Publications by authors named "Chitaranjan Mishra"

70 Publications

Surgical management of full-thickness macular hole following Nd:YAG laser hyaloidotomy for pre-macular haemorrhage in a patient with anaemic retinopathy.

BMJ Case Rep 2022 Aug 12;15(8). Epub 2022 Aug 12.

Department of Retina Vitreous, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Pre-macular haemorrhage (PMH) can cause profound visual loss. Some surgeons prefer neodymium-doped yttrium aluminium garnet (Nd:YAG) hyaloidotomy as the first line of treatment due to being an easy technique and having a high success rate. However, the use of high energy close to the fovea can lead to various macular complications. We present a case of a patient who presented with PMH secondary to anaemic retinopathy. He underwent Nd:YAG laser hyaloidotomy, but developed a full-thickness macular hole. He further underwent vitrectomy and a type 1 closure was achieved. However, the visual gain was poor due to the large hole size and the collateral thermal damage. The hole may not close spontaneously, thus requiring surgical intervention. The surgical outcome of these holes depends on the size of the hole and the collateral thermal damage caused during the laser procedure.
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http://dx.doi.org/10.1136/bcr-2022-249564DOI Listing
August 2022

Vortex vein ampullae seen in oculocutaneous albinism on ultrawide field imaging without angiography.

Natl Med J India 2021 Nov-Dec;34(6):373

Department of Vitreo-Retinal Services Aravind Eye Hospital and Post Graduate Institute of Ophthalmology Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.25259/NMJI_57_21DOI Listing
July 2022

Bilateral secondary angle-closure glaucoma and ciliochoroidal effusion as an initial manifestation of systemic lupus erythematosus.

Indian J Ophthalmol 2022 Jul;70(7):2659-2661

Department of Glaucoma Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_299_22DOI Listing
July 2022

A bibliometric analysis of research on genetic retinal diseases done in India.

Indian J Ophthalmol 2022 Jul;70(7):2546-2550

Department of Library, Aravind Library and Information Center, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Purpose: To conduct a bibliometric analysis of research on genetic retinal diseases (GRD) done in India published from 2011 to 2020 in peer-reviewed journals, and assess the productivity, trends in journal choice, publication types, research funding, and collaborative research.

Methods: We searched PubMed for articles indicating both vision-related content and author affiliation with an Indian research center. We identified research collaborations and classified articles as reporting basic science, clinical science, or clinically descriptive research. Impact factors were determined from Journal Citation Reports for 2015.

Results: The total number of published articles that were retrieved from 2011 to 2021 was 341. During the 10 years of study, the annual output of research articles has nearly doubled, that is, from 21 in 2011 to 44 in 2021. A total of 298 (87%) articles were published in international journals, and 149 (42%) articles in vision-related journals had an impact factor. A total of 224 (65%) articles came from six major eye hospitals. Clinical science articles were most frequently (86%) published, whereas basic science was the least (14%). The diseases on which the maximum and the minimum number of articles were published were retinoblastoma (n = 82,24%) and Stargardt disease (n = 3, 0.9%), respectively.

Conclusion: This bibliometric study provides a broad view of the current status and trends in the research on GRD done in India and may help clinicians, researchers, and policymakers to better understand this research field and predict its dynamic directions.
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http://dx.doi.org/10.4103/ijo.IJO_3154_21DOI Listing
July 2022

Commentary: Shifting our focus to diabetic retinopathy is the need of the hour.

Indian J Ophthalmol 2022 Jun;70(6):1956

Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_2987_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359228PMC
June 2022

Multimodal imaging of congenital retinal macrovessel with secondary foveal hypoplasia.

BMJ Case Rep 2022 Apr 20;15(4). Epub 2022 Apr 20.

Aravind Eye Hospital, Madurai, India.

Congenital retinal macrovessel (CRM) is defined as a large aberrant blood vessel that traverses through the central macula. It can have large tributaries extending on both sides of the horizontal raphe. The condition is typically asymptomatic. However, visual loss may be reported in case of associated branch retinal artery occlusion, cavernous haemangioma, retinal artery macroaneurysm, retinal deep capillary ischaemia, retinal detachment and vitreous haemorrhage. However, association of CRM and foveal hypoplasia has rarely been reported.We report multimodal imaging in a patient who was presented with visual loss due to foveal hypoplasia secondary to CRM.
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http://dx.doi.org/10.1136/bcr-2022-249563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021763PMC
April 2022

Angle-Closure Glaucoma Secondary to Malignant Hypertension: A Difficult Conundrum.

