and as liquid bandage in ocular surface disorders. In this article, we review the new developments, that have taken place over the years, in the field of scleral contact lenses as regard to new designs, materials, manufacturing technologies, and fitting strategies particularly for keratoconus.
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Affiliation(s)
| | - Preeji S Mandathara
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
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