Publications by authors named "Dewang Angmo"

59 Publications

Correction to: Evaluation of physical properties and dose equivalency of generic versus branded latanoprost formulations.

Int Ophthalmol 2021 Dec 27. Epub 2021 Dec 27.

Glaucoma Research Facility and Clinical Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.

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http://dx.doi.org/10.1007/s10792-021-02146-9DOI Listing
December 2021

Elevated histamine levels in aqueous humor of patients with glaucoma.

Mol Vis 2021 3;27:564-573. Epub 2021 Sep 3.

Ocular Pharmacology and Pharmacy Division, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Neurotransmitters (NTs) are the key mediators of essential ocular functions, such as processing the visual functions of the retina, maintaining homeostasis of aqueous humor, and regulating ocular blood flow. This study aims to determine variations in the levels of L-glutamate and γ-aminobutyric acid (GABA), histaminergic, adrenergic, cholinergic, and serotonergic NTs in patients with primary glaucoma versus patients with cataract.

Methods: This case-control study involved three age-matched groups of patients with primary open angle glaucoma (POAG, n = 14), primary angle closure glaucoma (PACG, n = 21), and cataract (control, n = 19). Patients' aqueous humor and plasma were collected, snap frozen at -80 °C, and subjected to ultrasensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis for quantification of NTs.

Results: Baseline intraocular pressure and the cup-to-disc ratio were found to be statistically significantly elevated in the POAG and PACG groups compared to the cataract control group. In aqueous humor, histamine was found to be statistically significantly elevated (5-fold, p<0.0001), whereas 1-methyl histamine was statistically significantly decreased (p<0.05) in POAG compared to the control group. A statistically significant increase in L-glutamate and GABA was observed among both patient groups with glaucoma compared to the cataract control group. Adrenaline was found to be elevated only in the PACG group (2.7-fold, p<0.05). No statistically significant difference was observed among the plasma NT levels between the groups.

Conclusions: This study demonstrated the prominent role of the histaminergic system apart from autonomic mechanisms in the progression of glaucoma. Elevated L-glutamate and GABA could be due to retinal ganglionic cell death. Further studies are required to evaluate the effects of histamine on Müller cell dysfunction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421060PMC
December 2021

Intraoperative Optical Coherence Tomography-Guided Bleb-sparing Epithelial Exchange: A Modified Approach.

J Ophthalmic Vis Res 2021 Jul-Sep;16(3):515-520. Epub 2021 Jul 29.

Glaucoma Research Facility & Clinical Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

With the advent of newer technologies, real-time anterior segment optical coherence tomography (OCT) integrated with the operating microscope has become possible. We are proposing the technique of bleb revision with greater precision under direct visualization of bleb anatomy and extent of tissue depth allowing better localization and easy maneuvering with lesser complications. In this surgical technique, bleb revision was performed using intraoperative real-time OCT incorporated in OPMI LUMERA 700 microscope. Live surgical and OCT view were seen on a common screen together. A moderately elevated, diffuse functional bleb was noted after three months of bleb revision in both cases with controlled intraocular pressure. Intraoperative OCT-guided bleb-sparing epithelial exchange is an adjunctive technique for bleb repair surgery with an increased precision of surgery which can reduce complications, minimize surgical time and maximize surgical outcome.
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http://dx.doi.org/10.18502/jovr.v16i3.9447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358750PMC
July 2021

In Vivo Imaging of the Schlemm's Canal and the Response to Selective Laser Trabeculoplasty.

Am J Ophthalmol 2021 Jul 18;234:126-137. Epub 2021 Jul 18.

From the Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.. Electronic address:

Objective: To evaluate the presence of angle dysgenesis on ASOCT (anterior segment optical coherence tomography) (ADoA) as a predictive factor in determining outcomes of selective laser trabeculoplasty (SLT).

Design: A prospective clinical cohort study.

Subjects: Patients with juvenile-onset open-angle glaucoma (JOAG) without angle dysgenesis on gonioscopy.

Method: JOAG patients with uncontrolled intraocular pressure (IOP), who were to undergo SLT, were evaluated for the presence or absence of ADoA, which was defined as the absence of Schlemm's canal (SC) and/or presence of a hyperreflective membrane (HM) over the trabecular meshwork, as identified on ASOCT before the SLT procedure. Furthermore, the number of ASOCT B-scans in which SC was identified as present, were then quantified. Success of SLT was defined as a reduction of IOP by 20% or more from pre-laser value at 6-month follow-up without any further IOP-lowering medication or surgery. Only 1 repeat SLT was admissible for defining SLT success over the 6-month period. A successful reduction in IOP at 6-month follow-up was correlated with the extent of ADoA.

