Publications by authors named "Krishnendu Nandi"

15 Publications

  • Page 1 of 1

Brolucizumab in Neovascular Age-Related Macular Degeneration - Indian Real-World Experience: The BRAILLE Study.

Clin Ophthalmol 2021 7;15:3787-3795. Epub 2021 Sep 7.

Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India.

Purpose: To assess the short-term efficacy and safety profile of intravitreal brolucizumab injection in Indian eyes with neovascular age-related macular degeneration (nAMD) under real-world conditions.

Patients And Methods: This was a multicenter, retrospective chart review of 94 eyes of 94 patients with nAMD (treatment-naïve and switch-therapy) undergoing brolucizumab therapy. Re-treatment as per pro-re-nata protocol was performed based on fixed visual and tomographic criteria. The main outcome measures were changes in the best-corrected visual acuity (BCVA), intraretinal fluid (IRF), subretinal fluid (SRF), central subfield thickness (CST), and pigment epithelial detachment (PED) along with safety analysis.

Results: Of the 94 eyes, 20 eyes (21.3%) were treatment-naïve, whereas the rest 74 eyes (78.7%) underwent switch therapy. One hundred and twenty-six injections were given over a mean follow-up of 7.3 ± 2.2 (range 5-30) weeks. The BCVA improved significantly from 0.82 ± 0.5 LogMAR at baseline to 0.66 ± 0.5 LogMAR at the final visit (p < 0.0001). Significant reduction in CST was simultaneously noted (Baseline: 408.45 ± 65.63 µm; Final: 281.14 ± 37.74 µm; p < 0.0001). On qualitative analysis, resolution of subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED) was observed in 15.5%, 39.29%, and 23.81% of the eyes, respectively. The mean interval of repeat injection was 10.2 ± 2.1 weeks. Three episodes of ocular adverse drug reaction were reported, including two patients developing subretinal hemorrhage while one having a retinal pigment epithelial (RPE) tear. Notably, no intraocular inflammation (IOI) was seen in any of the eyes, and no systemic side effects were identified.

Conclusion: In a real-world scenario, brolucizumab therapy is efficacious and safe in the management of nAMD over the short term. Further long-term studies are warranted to validate these findings. Additionally, lack of ocular inflammation after 126 brolucizumab injections in our Indian data is peculiar and underlines the necessity to explore the role of race and genetics in predisposing to/safeguarding against brolucizumab-related IOIs.
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http://dx.doi.org/10.2147/OPTH.S328160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434835PMC
September 2021

Detection of retinal laser injury using confocal scanning laser imaging.

Indian J Ophthalmol 2020 Aug;68(8):1688-1691

B. B. Eye Foundation, Kolkata, West Bengal, India.

The use of laser energy in medical practice requires specific safety measures. Accidental ocular exposure of laser can have vision-threatening consequences. We report a case of accidental laser exposure in a dentist who was working with a diode laser. The patient presented within 24 hours of exposure and the clinical fundus examination and spectral-domain optical coherence tomography (SDOCT) were unremarkable at this time. Blue light autofluorescence (BAF) and multicolor images obtained using the Spectralis SDOCT system revealed the laser impact site. The multicolor image showed a larger extent of retinal involvement highlighting its role in imaging.
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http://dx.doi.org/10.4103/ijo.IJO_54_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640869PMC
August 2020

The red lens: a case of florid lens neovascularisation.

Clin Exp Optom 2020 09 5;103(5):706-707. Epub 2019 Dec 5.

Retina Services, B. B. Eye Foundation, Kolkata, India.

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http://dx.doi.org/10.1111/cxo.13029DOI Listing
September 2020

Pars plana vitrectomy and re-directing a dexamethasone implant into vitreous cavity following misdirected entry into the crystalline lens.

Indian J Ophthalmol 2018 07;66(7):1033-1036

M.S Student, D.Y Patil Medical College, Hospital & Research Centre, Pune, Maharashtra, India.

A known diabetic patient presented with diabetic macular edema (DME) and nonproliferative diabetic retinopathy in both eyes with a vision of 6/18, Nin the right eye and 4/60, Nin the left eye (LE). The patient had undergone injection of dexamethasone implant in the LE which got misdirected into the crystalline lens. The patient was taken up for phacoemulsification with intraocular lens implantation along with vitrectomy and posterior vitreous detachment induction, and redirection of the dexamethasone implant into the vitreous cavity. The DME resolved over the next 3 months.
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http://dx.doi.org/10.4103/ijo.IJO_1179_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032724PMC
July 2018

Endophthalmitis caused by Alcaligenes faecalis: a case series.

