International Journal of Drug Research and Technology, 2021
Purpose: The single blind study was done to find out the effect of Fixed drug (FDC) combination B... more Purpose: The single blind study was done to find out the effect of Fixed drug (FDC) combination Brinzolamide/Timolol Versus Free equivalent combination therapy of Brinzolamide plus Timolol on Ocular hemodynamics in patients of Primary Open Angle Glaucoma (POAG). Methods: Two Groups were studied: Group 1-patient on 1% Brinzolamide/0.5% Timolol fixed dose combination and Group 2-patient on 1% Brinzolamide + 0.5% Timolol. A total of 40 study subjects were included who underwent measurement of IOP, Ocular Perfusion Pressure (OPP) and Ocular blood flow (OBF) by using Color Doppler.
Hypersensitivity reactions are our own immune responses to various triggering factors. These immu... more Hypersensitivity reactions are our own immune responses to various triggering factors. These immune responses result in different clinical presentations of various ocular diseases. Various cytokines, interleukins are responsible for a myriad of symptoms and thus our therapy should be targeted on specific immunological pathways. In this article we have summarized various ocular diseases with the causative immune pathways thus simplifying the underlying cause. This article will help in understanding why similar looking diseases may have requirement for different modalities of treatment or why similar medications may work in different ocular diseases.
Journal of Clinical & Experimental Ophthalmology, 2013
Background: Evaluate final visual outcome, visual recovery time, leakage resolution time on Fundu... more Background: Evaluate final visual outcome, visual recovery time, leakage resolution time on Fundus Angiography (FA), recurrence rate and complications in patients of Central Serous Chorioretinopathy (CSCR) treated with early double frequency Nd-YAG laser photocoagulation as compared to observation alone.Methods: Prospective, interventional, non-randomized, clinical, comparative trial. Two groups with 15 eyes of CSCR in each group were compared. First group treated with early double frequency Nd-YAG laser and other kept on observation. Best Corrected Visual acuity (BCVA) was recorded at baseline, 2 weeks, 1 month, 2 months and 3 months. FA was done at baseline, 2 weeks and 3 months. Contrast sensitivity was recorded at baseline and at the end of 3 months. Residual metamorphopsia checked at the end of 3 months using Amsler Grid.Results: BCVA significantly improved in the laser group at the end of 2 weeks (p<0.001). Although at the end of 3 months all 30 eyes had BCVA of 20/30 or better. At baseline all 30 eyes showed leakage on FA. At 2 weeks none of the eye in laser group showed leakage, while all 15 eyes in the observation group showed some amount of leakage. No leakage found in all 30 eyes at 3 months. Contrast sensitivity and residual metamorphopsia was similar in both groups at 3 months. There were no recurrences in the laser group during follow-up of 1 year, while in the observation group 2 eyes had recurrence. None of the eye in the laser group showed any complication related to laser on follow-up.Conclusions: Early double frequency Nd-YAG laser photocoagulation shortens the time for visual recovery and resolution of leakage on FA in patients of CSCR; is not associated with recurrences or complications but has no effect on the final outcome of quality of vision as compared to observation alone.
Rickettsioses are emergent and resurgent arthropod vector borne diseases due to obligate intracel... more Rickettsioses are emergent and resurgent arthropod vector borne diseases due to obligate intracellular small gram-negative bacteria. Most of them are transmitted to humans by the bite of infected arthropods, such as ticks. Ocular involvement is common, including conjunctivitis, keratitis, anterior uveitis, panuveitis, retinitis, retinal vascular changes, and optic nerve involvement. Though rickettsiosis is common in India, there is paucity of rickettsial retinitis (RR) reports from India. Moreover, rickettsial sub-types and their association with retinitis have not been studied.Ocular rickettsial infection may be a part of systemic rickettsial infection which is mainly autoimmune in nature so treatment is mostly based on steroids and antibiotics. We report the case of a 36 year old male native of North India.
