Publications by authors named "Saurabh Goyal"

25 Publications

  • Page 1 of 1

An Iatrogenic Accidental Overdose of Methotrexate.

J Clin Rheumatol 2021 May 29. Epub 2021 May 29.

From the Departments of Rheumatology Internal Medicine Pulmonology, Park Superspeciality Hospital, Gurugram, Haryana, India.

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http://dx.doi.org/10.1097/RHU.0000000000001753DOI Listing
May 2021

Endothelial corneal dystrophy with annular stromal clefts.

Can J Ophthalmol 2021 Mar 23. Epub 2021 Mar 23.

Moorfields Eye Hospital, London, England. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2021.02.029DOI Listing
March 2021

Reply.

Ophthalmology 2020 09;127(9):e81-e82

Department of Ophthalmology, University of California, Davis, Sacramento, California.

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http://dx.doi.org/10.1016/j.ophtha.2020.04.025DOI Listing
September 2020

Reply.

Ophthalmology 2020 09;127(9):e79-e80

Department of Ophthalmology, University of California, Davis, Sacramento, California.

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http://dx.doi.org/10.1016/j.ophtha.2020.04.014DOI Listing
September 2020

Reply.

Ophthalmology 2020 07;127(7):e45-e46

Department of Ophthalmology, University of California, Davis, Sacramento, California.

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http://dx.doi.org/10.1016/j.ophtha.2020.02.033DOI Listing
July 2020

Multidrug resistance in tubercular mediastinal adenopathy diagnosed by endobronchial ultrasound-transbronchial needle aspiration.

Lung India 2020 Mar-Apr;37(2):130-133

Department of Chest Medicine, Sir Ganga Ram Hospital, New Delhi, India.

Background: Drug resistance in tuberculosis (TB) is a major public health problem. It is easy to assess for drug resistance in pulmonary samples, but the resistance pattern of TB in the mediastinal nodes has not been studied. The aim of this study is to assess the incidence of multidrug resistance in tubercular mediastinal adenopathy with the help of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration.

Materials And Methods: This was a prospective study at a tertiary care teaching hospital in New Delhi where 102 patients with positive mycobacterial cultures from mediastinal lymph node aspirates taken with the help of EBUS were enrolled over 24 months and their drug sensitivity to the first-line antitubercular drugs analyzed.

Results: There were 30 cases of drug resistance of 102 culture-positive cases. Of them, 8 patients had multidrug resistant TB (MDR-TB), 16 cases had only single drug resistance, and the remaining 6 cases had more than one drug resistance pattern but not MDR. In our study, the overall incidence of MDR-TB is 7.8% (8/102), although the incidence of MDR-TB in new and re-treatment cases is 2.2% (2/89) and 46.1% (6/13), respectively.

Conclusion: Such a high percentage of drug-resistant patients is common in tertiary care hospitals; however, similar percentages may be found in other settings as well. Therefore, all efforts should be made to take samples for Mycobacterium tuberculosis culture from the involved nodes before commencing therapy to avoid treatment failures.
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http://dx.doi.org/10.4103/lungindia.lungindia_421_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065554PMC
February 2020

Predictors of selective laser trabeculoplasty success in open angle glaucoma or ocular hypertension: does baseline tonography have a predictive role?

Br J Ophthalmol 2020 10 27;104(10):1390-1393. Epub 2020 Jan 27.

Ophthalmology, King's College London, London, UK

Background: The determinants of success of selective laser trabeculoplasty (SLT) in treatment-naïve patients with open angle glaucoma (OAG) and ocular hypertension (OHT) have not been understood fully. Therefore, we have conducted this study to explore the predictors of success.

Methods: This is a retrospective review of a pre-existing database of patients who had received primary SLT at St Thomas' Hospital, London, UK. Patients with OAG and OHT who had received primary 360° SLT treatment and had reliable baseline tonographic outflow facility (TOF) with minimum of 1 year of follow-up were included. Univariate and multivariate analyses were performed to find the determinants of success.

Results: One hundred and seventy-four patients between August 2006 and February 2010 had received primary 360° SLT treatment and had baseline TOF measurement. Of these, 72 subjects fulfilled the eligibility criteria. In multivariate regression analysis, the only variable associated with success was baseline intraocular pressure (IOP) (R=0.32, beta=-0.51, p<0.001, 95% CI -2.02 to -0.74).