Results: In comparison to pre-SLT IOP, 57.1% eyes (20/35) showed more than 20% reduction in IOP at 6 months with a mean reduction of 7.6 ± 1.8 mm Hg (29.6%). When all 3 observers agreed, SC was identified in 90% eyes (18/20) with success vs 26.6% eyes (4/15) with failure (P < .001). All eyes (5/5) with presence of HM showed failure (P < .001). All eyes (19/19) in which SC was present in >50% ASOCT B scans (>25/50 scans/eye) showed success (P < .001). On a bias-reduced regression analysis, the identification of SC on any 2 consecutive scans increased the chances of success at 6 months by 8.3 times, whereas the identification of SC in >50% of ASOCT scans was associated with a 21.4 times greater chance of success.

Conclusions: The presence of SC on ASOCT is a strong predictor for successful IOP reduction after SLT in JOAG eyes.
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http://dx.doi.org/10.1016/j.ajo.2021.07.002DOI Listing
July 2021

Efficacy of Trabeculectomy Combined With Limited Deep Sclerectomy Versus Trabeculectomy Alone: A Randomized-controlled Trial.

J Glaucoma 2021 12;30(12):1065-1073

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Prcis: The addition of limited deep sclerectomy (LDS) to conventional trabeculectomy increases the success rate, especially in pseudophakic eyes.

Purpose: This study aimed to evaluate the efficacy of LDS in enhancing the intraocular pressure (IOP)-lowering outcomes of trabeculectomy.

Design: This was a parallel-arm, single-masked, randomized-controlled trial.

Methods: A total of 68 patients (68 eyes) with moderate to advanced primary open-angle glaucoma or primary angle-closure glaucoma with pseudophakia were recruited at a tertiary eye care center in Northern India and randomized into 2 groups. Thirty-five eyes in group 1 were subjected to trabeculectomy alone and 33 eyes in group 2 were subjected to trabeculectomy with LDS. All cases were supplemented with low-dose subconjunctival mitomycin-C (0.1 mg/mL for 1 min) in both groups. The primary outcome measure was IOP, and success rates were calculated for IOP ≤18/15/12 and ≥5 mm Hg. The secondary outcome measures included evaluation of bleb morphology, presence of an intrascleral aqueous lake, and supraciliary flow on ultrasound biomicroscopy.

Results: The mean postoperative IOP at 12 months was 13.4±1.83 mm Hg in group 1 and 12.5±1.67 mm Hg in group 2 (P=0.04). For IOP cutoff ≤15 mm Hg, absolute success was noted in 11 (31.4%) and 22 eyes (66.6%) in groups 1 and 2, respectively (P=0.004). At 12 months, the intrascleral lake was detected in 2 (6%) eyes in group 1 and in 9 (29%) eyes in group 2 (P=0.02). Supraciliary flow was detected in 2 eyes (6.2%) in group 2 and none in group 1 at 12 months (P=0.02). In the Cox proportional hazard model, trabeculectomy with LDS was associated with a lower rate of failure (hazard ratio: 0.32, 95% confidence interval: 0.13-0.75, P=0.009).

Conclusion: The addition of LDS to trabeculectomy led to lower mean IOP and higher success rates at 12 months, compared with trabeculectomy alone.
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http://dx.doi.org/10.1097/IJG.0000000000001896DOI Listing
December 2021

Comparative evaluation of Octopus semi-automated kinetic perimeter with Humphrey and Goldmann perimeters in neuro-ophthalmic disorders.

Indian J Ophthalmol 2021 04;69(4):918-922

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: The aim of this study was to compare the performance of Octopus 900(OVF) kinetic module with Goldmann perimeter (GVF) and Humphrey 750i (HVF) perimeters in neuro-ophthalmic disorders.

Methods: During this prospective observational cross-sectional study, 17 patients (26 eyes) with neuro-ophthalmic disorders underwent visual field examination on the three perimeters. Field defects on OVF were matched with HVF and GVF for the number of quadrants involved. An unmasked observer, and a masked observer (unaware of the clinical diagnosis) were made to separately diagnose the type of field defects on all three fields for the same patient. The pattern of field defect on OVF was compared with GVF and HVF field defects for both observers.

Results: When OVF was compared with HVF and GVF, 88% eyes correctly matched for normal or abnormal visual fields, while quadrant-matching was 80% and 89% respectively. For the unmasked observer, the pattern of field defects on OVF was similar to HVF and GVF in 58% and 65% eyes respectively while for a masked observer, it was 54% and 62%. Central and paracentral scotomas showed unmatched fields when OVF was compared with HVF and GVF. When these patients were excluded, sensitivity of OVF increased to 95%.

Conclusion: Clinical correlation aids in better characterisation of a field defect. All 3 perimeters are concurrent in the pattern of field defects for non-central defects. However, the default protocol on OVF may not be enough to demarcate the central and para-central scotomas. Development of a customised protocol for the assessment of central and centrocecal field defects increases the accuracy of OVF.
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http://dx.doi.org/10.4103/ijo.IJO_1266_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012927PMC
April 2021

Functional evaluation of the macular area in early glaucoma using microperimetry.

