Publications by authors named "Durgasri Jaisankar"

14 Publications

  • Page 1 of 1

Incidence and risk factors for retinal detachment following laser-assisted keratomileusis.

Indian J Ophthalmol 2021 07;69(7):1856-1860

Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: The aim of this work was to study the incidence and potential risk factors for development of retinal detachment (RD) after laser-assisted in situ keratomileusis (LASIK) surgery over a long-term follow-up.

Methods: This was a retrospective interventional case series. A total of 694 eyes of 352 patients were included who had undergone LASIK surgery at a tertiary eye care institute between January 2005 and September 2015 who had a minimum follow-up of 5 years after the surgery were included. Kaplan-Meier analysis and Cox proportion regression model was used to estimate the potential risk factors and cumulative risk for the development of RD.

Results: Out of the total patients, 5 eyes developed RD after a mean follow-up of 7 years. The cumulative risk of RD after 1 year was 0.4%, after 2 years was 0.5% and after 7 years was 0.7%. Increased risk of RD was not associated with age at LASIK surgery, gender, laterality, and spherical equivalent (P > 0.05). A significantly increased risk for the development of RD was observed in eyes that were given prior prophylactic laser photocoagulation for peripheral lesions in multivariate cox proportional regression analysis with a hazard ratio (HR) of 9.33 (CI- 1.554-56.094; P = 0.015).

Conclusion: We emphasize the need for a regular follow-up after the LASIK procedure to ensure timely treatment of any new retinal lesions.
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http://dx.doi.org/10.4103/ijo.IJO_3123_20DOI Listing
July 2021

Nasal-temporal asymmetry in peripheral refraction with an aspheric myopia control contact lens.

Biomed Opt Express 2020 Dec 1;11(12):7376-7394. Epub 2020 Dec 1.

Centre for Vision and Eye Research, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.

A combination of human subject data and optical modelling was used to investigate unexpected nasal-temporal asymmetry in peripheral refraction with an aspheric myopia control lens. Peripheral refraction was measured with an auto-refractor and an aberrometer. Peripheral refraction with the lens was highly dependent upon instrument and method (e.g. pupil size and the number of aberration orders). A model that did not account for on-eye conformation did not mirror the clinical results, but a model assuming complete lens conformation to the anterior corneal topography accounted for the positive shift in clinically measured refraction at larger nasal field angles. The findings indicate that peripheral refraction of highly aspheric contact lenses is dependent on lens conformation and the method of measurement. These measurement methods must be reported, and care must be used in interpreting results.
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http://dx.doi.org/10.1364/BOE.406101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747928PMC
December 2020

A multifocal electroretinography study to evaluate risk of developing macular hole in the fellow eye of patients suffering with unilateral macular hole.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841420908697. Epub 2020 Feb 26.

Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, 41/18, College Road, 600006 Chennai, India.

Background: Visual outcome of eyes has often been found to be unsatisfactory even after successful closure of a macular hole, owing to factors like persistent metamorphopsia, scotoma, and reduced sensitivity. Therefore, it becomes critical to evaluate and study the probability and risk of developing a macular hole in the fellow eyes of the patient. This study analyzed the multifocal electroretinographic responses to help predict the risk of macular hole development in fellow eyes.

Methods: In total 26 fellow eyes, 26 eyes with macular hole, and 50 eyes of 25 controls were enrolled prospectively. The retinal responses from the different rings were compared in the three groups. Optical coherence tomography was done to rule out macular pathology or vitreomacular traction in the fellow eyes.

Results: All the fellow eyes under observation showed significantly reduced mean amplitudes of retinal response densities, in all rings as compared with controls (31.45 ± 10.38 48.87 ± 7.55,  = 0.00). Three of the fellow eyes developed a macular hole during the 24 months observation period. The prevalence of fellow eye involvement was 11.5%. Relative risk of developing macular hole in the fellow eye ranged from 25 to 75.

Conclusion: All the fellow eyes, including those that did not develop a macular hole, showed significantly reduced responses on multifocal electroretinogram. This indicates that macular hole may not be a focal disease. It may have widespread functional deficit which is bilateral in nature and suggestive of a degenerative or ischemic insult.
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http://dx.doi.org/10.1177/2515841420908697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045290PMC
February 2020

Correlation of retinal changes with choroidal changes in acute and recurrent central serous chorioretinopathy assessed by swept-source optical coherence tomography.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841419899823. Epub 2020 Jan 20.