Ophthalmol Glaucoma 2022 Apr 7. Epub 2022 Apr 7.

Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India. Electronic address:

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http://dx.doi.org/10.1016/j.ogla.2022.03.009DOI Listing
April 2022

Combined treatment modality including topical 20% fluorescein dye in the management of phthiriasis palpebrarum - A case series.

Indian J Ophthalmol 2022 Apr;70(4):1327-1330

Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

Purpose: To study the clinical presentations and outcomes of phthiriasis palpebrarum (PP) managed with combined treatment modality comprising of 20% fluorescein dye, mechanical removal of the ectoparasites, and topical application of antibiotic eye ointment with paraffin base.

Methods: This is a prospective interventional noncomparative hospital-based series of 13 patients of PP. All the patients underwent local application of 20% fluorescein dye over the eyelashes and eyebrows of both the eyes followed by the mechanical removal of all the ectoparasites and trimming of the eyelashes from the base followed by application of ophthalmic ointment.

Results: Mean age of the patients was 28 ± 22 years (range 3-60 Years). Out of the total of 13 patients, 11 patients (85%) were having bilateral involvement. The mean duration of symptoms in 11 patients (rest 2 were accidental findings) was 4 ± 3 weeks (range 1-10 weeks). Three patients (23%) had a history of sexual contact with possible parasite-infested partners. Four patients (31%) had additional parasites in the pubic area or torso. All the patients were completely parasite free at the end of 1 month. There was no infestation of the treating medical personnel from the patient. The average follow-up was 8 ± 5 months (range 3-21 months).

Conclusion: Itching and irritation of the eyes were the most common presentations of PP. Combined treatment modality comprising of 20% fluorescein dye, mechanical removal of ectoparasites, and topical application of antibiotic eye ointment with paraffin base is effective in the management of PP.
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http://dx.doi.org/10.4103/ijo.IJO_1954_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240500PMC
April 2022

Clinical features, management and outcomes of expulsive choroidal hemorrhage during cataract surgery: 13 years experience from a tertiary eye center.

J Cataract Refract Surg 2022 Feb 25. Epub 2022 Feb 25.

Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, 625020, India.

Purpose: To study the risk factors, clinical features, management, and outcomes of intraoperative expulsive choroidal hemorrhage (ECH) during cataract surgery.

Setting: Aravind eye hospital, Madurai, Tamil Nadu, India.

Design: Retrospective hospital-based study.

Methods: Of the 1167250 patients who underwent cataract surgery between 2008 to 2020, patients diagnosed with intraoperative ECH were included. Demography, ocular and systemic risk factors, visual acuity, type of ocular anesthesia, intraoperative and postoperative records, management, and surgical outcomes were analyzed.

Results: A total of 52 eyes (0.004%) of 1167250 patients had ECH. Of the 52 cases, 43 cases (incidence rate 0.006%) were reported in the years 2008 to 2015 and 9 cases (incidence rate 0.002%) in the years 2016 to 2020. The change in the ocular anesthesia from peribulbar and retrobulbar anesthesia (2008-2015) to sub-Tenon's anesthesia (2016-2020) was associated with a reduced rate of ECH (p-value 0.002). Twenty-eight eyes (53.8%) were having limited ECH and 24 eyes (46.2%) were having full-blown ECH. The visual outcome was better in eyes with limited ECH compared to full-blown SCH in all follow-up visits. The median vision (IQR) before the cataract surgery and immediate postoperative day 1 were 1.30 (0.78 - 2.60) and 2.45 (1 - 2.75) respectively. The median final vision (IQR) after the secondary surgical intervention was 2.2 (0.60 - 2.60).

Conclusions: This series included 52 eyes with ECH, recognized associations of ECH with different types of anaesthesia as well as with different cataract surgical procedures, and described management of ECH. Postoperative visual outcome was poor.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000921DOI Listing
February 2022

Response to comment on: Incidence of ocular and systemic disease affecting visual function among state bus drivers.

Indian J Ophthalmol 2022 02;70(2):686-687

Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_2585_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023950PMC
February 2022

Peripapillary and macular retinoschisis - A vision-threatening sequelae of advanced glaucomatous cupping.

