Publications by authors named "Namrata Sharma"

406 Publications

Biomaterials for corneal endothelial cell culture and tissue engineering.

J Tissue Eng 2021 Jan-Dec;12:2041731421990536. Epub 2021 Feb 16.

Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.

The corneal endothelium is the posterior monolayer of cells that are responsible for maintaining overall transparency of the avascular corneal tissue via pump function. These cells are non-regenerative in vivo and therefore, approximately 40% of corneal transplants undertaken worldwide are a result of damage or dysfunction of endothelial cells. The number of available corneal donor tissues is limited worldwide, hence, cultivation of human corneal endothelial cells (hCECs) in vitro has been attempted in order to produce tissue engineered corneal endothelial grafts. Researchers have attempted to recreate the current gold standard treatment of replacing the endothelial layer with accompanying Descemet's membrane or a small portion of stroma as support with tissue engineering strategies using various substrates of both biologically derived and synthetic origin. Here we review the potential biomaterials that are currently in development to support the transplantation of a cultured monolayer of hCECs.
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http://dx.doi.org/10.1177/2041731421990536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894589PMC
February 2021

Scleral tunnel with conjunctival autograft for rescue management of extruded haptic: Surgical technique and review of literature.

Indian J Ophthalmol 2021 Mar;69(3):758-761

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

Extrusion of haptic is a rare complication after intra-scleral haptic fixation of intraocular lens (SF-IOL). Various techniques described for its management such as autologous scleral patch, cauterization of exposed haptic, reattempting the glued IOL and IOL explant have their own limitations. Presently, we describe a simple rescue technique for management of such situations. In this method, after performing localized conjunctival peritomy, 2 mm long partial-thickness scleral tunnel is fashioned with an angled 20-guage microvitreoretinal blade 1.5 mm away from the limbus in line with pre-existing defective scleral flap underneath which the exposed haptic is tucked securely. Following this, conjunctival autograft (CAG) with fibrin glue application is undertaken to combat conjunctival fibrosis. In three patients, where this technique was performed, had well-tucked haptic and maintained visual acuity with no complications at 3-months follow-up. This technique is a useful method of tucking extruded haptic after SFIOL in eyes subjected to multiple previous surgeries.
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http://dx.doi.org/10.4103/ijo.IJO_2149_20DOI Listing
March 2021

Study 3: Assessment of events during surgery on posterior polar cataracts using intraoperative optical coherence tomography.

Indian J Ophthalmol 2021 Mar;69(3):594-597

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

Purpose: To describe the changes along nucleo-epinuclear and the opacity-capsular junction during hydrodelineation and the entire period of phacoemulsification using intraoperative optical coherence tomography (iOCT).

Methods: A total of 12 eyes of 12 patients with clinically confirmed posterior polar cataract, who underwent cataract surgery by a single surgeon under the direct guidance of iOCT. The changes along nucleo-epinuclear junction and opacity-capsular junction during/following hydrodelineation and the changes along the opacity-capsular junction following nucleus removal, capsular changes before the opacity removal, and its dynamic changes throughout the surgical procedure were studied.

Results: The mean age of patients was 48.25 ± 7.89 years. Eight of them were males and the right eye was operated in seven patients. With regular hydrodelineation, optimal separation of the nucleus-epinuclear layer was evident in 11 patients. Once a golden ring is achieved through the hydro procedure, then repeated attempts can be performed within it to decrease the chances of capsular damage. Fracture of the posterior opacity with tension over the underlying capsule (n = 1), inadvertent hydro dissection while performing hydrodelineation (n = 1), continuous posterior capsular billowing (n = 2), and posterior capsular ruptures (n = 2) were encountered in this observation with even well-judged surgical maneuvering.

Conclusion: iOCT provides a better understanding of real-time changes along different layers of the human lens during posterior polar cataract surgery. The observations obtained here are likely to help in minimizing inadvertent complications in the future.
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http://dx.doi.org/10.4103/ijo.IJO_1052_20DOI Listing
March 2021

COVID-19 and Eye: A Review of Ophthalmic Manifestations of COVID-19.