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai 600 006, Tamil Nadu, India.

Purpose: To evaluate affected choroidal regions and corresponding retinal changes in acute and recurrent central serous chorioretinopathy using swept-source optical coherence tomography.

Methods: The foveal and subfoveal choroidal thicknesses were measured with swept-source optical coherence tomography. The retina was divided into five zones on the swept-source optical coherence tomography image based on baseline choroidal thickness being <100, 100-199, 200-299, 300-399 and ⩾400 μm. The retinal and choroidal thicknesses in the same five regions were evaluated during follow-up. The measurements were then compared between baseline (when central serous chorioretinopathy was active) and follow-up (after complete resolution of disease).

Results: At baseline, in the acute group, the mean outer retinal layer thickness was significantly higher in areas with thicker choroid and lower in areas with thinner choroid. No such change was noticed in the recurrent group. In the acute group, the overall retinal thickness from baseline to follow-up decreased from 269.84 to 251.9 µm, ganglion cell layer thickness decreased from 107.14 to 101.28 µm, retinal nerve fibre layer thickness decreased from 56.96 to 49.33 µm, and no significant difference was noted in choroidal thickness. In the recurrent group, choroidal thickness significantly increased from 254.58 to 262.55 µm and ganglion cell layer decreased from 103.43 to 94.01 µm. No significant difference was noted in overall retina and retinal nerve fibre layer. Reduction in choroidal and retinal layer thicknesses was better in eyes which underwent laser treatment than the observation group.

Conclusion: Swept-source optical coherence tomography might serve as an important non-invasive tool for both evaluating the extent of pathology and to predict the recurrence rate.
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http://dx.doi.org/10.1177/2515841419899823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971962PMC
January 2020

Choroidal Structural Changes in Sympathetic Ophthalmia on Swept-Source Optical Coherence Tomography.

Ocul Immunol Inflamm 2021 Apr 19;29(3):537-542. Epub 2019 Nov 19.

Medical Research Foundation, Sankara Netralaya, Chennai, India.

: To analyze choroidal angioarchitecture in sympathetic ophthalmia (SO) using swept-source optical coherence tomography (SS-OCT) images.: Case-control study of six patients with SO. Qualitative changes and quantitative parameters, including choroidal thickness (CT) and choroidal vascularity index (CVI), were analyzed.: Qualitative findings in the acute phase of SO on SS-OCT included retinal serous detachment with hyperreflective septa, choroidal folds, alterations in angioarchitecture with loss of vascular lacunae, and Dalen-Fuchs nodules. There was significantly higher CT in SO (284.05 ± 24.12 µm) compared to healthy controls (229.57 ± 46.67 µm, = 0.04) and also increased CVI in SO (62.06 ± 2.07% vs 56.79 ± 3.15%, = 0.006).: CVI was significantly increased in SO, representing a novel noninvasive biomarker of disease activity. SS-OCT provides a useful qualitative and quantitative parameter, which can be potentially explored in the diagnosis and monitoring of patients with SO.
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http://dx.doi.org/10.1080/09273948.2019.1685110DOI Listing
April 2021

Visual impairment in high flow and low flow carotid cavernous fistula.

Sci Rep 2019 09 6;9(1):12872. Epub 2019 Sep 6.

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.

Our aim is to study the varied posterior segment manifestations, level of visual impairment (VI) and its causes in carotid cavernous fistula (CCF) patients. A retrospective study was done, wherein data was obtained from 48 digital subtraction angiogram (DSA) proven CCF patients. CCF was classified according to Barrow et al., based on DSA into type A (high flow) and types B, C and D (low flow). High flow CCF was present in 8 (16.7%) and low flow CCF was present in 42 (83.3%). Compared to low flow group, patients in high flow group were younger and had a history of trauma (p < 0.05). Posterior segment findings ranged from familiar stasis retinopathy and optic neuropathy (both, glaucomatous and ischemic) to uncommon findings of central retinal artery occlusion, Terson syndrome and combined retinal and choroidal detachment. Retinal vein dilatation was the most common finding in both groups. The high flow CCF group had 6 (75%) patients that had VI. This was acute in 4 (50%) patients and delayed in 2 (25%). In the low flow group 10 (23.8%) of patients had delayed VI. The identification of "3 point sign" is a novel finding of this study, not described before. While none of three findings (disc hyperaemia, retinal vein dilatation and intra-retinal haemorrhage) in isolation were predictive of visual loss, but when present together results in visual loss. Posterior segment changes were varied, some are uncommon and can occur in various combinations. "3 point sign" must be identified at the earliest to prevent visual impairment. The incidence of VI in CCF patients is high.
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http://dx.doi.org/10.1038/s41598-019-49342-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731213PMC
September 2019

Effects of eye rotation and contact lens decentration on horizontal peripheral refraction.

