Publications by authors named "Parveen Sen"

74 Publications

Whole-exome sequencing identifies two novel ALMS1 mutations in Indian patients with Leber congenital amaurosis.

Hum Genome Var 2021 Mar 29;8(1):12. Epub 2021 Mar 29.

SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, Chennai, India.

Leber congenital amaurosis (LCA) is a severe autosomal recessive retinal degenerative disease. The current study describes exome sequencing results for two unrelated Indian LCA patients carrying novel nonsense p.(Glu636*) and frameshift p.(Pro2281Leufs*63) mutations in the ALMS1 gene. Although ALMS1 gene mutations are associated with Alstrom syndrome (AS), the current patients did not exhibit typical syndromic features of AS. These data suggest that ALMS1 should be included in the candidate gene panel for LCA to improve diagnostic efficiency.
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http://dx.doi.org/10.1038/s41439-021-00143-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007799PMC
March 2021

Aerosol containment box for laser treatment of retinopathy of prematurity in COVID-19 pandemic.

Indian J Ophthalmol 2021 Mar;69(3):743-745

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

Type 1 retinopathy of prematurity (ROP) requires emergency intervention and laser is an established modality of treatment. Laser treatment for ROP under topical anesthesia can be considered as an aerosol-generating procedure due to crying that puts health care workers at high risk of COVID-19 transmission. Aerosol containment box (ACB) is known to minimize aerosol transmission and there are reports of ROP laser done through incubator. Combining these two ideas, we describe a new application of ACB with suction for laser treatment of ROP thereby, reducing risk to health care team without compromising timely effective, and safe treatment for ROP.
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http://dx.doi.org/10.4103/ijo.IJO_3155_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942090PMC
March 2021

Surgical management of a large retinal cyst in X-linked retinoschisis with internal drainage: Report of an unusual case.

Indian J Ophthalmol 2020 Oct;68(10):2294-2296

Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Although X-linked retinoschisis is a common retinal degeneration condition, the presence of a large retinal cyst obscuring the visual axis in an infant is a rare presentation. Herein, we describe such a case of a child who presented to us with the diagnosis of retinal detachment in both the eyes. However, following multimodal imaging and electrophysiology, the child was found to have bilateral juvenile retinoschisis with a large retinoschisis cyst involving the visual axis seen intraoperatively in the left eye. A limbal approach followed by lensectomy was used to excise the inner retinal layer of the cyst. The intracystic fluid was then drained and the stretched retinal vessels were endocauterized and severed without causing any iatrogenic outer retinal breaks and retinal detachment. The correct diagnosis and meticulous preoperative planning of the surgical procedure helped us manage this challenging case with a favorable anatomical and functional outcome.
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http://dx.doi.org/10.4103/ijo.IJO_2336_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727930PMC
October 2020

CERKL mutation causing retinitis pigmentosa(RP) in Indian population - a genotype and phenotype correlation study.

Ophthalmic Genet 2020 12 31;41(6):570-578. Epub 2020 Aug 31.

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

Background: Mutations in gene has been reported to cause Retinitis pigmentosa (RP) and clinically appears discrete from other commonly encountered phenotypes. We report 14 patients who were seen to have CERKL mutation of the 152 patients of RP from Indian population who underwent genetic testing.

Materials And Methods: A retrospective analysis was performed in 28 eyes of the 14 unrelated patients to establish genotype phenotype correlation. Targeted next generation sequencing was performed using the STRAND® NGS v2.5 software. Validation was done using PCR-based bidirectional Sanger sequencing. Clinical data was collected along with imaging such as fundus photo, autofluorescence(AF), Optical coherence tomography and Electroretinogram wherever available.

Results: Three variants c.1045_1046delAT, c.847 C > T and a novel c.899-IG>A were identified. Retinal morphological features were typically bilaterally symmetrical with mild to moderate disc pallor and arteriolar attenuation in all cases, while sparse peripheral pigmentation was noted in seven patients indicating paucipigmentary character. Early macular involvement in all cases was a characteristic finding with central hypo-autofluorescence and surrounding hyper-autofluorescence. Peripheral scalloped chorioretinal atrophic patches were seen in five patients particularly in older patients.

Conclusions: Phenotype associated with CERKL mutation appears clinically discrete from other commonly encountered phenotypes of inherited retinal dystrophies. Recognizing this typical genotype phenotype correlation will help clinicians to identify this form of RP, prognosticate the disease and segregate candidates for futures gene therapy.
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http://dx.doi.org/10.1080/13816810.2020.1814347DOI Listing
December 2020

Secondary ocular hypertension post intravitreal dexamethasone implant (OZURDEX) managed by pars plana implant removal along with trabeculectomy in a young patient.

Oman J Ophthalmol 2020 May-Aug;13(2):92-94. Epub 2020 May 28.

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

We report a case of refractory secondary ocular hypertension after insertion of dexamethasone implant (OZURDEX) for posterior uveitis in a young patient, which necessitated removal of the implant through pars plana vitrectomy along with a trabeculectomy. A young male developed secondary ocular hypertension following dexamethasone implant (OZURDEX) injection for control of posterior uveitis. As the implant was still present in the vitreous cavity, we successfully performed a pars plana removal of the implant along with trabeculectomy with mitomycin C. Early intervention is essential to prevent glaucomatous optic neuropathy in young uveitic patients receiving OZURDEX implant.
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http://dx.doi.org/10.4103/ojo.OJO_40_2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394078PMC
May 2020

Ischemic macular hole in central retinal artery occlusion.