Indian J Ophthalmol 2021 04;69(4):876-881

Glaucoma Research Facility and Clinical Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To evaluate the central visual field by microperimetry (MP), in early glaucoma.

Methods: Consecutive perimetrically experienced patients with a single nasal step or arcuate scotoma and 14 control eyes underwent MP. Retinal sensitivity on MP was mapped for frequency and depth of loss in the central 10° around fixation.

Results: Twenty-one eyes had a single nasal step and 19 eyes with single arcuate scotoma on standard automated perimetry (SAP), with central 10° being normal on 30-2 and 10-2 perimetry. The average mean sensitivity on MP, in glaucomatous and control eyes was 11.8 ± 3.9 dB and 16.6 ± 1.2 dB, respectively, P = 0.0004. The average mean defect on MP-1, in glaucomatous and control eyes was -6.5 ± 2.0 dB and -3.0 ± 1.2 Db, respectively, P = 0.05. The corresponding retinal hemisphere showed significant defects in MP. In eyes with single nasal steps, an absolute scotoma was seen in 14-28% of eyes 8-10° off fixation, moderate to mild defects were seen in 10-52% eyes, and 10% eyes showed involvement up to 4° from the fixation. Eyes with arcuate scotoma had an absolute scotoma on MP in 95% of eyes, 6-10° from fixation, with extension up to 2° from fixation in 21%. In glaucomatous eyes, the normal hemisphere on SAP showed a mild defect on MP in 43%. Control eyes did not show any defect in SAP or MP.

Conclusion: A significant loss of central retinal sensitivity is recorded on MP in early glaucomatous neuropathy as compared to SAP. Paramacular absolute defects were seen at 6-10° from fixation.
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http://dx.doi.org/10.4103/ijo.IJO_1199_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012941PMC
April 2021

Commentary: Spectral domain optical coherence tomography parameters in pre-perimetric glaucoma.

Indian J Ophthalmol 2021 03;69(3):610-611

Glaucoma Research and Clinical Facility, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_2960_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942103PMC
March 2021

Comparative Evaluation of Rebound and Perkins Tonometers in Pediatric Glaucoma With Varied Corneal Characteristics.

J Glaucoma 2021 04;30(4):312-316

Dr Rajendra Prasad Centre for Ophthalmic Sciences.

Precis: Icare tonometer overestimated intraocular pressure (IOP) as compared with Perkins and this variation was higher in IOP>19 mm Hg and corneal opacity in patients with pediatric glaucoma.

Purpose: To compare the IOP measured by Icare ic200 with Perkins tonometer in pediatric glaucoma with different corneal characteristics.

Methods: Patients of pediatric glaucoma posted for routine examination under anesthesia, age below 12 years were enrolled. All patients underwent IOP measurement with Perkins and Icare ic200 tonometer by the same observer. Basic demographic data and other relevant clinical data were recorded. Central corneal thickness (CCT), horizontal corneal diameter, and corneal characteristics such as cornea clarity was recorded.

Results: A total of 194 eyes of 105 patients were analyzed. The difference between Perkins and Icare IOP was -0.816 mm Hg with the Bland-Altman plot 95% limits of agreement (LoA) from -11.194 to 9.562 mm Hg and 5.1% (10) values lying outside LoA. At IOP <19 mm Hg, the difference was -0.65 mm Hg and IOP ≥19 mm Hg, the difference was higher, -1.12 mm Hg. In the clear cornea group (123 eyes), the difference in IOP by 2 tonometers was -0.776 mm Hg with the Bland-Altman plot 95% LoA between -10.679 and 9.128 mm Hg. In hazy corneas (36 eyes), the difference in IOP was 0.531 mm Hg. The Bland-Altman plot showed 95% LoA between -6.242 and 7.303 mm Hg. In the scarred cornea group (35 eyes), the difference in IOP between the 2 was -2.343 mm Hg and the Bland-Altman plot showed wide 95% LoA from -16.302 to 11.616 mm Hg.

Conclusion: Icare tonometer overestimated IOP as compared with Perkins and this variation was higher in eyes with IOP≥19 mm Hg, CCT >615 μm, and scarred corneas. A moderate correlation between IOP and CCT for both tonometers was noted.
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http://dx.doi.org/10.1097/IJG.0000000000001765DOI Listing
April 2021

Effect of Mindfulness Meditation on Intraocular Pressure and Trabecular Meshwork Gene Expression: A Randomized Controlled Trial.

Am J Ophthalmol 2021 03 22;223:308-321. Epub 2020 Oct 22.

Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To evaluate the effect of mindfulness meditation (MM) on intraocular pressure (IOP) and trabecular meshwork (TM) gene expression in patients with medically uncontrolled primary open angle glaucoma (POAG).

Design: Parallel arm, single-masked, randomized controlled trial.