Ophthalmic Physiol Opt 2019 09 3;39(5):370-377. Epub 2019 Sep 3.

Institute of Health & Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.

Purpose: Peripheral refraction is important in design of myopia control therapies. The aim was to investigate the influence of contact lens decentration associated with eye rotation on peripheral refraction in the horizontal visual field.

Methods: Participants were 10 emmetropes and 10 myopes in good general and ocular health. Right eyes underwent cycloplegic peripheral refraction, using a Grand-Seiko WAM-5500 Autorefractor, in 5° steps to ±35° eccentricities along the horizontal visual field. Targets were fixated using eye rotation only or head rotation only. Refractions were measured without correction and with three types of contact lenses: single vision, a multifocal centre-distance aspheric with +2.50 D add and NaturalVue aspheric. Photographs of eyes during lens wear were taken for each eye rotation. Effects of visual field angle, lens type and test method (head or eye rotation) on vector components of relative peripheral refraction were evaluated using repeated measures anovas. Test method for each visual field angle/lens combination were compared via paired t-tests.

Results: Horizontal decentration ranges across the visual field were 1.2 ± 0.6 mm for single vision and 1.2 ± 0.4 mm for multifocal lenses but smaller at 0.7 ± 0.4 mm for NaturalVue lenses. There were only two significant effects of test method across the visual field angle/lens type combinations (single vision: for emmetropes horizontal/vertical astigmatism component at 35° nasal with mean difference -0.38 D and for myopes spherical equivalent refraction at 20° temporal with mean difference +0.24 D).

Conclusion: Upon eye rotation the contact lenses decentred on the eye, but not enough to affect peripheral refraction. For the types assessed and for the horizontal visual field out to ±35° when measurements were performed with the Grand-Seiko WAM-5500 autorefractor, it is valid to use eye rotations to investigate peripheral refraction.
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http://dx.doi.org/10.1111/opo.12641DOI Listing
September 2019

BILATERAL SIMULTANEOUS RHEGMATOGENOUS RETINAL DETACHMENT: Clinical Characteristics and Surgical Outcome.

Retina 2019 Aug;39(8):1504-1509

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.

Purpose: To elucidate the clinical characteristics and surgical outcome of consecutive patients with bilateral simultaneous retinal detachment who reported to a tertiary eye care institution over a period of 10 years.

Methods: Retrospective interventional consecutive study of 168 eyes of 84 patients with bilateral simultaneous retinal detachment, observed by indirect ophthalmoscopy at the initial examination was performed. Demographic and clinical characteristics were collected before and after surgery. Patients with attached retina at final follow-up were considered to have anatomical success and those with two or more lines improvement in visual acuity were considered to have functional success.

Results: Most cases (90% in the better eye and 82.1% in the worse eye) were managed by scleral buckling procedure. With scleral buckle, anatomical success was seen in 99% and functional success was seen in 87% of the cases. Pars plana vitrectomy was performed in remaining cases with anatomical success in 83% and functional success in 78% of cases. Eyes with partial retinal detachment, without macular involvement, and eyes in which additional surgeries were not performed had significantly better anatomical and functional results.

Conclusion: Early sequential surgery gives good anatomical and functional outcomes. Surgical outcomes were better with scleral buckling than pars plana vitrectomy.
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http://dx.doi.org/10.1097/IAE.0000000000002208DOI Listing
August 2019

Association of obesity and age-related macular degeneration in Indian population.

Indian J Ophthalmol 2018 07;66(7):976-983

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: The aim of this study was to establish the prevalence and association of age-related macular degeneration (AMD) and obesity which was not studied extensively in Indian population over 60 years of age.