Indian J Ophthalmol 2021 Dec;69(12):3552-3558

Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamilnadu, India.

Purpose: To present a selected case series of advanced glaucoma-associated peripapillary and macular retinoschisis and response to various treatment strategies with a comprehensive literature review.

Methods: Retrospective observational case series. Retrospective review of five selected cases of advanced glaucoma with peripapillary and macular retinoschisis.

Results: All five patients had advanced glaucomatous damage with macular and peripapillary retinoschisis, three (patients 2, 3, and 5) had a neurosensory detachment of the macula. Increased intraocular pressure was managed with maximal antiglaucoma medications and G6 micropulse diode laser treatment in the first patient, transscleral diode laser in the second patient, mitomycin-C augmented trabeculectomy in the third patient, maximal antiglaucoma medications alone in the fourth patient, pars plana vitrectomy followed by trabeculectomy in the fifth patient.

Conclusion: We speculate that peripapillary and macular retinoschisis may indicate a vision-threatening sequelae of advanced glaucoma. The probable inciting factor for this vision-threatening pathology being elevated intraocular pressure, fluctuations in intraocular pressure, and chronic glaucoma with advanced cupping. We emphasize that meticulous examination of the macula in patients with advanced glaucoma is mandatory. It is imperative to do OCT macula in patients with advanced glaucoma to diagnose this distinct entity at an earlier stage and preserve the existing visual potential.
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http://dx.doi.org/10.4103/ijo.IJO_668_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837292PMC
December 2021

Ultra-wide-field fundus autofluorescence and asteroid hyalosis.

Natl Med J India 2021 May-Jun;34(3):186

Department of Vitreo-Retinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.25259/NMJI_697_20DOI Listing
December 2021

The application of clinical registries in ophthalmic trauma-the International Globe and Adnexal Trauma Epidemiology Study (IGATES).

Graefes Arch Clin Exp Ophthalmol 2022 Apr 23;260(4):1055-1067. Epub 2021 Nov 23.

Lee Kong Chian School of Medicine, Singapore, Singapore.

Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.
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http://dx.doi.org/10.1007/s00417-021-05493-6DOI Listing
April 2022

Commentary: Obstructive sleep apnea: A silent associate of diabetic retinopathy.

Indian J Ophthalmol 2021 11;69(11):3357-3358

Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_864_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725113PMC
November 2021

Commentary: Delphi method in ophthalmology: The guiding principles from experienced minds for ambiguous clinical situations.

Indian J Ophthalmol 2021 11;69(11):3319-3320

Department of Retina, Uvea, and Cataract, ASG Eye Hospital, Kolkata, West Bengal, India.

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http://dx.doi.org/10.4103/ijo.IJO_2608_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725134PMC
November 2021

Surgical outcome of full-thickness macular hole secondary to tractional retinal detachment in proliferative diabetic retinopathy.

Indian J Ophthalmol 2021 Nov;69(11):3302-3307

Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

Purpose: To evaluate the surgical outcome of full-thickness macular hole (FTMH) secondary to active fibrovascular proliferation (FVP) and tractional retinal detachment (TRD) in eyes with proliferative diabetic retinopathy (PDR), and factors influencing the outcome.

Methods: This retrospective study included the patients who underwent vitrectomy for FTMH secondary to PDR TRD from 2016 to 2020. Anatomical and visual outcomes were analyzed after six months along with the factors predicting the final outcome and duration of subretinal fluid (SRF) resolution.

Results: Group A (macula-off combined RD, i.e., tractional and rhegmatogenous) included 10 eyes, while group B (macula-threatening TRD) included eight eyes. The mean best-corrected visual acuity improved from logMAR 1.21 (Snellen equivalent: 20/324) to logMAR 0.76 (Snellen equivalent: 20/115) (P = 0.008). Seventeen patients gained ≥1 line(s) of vision. Mean visual gain in groups A and B was 3.7 ± 1.9 and 1.9 ± 1.1 lines, respectively (P = 0.051). MH closed in 88.9% eyes. Type 1 anatomical closure was achieved in 88.9% of eyes. At 6 months, SRF and central macular thickness reduced from 479.6 ± 512.5 μm to 11.4 ± 23.5 μm (P = 0.002) and 874.3 ± 422.6 μm to 207.6 ± 81.7 μm (P = 0.0002), respectively. Finally, macular SRF resolved in all the patients. The mean duration for complete SRF resolution was 4.9 ± 3.2 months. Eyes with a shorter duration of diabetes mellitus (rho = -0.49, P = 0.040) and macula-off combined RD (P = 0.048) took a longer time for complete SRF resolution.