Indian J Ophthalmol 2020 Aug;68(8):1670-1671

Vitreoretina Consultant, Sarakshi Netralaya, Nagpur, Maharashtra, India.

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http://dx.doi.org/10.4103/ijo.IJO_67_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7640881PMC
August 2020

Commentary: Retinal folds: To operate or not to operate.

Indian J Ophthalmol 2020 06;68(6):1200-1201

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

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http://dx.doi.org/10.4103/ijo.IJO_106_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508075PMC
June 2020

ANATOMICAL AND VISUAL OUTCOMES IN STAGE 5 RETINOPATHY OF PREMATURITY WITH MICROINCISION VITRECTOMY SURGERY.

Retina 2021 Feb;41(2):331-337

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

Purpose: To report anatomical and visual outcomes and potential prognostic factors with microincision vitrectomy surgery in Stage 5 retinopathy of prematurity.

Methods: The medical records of premature babies who underwent microincision vitrectomy surgery for Stage 5 retinopathy of prematurity using 23G, 25G, or 27G instrumentation and had a minimum follow-up of 6 weeks were, retrospectively, analyzed. Primary outcome measures were anatomical success at last follow-up defined as retinal attachment at the posterior pole and visual outcomes. Potential risk factors and complications influencing anatomical outcomes were also analyzed.

Results: One hundred seventy eyes of 115 infants underwent lensectomy and vitrectomy with microincision vitrectomy surgery. After a mean follow-up of 30.59 ± 33.24 weeks, anatomical success was achieved in 56 eyes (33.7%) of 166 eyes that had a minimum follow-up of 6 weeks. Occurrence of vitreous hemorrhage was more with 23 gauge (62.27%) as compared to 25 gauge (37.73%) (P = 0.024). With increase in age with each week, the probability of achieving anatomical success was found to be significantly more (odds ratio 1.030; confidence interval = 1.010-1.060; P = 0.008). Presence of anterior segment pathology was associated with poor anatomical outcomes (odds ratio 2.480; confidence interval = 1.190-5.160; P = 0.010). Seventeen children with attached retina had a follow-up of 14 months-5 years, of which ambulatory vision was recorded in five eyes and the ability to identify objects close to face in 12 eyes.

Conclusion: Although surgery for Stage 5 retinopathy of prematurity is challenging, anatomical success can be seen in one-third of cases with microincision vitrectomy surgery. Visual prognosis may be limited but still beneficial.
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http://dx.doi.org/10.1097/IAE.0000000000002837DOI Listing
February 2021

Prevalence of polypoidal choroidal vasculopathy in Indian population: Risk factors, clinical and imaging characteristics.

PLoS One 2020 28;15(4):e0231901. Epub 2020 Apr 28.

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

Aim: To assess prevalence, clinical presentation and multimodal imaging characteristics of polypoidal choroidal vasculopathy (PCV) in a hospital-based setting in South India.

Methods: Electronic medical records (EMR) of new patients presenting with suspected clinical signs of wet age-related macular degeneration (AMD) in a tertiary hospital from January to December 2016 were retrospectively analyzed using keywords and filtered for patient who underwent multimodal imaging. Clinical presentations were categorized into predominantly hemorrhagic, exudative or mixed pattern. The imaging features were compared in these clinical groups. The multimodal images were graded by two masked graders and discrepancies between them were settled by a senior arbitrator.

Results: Of the 147 clinically suspicious cases of PCV out of 785 patients with clinical presentation of AMD as recorded in the EMR, 73 (49.7%) patients had a multimodal imaging diagnosis of PCV. There was no difference in the demography, distribution of polyps, ICGA and OCT characteristics in eyes presenting with hemorrhagic, exudative or mixed clinical features.

Conclusion: Approximately half of South Asian patients presenting with clinical features of neovascular AMD harbor PCV irrespective of their clinical presentation and so we recommend that multimodal imaging is done in all cases of suspicious neovascular AMD in Indian population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231901PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188226PMC
July 2020

Correspondence.

Retina 2020 08;40(8):e36-e37

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

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http://dx.doi.org/10.1097/IAE.0000000000002827DOI Listing
August 2020

Retrolental fibroplasias: What lies beneath?

GMS Ophthalmol Cases 2020 18;10:Doc14. Epub 2020 Mar 18.

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

A nine-month-old female baby with normal birth history presented with her mother complaining of a white spot in the baby's right eye, which the mother had noticed at five months of age. External photograph showed a retrolental fibroplastic membrane visible in the superior half of the dilated pupil. Retcam fundus photo revealed myelinated nerve fibers extending from the disc till the ora superiorly and forming a membranous fold. Intraoperative OCT confirmed thickened RNFL with compact retina. Thus, the retrolental fibroplasia turned out to be a masquerade for myelinated nerve fibers. Since it was not involving the visual axis with no coexisting traction, the mother was reassured regarding the benign nature of the condition.
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http://dx.doi.org/10.3205/oc000141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114638PMC
March 2020

Clinical and electrophysiological characteristics of Efavirenz-induced macular toxicity.