Aim: To compare optic nerve sheath diameter (ONSD) in primary open angle glaucoma (POAG), primary... more Aim: To compare optic nerve sheath diameter (ONSD) in primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and normal tension glaucoma (NTG). Material and Methods: Patients with POAG (n=38), PACG (n=32), NTG (n=18) and con-trols (n=48) underwent B-scan ultrasound and computed tomography scan (CT scan) measurement of ONSD. Intraocular pressure (IOP) was measured in all groups and was correlated with ONSD. Results: ONSD was significantly (p=
To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg r... more To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg retina tomograph (HRT), in an elderly population. A population-based, cross-sectional study included 1460 eyes of 1460 consecutive, subjects >60 years, in North India. All subjects underwent a detailed ophthalmic evaluation and imaged on HRT. Stereometric parameters, Moorfields regression analysis (MRA) and discriminant function analysis were analyzed. Correlation between ONH parameters and disc area, age, sex, and intraocular pressure was analyzed. Disc size had a normal Gaussian distribution (2.22 ± 0.48 mm), but all other stereometric parameters showed a wide variation. MRA found 1320 (90.4%) eyes within normal limits, 71 (4.86%), borderline limits, and 69 (4.73%) outside normal limits. Comparison of eyes meeting International Society of Geographical and Epidemiological Ophthalmology criteria for a glaucoma suspect, C:D > 0.7, with those that did not show a statistically signific...
This study was aimed to evaluate the difference in the ocular parameter changes following scleral... more This study was aimed to evaluate the difference in the ocular parameter changes following scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) in different age group patients. This prospective study included 26 eyes of 26 patients who underwent SB for uncomplicated RRD. The patients were divided into three age groups: 16-30 years (Group I), 31-45 years (Group II), and 46-60 years (Group III). Axial length (AL), anterior chamber depth (ACD), and corneal curvatures were measured preoperatively and postoperatively at 1 week, 1 month, and 3-month. The postoperative change and progression of these parameters were evaluated and compared between three age groups using nonparametric Wilcoxon signed-rank test and Kruskal-Wallis test. At 3-month follow-up, a statistically significant postoperative AL increase, ACD decrease, and surgically induced astigmatism (SIA) were observed in all groups (Group I - 0.75 ± 0.32 mm, 0.21 ± 0.21 mm, and 1.5 ± 0.48 D, respectively; Group II - 0.79 ± 0.41 mm, 0.14 ± 0.04 mm, and 2.07 ± 1.18 D, respectively; Group III - 0.86 ± 0.33 mm, 0.16 ± 0.05 mm, and 1.56 ± 1.19 D, respectively). However, surgery-induced change for any parameter was not significantly different between the groups (P for AL [0.7955]; ACD [0.8805]; and SIA [0.5485]). Progression in postoperative changes in AL and ACD was insignificant during three follow-up examinations in all the groups. However, SIA of Group I continued to change significantly up to 3 months but stopped to change at 1 month only in Group II and III. Age-related change in physical properties of ocular tissue does not have any major additional effect on the results of SB except that the postsurgical change in corneal curvature stops earlier in older patients compared to that in younger patients.
To analyze the correlation between subjective symptoms and clinical signs of dry eye among tanner... more To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers. In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey. All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.
SM: What are the common indications of amniotic membrane transplantation in your clinical practic... more SM: What are the common indications of amniotic membrane transplantation in your clinical practice? HSD: I use amniotic membrane in association with ocular surface reconstruction procedures such as auto or allo limbal transplants and occasionally for bullous keratopathy and persistent epithelial defects. For the latter two indications, anterior stromal puncture and tarsorrhaphy are equally effective. Patients are offered the options and may choose one or the other. NSG: Most common indications as a graft for corneal disease are persistent epithelial defects and along with stem cell grafting. As a graft for conjunctival disease it is used in ocular surface reconstruction such as for symblepharon and fornix reconstruction, after tumor excision, combined with conjunctival graft in recurrent pterygia. It is used as a patch for acute chemical burns and SJS. AN: 1) Severe Chemical Injuries 2) As a substrate in Ocular Surface reconstruction for Late Chemical Injury Sequalae usually along with Limbal Autograft. 3) Recurrent Pterygiums. MT: Common indications for Amniotic Membrane Transplantation (AMT) in my clinical practice are Persistent Epithelial Defects (PED), Chemical Injuries, Partial or Total Limbal Stem Cell Deficiencies, Shield Ulcer, Pseudophakic Bullous Keratopathy with poor visual potential, Acute Steven Johnson Syndrome, Symplepharon release, in that order. SM: Do you use fresh or cryopreserved Amniotic membrane? HSD: I always use cryopreserved amniotic membrane. European Union law forbids use of amniotic membrane which has not been tested for HIV twice. Once during pregnancy or Out of all the available cells on the ocular surface , the limbal stem cells are the most important, as they are felt to give rise to the corneal epithelium and therefore are especially important for maintenance of a smooth, clear corneal surface. Any damage to them may lead to state of limbal stem cell deficiency, resulting in breakdown of the ocular surface and corneal epithelial defects. Although the conjunctival epithelium may replace corneal epithelium but this results in loss of corneal transparency. The answer to such a disease state is amniotic membrane grafting. Human amniotic membrane, which is derived from the fetal membranes, is believed to be nonimmunogenic. Usage of Amniotic Membrane Transplantation (AMT) in ophthalmology dates way back to 1940s by De Rotth in the treatment of conjunctival epithelial defects after symblepharon release. Since then there has been tremendous development in the usage of AMG in the treatment of a variety of ocular surface disorders. Amniotic membrane grafting can be used as an inlay or overlay technique or can also be used in a filling technique. We questioned a few ophthalmic surgeons to find out what is the latest being done in the field of amniotic membrane grafting.