Methods: Sixty POAG patients with IOP ≥21 mm Hg taking maximal topical medication and scheduled for trabeculectomy were included in this study at a tertiary eye care center in India. Thirty patients (Group 1) underwent 3 weeks of 45-minute daily MM sessions in addition to medical therapy while Group 2 continued medical therapy only. Primary outcome was change in IOP (ΔIOP) after 3 weeks of MM. Secondary outcomes were probability of success, percentage of reduction in IOP, effect on diurnal variations of IOP, changes in quality of life (QoL), and changes in gene expression patterns in TM.

Results: At 3 weeks, a significant decrease in IOP was seen in Group 1 (20.16 ± 3.3 to 15.05 ± 2.4mm Hg; P = .001), compared to Group 2 (21.2 ± 5.6 to 20.0 ± 5.8mm Hg; P = .38). ΔIOP was significantly higher in Group 1 than in Group 2 (5.0 ± 1.80 vs. 0.20 ± 3.03mm Hg; P = .001). Analysis of gene expression revealed significant upregulation of nitric oxide synthetase (NOS1 and NOS3) and neuroprotective genes with downregulation of proinflammatory genes in Group 1 in comparison to Group 2 (P = .001).

Conclusions: MM was associated with significant decrease in IOP and changes in TM gene expression, indicating its direct impact on ocular tissues.
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http://dx.doi.org/10.1016/j.ajo.2020.10.012DOI Listing
March 2021

Iris implantation cyst: A benign visual prognosticator.

Indian J Ophthalmol 2020 Nov;68(11):2526

Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_241_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774199PMC
November 2020

Response to comments on: Preferred practice guidelines for glaucoma management during COVID-19 pandemic.

Indian J Ophthalmol 2020 10;68(10):2312-2313

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_2339_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727981PMC
October 2020

Comment on "Possible prophylactic or preventive role of topical povidone iodine during accidental ocular exposure to 2019-nCoV".

Graefes Arch Clin Exp Ophthalmol 2020 11 3;258(11):2573-2574. Epub 2020 Aug 3.

Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

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http://dx.doi.org/10.1007/s00417-020-04863-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396929PMC
November 2020

Preferred practice guidelines for glaucoma management during COVID-19 pandemic.

Indian J Ophthalmol 2020 Jul;68(7):1277-1280

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

The COVID-19 pandemic has threatened the humanity at a global level to a large extent by the burden of the disease with significant mortality and to a certain extent as a byproduct of the necessary efforts to contain the same. There is a significant impact on the health care system, as we not only have to contain pandemic, but continue to treat our non-COVID-19 patients in a safe and responsible manner. Ophthalmology practice in general and glaucoma in particular needs certain modifications and additional precautions while examining as well as managing these patients keeping their and our safety in mind. As the lockdown relaxations are in vogue we need to learn how to deal with our regular patients as well in addition to emergency care. This paper presents the consensus-based guidelines by an expert panel on how to restart glaucoma practice during this COVID-19 time. These guidelines will be applicable across the country and should help ophthalmologists and glaucoma specialist to restart their practices while safeguarding the patients and their own selves from getting infected.
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http://dx.doi.org/10.4103/ijo.IJO_1724_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574094PMC
July 2020

Quantification of Iridotrabecular Contact in Primary Angle-Closure Disease.

J Glaucoma 2020 08;29(8):681-688

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Precis: Iridotrabecular contact (ITC), a measure of angle closure, can be quantified along with other angle parameters on anterior segment optical coherence tomography (ASOCT). Hence, angle changes and angle closure mechanisms can be detected predicting the efficacy of iridotomy.

Purpose: To assess 360-degree ITC and ocular parameter changes, after laser peripheral iridotomy (LPI), in primary angle-closure disease (PACD) subgroups.

Methodology: This was a prospective observational study including 90 subjects, 30 each of primary angle-closure suspect (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG). Anterior segment OCT parameters were measured before and 3 weeks after LPI ITC: central anterior chamber depth, lens vault, angle-opening distance, angle recess area, trabecular iris space area, trabecular iris angle at 500 and 750 μm from scleral spur.

Results: ITC was highest in PACG, 81.43%±22.39%, followed by PAC, 28.53%±21.30%, and PACS, 10.76%± 8.54% (P=0.011). There was a significant decrease in ITC in all 3 groups after iridotomy (P<0.001), with a residual ITC of 68.56%±26.44% in PACG, 18.23%±15.98% in PAC, and 5.13%±5.11% in PACS. A significant positive correlation was seen between the extent of ITC, baseline intraocular pressure, and visual field index. ITC was highest in eyes with exaggerated lens vault (77.3%±32.03%), as compared with eyes having a plateau iris configuration or relative pupillary block configuration (P<0.001).