Conclusion: To our knowledge, this is the only study investigating the pretreatment TOF (measured with electronic Shiøtz tonography) and IOP as determinants of success 12 month's post-360° SLT in treatment-naïve patients with OAG and OHT. This study demonstrated that pretreatment IOP (and not TOF) is the only determinant of success after primary SLT therapy.
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http://dx.doi.org/10.1136/bjophthalmol-2019-315489DOI Listing
October 2020

Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 3 Years of Follow-up.

Ophthalmology 2020 03 9;127(3):333-345. Epub 2019 Oct 9.

Department of Ophthalmology, University of California, Davis, Sacramento, California.

Purpose: To report 3-year results of the Primary Tube Versus Trabeculectomy (PTVT) Study.

Design: Unmasked multicenter randomized clinical trial.

Participants: Two hundred forty-two eyes of 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery, including 125 in the tube group and 117 in the trabeculectomy group.

Methods: Patients were enrolled at 16 clinical centers and were assigned randomly to treatment with a tube shunt (350-mm Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC; 0.4 mg/ml for 2 minutes).

Main Outcome Measures: The primary outcome measure was the rate of surgical failure, defined as intraocular pressure (IOP) of more than 21 mmHg or reduced less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision. Secondary outcome measures included IOP, glaucoma medical therapy, visual acuity, and surgical complications.

Results: The cumulative probability of failure after 3 years of follow-up was 33% in the tube group and 28% in the trabeculectomy group (P = 0.17; hazard ratio, 1.39; 95% confidence interval, 0.9-2.2). Mean ± standard deviation IOP was 14.0±4.2 mmHg in the tube group and 12.1±4.8 mmHg in the trabeculectomy group at 3 years (P = 0.008), and the number of glaucoma medications was 2.1±1.4 in the tube group and 1.2±1.5 in the trabeculectomy group (P < 0.001). Serious complications requiring reoperation or producing loss of 2 or more Snellen lines developed in 3 patients (2%) in the tube group and 9 patients (8%) in the trabeculectomy group (P = 0.11).

Conclusions: There was no significant difference in the rate of surgical failure between the 2 surgical procedures at 3 years. Trabeculectomy with MMC achieved lower IOP with use of fewer glaucoma medications compared with tube shunt surgery after 3 years of follow-up in the PTVT Study. Serious complications producing vision loss or requiring reoperation occurred with similar frequency after both surgical procedures.
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http://dx.doi.org/10.1016/j.ophtha.2019.10.002DOI Listing
March 2020

Phacoemulsification Combined With Endoscopic Versus Transscleral Cyclophotocoagulation in Poorly Controlled Glaucoma: A Comparative Case Series.

J Glaucoma 2020 01;29(1):53-59

Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust.

Objective: The objective of this study was to report medium-term outcomes of a novel combination of phacoemulsification with transscleral cyclophotocoagulation (phaco-TCP) compared with combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) in patients with uncontrolled or suboptimally controlled glaucoma and coexisting cataract.

Materials And Methods: Retrospective case series of 80 consecutive patients with a minimum of 12 months of follow-up. In total, 46 eyes underwent phaco-ECP and 34 phaco-TCP. Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction from preoperative IOP (with no increase in ocular hypotensive medications or further glaucoma surgery). Secondary outcomes were change in IOP, number of ocular hypotensive medications and safety.

Results: The mean follow-up was 32.6 ±10.3 months. Preoperative clinical characteristics were similar in both groups. At latest follow-up, success rate was greater with phaco-TCP than phaco-ECP (67.6% and 47.8%, P=0.037). IOP was also significantly lower after phaco-TCP (14.88±5.57 mm Hg, from 22.62±6.52 mm Hg) than phaco-ECP (18.07±6.72 mm Hg, from 22.83±7.88, P=0.0273). Ocular hypotensive medications required reduced similarly after phaco-TCP (from 3.38±0.88 to 2.65±1.04 medications, P=0.0012) and phaco-ECP (from 3.07±0.929 to 2.63±1.42 medications, P=0.0108). There were no cases of hypotony or reduction in vision related to glaucoma with either surgical intervention and a similar proportion required further glaucoma surgery (phaco-ECP 15.2%, phako-TCP 5.9%, P=0.2884).