Conclusion: Good anatomical and visual outcomes can be achieved in eyes with PDR TRD-associated FTMH. The residual macular SRF resolves slowly after the surgery and extra intervention is not required. Macula-off combined RD is associated with worse outcome and a slower SRF resolution rate.
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http://dx.doi.org/10.4103/ijo.IJO_1204_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725085PMC
November 2021

Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study.

Indian J Ophthalmol 2021 Nov;69(11):3289-3295

Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

Purpose: To evaluate the clinical profile, visual outcomes, and complications among young adult patients with type 1 diabetes mellitus (insulin-dependent DM-T1DM) in comparison with patients with type 2 diabetes mellitus (T2DM) undergoing vitrectomy for complications of proliferative diabetic retinopathy (PDR)..

Methods: A retrospective review of patients between 18 and 45 years with T1DM undergoing vitrectomy for complications of PDR between June 2017 and June 2019, with a minimum follow-up of 12 months. Consecutive patients between 30 and 45 years with type 2 diabetes (non-insulin-dependent DM-T2DM) who underwent vitrectomy for the same indications were retrospectively enrolled as the control group.

Results: There were 42 eyes (28 patients) in the T1DM group and 58 eyes (47 patients) in the T2DM group. The average age at operation was 35.9 ± 6.88 years and 39.8 ± 3.03 years, respectively (P < 0.001). At the end of follow-up, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 1.53 ± 0.55 to 1.30 ± 0.93 (P value 0.07) in the T1DM group and from 1.59 ± 0.46 to 1.00 ± 0.78 in the T2DM group (P = 0.0001). The rate of the primary and final reattachment was 76.2% and 88.1% in the T1DM group and 84.5% and 96.6% in the T2DM group. Preoperative macular tractional retinal detachment (MTRD) and neovascular glaucoma (NVG) in both the groups, chronic kidney disease (CKD) and lack of preoperative Pan retinal photocoagulation (PRP) in the T1DM group, hypertension (HTN) and, resurgery in the T2DM group, were risk factors for poor vision at the final follow-up.

Conclusion: The visual and anatomic outcomes were poorer in the T1DM patients which could be due to the longer duration of diabetes with worse glycemic control, associated comorbidities like CKD, and a higher incidence of MTRD.
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http://dx.doi.org/10.4103/ijo.IJO_1293_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725156PMC
November 2021

Commentary: Smartphone imaging integrated with offline artificial intelligence - A boon for the screening of diabetic retinopathy.

Indian J Ophthalmol 2021 11;69(11):3154-3155

Department of Vitreo-Retina, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_1156_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725117PMC
November 2021

Telemedicine in diabetic retinopathy screening in India.

Indian J Ophthalmol 2021 Nov;69(11):2977-2986

Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India.

With ever-growing prevalence of diabetes mellitus and its most common microvascular complication diabetic retinopathy (DR) in Indian population, screening for DR early for prevention of development of vision-threatening stages of the disease is becoming increasingly important. Most of the programs in India for DR screening are opportunistic and a universal screening program does not exist. Globally, telemedicine programs have demonstrated accuracy in classification of DR into referable disease, as well as into stages, with accuracies reaching that of human graders, in a cost-effective manner and with sufficient patient satisfaction. In this major review, we have summarized the global experience of telemedicine in DR screening and the way ahead toward planning a national integrated DR screening program based on telemedicine.
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http://dx.doi.org/10.4103/ijo.IJO_1442_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725153PMC
November 2021

Polyvivyl chloride deflector: A simple way to reduce slit-lamp lens fogging.

Indian J Ophthalmol 2021 Oct;69(10):2883-2884

Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/ijo.IJO_1164_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597494PMC
October 2021

Incidence of ocular and systemic diseases affecting visual function among state bus drivers.

Indian J Ophthalmol 2021 Oct;69(10):2625-2628

Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.

Purpose: To evaluate the incidence of ocular and systemic disease affecting visual function among state transport corporation bus drivers in a south Indian district.