Ocul Immunol Inflamm 2013 Dec 29;21(6):446-8. Epub 2013 Jul 29.

Sankara Nethralaya, Department of Vitreo-retina , Kolkata, West Bengal , India , and.

Purpose: To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Alcaligenes faecalis.

Methods: Retrospective analysis of all the cases of A. faecalis endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2012 was done.

Results: A total of five cases were included in the study. Out of the five cases, one was of endogenous origin and the rest were post cataract surgery. All but one case underwent vitreo-retinal surgical intervention followed by intravitreal antibiotics. Alcaligenes faecalis was isolated in all the cases. Sensitivity to ceftazidime, aminoglycosides and ciprofloxacin was 20%, 60% and 80%, respectively. Two patients attained a final visual acuity of 6/24. One eye became phthisical in due course.

Conclusion: Alcaligenes faecalis is a very rare cause of endophthalmitis. Aminoglycosides and fluroquinolones can be considered as main line of treatment.
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http://dx.doi.org/10.3109/09273948.2013.817592DOI Listing
December 2013

Endophthalmitis caused by Citrobacter species: a case series.

Can J Ophthalmol 2013 Jun;48(3):216-7

Vitreo Retina Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal.

Objective: To report the clinical profile and drug sensitivity patterns in Citrobacter endophthalmitis.

Design: Retrospective interventional case series.

Methods: Retrospective analysis of all the cases of Citrobacter endophthalmitis presenting to a tertiary referral ophthalmic centre in eastern India from January 2009 to December 2011 was done.

Results: Five cases were included in the study. Of these 5, 1 was posttraumatic, 1 was of endogenous origin, and the rest were postoperative. Vitreous surgery was done for 3 cases, whereas 1 patient declined surgery. The endogenous case received only intravitreal antibiotics. All isolates were sensitive to ciprofloxacin. Only 1 of the 5 isolates was sensitive to ceftazidime. Only 1 eye achieved a final visual acuity of 20/60 and the rest became phthisical at final follow-up.

Conclusions: Citrobacter is a rare cause of endophthalmitis with poor outcome. Ciprofloxacin should be considered as the first line of treatment.
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http://dx.doi.org/10.1016/j.jcjo.2012.12.009DOI Listing
June 2013

An unusual intraocular tongue worm in anterior chamber: a case report.

Ocul Immunol Inflamm 2011 Dec;19(6):442-3

Purpose: To present an interesting case of intraocular Linguatula serrata in a 5-year-old boy.

Design: Case report.

Methods: Visual acuity testing, biomicroscopic slit-lamp examination, and indirect ophthalmoscopy were performed on a 5-year-old boy with a progressively enlarging white lesion in the anterior chamber of the right eye.

Results: The worm was found in the anterior chamber, attached firmly to the peripheral iris with free-floating tail. The living worm, which grew progressively over 2 months, caused a mild anterior chamber reaction with marginally raised intraocular pressure. The worm was removed surgically in toto. This is the first documentation of human ocular pentastomiasis in India.

Conclusions: An adult worm in the anterior chamber is apparently rare and can present even with a quiet eye. Surgical removal is essential. However, visual prognosis is good.
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http://dx.doi.org/10.3109/09273948.2011.621579DOI Listing
December 2011

Spontaneous closure of a posttraumatic scleral fistula in an atypical choroidal coloboma.

Retin Cases Brief Rep 2010 ;4(3):268-9

From the Medical and Vision Research Foundations, Sankara Nethralaya, Chennai, India.

Background: Scleral fistulas have been reported to occur in choroidal colobomas, and their repair has been described in the literature. Spontaneous closure of a posttraumatic fistula has not been reported.

Purpose: To describe the occurrence of posttraumatic scleral fistula formation and its spontaneous closure in an eye with an atypical choroidal coloboma.

Methods: Interventional case report.

Results: Spontaneous closure of the posttraumatic scleral fistula was noted at 1-month follow-up. This was documented clinically and confirmed by B-scan ultrasound.

Conclusion: Scleral fistula formation can occur at the base of a choroidal coloboma after blunt injury, and this can close spontaneously over a period of time.
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http://dx.doi.org/10.1097/ICB.0b013e3181a3b9efDOI Listing
November 2014

Endophthalmitis in eyes presenting with orbital signs: a case-control study.

Retina 2010 Mar;30(3):491-4

Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai 600006, Tamil Nadu, India.

Purpose: The purpose of this study was to assess the clinical profile and treatment outcomes in eyes with endophthalmitis presenting with orbital signs.

