Publications by authors named "Bharat Kapoor"

11 Publications

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Survey on the impact of COVID19 in patients on immunosuppression for ocular and orbital inflammatory disorders.

Eur J Ophthalmol 2021 Apr 8:11206721211008039. Epub 2021 Apr 8.

Department of Ophthalmology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.

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http://dx.doi.org/10.1177/11206721211008039DOI Listing
April 2021

An Atypical Presentation of Sympathetic Ophthalmia in an Intact Globe Following Mechanical Fall: A Case Report and Literature Review.

Vision (Basel) 2021 Feb 21;5(1). Epub 2021 Feb 21.

Department of Ophthalmology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK.

Purpose: To describe an atypical case of sympathetic ophthalmia presenting after blunt trauma causing disinsertion of the iris in an intact globe.

Methods: Case report.

Results: A 71-year-old lady presented to the Emergency Department following a mechanical fall. On examination, she was noted to have periocular haematoma, subconjunctival haemorrhage, hyphaema, and vitreous haemorrhage in the left eye, but there was no evidence of globe rupture. The presenting visual acuity was 6/18. As the hyphaema and vitreous haemorrhage settled, a complete loss of the iris was noted with normal fundus. She was re-admitted a month later under the medical team with urinary tract infection and reduced vision in both eyes. On examination, there was mild conjunctival injection, keratic precipitates, anterior chamber flare, 180-degree posterior synechiae, and vitritis with no fundal view of the right eye. She was diagnosed with sympathetic ophthalmia and was treated with topical and systemic corticosteroid. Her vision improved gradually with treatment and was stable at 6/6 on the right (sympathising) eye and 6/9 on the left (excited) eye at final follow-up.

Conclusion: Sympathetic ophthalmia may result from non-penetrating ocular trauma. Comprehensive history of mechanism of injury and ophthalmic examination is essential so that prompt treatment can be given to improve the visual prognosis of affected patients.
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http://dx.doi.org/10.3390/vision5010011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930941PMC
February 2021

Implementation of the LOOP pathway-a framework for the management of ocular tuberculosis across the United Kingdom?

Eye (Lond) 2021 Jan 14. Epub 2021 Jan 14.

Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.

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http://dx.doi.org/10.1038/s41433-020-01348-2DOI Listing
January 2021

Long-term results of intravitreal bevacizumab and dexamethasone for the treatment of punctate inner choroidopathy associated with choroidal neovascularization: A case series.

SAGE Open Med Case Rep 2018 6;6:2050313X18772478. Epub 2018 May 6.

Medical Retina, Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK.

Introduction: To present a case series of three female patients with punctate inner choroidopathy. We report the outcomes after an essentially long follow-up period of up to 14 years and provide evidence of the effectiveness of intravitreal injections of bevacizumab and dexamethasone 0.7 mg in punctate inner choroidopathy patients with choroidal neovascular membrane formation.

Case Series Presentation: This is a retrospective case series of three female patients with punctate inner choroidopathy who were treated with intravitreal injections anti-vascular endothelial growth factor agent (bevacizumab, 1.25 mg/0.05 mL). Two patients also received intravitreal dexamethasone 0.7 mg. Once a choroidal neovascular membrane developed, the outcome was poor with a best-corrected visual acuity of 6/60 or counting fingers in the affected eyes. The patients were followed up for 5, 14 and 8 years.

Conclusion: The use of dexamethasone 0.7 mg in punctate inner choroidopathy yielded encouraging results and long periods of stability. When choroidal neovascular membrane complicates the primary disease, the prognosis is unfavourable, especially if the macula integrity has already been considerably affected. On the contrary, aggressive early therapy and continued monthly monitoring can prevent severe fibrosis, as showed in previous reports. Further larger-scale studies are needed to evaluate the efficacy of intravitreal dexamethasone 0.7 mg and bevacizumab as an alternative treatment in non-infectious uveitis.
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http://dx.doi.org/10.1177/2050313X18772478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946604PMC
May 2018

Safety profile and efficacy of tacrolimus in the treatment of birdshot retinochoroiditis: a retrospective case series review.

Br J Ophthalmol 2018 07 19;102(7):983-990. Epub 2017 Oct 19.

Department of Medical Retina, Moorfields Eye Hospital, London, UK.