Conclusions: Iridotomy at any stage of PACD shows a significant decrease in ITC, with areas of residual ITC. Even in PACG, the iridotomy is effective in exposing parts of the trabecular meshwork that had contact earlier. Greater baseline ITC and postlaser ITC are a biomarker for higher intraocular pressure and greater visual field damage, which need lifelong review and appropriate management.
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http://dx.doi.org/10.1097/IJG.0000000000001572DOI Listing
August 2020

Association of pseudo-exotropia with true esotropia in cicatricial retinopathy of prematurity.

Indian J Ophthalmol 2020 05;68(5):901-902

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_1055_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350496PMC
May 2020

Severity of visual field defects in primary congenital glaucoma and their risk factors.

Graefes Arch Clin Exp Ophthalmol 2020 Jul 15;258(7):1483-1491. Epub 2020 Apr 15.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Purpose: The primary objective of the study was to assess the frequency and severity of visual field defects (VFD) in primary congenital glaucoma (PCG). The secondary objective was to ascertain any associated risk factors.

Methods: An ambispective review of patients with PCG on follow-up with a 'target' intraocular pressure (IOP) of ≤ 15 mmHg. Age, sex, laterality, duration of follow-up, baseline IOP, baseline cup-disc ratio (CDR), central corneal thickness (CCT), age during filtering surgery, second surgery if any, yearly IOP, glaucoma medications and best corrected visual acuity from 2013 (year 1) to the final review and final CDR were noted down. Children ≥ 5 years of age with best corrected visual acuity ≥ 6/60 were subjected to manual kinetic Goldmann perimetry, and visual field defects (VFD) were identified.

Results: Seventy-one of 90 eyes completed a reliable kinetic perimetry. The mean age of children was 12.34 ± 4.86 years, and the mean follow-up duration was 10.77 ± 4.69 years. Baseline IOP and CDR were 29.07 ± 8.83 mmHg and 0.66 ± 0.22, respectively. 86.67% of eyes underwent a trabeculotomy + trabeculectomy with mitomycin-C. Thirty-one eyes (34.44%) required a second surgery, 25 of which were bleb revisions and 3 trabeculectomies. Mean IOP and CDR during last visit were 10.23 ± 2.76 mmHg and 0.52 ± 0.25, p < 0.001 as compared with baseline. On Goldmann perimetry, 19 eyes, 26.76%, had defects, arcuate scotoma being most frequent. On the Fisher exact test, a baseline/final CDR > 0.8, undergoing just a trabeculectomy with MMC, needing ≥ 2 glaucoma medications on review or a repeat trabeculectomy was associated with greater severity of VFD. On univariate logistic regression, eyes that needed a bleb revision [OR, 95% CI 9.75 (2.66-35.67), p = 0.001], a repeat trabeculectomy with mitomycin-C [OR (CI) 18 (1.31-245.58), p = 0.03] and final CDR of > 0.8 [OR (CI) 23.1 (3.7-144.21), p = 0.001] were associated with VFD. On multivariable regression analysis, female sex [OR (CI) 18 (2.01-161.04), p = 0.01] was identified as the single most important risk factor for development of a VFD.

Conclusion: At a 'target' IOP of ≤ 15 mmHg, 26.76% of PCG eyes manifested a VFD over 10 years. Baseline and/or final CDR > 0.8, necessity for ≥2 medications or a repeat glaucoma surgery, and female sex were identified as risk factors for development and greater severity of glaucomatous VFD.
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http://dx.doi.org/10.1007/s00417-020-04677-wDOI Listing
July 2020

Pigment dispersion syndrome presenting as endothelial dystrophy: An atypical presentation.

J Curr Ophthalmol 2019 Dec 2;31(4):446-449. Epub 2018 Dec 2.

Cornea and Refractive Facility, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To describe an atypical presentation of pigment dispersion syndrome (PDS) with diffuse, homogeneous pigment deposition on the corneal endothelium and its management.

Methods: A 44-year-old female was referred to a cornea clinic as a case of endothelial dystrophy. Slit-lamp examination revealed bilateral, diffuse, and homogeneous pigment deposition on entire corneal endothelium without any iris transillumination defects. Intraocular pressure (IOP) at presentation were 18 mmHg OD and 16 mmHg OS. Gonioscopy showed dense, homogeneous pigment deposition in the angles. The optic nerve head examination revealed a cup disc ratio of 0.6:1-0.7:1 in both eyes with neuroretinal rim thinning.

Results: Peripheral Nd:YAG laser peripheral iridotomy (PI) was performed. On follow-up, a localized clear pigment free endothelial area was noted over the iridotomy sites bilaterally. IOP was well controlled within 12-14 mmHg with prostaglandin analogue at last follow-up of 24 months.

Conclusions: Diffuse homogeneous pigment dispersion on the endothelium may occur in atypical cases of PDS which may clear in the areas overlying the PI site and, therefore, should not be confused with endothelial disease. This case demonstrates the significance of a thorough clinical evaluation in cases with unusual presentation.
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http://dx.doi.org/10.1016/j.joco.2018.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896454PMC
December 2019

Clinical and ASOCT evaluations of 'bleb-sparing epithelial exchange' in paediatric and adult dysfunctional blebs over 5 years.