4 weeks after an uneventful myopic LASIK, a 35-year-old, healthy female patient presented with co... more 4 weeks after an uneventful myopic LASIK, a 35-year-old, healthy female patient presented with complaints of brow ache and blurring of vision. Though advised to taper the routine antibiotic steroid drops the patient continued treatment with ofloxacin dexamethasone eye drops, which she was using 4 times a day. On examination her uncorrected visual acuity was 6/24, there was a diffuse, multifocal granular haze confined to the flap interface initially interpreted as a diffuse lamellar keratitis. Tonometry (tonopen) showed a reading of 34 mm Hg in both her eyes. There was no apparent field defect and fundoscopy revealed normal cup-disc ratio. The steroid eye drops were discontinued and topical antiglaucoma medication (Timolol with Brimonidine) was administered. This induced a rapid regression of IOP and corneal transparency returned. IOP was normalized down to 10 mm Hg. We present this masquerade syndrome following uneventful LASIK to show the importance of measuring IOP in the postoperative phase after LASIK, especially in cases of corneal haze. In cases of stromal infiltration after LASIK and increased IOP, local steroids have to be reduced immediately. If misdiagnosed or left unattended, this condition can lead to severe visual loss.
International Journal of Drug Research and Technology, 2021
Purpose: The single blind study was done to find out the effect of Fixed drug (FDC) combination B... more Purpose: The single blind study was done to find out the effect of Fixed drug (FDC) combination Brinzolamide/Timolol Versus Free equivalent combination therapy of Brinzolamide plus Timolol on Ocular hemodynamics in patients of Primary Open Angle Glaucoma (POAG). Methods: Two Groups were studied: Group 1-patient on 1% Brinzolamide/0.5% Timolol fixed dose combination and Group 2-patient on 1% Brinzolamide + 0.5% Timolol. A total of 40 study subjects were included who underwent measurement of IOP, Ocular Perfusion Pressure (OPP) and Ocular blood flow (OBF) by using Color Doppler.
Hypersensitivity reactions are our own immune responses to various triggering factors. These immu... more Hypersensitivity reactions are our own immune responses to various triggering factors. These immune responses result in different clinical presentations of various ocular diseases. Various cytokines, interleukins are responsible for a myriad of symptoms and thus our therapy should be targeted on specific immunological pathways. In this article we have summarized various ocular diseases with the causative immune pathways thus simplifying the underlying cause. This article will help in understanding why similar looking diseases may have requirement for different modalities of treatment or why similar medications may work in different ocular diseases.