Aim: Evaluation of the use of tacrolimus in the treatment of birdshot retinochoroiditis (BRC) at a tertiary referral centre with the aim to describe its safety and efficacy.

Methods: The medical records of 25 patients diagnosed with BRC at uveitis service, Moorfields Eye Hospital, and who had received tacrolimus treatment were retrospectively reviewed. The main outcome measures of the study were (1) safety of tacrolimus in terms of side effects and (2) efficacy, as measured both by control of inflammation and visual function assessed by Humphrey visual fields and electrophysiological testing over at least 6 months and then 1 year.

Results: Tacrolimus was commenced in 25 patients (mean age 50.4±10.8 years) and was well tolerated in 21 patients (84%). It was necessary to stop the tacrolimus in four patients. No patient showed major changes in renal function: 3/21 patients (14.28%) showed slightly abnormal (less than 30%) function at the end of the first month of treatment; 1/21 (4.76%) patients at 3 months, but at the end of a 6-month treatment period only 1/21 patients (4.76%) showed minor abnormality in renal function. The mean daily prednisolone dose was 19.7 mg at the beginning of the study, which had fallen to 6.9 mg at the end (t=5.071, p=0.001). Visual acuity mostly remained stable. Visual fields improved over time (mean improvement in Humphrey mean deviation, right eye=1.8±2.4 dB, t=3.821, p=0.004; left eye=1.9±2.7, dB, t=3.06, p=0.007). Electrophysiological function showed improvement in 10 patients, and in four patients an initial deterioration in function improved following tacrolimus dose adjustment.

Conclusion: Tacrolimus has a good safety profile for long-term use in patients with BRC as a second-line agent enabling steroid sparing and visual function stabilisation or improvement.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310436DOI Listing
July 2018

The concept of virtual clinics in monitoring patients with age-related macular degeneration.

Acta Ophthalmol 2016 Aug 19;94(5):e353-5. Epub 2015 Sep 19.

Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Leicester, UK.

Purpose: To present clinical results regarding the treatment of patients with age-related macular degeneration (neovascular form) after the implementation of a 'virtual' type of follow-up in a single retina service centre.

Methods: Retrospective study based on the clinical records of the Leicester Royal Infirmary Retina department. Two periods were compared, the 2-year period of 2011-2012 and the following one of 2012-2013 when the 'virtual' clinics model applied in the department. Primary outcomes were as follows: the time between two appointments, follow-up or treatment and the number of patients with significant (>15 letters) improvement of their best corrected distance visual acuity. Secondary parameters of interest were as follows: mean number of injections per patient/year and the average duration of a 'virtual' vs. a regular visit.

Results: The mean time interval between two appointments was 5.3 weeks following the implementation of the 'virtual' clinics compared to 6.9 weeks in the previous period of regular appointments. Mean visual acuity improvement >15 letters was achieved in 6.9% of the patients compared to 23.1% of the 'virtual' appointments period. The results regarding injections/patient/year were as follows: 5.6 before the model of 'virtual' appointments and 5.9 after the implementation. The average time a patient spent for a conventional visit was 71.4 ± 24.1 min, and the respective time needed in the virtual clinic was 47.3 ± 18.6 min.

Conclusion: The model of 'virtual' (without actual consultation) follow-up appointments assisted our service to contend with the increased number of patient. In general, the specific pattern of patients' management could be widely considered obviously after comprehensive and all-embracing assessment of its safety and efficiency.
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http://dx.doi.org/10.1111/aos.12832DOI Listing
August 2016

Incidence of Retinal Pigment Epithelial Tears and Associated Risk Factors After Treatment of Age-Related Macular Degeneration with Intravitreal Anti-VEGF Injections.

Open Ophthalmol J 2014 31;8:101-4. Epub 2014 Dec 31.

Ophthalmology Department, Medical Retina Unit, Leicester Royal Infirmary, Leicester, UK.

Purpose: To study the incidence and risk factors for retinal pigment epithelium tears following intravitreal anti-vascular endothelial growth factor (VEGF) injections.

Methods: Retrospective longitudinal study. 4027 intravitreal anti-VEGF injections in 628 patients (676 eyes) for choroidal neovascularisation associated with age related macular degeneration in a period of 18 months were studied.