Indian J Ophthalmol 2021 03;69(3):488-509

President, All India Ophthalmological Society and Chairman, Centre for Sight, New Delhi, India.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had health implications of unprecedented magnitude. The infection can range from asymptomatic, mild to life threatening respiratory distress. It can affect almost every organ of the body. Ophthalmologists world over are reporting various manifestations of the infection in the eye. This review was undertaken to help ophthalmologists recognize the possible manifestations and the stage of the viral disease when they commonly appear. Literature search was performed for the publications on ophthalmic manifestations of coronavirus disease-19 (COVID-19) between January 1, 2020 and January 31, 2021. 46 case reports, 8 case series, 11 cross sectional/cohort observational studies, 5 prospective interventional studies, 3 animal models/autopsy studies and 6 reviews/meta-analysis were included. Conjunctivitis is the most common manifestation and can develop at any stage of the disease. Direct effect due to virus, immune mediated tissue damage, activation of the coagulation cascade and prothrombotic state induced by the viral infection, the associated comorbidities and drugs used in the management are responsible for the findings in the eye. The viral ribonucleic acid (RNA) has been isolated from ocular tissues but the role of eye as a route for infection is yet to be substantiated. Ophthalmic manifestations may be the presenting feature of COVID-19 infection or they may develop several weeks after recovery. Ophthalmologists should be aware of the possible associations of ocular diseases with SARS-CoV-2 in order to ask relevant history, look for specific signs, advise appropriate tests and thereby mitigate the spread of infection as well as diagnose and initiate early treatment for life and vision threatening complications.
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http://dx.doi.org/10.4103/ijo.IJO_297_21DOI Listing
March 2021

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives.

Clin Ophthalmol 2021 3;15:389-401. Epub 2021 Feb 3.

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

Modern-day cataract surgery has achieved equivalence with refractive surgery, thus requiring surgeons to perform all possible pre-emptive exercises to mitigate intraoperative complications. In this direction, we possess a tremendous amount of technology to understand the preoperative status of the lens. Anterior segment optical coherence tomography (ASOCT) is one such tool, which has played a distinctive role in imaging various forms of cataracts. In this review, we critically analyse the practical role of ASOCT in the preoperative and intraoperative periods from a cataract surgeon's perspective. After a thorough literature assessment, it was substantiated that the cross-sectional imaging ability of ASOCT can demonstrate delicate anatomical and pathological lenticular changes in a visually and clinically comprehensible way. The objective grading of immature cataracts to intralenticular and posterior capsular details in mature/white, posterior polar, traumatic and other forms of cataracts paves the way for various practical innovations as and when required. Hence, preoperative more than intraoperative ASOCT-derived lenticular knowledge is of immense help in careful surgical planning, with improved complication rates.
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http://dx.doi.org/10.2147/OPTH.S286996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869024PMC
February 2021

The enigma of subnormal vision in persistent pupillary membrane.

Med Hypotheses 2021 Jan 24;148:110514. Epub 2021 Jan 24.

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

Persistent pupillary membrane (PPM) is a common congenital anomaly of the eye, representing the remnants of tunica vasculosa lentis. It is often detected as an incidental finding upon examination. The presentation may vary from being an insignificant strand of iris to a hyperplastic dense membrane, with or without adhesions to the surrounding structures, which notably obscures the visual axis. When present as an isolated pathology, these patients are often asymptomatic. However, some patients with isolated PPM do present with poor visual acuity or subnormal quality of vision. The severity of their disability does not always correlate to the extent of the anomaly present in the eye. The rationale as to why only some patients with significant PPM experience this visual handicap while others don't is one of the baffling conundrums in ophthalmology at present. Hence, we attempt to elaborate on the possible mechanisms that explain the unpredictable and variable clinical manifestation of persistent pupillary membranes.
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http://dx.doi.org/10.1016/j.mehy.2021.110514DOI Listing
January 2021

Atropine for treatment of childhood myopia in India (I-ATOM): multicentric randomized trial.

Ophthalmology 2021 Feb 2. Epub 2021 Feb 2.

Pediatric Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi.

This multicentric, double-blinded, placebo-controlled randomized clinical trial reports 1-year-data proving efficacy of 0.01% atropine drops in reducing myopia progression (spherical equivalent) in Indian children having mild to moderate myopia without any significant effect on axial length elongation.
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http://dx.doi.org/10.1016/j.ophtha.2021.01.026DOI Listing
February 2021

Modified Contact Lens Sandwich Technique of Glue for Management of Medium to Large Corneal Perforations in the COVID Era.

Eye Contact Lens 2021 Jan 29. Epub 2021 Jan 29.