GMS Ophthalmol Cases 2020 27;10:Doc08. Epub 2020 Feb 27.

Medical Research Foundation, Chennai, India.

Efavirenz (EFV), a non-nucleoside reverse transcriptase inhibitor, is commonly used to treat HIV-infected individuals. We report a case of painless, progressive and bilateral blurring of vision in an HIV-positive 54-year-old lady within months of treatment with anti-retro viral therapy including Efavirenz. On presentation, her visual acuity was 6/18; N24 and 6/9; N10 in both eyes with mottling of the retinal pigment epithelial at the macula with corresponding scotomas on HVF 30-2 and loss of ellipsoid layer on spectral domain optical coherence topography (OCT). Though full field ERG was normal, multifocal ERG revealed reduced foveal and parafoveal amplitudes. Our case emphasizes the need of periodic ocular examination of these patients on long-term EFV.
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http://dx.doi.org/10.3205/oc000135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113613PMC
February 2020

Outcome of sutured scleral fixated intraocular lens in Marfan syndrome in pediatric eyes.

Int Ophthalmol 2020 Jun 28;40(6):1531-1538. Epub 2020 Feb 28.

Shri Bhagwan Mahavir Vitreo-Retinal Services, Medical Research Foundation, Sankara Nethralaya, 18-College Road, Nungambakkam, Chennai, Tamil Nadu, 600006, India.

Purpose: To report the clinical outcomes and complications in eyes with Marfan syndrome with subluxated/dislocated lens undergoing sutured scleral fixated intraocular lens (SSFIOL) implantation.

Methods: A retrospective review was done for a consecutive series of 73 eyes of 43 patients with Marfan syndrome, with age less than 18 years who underwent SSFIOL from July 2000 to June 2017. Postoperative best corrected visual acuity, intraocular pressure and refractive error, intraoperative and postoperative complications and time for the development of these complications were analyzed.

Results: Visual acuity improved significantly to 0.43 ± 0.30 (p = 0.01), 0.40 ± 0.3 (p = 0.00) and 0.39 ± 0.3 (p = 0.00) logMAR units at 6 weeks, 1 year and at last follow-up, respectively. The refractive error reduced significantly (p = 0.056, 0.039 and 0.031) at 6 weeks, 1 year and final follow-up following surgery. Intraoperative complications included iatrogenic retinal break (n = 3) and surgical trauma to the iris (n = 1). Postoperative complications included increased intraocular pressure in 3 eyes (4.1%), intraocular lens dislocation/subluxation in 5 eyes (6.8%), retinal detachment in 3 eyes (4.1%), choroidal detachment in 1 eye (1.3%), pupillary capture in 15 eyes (20.5%), vitreous hemorrhage in 1 eye (1.3%), pre-retinal hemorrhage in 1 eye (1.3%) and hyphema in 1 eye (1.3%).

Conclusion: SSFIOL provides good visual outcomes in eyes with ectopia lentis associated with Marfan syndrome. Complications can be seen in some cases, and the parents need to be counseled regarding the same before surgical intervention.
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http://dx.doi.org/10.1007/s10792-020-01322-7DOI Listing
June 2020

Treatment outcomes of zone 1 retinopathy of prematurity: A study from a tertiary eye care center in South India.

Taiwan J Ophthalmol 2019 Oct-Dec;9(4):255-261. Epub 2019 Dec 13.

Department of Retina, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: The main purpose is to study the treatment outcomes of zone 1 retinopathy of prematurity (ROP).

Materials And Methods: A retrospective analysis was done of infants diagnosed with zone 1 ROP with any stage with or without plus disease who were treated with either laser photocoagulation and/or intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents and/or underwent surgery according to their stage at presentation. The retinal outcome at the final visit was analyzed. A favorable outcome was characterized by an attached retina at the posterior pole with regression of ROP (regression of plus disease as well as new vessels) while an unfavorable outcome was detached retina at posterior pole in spite of treatment.

Results: Seventy-eight eyes of 39 infants presented with zone 1 ROP in various stages with plus disease in 50% cases. About 60 eyes underwent treatment. Forty eyes (66.6%) had an attached retina at the final follow-up. Thirty-three eyes (55%) underwent monotherapy with 14 eyes (23.3%) showing regression of ROP with laser alone. Nineteen (31.6%) eyes were treated only by surgery. Of these, a favorable outcome was seen in four eyes (44.4%) with Stage 4 disease and three eyes (30%) with Stage 5 disease. None of the eyes received anti-VEGF as monotherapy. A combination of two or more modalities was required in the remaining 27 eyes (45%). Six eyes (10%) needed anti-VEGF injections in addition to laser and six eyes needed surgery in addition to laser to achieve a favorable outcome. Six eyes (10%) required surgery in addition to both laser and anti-VEGF therapy, and one eye (1.6%) required surgery in addition to anti-VEGF therapy for a favorable final outcome. Among the eyes undergoing treatment, 66.6% had a favorable outcome with 92.9% of eyes in Stage 3, 59% in Stage 4, and 33% in Stage 5 showing regression of disease and attached retina.