Graefes Arch Clin Exp Ophthalmol 2020 Feb 25;258(2):367-377. Epub 2019 Nov 25.

Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.

Purpose: To evaluate the long-term outcome of 'bleb-sparing epithelial exchange' surgery for dysfunctional filtering blebs in paediatric and adult eyes.

Methods: Patients who had undergone bleb revision ≥ 5 years back and were on regular follow-up were included. Age, ocular diagnosis, details of primary filtering surgery including mitomycin-C (MMC) usage, indication and year of bleb revision were recorded. After bleb revision, the mean intraocular pressure (IOP), glaucoma medications and best corrected visual acuity (BCVA) up to 5 years were noted. On last review, clinical details, bleb characteristics and swept source anterior segment tomographic (SSOCT) assessment of bleb were recorded. Comparative analysis of paediatric and adult eyes was performed.

Main Outcome Measures: Change in IOP and BCVA. 'Complete success' was defined as IOP ≥ 6 to ≤ 18mmHg without use of any topical glaucoma medications and 'Qualified success' when ≥ 1 topical glaucoma medication(s) was required.

Results: A total of 51 eyes of 51 consecutive patients were studied, among which 22 were children. The mean duration between filtering surgery and bleb revision was 4.54 ± 1.53 years in paediatric and 6.48 ± 3.5 years in the adult group, p = 0.04. Children underwent trabeculotomy + trabeculectomy with 0.04% MMC, while adults underwent trabeculectomy with 0.02% MMC. The mean pre-revision IOP was 6.38 ± 2.80 and 6.51 ± 2.78 mmHg in the paediatric and adult group respectively, p = 0.86. At 3 months post-revision, it increased to 11.81 ± 3.48 and 12.75 ± 3.52 mmHg respectively (p < 0.001). At final review, mean IOP of paediatric group was 10.90 ± 2.59 and adult group was 11.86 ± 2.66 mmHg, p = 0.20. At 5 years, complete success was 68.18% and 72.41%, and qualified success was 31.87% and 27.59% in the former and latter group respectively, p = 0.49. No failures were seen. Kaplan-Meier probability at 5 years for IOP target ≤ 18, ≤ 15 and ≤ 12 in children was 95.45%, 63.64% and 50% and in adults 93.10%, 65.52% and 41.38% respectively. BCVA improved up to 1 year in paediatric group, with continued improvement in adults up to 3 years. SSOCT measured bleb height was 0.88 ± 0.37 and 1.32 ± 0.49mm in children versus adults (p = 0.006) and wall thickness, 0.35 ± 0.22 and 0.58 ± 0.24mm respectively, p = 0.008.

Conclusion: Bleb-sparing epithelial exchange is an equally safe and effective technique with good long-term success in both paediatric and adult dysfunctional blebs.
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http://dx.doi.org/10.1007/s00417-019-04527-4DOI Listing
February 2020

Is this iris or an implant?

Clin Exp Optom 2020 11 19;103(6):920. Epub 2019 Nov 19.

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1111/cxo.13014DOI Listing
November 2020

Aniridia with lenticular and choroidal coloboma.

Eur J Ophthalmol 2021 Mar 25;31(2):NP116-NP118. Epub 2019 Jul 25.

Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

This case report presents a rare association of a complete aniridia with lenticular and choroidal coloboma. An 8-year-old female patient was referred to our glaucoma clinic with aniridia, nystagmus and bilateral corneal opacity with right eye being phthisical. Ultrasonography of the phthisical eye revealed the presence of an old closed funnel retinal detachment. Further examination under anaesthesia revealed lens coloboma in the inferonasal quadrant and presence of a choroidal coloboma in the left eye. The intraocular pressure was 28 mmHg with a central corneal thickness of 693 µm. A macula sparing laser barrage around the colobomatous area was done in the left eye and topical ocular hypotensives were started.
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http://dx.doi.org/10.1177/1120672119866106DOI Listing
March 2021

Cogan-Reese syndrome with Iris cyst: A novel presentation.

Cont Lens Anterior Eye 2019 08 17;42(4):467-469. Epub 2019 May 17.

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India. Electronic address:

Purpose: To report an atypical case of Cogan-Reese syndrome associated with iris cyst in a young adult male.

Methods: Slit-lamp biomicroscopic examination, swept-source anterior segment optical coherence tomography (ASOCT) and ultrasound bio-microscopy (UBM) were done to evaluate and characterize the nature of the iris cyst. Gonioscopy, specular microscopy and confocal microscopy were attempted, but unsuccessful due to the large corneal opacity.