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

Abstract: The aim of this article is to describe a novel technique of gluing as an interim measure to provide tectonic support in cases of medium-sized to large-sized (3-6 mm) corneal perforations. Five eyes of five patients in which conventional cyanoacrylate glue application was not feasible, and therapeutic keratoplasty could not be performed in view of the unavailability of corneal tissues were included. Surgery to maintain integrity of the globe was performed, and a therapeutic keratoplasty was performed on tissue availability (mean interval of 7.4 days). On follow-up, all patients had a well-formed anterior chamber, and none of them had progression. The contact lens sandwich technique of glue was a feasible, reproducible, and economical technique during times of tissue unavailability such as the present COVID pandemic, in patients with medium to large perforated corneal ulcers.
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http://dx.doi.org/10.1097/ICL.0000000000000773DOI Listing
January 2021

Modified emulsion polymer isocyanate-gluing: A minor amendment in cyanoacrylate glue application.

Indian J Ophthalmol 2021 Feb;69(2):460-461

Department of Ophthalmology, 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_2602_20DOI Listing
February 2021

Pediatric Keratoconus: Topographic, Biomechanical and Aberrometric Characteristics.

Am J Ophthalmol 2020 Dec 29. Epub 2020 Dec 29.

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

Purpose: Evaluation of the demographic profile, clinical features, topographic, biomechanical and aberrometric characteristics in pediatric keratoconus (KC).

Design: Cross-sectional study METHODS: Cases with KC aged <18 years were evaluated at a tertiary hospital. The main outcome measures were demographic profile, clinical features, visual acuity, corneal topography, aberrometry, biomechanical and confocal microscopy findings.

Results: 116 eyes of 62 consecutive patients were recruited with mean age of participants as 14.7±2.77 (range: 8-18) years (46/62; 88% males). 92% (57/62) cases had bilateral disease, 46% (53/116) eyes had progressive KC, and 8% (9/116) eyes had acute hydrops. Systemic associations were in 9.7% (6/62) patients and ocular associations in 66.3% eyes (77/116). 58.6% (68/116) of eyes had associated vernal keratoconjunctivitis (VKC). Among eyes with VKC, 46% (29/68) were in stage IV KC, versus 25% in eyes with no VKC (p=0.004). The mean refractive spherical equivalent (MRSE) was -4.72 ± 3.32 diopters (D) and refractive astigmatism was 3.69 ± 3.09 D. The mean values of maximum keratometry, thinnest pachymetry and corneal higher order aberrations were 60.89 ± 10.9 D, 396.05 ± 95.03 μm and 1.18±1.2 μm respectively. The values of corneal hysteresis (CH) and corneal resistance factor (CRF) correlated with stage of KC (r=-0.26, p=0.007).

Conclusions: Pediatric KC was commonly associated with VKC in this cohort. Eyes with VKC had more severe KC compared to those without VKC. Nearly half of the patients presented with progressive disease. Corneal biomechanical changes correlated well with stage of KC in pediatric age group.
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http://dx.doi.org/10.1016/j.ajo.2020.12.020DOI Listing
December 2020

Role of therapeutic contact lens following Descemet's stripping automated endothelial keratoplasty: A randomized control trial.

Indian J Ophthalmol 2021 01;69(1):75-81

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

Purpose: Therapeutic contact lenses (TCL) are known to help in epithelial healing and decreasing pain after various corneal surgeries. However, literature lacks any data describing their use following Descemet's stripping automated endothelial keratoplasty (DSAEK) where intraoperative epithelial debridement is commonly performed. Here we study the efficacy and safety of TCL in patients undergoing DSAEK.

Methods: In this prospective, randomized, controlled clinical trial. 40 eyes of 40 patients of pseudophakic bullous keratopathy undergoing DSAEK were enrolled and randomized into two groups, control (no TCL) and test (TCL). Primary outcome was time taken for epithelial healing and secondary outcomes were postoperative pain score, graft attachment, best spectacle-corrected visual acuity, and endothelial cell loss at 3 months.

Results: Average time taken for epithelial healing was 3.35 ± 0.49 days in the test group and 4.95 ± 1.05 days in the control group (P < 0.001). Average pain scores in first operative week were significantly lower in the test group as compared to control (P < 0.001). Graft detachment occurred in eight patients in control group and two in test group (P = 0.03). Both rebubbling rates and average endothelial cell loss at 3 months were higher in the control group with P = 0.07 and 0.06 respectively. No contact lens-related adverse effects were noted during the study period.