Conclusion: In spite of the aggressive nature of zone 1 ROP, favorable outcome is possible as was seen in 66.6% of our cases. A multipronged approach using a combination of laser, intravitreal anti-VEGF agents with or without surgery may be necessary for the management of these eyes.
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http://dx.doi.org/10.4103/tjo.tjo_62_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947749PMC
December 2019

Outcomes of surgery in eyes with familial exudative vitreoretinopathyassociated retinal detachment.

Can J Ophthalmol 2020 06 13;55(3):253-262. Epub 2020 Jan 13.

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

Objective: The aim of this study was to evaluate various techniques of surgical treatment of retinal detachment associated with familial exudative vitreoretinopathy (FEVR) and the factors affecting the anatomical and visual outcome.

Design: Retrospective case series.

Participants: Patients diagnosed with FEVR associated retinal detachment and operated for the same between January 2004 and September 2017.

Methods: A retrospective chart review was conducted of all patients diagnosed with FEVR between January 2004 and September 2017. Patients with rhegmatogenous retinal detachment (RRD) and tractional retinal detachment (TRD) were included for analysis. Statistical analysis was performed using the t test for mean visual acuities, Fisher's exact test for categorical data, and the one-way analysis of variance for visual outcomes among surgical management options.

Results: A total of 44 eyes of 38 patients diagnosed with FEVR-associated retinal detachment and operated for the same were evaluated. At the time of initial presentation, the mean age of the 38 patients was 14.6 ± 10.9 years and 57.8% were males. Out of 44 eyes that underwent surgical intervention, 79.5% cases were of RRD (n = 35), and TRD was seen in 20.5% cases (n = 9). Primary management in the form of scleral buckle was done in 14 (31.8%) eyes, with 11 eyes (78.6%) having an attached retina after a single surgery and 85.7% after multiple surgeries. Primary pars plana vitrectomy (PPV) was done in 30 (68.2%) eyes, of which 73.3% had attached retina after single surgery and 83.8% after multiple surgeries. Poor pre-operative best-corrected visual acuity, presence of TRD, and presence of falciform folds were associated with poor anatomical outcome.

Conclusions: Favourable outcomes can be achieved, though multiple surgical interventions may, however, be necessary for the ultimate success in some cases.
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http://dx.doi.org/10.1016/j.jcjo.2019.11.001DOI Listing
June 2020

Exploring choroidal angioarchitecture in health and disease using choroidal vascularity index.

Prog Retin Eye Res 2020 07 10;77:100829. Epub 2020 Jan 10.

Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

The choroid is one of the most vascularized structures of the human body and plays an irreplaceable role in nourishing photoreceptors. As such, choroidal dysfunction is implicated in a multitude of ocular diseases. Studying the choroid can lead to a better understanding of disease pathogenesis, progression and discovery of novel management strategies. However, current research has produced inconsistent findings, partly due to the physical inaccessibility of the choroid and the lack of reliable biomarkers. With the advancements in optical coherence tomography technology, our group has developed a novel quantitative imaging biomarker known as the choroidal vascularity index (CVI), defined as the ratio of vascular area to the total choroidal area. CVI is a potential tool in establishing early diagnoses, monitoring disease progression and prognosticating patients. CVI has been reported in existing literature as a robust marker in numerous retinal and choroidal diseases. In this review, we will discuss the current role of CVI with reference to existing literature, and make postulations about its potential and future applications.
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http://dx.doi.org/10.1016/j.preteyeres.2020.100829DOI Listing
July 2020

Retinopathy of prematurity treatment: Asian perspectives.

Eye (Lond) 2020 04 29;34(4):632-642. Epub 2019 Oct 29.

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

Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.
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http://dx.doi.org/10.1038/s41433-019-0643-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093470PMC
April 2020

Macular edema secondary to malignant Hypertension managed with Intravitreal Bevacizumab.

Nepal J Ophthalmol 2019 Jan;11(21):98-101

Introduction: Intravitreal anti VEGF agents are used in a variety of retinal pathologies to decrease the VEGF levels resulting due to breakdown of the blood retinal barrier hence decrease the exudation from vessels which causes macular edema (ME).

Case: A 61year old patient presented with sudden decrease in vision in both eyes with a history of systemic malignant hypertension leading to macular edema as documented on optical Coherence Tomography (OCT) in both eyes. The foveal thickness (FT)of 536 and 328 microns (μ) were observed in the right and left eye each. He was advised intravitreal anti vascular endothelial growth factor (VEGF) in both eyes and advised complete systemic evaluation with the physician. Following one month postintravitreal bevacizumab ( IVB) injection in right eye, marked visual improvement was noted with concomitant significant reduction in macular edema in both eyes.

Observation: Single Bevacizumab injection with control of hypertension in our patient resulted in rapid resolution of the macular edema and early visual recovery. Intravitreal anti VEGF is an effective treatment option in eyes due to hypertensivemaculopathy especially to gain speedy visual recovery.

Conclusion: The case gives a unique outlook to the course of ME in the single patient with malignant HTN with or without IVB injection. We believe that anti VEGF injections may result in rapid recovery in vision and minimize the risk of permanent vision loss in eyes with malignant hypertension.
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http://dx.doi.org/10.3126/nepjoph.v11i1.25444DOI Listing
January 2019

Surgical outcomes of vitreoretinal surgery for rhegmatogenous retinal detachment in eyes with regressed retinopathy of prematurity.