Methods: This retrospective study analysed the records of all the drivers who presented to a south Indian tertiary-care eye hospital in 2019 for their mandatory annual ocular check-up. Details reviewed included demographic details; refraction; presence of systemic and ocular diseases with vision-threatening potential; presence of ocular conditions responsible for visual loss and the treatment administered.

Results: 3042 drivers (mean age, 47.0 ± 5.7 years) were evaluated. Visual function-threatening systemic diseases were present in 25.0% drivers, out of which diabetes mellitus (18.7%) was the most common pathology. The most common ocular problem was refractive error (45.0%). Visual function-threatening ocular diseases were present in 9.5% drivers. Diabetic retinopathy, visually-significant cataract, glaucoma and central serous chorioretinopathy were noted in 4.0%, 1.9%, 1.7% and 0.8% drivers. Surgical intervention was required in 2.2% drivers. Thirteen drivers were temporarily deemed unfit for driving heavy-weight vehicles.

Conclusion: Several bus drivers suffer from vision-threatening systemic and ocular diseases. Some of them require surgical intervention to retain fitness. A complete ocular and systemic evaluation of diseases with vision-threatening potential should be performed at the time of renewal of the driving license. The drivers should be educated about the systemic diseases which can affect their driving skills and must be encouraged to seek medical help at an early stage.
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http://dx.doi.org/10.4103/ijo.IJO_76_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597470PMC
October 2021

Peripapillary and Macular Retinoschisis Associated with Advanced Glaucoma.

Ophthalmol Glaucoma 2021 Sep-Oct;4(5):462

Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research Institute, Anna Nagar, Madurai, Tamilnadu, India.

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http://dx.doi.org/10.1016/j.ogla.2021.04.001DOI Listing
October 2021

Outcomes of manual small incision cataract surgery and phacoemulsification in eyes with chorioretinal coloboma.

J Cataract Refract Surg 2021 Sep;47(9):1127-1132

From the Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India (Shekhar, Pai, Kumar, R, Prasad R, H S); Department of Glaucoma Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India (Wijesinghe); Department of Vitreo-Retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India (Mishra).

Purpose: To evaluate outcomes of manual small-incision cataract surgery (MSICS) and phacoemulsification in eyes with chorioretinal coloboma.

Setting: Tertiary eye center, South India.

Design: Retrospective study.

Methods: Electronic medical records of 71 patients with chorioretinal coloboma undergoing cataract surgery from January 2017 to December 2019 were evaluated. Demographics, corrected distance visual acuity (CDVA), slitlamp biomicroscopy findings, grade of cataract, type of coloboma and associated posterior segment pathology, outcomes of different surgical techniques and risk factors for poor visual outcomes, and intraoperative complications were analyzed.

Results: Among the 78 eyes studied, 53.9% eyes achieved visual outcome of 20/40 or greater and 20.5% eyes achieved CDVA less than 20/200. For the MSICS group, the median preoperative CDVA was 1.78 (interquartile range [IQR] 1.08 to 2.60) logMAR), which improved to 0.60 (IQR 0.30-1.08) logMAR postoperatively. In phacoemulsification group, the CDVA improved from 0.78 (IQR 0.60-1.00) logMAR to 0.18 (IQR 0.18-0.30) logMAR. Statistically significant visual improvement was noticed in both groups (P < .001 in both). However, eyes that underwent phacoemulsification showed better visual recovery (P < .001). The mean age at presentation was 49.7 ± 10.8 years. MSICS was the most commonly performed surgery (61.54%), and 62 eyes had uneventful cataract surgery. Twelve eyes in MSICS group and 4 eyes in phacoemulsification group had intraoperative complications. Poor visual outcome was associated with male sex, microcornea, hard cataracts, and macular involvement of coloboma.

Conclusions: MSICS is an alternative to phacoemulsification in colobomatous eyes with advanced cataract. Hard cataract and microcornea were risk factors for intraoperative complications. Significant postoperative improvement in CDVA was noticed in both macula involved and macula not involved groups.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000586DOI Listing
September 2021

Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES).

Graefes Arch Clin Exp Ophthalmol 2022 Jan 28;260(1):371-383. Epub 2021 Aug 28.

National Healthcare Group Eye Institute at Tan Tock Seng Hospital, Singapore, 308433, Singapore.

Purpose: To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals.

Methods: Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported.

Results: Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298-18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378-20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096-12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury.

Conclusions: Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.
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http://dx.doi.org/10.1007/s00417-021-05284-zDOI Listing
January 2022
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