Conclusion: Use of TCL in DSAEK leads to faster epithelial healing and lesser postoperative pain. In addition, it may also contribute to lower rebubbling rates and endothelial cell loss.
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http://dx.doi.org/10.4103/ijo.IJO_538_20DOI Listing
January 2021

Comment on "New surgical approach for sutureless scleral fixation".

Eur J Ophthalmol 2020 Dec 2:1120672120974294. Epub 2020 Dec 2.

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

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http://dx.doi.org/10.1177/1120672120974294DOI Listing
December 2020

Clear crescent: Laser-assisted keratomileusis flap displacement.

Indian J Ophthalmol 2020 Dec;68(12):3035

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

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http://dx.doi.org/10.4103/ijo.IJO_909_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856987PMC
December 2020

Complications of small incision lenticule extraction.

Indian J Ophthalmol 2020 Dec;68(12):2711-2722

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

The procedure of small incision lenticule extraction (SMILE) was introduced in 2011, and since then there has been an increase in the number of cases undergoing this procedure worldwide. The surgery has a learning curve and may be associated with problems in the intraoperative and postoperative periods. The intraoperative problems during SMILE surgery include the loss of suction, the occurrence of altered or irregular opaque bubble layer and black spots, difficulty in lenticular dissection and extraction, cap perforation, incision-related problems, and decentered ablation. Most of the postoperative problems are similar as in other laser refractive procedures, but with decreased incidence. The identification of risk factors, clinical features, and management of complications of SMILE help to obtain optimum refractive outcomes.
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http://dx.doi.org/10.4103/ijo.IJO_3258_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856979PMC
December 2020

Suturing large therapeutic corneal grafts based on donor size: A simplified technique for the novice corneal surgeon.

Eur J Ophthalmol 2020 Nov 23:1120672120974285. Epub 2020 Nov 23.

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

Purpose: We describe a simple technique for achieving radial and equally spaced sutures by novice corneal surgeon in cases of large penetrating keratoplasties.

Method: A simple mathematical equation was derived for precise calculation of spacing between interrupted sutures in large grafts ( = 50). The ubiquitous and easily available Castroviejo calipers were used to mark the donor cornea according to the derived formula. Interrupted sutures were passed over the pre-marked points and tied. Radiality was assessed in the post-operative period.

Results: A total of 50 eyes undergoing therapeutic keratoplasty with graft size between 9 and 12 mm were enrolled. Equally spaced and radially aligned sutures were achieved in all cases postoperatively with watertight apposition of the graft host junction using our simple technique.

Conclusion: The Castroviejo caliper can be effectively used for equidistant spacing of interrupted sutures in large therapeutic grafts by a novice surgeon thereby simplifying the procedure and reducing the surgical time.
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http://dx.doi.org/10.1177/1120672120974285DOI Listing
November 2020

Infectious keratitis after lamellar keratoplasty.

Surv Ophthalmol 2020 Nov 17. Epub 2020 Nov 17.

The Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Infectious keratitis after lamellar keratoplasty is a potentially devastating complication that may severely limit the visual and anatomical outcomes. The deep-seated location of the infiltrates, sequestration of the pathogenic microorganisms and limited penetration of the currently available antimicrobial agents often results in delayed diagnosis that may jeopardize the management in these cases. Fungal keratitis is more common as compared with bacterial or viral keratitis and classically presents as white interface infiltrates that may not be associated with significant inflammation. Confocal microscopy may help to establish a rapid diagnosis in such cases, and anterior segment optical coherence tomography may be used to determine the extent of infection and monitor its progression. Conservative measures such as topical antimicrobials and interface irrigation with antimicrobial agents may be done. Surgical intervention in the form of partial excision/removal of the graft in endothelial keratoplasty or a full-thickness keratoplasty is often required for the effective management of deep-seated infections. Timely diagnosis and intervention may result in complete resolution of infection in both anterior lamellar and endothelial keratoplasty. Infections after anterior lamellar keratoplasty have a fair prognosis, and a clear graft with functional visual acuity may be achieved in most cases. By contrast, infections after endothelial keratoplasty have a guarded prognosis, and the presence of concomitant endophthalmitis may further complicate the graft survival and visual outcomes.
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http://dx.doi.org/10.1016/j.survophthal.2020.11.001DOI Listing
November 2020

Necrotizing scleritis following uncomplicated strabismus surgery.