Indian J Ophthalmol 2019 06;67(6):896-902

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

Purpose: To report the anatomical and functional outcomes of vitreoretinal surgery in eyes with "regressed ROP" presenting with rhegmatogenous retinal detachment (RRD).

Methods: In this retrospective interventional case series, twenty-two eyes (of 22 patients) with regressed ROP, who underwent surgery for RD. Primary outcome measures were final anatomical and visual outcome for scleral buckling and pars plana vitrectomy (PPV). Visual outcomes were categorized into three groups: improved, remained stable, and deteriorated. Univariate binary logistic regression analysis was used to determine the risk factors for RD.

Results: Of 22 eyes in the study, overall anatomic success was achieved in 16 of 22 eyes (72.7%). The macula was attached in 17 of 22 eyes (77.3%) at final visit. In the scleral buckle (SB) group, overall anatomical success was achieved in six of seven eyes (85.7%). Overall, in the PPV group, anatomical success was seen in 10 of 15 eyes (66.7%) at final visit. At final follow-up, significant improvement in best-corrected visual acuity from baseline was seen in 11 cases (50%, P = 0.02), stable in 5 cases (22.7%), and significant visual deterioration was seen in 6 cases (27.3%, P = 0.02). The total mean follow-up duration of the patients was 45.5 months (range: 2.1 months to 11.2 years).

Conclusion: Early recognition and surgical intervention in such cases can lead to a high rate of anatomical success and can prevent the development of profound visual impairment in some patients.
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http://dx.doi.org/10.4103/ijo.IJO_706_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552606PMC
June 2019

Surgical outcomes of microincision vitrectomy surgery in eyes with retinal detachment secondary to retinopathy of prematurity in Indian population.

Indian J Ophthalmol 2019 06;67(6):889-895

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

Purpose: To analyze and report outcomes of microincision vitrectomy surgery (MIVS) for Stage 4 and 5 retinopathy of prematurity (ROP).

Methods: Medical records of 202 eyes of 129 premature children undergoing MIVS for Stage 4/Stage 5 ROP between January 2012 and April 2015 were evaluated. The primary outcome measure was the proportion of eyes with anatomical success (defined as attached retina at the posterior pole at last follow-up). Complications associated with MIVS were noted and analysis of risk factors associated with poor anatomical outcome was also done using logistic regression.

Results: Mean age of presentation of babies with Stage 4 ROP (2.9 ± 1.75 months) was lower than those with stage 5 disease (5.62 ± 2.55 months) (P < 0.005). One hundred seventeen eyes (56% or 58%) had Stage 5, 38 (19%) had Stage 4a, and 47 (23%) Stage 4b. Ninety-four eyes (47%) had received prior treatment (laser and/or anti-vascular endothelial growth factors [VEGF]). Lens-sparing vitrectomy (LSV) was performed in 58 (29%) eyes while lensectomy with vitrectomy (LV) was performed in 144 (71%) eyes. At a mean follow-up of 32.5 weeks, 102 (50.5%) eyes achieved anatomical success, including 74% eyes in Stage 4a and 4b and 33% in Stage 5. Complications included intraoperative break formation (19%), postoperative vitreous hemorrhage (28%), raised intraocular pressure (12.7%), and cataract progression (2.4%). Factors significantly associated with favorable anatomical outcome were Stage 4 disease (vs. Stage 5) (odds ratio [OR] 5.8; confidence interval [CI] =2.6-13.8, P < 0.005), prior treatment (laser ± anti-VEGF) (OR 2.5; CI 1.4-4.7, P < 0.005) surgery with 25G MIVS (vs. 23G) (OR: 1.7; CI = 0.98-3.00, P = 0.05) and LSV (vs. LV) (OR 7; CI = 3.4-14.6, P < 0.005). Retinal break was significantly associated with poor anatomical outcome (OR 0.21; CI = 0.09-0.5, P < 0.005).

Conclusion: MIVS along with wide angle viewing systems allow surgeons to effectively manage ROP surgeries while at the same time reducing complication rate in these eyes which have complex pathoanatomy and otherwise grim prognosis.
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http://dx.doi.org/10.4103/ijo.IJO_1030_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552624PMC
June 2019

Inverted Flap Technique for Large Macular Hole Secondary to Chronic Uveitis.

Middle East Afr J Ophthalmol 2019 Jan-Mar;26(1):43-45

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

Macular hole is a defect in the neurosensory retina at the center of the fovea, seen in 8.3% of the postuveitic cases. In such cases, macular holes tend to be large and are associated with structural damage in the outer retinal layers. Here, we report a case of bilateral chronic intermediate uveitis treated with sub-Tenon steroids that developed a full-thickness macular hole in the right eye. We treated it surgically with inverted flap technique of internal limiting membrane peeling. Postoperatively, the patient showed Type-1 closure of the hole with visual improvement.
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http://dx.doi.org/10.4103/meajo.MEAJO_271_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507377PMC
July 2019

Elevated serum OxLDL is associated with progression of type 2 Diabetes Mellitus to diabetic retinopathy.