Results: Seventeen patients (mean age 83.95±5.84) developed retinal pigment epithelium tears. The incidence rate was 0.4%. Fibrovascular pigment epithelium detachment (PED) was previously observed in all cases. In 88 % (15/17) of AMD patients that had a RPE tear, PED height was found to be less than 400 microns at presentation. In 5 of 7 patients with RPE tear grade <4, continuing of anti-VEGF treatment resulted to improvement of visual acuity.

Conclusion: Critical risk factors for RPE tears are presence of PED as well as advanced age. Visual improvement appears to depend more on the extent and location of the RPE tear and less on the PED height.
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http://dx.doi.org/10.2174/1874364101408010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319202PMC
February 2015

Successful treatment of retinal angiomatous proliferation with intravitreal triamcinolone and ranibizumab injections in a 67-year-old male.

Case Rep Ophthalmol 2014 Sep 26;5(3):392-9. Epub 2014 Nov 26.

Eye Department, Northampton General Hospital, Northampton, UK.

A 67-year-old male who presented to the eye casualty department with deterioration in his vision was diagnosed with retinal angiomatous proliferation. After initial deterioration with ranibizumab intravitreal injections, we have demonstrated successful treatment and stabilised vision with ranibizumab and a single intravitreal triamcinolone injection. Stringent follow-up and top-up ranibizumab injections have stabilised his vision and have shown foveal improvement on optical coherence tomography imaging.
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http://dx.doi.org/10.1159/000369611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280470PMC
September 2014

Selective Laser Trabeculoplasty in Pseudophakic Glaucoma.

Ophthalmic Surg Lasers Imaging 2010 Mar 9:1-2. Epub 2010 Mar 9.

Glaucoma following cataract operation is more common when complications occur during surgery. Patients who had posterior capsule rupture during cataract surgery usually have a prolonged intraoperative time and manipulation. In such cases, secondary glaucoma may develop due to chronic trabecular damage and prolong topical steroid use. It is usually treated with topical anti-glaucoma medication or surgery. Recently selective laser trabeculoplasty (SLT) has emerged as a relatively new, safe and effective treatment modality. Three cases of pseudophakic secondary glaucoma following complicated cataract surgery treated successfully with 180 degrees SLT treatment are presented. Case 1 responded well to SLT during 5-year available follow-up, along with reduction in topical anti-glaucoma medication. In Cases 2 and 3, SLT was used as adjunctive to topical anti-glaucoma medication and target intra ocular pressure (IOP) was maintained for 4 and 2 years of available follow-up, respectively. To our best knowledge this is the first case series where SLT has been shown effective in cases of pseudophakic secondary glaucoma.
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http://dx.doi.org/10.3928/15428877-20100215-15DOI Listing
March 2010

An unusual case of acute angle closure glaucoma following argon laser pan retinal photocoagulation.

BMJ Case Rep 2010 Aug 9;2010. Epub 2010 Aug 9.

Royal Eye Infirmary, Plymouth Hospital NHS Trust, Plymouth, UK.

Acute angle closure glaucoma (AACG) is a painful, potentially blinding condition with patients frequently presenting within hours of onset with ocular pain, nausea and vomiting. Argon laser pan-retinal photocoagulation (PRP) is one of the commonest ophthalmic outpatient procedures. It is used in the treatment of vascular disorders of the retina; most commonly diabetic retinopathy. AACG following PRP is a recognised, but rarely occurring, complication. Prompt treatment alleviates pain and improves visual prognosis. The authors report a case of AACG following PRP treatment which was initially mistaken for a viral illness.
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http://dx.doi.org/10.1136/bcr.12.2009.2511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029597PMC
August 2010

Neurotrophic keratitis in a patient with dihydroxypyrimidine dehydrogenase deficiency.

Indian J Ophthalmol 2008 Jul-Aug;56(4):336-7

Clayton Centre for Advanced Eye Specialties, Wakefield, United Kingdom.

We describe a case of neurotrophic keratitis in association with dihydroxypyrimidine dehydrogenase (DHPD) deficiency. Ocular manifestations in patients with DHPD are rare and neurotrophic keratitis has never been reported before. A six-year-old boy who was a known case of DHPD deficiency and born of a consanguineous marriage presented to our clinic with non-healing corneal ulcers in both eyes. Reduced corneal sensations were detected and the patient was started on lubricating eye drops. The patient continues to be on lubricant eye drops and there has been no recurrence of the disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636154PMC
http://dx.doi.org/10.4103/0301-4738.41422DOI Listing
November 2008