Indian J Ophthalmol 2020 Nov;68(11):2555-2557

Professor Cornea and Refractive Surgery, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

A 5-year-old child having infantile esotropia with bilateral inferior oblique over action underwent uncomplicated strabismus surgery. On the first postoperative day, the child was orthophoric but on day 10, the child was brought with the complaints of severe pain and redness along the original insertion of left medial rectus muscle. Immediate medical management was initiated after appropriate microbiological sampling. Subsequently, on day 13, patient developed sudden discomfort after a bout of violent cough followed by severe pain and discomfort. Slit-lamp examination confirmed the scleral wound dehiscence with vitreous prolapse for which early scleral patch graft within 6 h was performed to achieve optimal visual and cosmetic outcomes.
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http://dx.doi.org/10.4103/ijo.IJO_1839_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774220PMC
November 2020

Guidelines for the management of ocular trauma during the COVID-19 pandemic.

Indian J Ophthalmol 2020 Nov;68(11):2483-2485

Treasurer, All India Ophthalmological Society, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Madhya Pradesh, India.

As the COVID-19 pandemic rages on, India is recording a very high number of new cases daily; even as the country prepares to gradually "unlock", after months of lockdown. While elective eye surgeries such as uncomplicated cataract surgeries, blepharoplasty and eyelid procedures and refractive surgeries can be planned at a later date; emergency cases pertaining to ocular trauma cannot be deferred. This manuscript gives a brief overview of the general guidelines for the management of ocular trauma during the COVID-19 pandemic.
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http://dx.doi.org/10.4103/ijo.IJO_1892_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774135PMC
November 2020

Surface quality and endothelial cell viability after femtosecond laser-assisted donor lenticule preparation for endothelial keratoplasty - An study.

Indian J Ophthalmol 2020 Nov;68(11):2404-2407

Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Purpose: To compare surface quality and endothelial cell viability of descemet stripping automated endothelial keratoplasty (DSAEK) donor lenticules prepared with femtosecond laser (FSL) or microkeratome (MK).

Methods: Experimental ex-vivo evaluation of 15 DSAEK donor lenticules prepared from optical quality donor corneas using 200 KHz FSL (9 eyes) or MK (6 eyes). Surface quality and smoothness of the cut were assessed using atomic force microscopy and endothelial cell viability was assessed using transmission electron microscopy.

Results: Mean lenticule thickness was 121.89 ± 17.13 μm in FSL group and 112.67 ± 5.89 μm in MK group (P = 0.33). Average roughness of stromal surface (RMSavg) [FSL- 30.51 ± 4.55 nm, MK-22.37 ± 1.83 nm; P = 0.02] and root mean square roughness (RMSrough) [FSL-31.39 ± 5.75 nm, MK-23.08 ± 0.40 nm; P = 0.012] was significantly more in FSL group. Increased granular and linear irregularities were observed in the FSL group. Endothelial cell disruption was more in FSL group (FSL- 29.49 ± 6.91% MK-13.28 ± 3.62%; P < 0.001) with decreased mean nucleus length (FSL-5.56 ± 0.17 μm, MK-7.52 ± 0.65 μm; P < 0.001).

Conclusion: Automated MKs are still the standard of care for donor lenticule preparation and MK-assisted donor lenticules have smoother surface with less endothelial cell disruption than FSL. Further research is mandatory before FSL platforms can be considered a viable alternative to the MK.
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http://dx.doi.org/10.4103/ijo.IJO_99_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774225PMC
November 2020

Impact of COVID-19 pandemic, national lockdown, and unlocking on an apex tertiary care ophthalmic institute.

Indian J Ophthalmol 2020 Nov;68(11):2391-2395

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

Purpose: To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India.

Methods: Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions.

Results: During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period.

Conclusion: COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.
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http://dx.doi.org/10.4103/ijo.IJO_2366_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774173PMC
November 2020

Descemetocele.

Surv Ophthalmol 2021 Jan - Feb;66(1):2-19. Epub 2020 Oct 13.