Exp Eye Res 2019 09 14;186:107668. Epub 2019 May 14.

Biochemistry and Cell Biology Department, Vision Research Foundation, Chennai, 600 006, India. Electronic address:

Hyperlipidemia is associated with the progression of diabetic retinopathy (DR). Paraoxonase 1 (PON1), an esterase is known to prevent systemic LDL oxidation. This study assessed if serum oxLDL is associated with the progression of Type 2 DM to DR. This study is part of a three-year hospital based prospective study where 87 subjects were recruited. This included T2DM without DR (n = 22); Non-Proliferative (NPDR) (n = 21) and Proliferative DR (PDR) (n = 22) along with age/sex matched controls (n = 22). Serum oxLDL-Ab was estimated by ELISA. Serum PON esterase activity and plasma Malondialdehyde (MDA) level were estimated by spectrophotometry and the serum Advanced Glycation End products (AGE) level by spectroflourimetry. The systemic levels of oxLDL, AGE and MDA were increased with the progression of T2DM without DR to DR as seen by ANOVA (P < 0.05). Serum oxLDL-Ab levels showed a positive correlation to total cholesterol (P = 0.04) as evaluated in the DR group. Statin intake was found to lower PON esterase activity (P < 0.05). Based on this pilot study, it is proposed that elevated serum oxLDL should be validated in larger cohort studies to ensure it could be potential risk factor for the progression of T2DM to DR.
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http://dx.doi.org/10.1016/j.exer.2019.05.008DOI Listing
September 2019

Oxidized LDL, homocysteine, homocysteine thiolactone and advanced glycation end products act as pro-oxidant metabolites inducing cytokine release, macrophage infiltration and pro-angiogenic effect in ARPE-19 cells.

PLoS One 2019 14;14(5):e0216899. Epub 2019 May 14.

R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Sankara Nethralaya, Chennai, India.

Age-related Macular Degeneration (AMD) is one of the major vision-threatening diseases of the eye. Oxidative stress is one of the key factors in the onset and progression of AMD. In this study, metabolites associated with AMD pathology more so at the systemic level namely, oxidized LDL (oxLDL), homocysteine (Hcy), homocysteine thiolactone (HCTL), advanced glycation end product (AGE) were evaluated for their pro-oxidant nature in a localized ocular environment based on in vitro studies in human retinal pigment epithelial cells (ARPE-19 cells). Human ARPE-19 cells were treated with pro-oxidants 50 μg/mL oxLDL, 500 μM Hcy, 500 nM HCTL, 100 μg/mL AGE, 200 μM H2O2 and 200 μM H2O2 with and without pre-treatment of 5 mM N-acetyl cysteine (NAC). The cytokines IL-6, IL-8 and vascular endothelial growth factor (VEGF) secreted from ARPE-19 cells exposed to pro-oxidants were estimated by ELISA. In vitro angiogenesis assay was performed with conditioned media of the pro-oxidant treated ARPE-19 cells in Geltrex-Matrigel coated 96-well plate. The human acute monocytic leukemia cell line (THP-1) was differentiated into macrophages and its migration in response to conditioned media of ARPE-19 cells insulted with the pro-oxidants was studied by transwell migration assay. Western blot was performed to detect the protein expression of Bax, Bcl-2 and NF-κB to assess apoptotic changes. The compounds involved in the study showed a significant increase in reactive oxygen species (ROS) generation in ARPE-19 cells (oxLDL; Hcy; AGE: p < 0.001 and HCTL: p < 0.05). NAC pre-treatment significantly lowered the oxidative stress brought about by pro-oxidants as seen by lowered ROS and MDA levels in the cells. Treatment with pro-oxidants significantly increased the secretion of IL-6 (oxLDL: p < 0.05; Hcy, HCTL and AGE: p < 0.01) and IL-8 cytokines (oxLDL: p < 0.05; HCTL: p <. 001 and AGE: p < 0.01) in ARPE-19 cells. Serum samples of AMD patients (n = 23) revealed significantly higher IL-6 and IL-8 levels compared to control subjects (n = 23) (IL6: p < 0.01 and IL8: p < 0.05). The pro-oxidants also promoted VEGF secretion by ARPE-19 cells compared to untreated control (oxLDL: p < 0.001; Hcy: p < 0.01; HCTL and AGE: p < 0.05). In vitro angiogenesis assay showed that the conditioned media significantly increased the tube formation in RF/6A endothelial cells. Transwell migration assay revealed significant infiltration of macrophages in response to pro-oxidants. We further demonstrated that the pro-oxidants increased the Bax/Bcl-2 ratio and increased the NF-κB activation resulting in pro-apoptotic changes in ARPE-19 cells. Thus, oxLDL, Hcy, HCTL and AGE act as pro-oxidant metabolites in RPE that promote AMD through oxidative stress, inflammation, chemotaxis and neovascularization.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216899PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516731PMC
January 2020

Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children.

Br J Ophthalmol 2020 01 28;104(1):115-120. Epub 2019 Mar 28.

Smt Jadhavabhai Nathmal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India.

Aims: To assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation.

Methods: A retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period.