Methods: This was a cross-sectional, population-based study. A total of 4791 patients with gradable fundus photography were included. All patients underwent detailed ophthalmic examination and AMD was graded with retinal photographs. Grading of AMD was done according to the International ARM Epidemiological Study Group and staged based on grading in worse eye. The association of AMD severity and obesity (based on body mass index, waist-hip ratio, waist circumference, isolated abdominal obesity, isolated generalized obesity, and combined obesity) was assessed. The main outcome variable was an association between the presence and severity of AMD with different grades of obesity.

Results: No direct significant association was noted between the presence and severity of AMD and any obesity indices. Subgroup analyses based on lifestyle patterns and common systemic pathologies in AMD population were done. Late AMD was significantly associated with tobacco consumption in population with combined obesity (P = 0.033 and odds ratio = 2.998).

Conclusion: No direct association was noted between the presence or severity of AMD and obesity in South Indian population. However, indirect associations between the severity of AMD and combined obesity were found.
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http://dx.doi.org/10.4103/ijo.IJO_1265_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032723PMC
July 2018

Pupillary Abnormalities with Varying Severity of Diabetic Retinopathy.

Sci Rep 2018 04 4;8(1):5636. Epub 2018 Apr 4.

Shri Bhagwan Mahavir Vitreoretinal services, 18, College Road, Sankara Nethralaya, Chennai, 600 006, Tamil Nadu, India.

Our aim is to study the dynamics of pupillary abnormalities in varying severity of diabetic retinopathy. A non-interventional case-control study with 405 eyes of 244 subjects with diabetes, and 41 eyes of 26 subjects with no history of diabetes was done. Diabetes group was classified according to retinopathy severity: no retinopathy, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). After dark adaptation, pupil size and flashlight response were captured with an infrared camera. Baseline Pupil Diameter (BPD), Amplitude of Pupillary Constriction (APC), Velocity of Pupillary Constriction (VPC) and Velocity of Pupillary Dilatation (VPD). Compared to controls, mean BPD decreased with increasing severity of diabetic retinopathy. Mean APC in control group was 1.73 ± 0.37 mm and reduced in mild NPDR (1.57 ± 0.39, p = 1.000), moderate NPDR (1.51 ± 0.44, p = 0.152) and found to be significant reduced in severe NPDR (1.43 ± 0.48, p = 0.001) and PDR (1.29 ± 0.43, p = 0.008). Compared to controls, mean VPC decreased progressively with increasing severity of retinopathy, with a maximal difference in the PDR group. Mean VPD as compared to the control group was significantly reduced in the no DR (p = 0.03), mild NPDR (p = 0.038), moderate NPDR (p = 0.05), PDR group (p = 0.02). We found pupillary dynamics are abnormal in early stages of diabetic retinopathy and progress with increasing retinopathy severity.
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http://dx.doi.org/10.1038/s41598-018-24015-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5884827PMC
April 2018

Influence of laser versus lens-sparing vitrectomy on myopia in children with retinopathy of prematurity.

Indian J Ophthalmol 2017 Sep;65(9):841-845

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: The purpose of this study is to compare the refractive error outcomes in the eyes of premature babies with retinopathy of prematurity (ROP) who underwent laser plus lens-sparing vitrectomy (LSV) in one eye and laser alone in the fellow eye.

Methods: This is a retrospective study. Fourteen babies with Stage 4A of ROP or worse who underwent laser plus LSV in one eye (Group 1) and laser alone in the fellow eye (Group 2) were followed at 2 months, 6 months, 1 year, one and a half year, and 2 years. The main outcome variable studied was cycloplegic refraction at the baseline and follow-up visits. The change in spherical and cylindrical power at each visit was compared in Groups 1 and 2. The changes in spherical equivalent in subgroups were analyzed.

Results: Mean gestational age at birth was 29.43 ± 2.10 weeks (range 26-32 weeks). Mean chronological age at the time of surgery was 4.11 ± 3.00 months (range 2-10 months). Mean postmenstrual age was 45.86 ± 12.13 weeks (range 39-75 weeks). Mean birth weight was 1340.71 ± 361.59 g (range 860-1980 g). All the babies in both groups had progressive myopia till 2 years follow-up; laser group had less myopia than LSV group till 1 year, thereafter, there was no difference in median till 2-year follow-up. The mean ± standard deviation of spherical equivalent in LSV versus laser group was: -4.36 ± 5.52 versus -3.21 ± 4.59 at 2 months; -5.09 ± 5.82 versus -4.04 ± 4.68 at 6 months; -7.14 ± 5.36 versus -5.36 ± 5.09 at 1 year; and -7.47 ± 1.38 versus -6.41 ± 1.91 at 2 years. Spherical equivalent difference across the visits did not differ significantly between Groups 1 and Group 2 in children whose birth weight was <1500 g (P = 0.247) and those who had more than 1500 g (P = 0.748), in those with gestational age between 20 and 30 weeks (P = 0.215) compared to those> 30 weeks (P = 0.602).