Professor of Ophthalmology, Cornea, Cataract and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. Electronic address:

A corneal descemetocele, the anterior herniation of an intact Descemet membrane through an overlying stromal defect, is a rare, but serious outcome of progressive corneal ulceration and mandates urgent intervention owing to the imminent risk of perforation. Various ocular and systemic abnormalities that can lead to the formation of descemetocele include microbial keratitis, neurotrophic keratopathy, dry eye disorders, and corneal inflammation associated with immune-mediated disorders. The primary aim of management of a descemetocele remains prompt restoration of ocular integrity to prevent the rupture of the Descemet membrane and further complications. Medical therapy is instituted immediately while deciding on the most suitable operative modality for an individual case. Commonly available treatment options include therapeutic bandage contact lenses, tissue adhesives, amniotic membrane transplantation, corneal patch grafts, penetrating or lamellar keratoplasty, and conjunctival flaps. Infrequently, platelet-rich fibrin membrane grafting and umbilical cord patch transplantation have also been tried with success. The surgical strategy and the outcome are commonly determined by the size, location, and etiology of descemetoceles. Despite the availability of all these treatment options, ambiguity remains about management. We review the available literature on pathogenesis, causes, presentation, differential diagnoses, and management of this disorder and also discuss our experience.
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http://dx.doi.org/10.1016/j.survophthal.2020.10.004DOI Listing
October 2020

Mucous membrane grafting (fibrin glue vs. suture) for lid margin pathologies in Stevens-Johnson syndrome: randomized comparative study.

Eye (Lond) 2020 Oct 6. Epub 2020 Oct 6.

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

Objective: To compare fibrin glue (with three cardinal sutures) (FG) and polygalactin suture (PS) for mucous membrane grafting (MMG) in terms of graft apposition and recurrence of lid margin keratinization (LMK) and metaplastic lashes (ML) in patients with Stevens-Johnson syndrome (SJS).

Design: Prospective randomized comparative interventional study.

Methods: Twenty patients diagnosed with SJS and lid margin abnormalities including LMK with or without ML were randomized to undergo either fibrin glue (FG)-assisted MMG (n = 10) or continuous 8-0 polygalactin suture (PS)-assisted MMG (n = 10). They were evaluated preoperatively and during follow-up at 1 week and 1, 2, 3, and 6 months. The parameters assessed were best-corrected visual acuity (BCVA), tear break-up time (TBUT), Schirmer-1 test, corneal and conjunctival complications, graft apposition and width (GW), LMK, ML, impression cytology, and operative time. The primary outcome measures are incidence of graft displacement and recurrence of LMK and ML.

Results: None of the eyelids in FG group (0/40) and 1 eyelid in PS group (1/40) had graft displacement. Recurrence of LMK occurred in 7.5% of eyelids (3/40) in both the study groups. Recurrence of ML occurred in 2.5% (1/40) in FG group and 5% (2/40) in PS group. The mean operative time for MMG in FG group was 39.5 ± 2.40 min and in PS group was 56 ± 1.63 min (p = 0.001).

Conclusions: As graft apposition with suture involves significantly longer intraoperative time, if cost is not a limiting factor then fibrin glue is a viable option for the MMG for lid margin pathologies.
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http://dx.doi.org/10.1038/s41433-020-01203-4DOI Listing
October 2020

Real-time optical coherence tomography-guided scleral flap creation for intrascleral haptic fixation of posterior chamber intraocular lens.

Clin Exp Ophthalmol 2020 Dec 1;48(9):1310-1312. Epub 2020 Oct 1.

Department of Ophthalmology, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1111/ceo.13862DOI Listing
December 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

Corneal melt causing direct visualization of choroidal detachment.

Indian J Ophthalmol 2020 Oct;68(10):2259

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

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http://dx.doi.org/10.4103/ijo.IJO_1024_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728035PMC
October 2020

Commentary: Call for innovative indigenous ideas in smartphone ophthalmic imaging.

Indian J Ophthalmol 2020 10;68(10):2250

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_920_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727932PMC
October 2020

Sinskey hook and viscoelastic assisted posterior capsular plaque extraction.

Indian J Ophthalmol 2020 Oct;68(10):2202-2204

Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Posterior capsule plaques (PCPs) are a rare cause of suboptimal vision after eventless cataract surgery. While these can be managed with posterior capsulotomy, violation of the posterior capsular integrity and associated vitreous disturbances may lead to sight-threatening complications. Viscoseparation and peeling of PCPs with the aid of retinal end-grasping forceps and irrigation and aspiration have also been described in adults for getting rid of PCPs with minimal disturbance of PC and vitreous. While Sinskey hook (SH) has been used to peel PCPs in children, the combined use of SH with viscoseparation for removal of PCP, particularly for adults, remains vaguely described in the literature. Presently, we describe a method of SH and viscoelastic assisted PCP extraction (SVAPE) in adult eyes with centrally located PCPs.
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http://dx.doi.org/10.4103/ijo.IJO_2013_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727962PMC
October 2020

Use of 'U-shaped tool for follow up of corneal ulcer cases in the COVID-19 pandemic.