Methods: A case-control study of 24 eyes with endophthalmitis and orbital signs at presentation (defined as ocular motility restriction and/or presence of " inverted perpendicular" sign on ultrasonography) was conducted between January 2000 and December 2006. The control group was constituted of 40 age- and sex-matched eyes with endophthalmitis presenting without orbital signs. Optimal structural outcome was defined as resolution of inflammation and infection. Adverse structural outcome was defined as development of phthisis bulbi or need for evisceration or development of retinal detachment. Optimal functional outcome was defined as improvement in postoperative visual acuity to 3/60 or better. The Pearson chi-square test was used with appropriate significance (P < or = 0.05) to compare the mean visual acuity before and after treatment.

Results: Twenty-four patients with a mean age of 46.4 years and a mean follow-up of 14.6 months were included. Treatment options included intravitreal antibiotics, vitrectomy, evisceration, and systemic antibiotics. Optimal structural outcome was achieved in 6 (25%) eyes. A total of 70.8% eyes had no light perception, whereas 4 (16.66%) patients regained ambulatory vision (>3/60). There was a statistically significant poor visual (P = 0.05) and structural outcome (P = 0.004), whereas in the control group, 25 patients (62.5%) had vision 3/60 or better (P = 0.001).

Conclusion: Orbital signs are independent risk factors for poor structural and visual outcomes in eyes with endophthalmitis.
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http://dx.doi.org/10.1097/IAE.0b013e3181bced7fDOI Listing
March 2010

Endophthalmitis caused by Enterococcus faecalis: a case series.

Retina 2009 Feb;29(2):214-7

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

Background: To profile the etiology, clinical features, visual and anatomical outcomes in eyes diagnosed with Enterococcus faecalis endophthalmitis.

Methods: A single (tertiary care) center, Retrospective interventional case series. Clinical and microbiological records of 26 consecutive eyes with culture positive E. faecalis endophthalmitis treated at a tertiary referral ophthalmic hospital in south India from 1st January 1995 to September 2007 were reviewed and analyzed.

Results: Of the twenty-six eyes, 12 were of postsurgical etiology, 11 cases were posttraumatic while 3 were of endogenous causes. Two eyes had an intraocular foreign body. Initial mean visual acuity was 3.19 logMAR (range: 0.77-4). All cases were treated with vitrectomy and intravitreal injections. Six cases developed retinal detachment after initial surgery, but only 30.7% eyes had a poor anatomical outcome (8 patients out of 26). All cases except one were sensitive to Vancomycin. Final mean visual acuity was 2.12 logMAR (range: 0.17-4). Paired 't' test showed statistically significant (P = 0.008) good visual outcome (better than or equal to 3/60).

Conclusions: Surgery (12 of 26 eyes) and trauma (11 of 26 eyes) were the commonest causes of E. faecalis endophthalmitis. Our results indicate that early surgical intervention can lead to a good functional outcome despite the virulent nature of the organism. Since almost all the cases were sensitive to Vancomycin, it may be considered as a first line drug in the management of such eyes.
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http://dx.doi.org/10.1097/IAE.0b013e31818eccc7DOI Listing
February 2009

Clinical and histopathological features of posttraumatic iris cyst.

Indian J Ophthalmol 2008 Nov-Dec;56(6):518-21

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

Iris cyst excision involves complex surgical maneuvers and may have a variable visual outcome depending upon preexisting and postoperative complications. Hereby, we report a case series of 10 eyes from which posttraumatic iris cysts were excised and proven histopathologically. Histopathology records were reviewed. Data regarding patient profile, clinical profile, surgical details, treatment outcomes and follow-up were reviewed. Outcome measures were defined as recurrences, visual acuity and number of other surgeries required. Non-parametric Wilcoxon test was used to compare changes in the visual acuity and Fisher test was used to find out the significance of several risk factors. Mean age was 24.7 years (3-58 years). Mean follow-up was 2.36 years. Mean preoperative logMAR visual acuity was 0.56 in comparison to final logMAR visual acuity of 1.62. Factors related to adverse functional outcome were related to post-surgical complications.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612990PMC
http://dx.doi.org/10.4103/0301-4738.43383DOI Listing
June 2009

Ocular manifestation of storage diseases.

Curr Opin Ophthalmol 2008 Nov;19(6):507-11

Department of Ocular Pathology, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.

Purpose Of Review: This is an attempt to provide a brief overview of ocular manifestation of storage diseases (lysosomal storage diseases).