Results: The incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02), diagnosis of primary congenital glaucoma (p=0.05), postoperative hypotony (p=0.07) and aphakia (p=0.1). None of them were found to be significant on multivariate analysis. Five eyes, three with retinal apposition and two with retinal detachment, underwent surgical drainage. There were no significant differences in the outcomes of eyes which underwent drainage compared with those which did not. Failures, defined as IOP>18 mm Hg despite use of medications, loss of light perception, phthisis or removal of the implant were more frequent in cases (three eyes, 33.3%) compared with controls (four eyes, 14.8%) (p=0.002).

Conclusions: None of the risk factors analysed in our series proved to be significant. Failures were more common in eyes with choroidal haemorrhage, despite surgical intervention.
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http://dx.doi.org/10.1136/bjophthalmol-2018-313804DOI Listing
January 2020

Enhanced S-cone syndrome: Clinical spectrum in Indian population.

Indian J Ophthalmol 2019 Apr;67(4):523-529

Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, College Road, Chennai, Tamil Nadu, India.

Purpose: Enhanced S-cone syndrome (ESCS), a rare disorder, is often misdiagnosed as other forms of retinal degenerations, which have a poorer prognosis than ESCS. The aim of this study is to report the varied clinical features of ESCS and distinguish it from other similar disorders.

Methods: We retrospectively scrutinized the records of patients with confirmed diagnosis of ESCS and analyzed the findings.

Results: We included 14 patients (age range 4-39 years) who were confirmed to have ESCS according to pathognomonic electroretinography (ERG) showing reduced photopic, combined responses, and 30 Hz flicker with reduced L, M cone responses and supernormal S cone responses. The disease presented in the 1 decade with night blindness and was almost stationary or minimally progressive. Mid-peripheral fundus changes in form of nummular pigmentary alterations, yellow punctate lesions, and macular schisis were noted. The vision ranged from 6/6 to 6/36 with follow-up ranging from 1month to 22 years.

Conclusion: ESCS shows varied clinical features ranging from unremarkable fundus to pigment clumping and atrophic lesions. It has good prognosis with patients mostly maintaining their vision. ERG is diagnostic. More awareness and knowledge about this entity can help to differentiate it from other forms of night blindness.
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http://dx.doi.org/10.4103/ijo.IJO_1480_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446635PMC
April 2019

Stage 5 retinopathy of prematurity: An update.

Taiwan J Ophthalmol 2018 Oct-Dec;8(4):205-215

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

Retinopathy of prematurity (ROP) is one of the most common causes of preventable blindness in children. In spite of the availability of various treatment options, and favorable results with timely intervention, many infants present to the ophthalmologists in the advanced end stage of the disease due to lack of awareness especially in the developing nations. This blinding or Stage 5 of ROP presents with total retinal detachment and has to be managed surgically. The surgical techniques for Stage 5 ROP are unique and demanding. The successful anatomical results after surgery are only seen in 20%-50% of cases. In spite of a successful anatomical result, the visual outcome may be slow and limited. The use of newer pharmacological adjuncts has shown promising results. Because of heterogeneity of presentation of the disease severity, a genetic predisposition has also been proposed. A concerted effort from the pediatricians, ophthalmologists, and healthcare workers is required to establish effective screening and treatment guidelines to prevent blindness due to ROP. Till then surgical management has to be done. Parents must be educated regarding the limited visual benefits of surgery and the need for prolonged follow-up. This review gives a comprehensive overview of the pathogenesis, clinical aspects, surgical interventions, and their outcomes and future prospects of Stage 5 ROP.
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http://dx.doi.org/10.4103/tjo.tjo_61_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302569PMC
January 2019

Comparison between broadband and monochromatic photopic negative response in full-field electroretinogram in controls and subjects with primary open-angle glaucoma.

Doc Ophthalmol 2019 02 12;138(1):21-33. Epub 2019 Jan 12.

Department of Retina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, 18 College Road, Nungambakkam, Chennai, 600 006, India.

Purpose: A prospective, cross-sectional, case-control study was conducted to investigate the role of broadband and monochromatic photopic negative response (PhNR) of the full-field flash electroretinogram (ERG) in the evaluation of ganglion cell damage in primary open-angle glaucoma (POAG) subjects.

Methods: Subjects with POAG and age-matched normal subjects were recruited from the outpatient department of a tertiary eye care center in South India. A total of 25 patients with POAG and 50 age-matched normal subjects were recruited. ERG was recorded using broadband (3.5 cd.s/m white stimulus on 10 cd/m white background) and monochromatic (3.5 cd.s/m red stimulus on 10 cd/m blue background and 1 cd.s/m blue stimulus on 10 cd/m yellow background) stimuli.