Results: On slit-lamp biomicroscopy, a large nasal corneal opacity with overlying band-shaped keratopathy was noted, with history suggestive of a trivial non-penetrating trauma and likely healed corneal ulcer. Through the temporal clear cornea, the iris displayed altered pattern with overlying shiny membrane and multiple, small, discrete, hyperpigmented, irregular nodules suggestive of Cogan-Reese syndrome. On the nasal side, an iris cyst with typical 'stuck-on appearance' onto the endothelium was visible. ASOCT and UBM failed to show any evidence of epithelial downgrowth or Descemet membrane disintegrity, ruling out the possibility of a post-traumatic implantation iris cyst.

Conclusion: The occurrence of iris cyst in this case of Cogan-Reese syndrome is unique, and could be related to the disease pathogenesis, or a rare co-incidental finding.
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http://dx.doi.org/10.1016/j.clae.2019.04.014DOI Listing
August 2019

The Missing Mesenchyme Captured-Axenfeld-Rieger Anomaly.

JAMA Ophthalmol 2019 May 9;137(5):e184507. Epub 2019 May 9.

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1001/jamaophthalmol.2018.4507DOI Listing
May 2019

Evaluation of anterior segment parameters with two anterior segment optical coherence tomography systems: Visante and Casia, in primary angle closure disease.

Indian J Ophthalmol 2019 Apr;67(4):500-504

Department of Ophthalmology, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To determine the comparability of anterior chamber biometric measurements in primary angle closure disease (PACD) patients using two commercially available anterior segment optical coherence tomography machines (ASOCT): Visante and Casia.

Methods: This was a cross-sectional observational study, which included clinically, diagnosed cases of PACD. Anterior segment biometric measurements were done using Casia and Visante ASOCT. Parameters studied were central corneal thickness (CCT), anterior chamber depth (ACD), nasal (N) and temporal (T) angle opening distance at 500 μm (AOD500) and 750 μm (AOD750), and N and T trabecular iris space area at 500 μm (TISA500) and 750 μm (TISA750).

Results: Total 36 PACD patients (72 eyes) with average age of 59.48 ± 7.95 years were recruited, out of which 25 were females (69.44%) and 11 males (30.56%). The mean measurements of CCT, ACD, AOD500, and TISA on Casia and Visante machines were 522.5 ± 34.75 μm and 539.55 ± 29.56 μm (P = 0.00); ACD- 2.144 ± 0.38 mm and 2.133 ± 0.39 mm (P = 0.487); AOD500-0.27 ± 0.16 μm and 0.21 ± 0.10 μm (P = 0.04); and TISA500-0.100 ± 0.07 μm and 0.063 ± 0.03 μm (P = 0.00), respectively. A statistically significant difference was noted in CCT, N and T AOD, and TISA. A good corelation for ACD and CCT (ACD = 0.9816 and CCT = 0.772) only were noted between the two machines. The Bland-Altman plot analysis of different parameters between two machines has revealed good agreement of measurement of ACD and CCT but poor agreement for rest of the parameters.

Conclusion: It is advisable not use the two machines interchangeably because of the wide limits of agreement and poor correlation of angle measurement values of Casia and Visante ASOCT.
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http://dx.doi.org/10.4103/ijo.IJO_641_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446640PMC
April 2019

Response to comment on 'Unilateral corneal edema in young: A diagnostic dilemma'.

Indian J Ophthalmol 2019 03;67(3):442-443

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_2079_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407402PMC
March 2019

Double trouble: Microspherophakia with Axenfeld-Rieger anomaly.

Indian J Ophthalmol 2019 Mar;67(3):394-395

Glaucoma Research Facility and Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_978_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407397PMC
March 2019

Changes in Intraocular Pressure and Angle Status After Phacoemulsification in Primary Angle Closure Hypertension.

J Glaucoma 2019 02;28(2):105-110

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To study the change in intraocular pressure (IOP) and angle status after phacoemulsification in a cohort of primary angle closure hypertension (PACHT) patients.

Setting: Tertiary Eye Care, India.

Design: Prospective interventional case-series.

Methods: Case-series of 18 eyes of 18 patients. Preoperative biometry including axial length, anterior chamber depth (ACD), lens thickness, and central corneal thickness were studied. Preoperative and postoperative IOP, number of topical glaucoma medications, angle swept source optical coherence tomography (SS-OCT) parameters of nasal and temporal angle opening distance, trabecular iris space area, scleral spur angle, lens vault and circumferential iridotrabecular contact (ITC) were studied and their correlations derived.

Results: The mean preoperative IOP, 31±6 mm Hg, decreased to 14±1 mm Hg at 6-months postoperative period, P<0.001, a fall by 58±14%. The number of glaucoma medications reduced from 4(3-5) to 2(1-3), P<0.001. All SS-OCT studied parameters denoted significant angle widening postsurgery. The ITC% reduced from 52(16-100) to 19(0-97), P<0.001. The preoperative ITC showed moderate to strong correlation with all preoperative nasal and temporal angle parameters. It also showed moderate positive correlation with percentage fall in IOP at 1-month postoperative period. The preoperative ACD showed significant negative correlation with preoperative and postoperative ITC.