Indian J Ophthalmol 2020 Oct;68(10):2199-2201

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

To describe a smartphone-based telemedicine tool for monitoring of corneal ulcer size during the corona pandemic, a simple "U"-shaped tool was constructed using three Schirmer's strips that were provided to the patients with small to medium-sized corneal ulcers. The patient and the attendant were trained to use this simple U-shaped tool at home and send digital images to the treating ophthalmologist, to monitor the course of the ulcer. The tool was used in five eyes of five patients with active microbial keratitis. Patients were followed up regularly with the use of telemedicine facility every 48 h for an average duration of 7.6 days (range 6-9 days). In all the five eyes, assessment of the serial images with U-shaped tool showed decrease in size of corneal ulcer, which corroborated with subjective improvement in symptoms. Hence, the novel "'U'-shaped tool" may provide an effective measure in following-up of corneal ulcer patients in times of the COVID-19 pandemic, obviating frequent hospital visits and risk of contracting COVID.
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http://dx.doi.org/10.4103/ijo.IJO_1560_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728037PMC
October 2020

Intralenticular changes in eyes with mature senile cataract on modified posterior segment optical coherence tomography.

Indian J Ophthalmol 2020 Oct;68(10):2099-2102

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

Purpose: To study the morphological changes within mature senile cataracts on modified posterior segment optical coherence tomography (OCT).

Methods: A cross-sectional observational study recruiting patients of mature cataracts admitted for elective cataract surgery in tertiary eye care. A modified OCT imaging of the lens was done and lenticular findings were noted by a single observer. Corresponding slit-lamp biomicroscopic findings and intraoperative experiences were also noted by a second observer and respective surgeons.

Results: Forty-four eyes of 44 patients were included. The mean age of patients was 65 ± 5.7 years. The intralenticular findings were uniform in groups of eyes, and they were characterized into three stages. First was a stage of early lamellar separation where small intralenticular clefts were noted superficially. Second was the stage of established lamellar separation where crescentic fluid clefts appeared interspersed between the lens fibers, and the depth increased as a function of severity. Both these stages did not show any distinct slit-lamp or intraoperative findings. A third stage of liquefaction identified as extensive lamellar separation with subcapsular fluid pockets. This was also reflected in slit-lamp biomicroscopy, showing the hydrated cortex with intraoperative challenges. Two cases showed peculiar changes, one of a hyperreflective subcapsular sheath and another of superficial nuclear lamellar separation.

Conclusion: Mature cataracts may also show graded progression, which could be delineated on lenticular OCT. This could be of immense help in pre-operative planning and optimal management of these high-risk cases.
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http://dx.doi.org/10.4103/ijo.IJO_1650_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728036PMC
October 2020

Clinically useful smartphone ophthalmic imaging techniques.

Graefes Arch Clin Exp Ophthalmol 2021 Feb 11;259(2):279-287. Epub 2020 Sep 11.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 212, RPC-1, AIIMS, New Delhi, India.

Imaging devices in ophthalmology are numerous, and most of them are sophisticated and specialized for specific regions of the eye. In addition, these are fixed and involve close interaction of the patient and the examiner; therefore, simple, portable and tele facility-imbibed imaging tools can be considered optimal alternatives to routine exercises. In the last 10 years, utility of smartphones in ophthalmology is being continuously explored to unearth their potential benefits. In this direction, a smartphone device with/without simple attachments has been noted to aid in detailed, high-quality imaging of the ocular adnexa, cornea, angle, iris, lens, optic disc, and the retina including its periphery. In addition, such utility has also been extended in strabismology workup and intraocular pressure measurements. Hence, using these clinician friendly tools and techniques or by devising newer and more comprehensive tool kits, ophthalmic care can be well-managed with apt use of technology. Also, the smartphone companies are encouraged to collaborate with the medical experts to endeavor more, and help and serve the people better.
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http://dx.doi.org/10.1007/s00417-020-04917-zDOI Listing
February 2021