Journal of Clinical & Experimental Ophthalmology, 2013
Background: Evaluate final visual outcome, visual recovery time, leakage resolution time on Fundu... more Background: Evaluate final visual outcome, visual recovery time, leakage resolution time on Fundus Angiography (FA), recurrence rate and complications in patients of Central Serous Chorioretinopathy (CSCR) treated with early double frequency Nd-YAG laser photocoagulation as compared to observation alone.Methods: Prospective, interventional, non-randomized, clinical, comparative trial. Two groups with 15 eyes of CSCR in each group were compared. First group treated with early double frequency Nd-YAG laser and other kept on observation. Best Corrected Visual acuity (BCVA) was recorded at baseline, 2 weeks, 1 month, 2 months and 3 months. FA was done at baseline, 2 weeks and 3 months. Contrast sensitivity was recorded at baseline and at the end of 3 months. Residual metamorphopsia checked at the end of 3 months using Amsler Grid.Results: BCVA significantly improved in the laser group at the end of 2 weeks (p<0.001). Although at the end of 3 months all 30 eyes had BCVA of 20/30 or better. At baseline all 30 eyes showed leakage on FA. At 2 weeks none of the eye in laser group showed leakage, while all 15 eyes in the observation group showed some amount of leakage. No leakage found in all 30 eyes at 3 months. Contrast sensitivity and residual metamorphopsia was similar in both groups at 3 months. There were no recurrences in the laser group during follow-up of 1 year, while in the observation group 2 eyes had recurrence. None of the eye in the laser group showed any complication related to laser on follow-up.Conclusions: Early double frequency Nd-YAG laser photocoagulation shortens the time for visual recovery and resolution of leakage on FA in patients of CSCR; is not associated with recurrences or complications but has no effect on the final outcome of quality of vision as compared to observation alone.
Rickettsioses are emergent and resurgent arthropod vector borne diseases due to obligate intracel... more Rickettsioses are emergent and resurgent arthropod vector borne diseases due to obligate intracellular small gram-negative bacteria. Most of them are transmitted to humans by the bite of infected arthropods, such as ticks. Ocular involvement is common, including conjunctivitis, keratitis, anterior uveitis, panuveitis, retinitis, retinal vascular changes, and optic nerve involvement. Though rickettsiosis is common in India, there is paucity of rickettsial retinitis (RR) reports from India. Moreover, rickettsial sub-types and their association with retinitis have not been studied.Ocular rickettsial infection may be a part of systemic rickettsial infection which is mainly autoimmune in nature so treatment is mostly based on steroids and antibiotics. We report the case of a 36 year old male native of North India.
Aim: To compare optic nerve sheath diameter (ONSD) in primary open angle glaucoma (POAG), primary... more Aim: To compare optic nerve sheath diameter (ONSD) in primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and normal tension glaucoma (NTG). Material and Methods: Patients with POAG (n=38), PACG (n=32), NTG (n=18) and con-trols (n=48) underwent B-scan ultrasound and computed tomography scan (CT scan) measurement of ONSD. Intraocular pressure (IOP) was measured in all groups and was correlated with ONSD. Results: ONSD was significantly (p=
To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg r... more To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg retina tomograph (HRT), in an elderly population. A population-based, cross-sectional study included 1460 eyes of 1460 consecutive, subjects >60 years, in North India. All subjects underwent a detailed ophthalmic evaluation and imaged on HRT. Stereometric parameters, Moorfields regression analysis (MRA) and discriminant function analysis were analyzed. Correlation between ONH parameters and disc area, age, sex, and intraocular pressure was analyzed. Disc size had a normal Gaussian distribution (2.22 ± 0.48 mm), but all other stereometric parameters showed a wide variation. MRA found 1320 (90.4%) eyes within normal limits, 71 (4.86%), borderline limits, and 69 (4.73%) outside normal limits. Comparison of eyes meeting International Society of Geographical and Epidemiological Ophthalmology criteria for a glaucoma suspect, C:D > 0.7, with those that did not show a statistically signific...
This study was aimed to evaluate the difference in the ocular parameter changes following scleral... more This study was aimed to evaluate the difference in the ocular parameter changes following scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) in different age group patients. This prospective study included 26 eyes of 26 patients who underwent SB for uncomplicated RRD. The patients were divided into three age groups: 16-30 years (Group I), 31-45 years (Group II), and 46-60 years (Group III). Axial length (AL), anterior chamber depth (ACD), and corneal curvatures were measured preoperatively and postoperatively at 1 week, 1 month, and 3-month. The postoperative change and progression of these parameters were evaluated and compared between three age groups using nonparametric Wilcoxon signed-rank test and Kruskal-Wallis test. At 3-month follow-up, a statistically significant postoperative AL increase, ACD decrease, and surgically induced astigmatism (SIA) were observed in all groups (Group I - 0.75 ± 0.32 mm, 0.21 ± 0.21 mm, and 1.5 ± 0.48 D, respectively; Group II - 0.79 ± 0.41 mm, 0.14 ± 0.04 mm, and 2.07 ± 1.18 D, respectively; Group III - 0.86 ± 0.33 mm, 0.16 ± 0.05 mm, and 1.56 ± 1.19 D, respectively). However, surgery-induced change for any parameter was not significantly different between the groups (P for AL [0.7955]; ACD [0.8805]; and SIA [0.5485]). Progression in postoperative changes in AL and ACD was insignificant during three follow-up examinations in all the groups. However, SIA of Group I continued to change significantly up to 3 months but stopped to change at 1 month only in Group II and III. Age-related change in physical properties of ocular tissue does not have any major additional effect on the results of SB except that the postsurgical change in corneal curvature stops earlier in older patients compared to that in younger patients.