Results: The reduction in PhNR amplitude in POAG compared to normal individuals was higher in red-on-blue PhNR [26.37 µV; p < 0.001, confidence interval (CI) 19.34 to 33.4] as compared to broadband stimuli (16.41 µV; p < 0.001, CI 8.68 to 24.13), and blue on yellow (21.96 µV; p < 0.001, CI 10.12 to 33.8). Red-on-blue PhNR amplitudes correlated better with mean deviation (MD; r = - 0.66, p < 0.05), pattern standard deviation (PSD; r = - 0.4, p = 0.04), visual field index (VFI; r = - 0.58, p < 0.05), and retinal nerve fiber layer thickness (r = - 0.67, p < 0.05) in comparison with broadband and monochromatic blue-on-yellow PhNR. Receiver operating characteristic curve revealed largest area under the curve (0.89) in red-on-blue PhNR compared to broadband (0.76) and blue on yellow (0.74). The sensitivity and specificity was also higher in red-on-blue PhNR (72% and 80%, respectively) as compared to the other stimuli (sensitivity and specificity of broadband 0.68 and 0.7, blue on yellow 0.64 and 0.7, respectively).

Conclusion: Correlation of PhNR with Humphrey visual field parameters and retinal nerve fiber layer thickness showed that red-on-blue PhNR can be a useful additional tool for clinical assessment of retinal ganglion cell dysfunction in glaucoma patients. Red-on-blue PhNR was more sensitive as compared to white-on-white and blue-on-yellow PhNR in identifying ganglion cell dysfunction and correlates well with other structural and functional tests for glaucoma such as MD, PSD, VFI, and RNFL thickness.
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http://dx.doi.org/10.1007/s10633-018-09668-1DOI Listing
February 2019

Choroidal structural analysis in eyes with diabetic retinopathy and diabetic macular edema-A novel OCT based imaging biomarker.

PLoS One 2018 11;13(12):e0207435. Epub 2018 Dec 11.

Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: To evaluate structural changes in the choroid among patients with diabetic macular edema (DME), with varying grades of diabetic retinopathy (DR), using enhance depth imaging spectral domain optical coherence tomography (EDI SD-OCT) scans.

Methods: A cross-sectional study was conducted on 82 eyes with DR and DME and 86 healthy control eyes. Eyes with DME were classified according to the severity of DR as per the international DR severity scale. Sub foveal choroidal thickness (SFCT)was obtained using EDI SD-OCT scans. These scans were binarized into luminal and stromal areas, to derive the choroidal vascularity index (CVI). CVI and SFCT were analyzed between the study and control group using paired-T test. Tukey's test was used to correlate the differences in CVI and SFCT between different grades of DR. Further analysis was done to look for the effect of DR severity and type of DME on CVI as well as SFCT using correlation coefficient and linear regression analysis.

Results: SFCT was significantly increased in eyes with DME as compared to the controls (334.47±51.81μm vs 284.53±56.45μm, p<0.001), and showed an ascending trend with worsening of DR, though this difference was not statistically significant [mild non-proliferative diabetic retinopathy (NPDR) = 304.33±40.39μm, moderate NPDR = 327.81±47.39μm, severe NPDR = 357.72±62.65μm, proliferative DR (PDR) = 334.59±47.4μm, p-0.09]. CVI was significantly decreased in DME with DR eyes as compared to controls (63.89±1.89 vs 67.51±2.86, p<0.001). CVI was also significantly decreased with worsening DR (mild NPDR = 66.38±0.3, moderate NPDR = 65.28±0.37, severe NPDR = 63.50±0.47, PDR = 61.27±0.9, p<0.001).

Conclusion: SFCT and CVI are dynamic parameters that are affected by DME. Unlike CVI, SFCT is also affected by ocular and systemic factors like edema and hypertension. CVI may be a more accurate surrogate marker for DME and DR and can potentially be used to monitor the progression of DR.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207435PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289408PMC
April 2019

Outcome of vitreoretinal surgery for rhegmatogenous retinal detachment in X-linked juvenile retinoschisis.

Indian J Ophthalmol 2018 Dec;66(12):1825-1831

Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.

Purpose: Rhegmatogenous retinal detachment (RRD) is a vision-threatening complication of X-linked juvenile retinoschisis (XLRS). The aim of this study is to report the anatomical and functional outcomes of vitreoretinal surgery for the treatment of RRD in X-linked juvenile retinoschisis (XLRS).

Methods: This is a retrospective, interventional, consecutive case series in which case records of 34 eyes of 28 XLRS patients, who underwent surgery for RRD, were reviewed. Statistical analysis used is as follows: visual outcomes were categorized into three groups: improved, remained stable or deteriorated. Wilcoxon signed-rank test was used to determine the difference in visual acuity at baseline and at final visit. Univariate binary logistic regression analysis was used to determine the risk factors for retinal detachment. Any P value < 0.05 was considered as statistical significant.

Results: Mean age of the boys at presentation was 9.2 ± 3.5 years. Indication for surgery was RRD in all eyes. Concurrent vitreous haemorrhage was present in four eyes (11.8%). The primary surgical intervention was scleral buckle in 12 eyes and pars plana vitrectomy in 22 eyes. Persistence of subretinal fluid/redetachment was seen in 15 eyes of which 11 eyes underwent additional surgeries. At final follow up, 27 eyes (79.4%) were noted to have an attached retina. Of the total eyes, in 20, 6 and 8 eyes the visual acuity improved, stabilized and deteriorated, respectively.

Conclusion: Favourable outcomes are seen in a majority of eyes after vitreoretinal surgery for RRD in XLRS; however, multiple surgical interventions may be necessary.
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http://dx.doi.org/10.4103/ijo.IJO_607_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256875PMC
December 2018