Recent Findings: Lysosomal storage disorder is a heterogeneous group of rare disorders characterized by abnormal accumulation of incompletely degraded substances in various tissues and organs. Patients with these kinds of inherited disorder often present with ocular manifestation along with various systemic features. Systemic manifestations including neurological impairment, skeletal deformities, intellectual and cardiac abnormalities, and gastrointestinal problems are quite common. Ocular complication may cause severe reduction in vision and can affect any part of the eye. Corneal opacification of varying severity is frequently seen. Patients can also present with cataract, vitreous degeneration, retinopathy, optic nerve swelling and atrophy, ocular hypertension, and glaucoma.

Summary: The majority of these patients have poor vision due to various ocular complications that are often very difficult to monitor and treat.
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http://dx.doi.org/10.1097/ICU.0b013e32831215c3DOI Listing
November 2008

Ophthalmic manifestations in people living with HIV attending a tertiary care centre of Eastern India.

J Indian Med Assoc 2008 May;106(5):292-4

Regional Institute of Ophthalmology, Kolkata 700073.

A cross-sectional study was undertaken to evaluate ophthalmic lesions in human immunodeficiency virus-infected individuals in eastern part of India. One hundred and seventy-five Indian patients attending one tertiary care centre in Kolkata, were included in the study. Ophthalmic manifestations were found in 29.14%. Of them 64.70% had posterior segment lesion, 23.52% had neuro-ophthalmic lesion, 19.60% had anterior segment lesion, 15.69% had adnexal lesion. Human immunodeficiency virus retinopathy was the commonest ophthalmic lesion involving 23 eyes. Cytomegalovirus retinitis was found in only 10 eyes. Ophthalmic lesions were less common in this study than reported in earlier literature in India and abroad.
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May 2008

Lysyl oxidase activity in the ocular tissues and the role of LOX in proliferative diabetic retinopathy and rhegmatogenous retinal detachment.

Invest Ophthalmol Vis Sci 2008 Nov 19;49(11):4746-52. Epub 2008 Jun 19.

Biochemistry Research Department, Vision and Medical Research Foundation, Chennai, India.

Purpose: Lysyl oxidase (LOX) cross-links the side chain of collagen and elastin and thereby contributes to extracellular matrix (ECM) integrity. ECM remodeling is seen in various ocular diseases. Until now, there have been no reports on the LOX enzyme's activity in ocular tissues. The purpose of this study was to estimate LOX activity and expression in human donor ocular tissues and to measure the specific activity of LOX in the vitreous of proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD).

Method: Human donor eyeballs obtained from an eye bank were used to study tissue distribution of LOX. Human vitreous specimens were obtained during vitreoretinal surgery from PDR (n = 16) and RRD (n = 10). LOX activity was estimated by N-acetyl-3,7-dihydroxyphenoxazine assay, immunohistochemistry, and real-time polymerase chain reaction (RT-PCR). Matrix metalloprotease (MMP)-2 and -9 were quantified in the vitreous by sandwich enzyme-linked immunosorbent assay (ELISA).

Results: The specific activity of LOX in ocular tissues was on the order of vitreous, iris ciliary body, lens, choroid RPE, and retina, which were comparable by mRNA expression and immunolocalization. The vitreous level of LOX activity decreased significantly in PDR and RRD, with an increase in total MMP-2 and -9 levels compared with normal donor vitreous.

Conclusions: LOX activity showed a statistically significant decrease in the vitreous of PDR and RRD relative to control specimens. This effect can contribute to the inadequate collagen cross-linking that causes the ECM changes that occur in these diseases.
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http://dx.doi.org/10.1167/iovs.07-1550DOI Listing
November 2008

Polymerase chain reaction in intraocular inflammation.

Open Ophthalmol J 2008 Oct 22;2:141-5. Epub 2008 Oct 22.

Vision Research Foundation, Sankara Nethralaya, 18 College Road, Chennai 600 006, India.

Polymerase chain reaction (PCR) is a technique involving enzymatic amplification of nucleic acid sequences in repeated cycles of denaturation, oligonucleotide annealing and DNA polymerase extension. It is a powerful molecular biologic tool that allows the rapid production of analytic quantities of DNA from small amounts of starting material. PCR can be performed on nearly any ocular specimen or biopsy. For diagnosis of uveitis, the obtained sample is usually an anterior chamber paracentesis or vitreous tap. PCR potentially is more sensitive than culture for detection of many organisms. By utilizing a secondary detection system in concert with the initial PCR reaction, perfect specificity can be assured. The initial application of PCR diagnostics to ophthalmic disease was in the detection of viral uveitis. PCR has also been implicated in studies of noninfectious uveitis. The most common application is HLA typing. A universal bacterial PCR can be very helpful for the diagnosis of bacterial endophthalmitis at an early stage of the disease.
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http://dx.doi.org/10.2174/1874364100802010141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694597PMC
October 2008
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