To analyze the correlation between subjective symptoms and clinical signs of dry eye among tanner... more To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers. In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey. All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.
SM: What are the common indications of amniotic membrane transplantation in your clinical practic... more SM: What are the common indications of amniotic membrane transplantation in your clinical practice? HSD: I use amniotic membrane in association with ocular surface reconstruction procedures such as auto or allo limbal transplants and occasionally for bullous keratopathy and persistent epithelial defects. For the latter two indications, anterior stromal puncture and tarsorrhaphy are equally effective. Patients are offered the options and may choose one or the other. NSG: Most common indications as a graft for corneal disease are persistent epithelial defects and along with stem cell grafting. As a graft for conjunctival disease it is used in ocular surface reconstruction such as for symblepharon and fornix reconstruction, after tumor excision, combined with conjunctival graft in recurrent pterygia. It is used as a patch for acute chemical burns and SJS. AN: 1) Severe Chemical Injuries 2) As a substrate in Ocular Surface reconstruction for Late Chemical Injury Sequalae usually along with Limbal Autograft. 3) Recurrent Pterygiums. MT: Common indications for Amniotic Membrane Transplantation (AMT) in my clinical practice are Persistent Epithelial Defects (PED), Chemical Injuries, Partial or Total Limbal Stem Cell Deficiencies, Shield Ulcer, Pseudophakic Bullous Keratopathy with poor visual potential, Acute Steven Johnson Syndrome, Symplepharon release, in that order. SM: Do you use fresh or cryopreserved Amniotic membrane? HSD: I always use cryopreserved amniotic membrane. European Union law forbids use of amniotic membrane which has not been tested for HIV twice. Once during pregnancy or Out of all the available cells on the ocular surface , the limbal stem cells are the most important, as they are felt to give rise to the corneal epithelium and therefore are especially important for maintenance of a smooth, clear corneal surface. Any damage to them may lead to state of limbal stem cell deficiency, resulting in breakdown of the ocular surface and corneal epithelial defects. Although the conjunctival epithelium may replace corneal epithelium but this results in loss of corneal transparency. The answer to such a disease state is amniotic membrane grafting. Human amniotic membrane, which is derived from the fetal membranes, is believed to be nonimmunogenic. Usage of Amniotic Membrane Transplantation (AMT) in ophthalmology dates way back to 1940s by De Rotth in the treatment of conjunctival epithelial defects after symblepharon release. Since then there has been tremendous development in the usage of AMG in the treatment of a variety of ocular surface disorders. Amniotic membrane grafting can be used as an inlay or overlay technique or can also be used in a filling technique. We questioned a few ophthalmic surgeons to find out what is the latest being done in the field of amniotic membrane grafting.
4 weeks after an uneventful myopic LASIK, a 35-year-old, healthy female patient presented with co... more 4 weeks after an uneventful myopic LASIK, a 35-year-old, healthy female patient presented with complaints of brow ache and blurring of vision. Though advised to taper the routine antibiotic steroid drops the patient continued treatment with ofloxacin dexamethasone eye drops, which she was using 4 times a day. On examination her uncorrected visual acuity was 6/24, there was a diffuse, multifocal granular haze confined to the flap interface initially interpreted as a diffuse lamellar keratitis. Tonometry (tonopen) showed a reading of 34 mm Hg in both her eyes. There was no apparent field defect and fundoscopy revealed normal cup-disc ratio. The steroid eye drops were discontinued and topical antiglaucoma medication (Timolol with Brimonidine) was administered. This induced a rapid regression of IOP and corneal transparency returned. IOP was normalized down to 10 mm Hg. We present this masquerade syndrome following uneventful LASIK to show the importance of measuring IOP in the postoperative phase after LASIK, especially in cases of corneal haze. In cases of stromal infiltration after LASIK and increased IOP, local steroids have to be reduced immediately. If misdiagnosed or left unattended, this condition can lead to severe visual loss.
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