Conclusion: No difference in the progression of myopia was noted in eyes that underwent additional LSV following laser photocoagulation in one eye and laser alone in the fellow eye.
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http://dx.doi.org/10.4103/ijo.IJO_165_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621267PMC
September 2017

Choroidal and Retinal Anatomical Responses Following Systemic Corticosteroid Therapy in Vogt-Koyanagi-Harada Disease Using Swept-Source Optical Coherence Tomography.

Ocul Immunol Inflamm 2019 12;27(2):235-243. Epub 2017 Jul 12.

b Department of Uvea , Sankara Nethralaya , Chennai , Tamil Nadu , India.

Purpose: To assess structural changes in retina and choroid after systemic corticosteroid therapy in Vogt-Koyanagi-Harada (VKH) disease using swept-source optical coherence tomography (SS-OCT).

Methods: SS-OCT was conducted before treatment and during first-month follow-up in 16 eyes treated with systemic corticosteroids for active VKH. Retina was divided into five zones depending on pretreatment choroidal thickness (CT) of <100, >100 to <200, >200 to <300, >300 to <400 and >400μm, and changes in retinal thickness and CT after treatment in these zones were compared with baseline.

Results: Mean CT significantly improved from 83.1±8.75 to 156.4±62.73μm(p = 0.008) in the zone with pre-CT <100μm and significantly decreased from 336.1 ± 17.28 to 266.28 ± 81.39μm(p = 0.008) in the zone with pre-CT > 300μm.

Conclusions: We have shown choroidal remodeling in VKH. SS-OCT can serve as an important noninvasive tool in assessment of treatment response in patients with VKH disease.
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http://dx.doi.org/10.1080/09273948.2017.1332231DOI Listing
January 2020

VISUAL FUNCTION CORRELATES OF FOVEAL SLOPE CHANGES ON OPTICAL COHERENCE TOMOGRAPHY IN MACULAR TELANGIECTASIA TYPE 2.

Retina 2017 Dec;37(12):2248-2253

Department of Vitreoretina, Dr. Shroff's Charity Eye Hospital, Daryaganj, India.

Purpose: To evaluate changes in foveal and parafoveal thickness measured using optical coherence tomography across five stages of macular telangiectasia 2 (MacTel 2) and to correlate the foveal slope angle with best-corrected visual acuity (BCVA).

Methods: A multicentered, cross-sectional study of 90 patients with bilateral MacTel 2 was carried out. We reviewed medical records of patients who had undergone optical coherence tomography. Mean retinal thickness foveal and subfoveal were noted from ETDRS (Early Treatment Diabetic Retinopathy Study) mapping and later used for calculating foveal slope angle. The change in retinal thickness and foveal angle across five stages of MacTel 2 was assessed. Central foveal thickness and foveal slope angle were correlated with BCVA.

Results: The foveal slope angles were calculated quadrantwise and stagewise. The mean slope angle was minimum in temporal quadrant (6.29°) followed by inferior (7.13°), superior (7.54°), and nasal (7.93°). The slope angles were 9.27°, 7.95°, 6.70°, 6.10°, and 6.31° in Stages 1, 2, 3, 4, and 5, respectively. Statistically significant correlation noted between the temporal, superior, inferior slope angles and BCVA (in logarithm of the minimum angle of resolution) with r = -0.18, -0.19, and -0.25, respectively (P < 0.05). No statistically significant correlation was noted between central retinal thickness and BCVA.

Conclusion: The BCVA correlates better with slope angles than central retinal thickness. This implies that, change in both foveal and parafoveal regions accounts for vision change. Greater the foveal slope angle, the better the vision.
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http://dx.doi.org/10.1097/IAE.0000000000001416DOI Listing
December 2017