Conclusions: PACHT patients benefit significantly from cataract surgery with marked angle widening, IOP reduction and a decrease in the number of glaucoma medications. The SS-OCT derived circumferential iridotrabecular contact index can be used as the single best parameter to indicate the preoperative angle status and predict postoperative change in IOP, as against the numerous single section measured angle parameters.
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http://dx.doi.org/10.1097/IJG.0000000000001137DOI Listing
February 2019

Uncontrolled neovascular glaucoma - an alarming manifestation of chronic myeloid leukemia on imatinib therapy - a case report and review of literature.

Indian J Ophthalmol 2019 Feb;67(2):285-287

Glaucoma Research and Clinical Facility, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

A 45-year-old diabetic male, with diabetic retinopathy and medically uncontrolled neovascular glaucoma (NVG) underwent intracameral bevacizumab followed by trabeculectomy, with controlled intraocular pressures (IOP) post-operatively, OD: 12 mmHg; OS: 14 mmHg. Patient was referred to hematology, where he was diagnosed as chronic myeloid leukemia (CML) and started on imatinib mesylate. Thereafter, he presented with recurrence of neovascularization and vascularization of the bleb along with OS vitreous hemorrhage at 6 weeks follow-up. While he was planned for OS vitreo-retinal surgery, he presented with OD spontaneous hyphema with raised IOP (OD: 38 mmHg, OS: 16 mmHg). He had maintained a tight glycemic control. Following imatinib therapy, there was a rapid progression and recurrence of neovascularization, eventually leading to failure of trabeculectomy OD and bilateral severe loss of vision. Imatinib may be implicated in the worsening of NVG in CML patients, especially with co-existing diabetes and thus, such patients should receive regular thorough ophthalmic evaluation as long as imatinib continues.
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http://dx.doi.org/10.4103/ijo.IJO_1288_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376821PMC
February 2019

Comparative Evaluation of Phacoemulsification Alone versus Phacoemulsification with Goniosynechialysis in Primary Angle-Closure Glaucoma: A Randomized Controlled Trial.

Ophthalmol Glaucoma 2019 Sep - Oct;2(5):346-356. Epub 2019 Jun 4.

Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Comparative evaluation of phacoemulsification (phaco) alone versus phacoemulsification combined with goniosynechialysis (phacoGSL) in primary angle-closure glaucoma (PACG).

Design: Prospective, randomized, parallel group, active controlled trial.

Participants: Patients with PACG.

Methods: A total of 120 consecutive patients with PACG were screened, of whom 80 met inclusion criteria, with PACG uncontrolled on maximal hypotensive therapy and were recruited. Patients were randomized into 2 groups and underwent phaco alone in group 1 or phacoGSL in group 2. The patients were examined at baseline and at 1 week and 1, 3, and 6 months. The anterior chamber angle parameters on swept-source anterior segment OCT (SS-ASOCT) were noted at 1 and 6 months.

Main Outcome Measures: The primary outcome measure was intraocular pressure (IOP) reduction. A reduction in IOP of ≥ 20% from baseline IOP with or without medications was considered a success. Secondary outcome measures included change in the anterior chamber angle temporal parameters, angle-opening distance, trabecular-iris space area and scleral spur angle, surgical safety, visual acuity, and reduction in the number of glaucoma medications postoperatively.

Results: The average age of patients was 58.77±8.14 years and 56.50±9.17 years in groups 1 and 2, respectively (P = 0.31). The mean baseline IOP was 29.48±6.76 mmHg and 30.72±3.88 mmHg in groups 1 and 2, respectively (P = 0.13). Success was obtained in 93.33% of patients in group 1 and 91.18% of patients in group 2 at 6 months (P = 0.39). Mean IOP was 13.17±1.66 mmHg and 13.21±1.97 mmHg at 6 months in groups 1 and 2, respectively (P = 0.001). The reduction in IOP was 55.32% and 56.99% at 6 months in groups 1 and 2 (P = 0.48). Significant widening of the angle parameters was noted at 6 months with an increase compared with baseline values in both groups. In multivariate analysis, the significant predictor of decrease in IOP was the higher baseline IOP.

Conclusions: Both phaco and phacoGSL are associated with a significant reduction in IOP along with a noteworthy widening of the anterior chamber angle parameters. Both procedures succeeded in reducing the necessity of glaucoma medications postoperatively in PACG eyes. There is no additional benefit of phacoGSL over phaco in PACG.
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http://dx.doi.org/10.1016/j.ogla.2019.05.004DOI Listing
August 2021

Unilateral corneal edema in young: A diagnostic dilemma.

Indian J Ophthalmol 2018 Nov;66(11):1612-1614

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.4103/ijo.IJO_564_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213689PMC
November 2018
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