Conclusions: Phaco-TCP appears more successful in controlling IOP than phaco-ECP with similar safety. Further investigation is warranted of this newly proposed combination which may be particularly useful where access or experience with ECP or other minimally invasive glaucoma surgery is limited.
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http://dx.doi.org/10.1097/IJG.0000000000001403DOI Listing
January 2020

The Cost and Economics of Endoscopic Cyclophotocoagulation in the United Kingdom: A Tertiary Center Experience.

J Glaucoma 2019 06;28(6):563-567

Department of Ophthalmology, St Thomas' Hospital, London, UK.

Precis: As the only microinvasive glaucoma surgery (MIGS) with a reusable component, the cost per procedure of endoscopic cyclophotocoagulation (ECP) diminishes with each successive use. We present a cost comparison of ECP with other MIGS devices, based on our clinical practice.

Purpose: ECP delivers diode laser via a reusable probe to the ciliary processes under direct visualization. The aim of our study is to evaluate the direct cost of ECP based on a retrospective review of cases and compare the cost per procedure with other MIGS devices.

Methods: We conducted a retrospective review of ECP procedures performed at St Thomas' Hospital over 4.5 years. The cost of the ECP endoscope and diode laser consoles, reusable probes, and maintenance contracts were obtained from the hospital procurement log. The on-site Central Sterile Services Department was contacted for probe sterilization and repackaging costs. The cost per device for ECP and commonly performed MIGS procedures were obtained from the product specialists of each company.

Results: A total of 332 procedures were performed using 37 ECP probes during the study period. Each reusable ECP laser probe was found to give an average of 8.97 laser treatments. The cost per procedure decreased over the course of 4.5 years from £819.43 for the first 42 cases to £341.50 after 332 cases. Compared with other MIGS devices, the cost per procedure of ECP after 100 procedures is second lowest to the Kahook Dual Blade and reduces with each successive procedure performed.

Conclusion: The ability to reuse each ECP probe significantly lowers the cost per procedure compared with other MIGS devices in the United Kingdom. The cost per procedure continues to reduce with each successive procedure.
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http://dx.doi.org/10.1097/IJG.0000000000001245DOI Listing
June 2019

In vitro and in vivo delivery of a sustained release nanocarrier-based formulation of an MRTF/SRF inhibitor in conjunctival fibrosis.

J Nanobiotechnology 2018 Nov 27;16(1):97. Epub 2018 Nov 27.

Department of Ophthalmology, King's College London, Westminster Bridge Road, London, SE1 7EH, UK.

Background: Sustained drug delivery is a large unmet clinical need in glaucoma. Here, we incorporated a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor, CCG-222740, into slow release large unilamellar vesicles derived from the liposomes DOTMA (1,2-di-O-octadecenyl-3-trimethylammonium propane) and DOPC (1,2-dioleoyl-sn-glycero-3-phosphocholine), and tested their effects in vitro and in vivo.

Results: The vesicles were spherical particles of around 130 nm and were strongly cationic. A large amount of inhibitor could be incorporated into the vesicles. We showed that the nanocarrier CCG-222740 formulation gradually released the inhibitor over 14 days using high performance liquid chromatography. Nanocarrier CCG-222740 significantly decreased ACTA2 gene expression and was not cytotoxic in human conjunctival fibroblasts. In vivo, nanocarrier CCG-222740 doubled the bleb survival from 11.0 ± 0.6 days to 22.0 ± 1.3 days (p = 0.001), decreased conjunctival scarring and did not have any local or systemic adverse effects in a rabbit model of glaucoma filtration surgery.

Conclusions: Our study demonstrates proof-of-concept that a nanocarrier-based formulation efficiently achieves a sustained release of a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor and prevents conjunctival fibrosis in an established rabbit model of glaucoma filtration surgery.
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http://dx.doi.org/10.1186/s12951-018-0425-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258153PMC
November 2018

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Ophthalmology 2018 10;125(10):e75-e76

Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

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http://dx.doi.org/10.1016/j.ophtha.2018.04.030DOI Listing
October 2018

Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma.

J Curr Glaucoma Pract 2018 Jan-Apr;12(1):45-49. Epub 2018 Mar 1.

Consultant, Department of Ophthalmology, St Thomas Hospital, London United Kingdom.

Primary angle closure glaucoma (PACG) is more blinding (1 in 4 cases) than primary open angle glaucoma (1 in 10 cases). Cataract surgery is an effective initial treatment for majority of cases of PACG. However, cataract surgery alone may not be enough to control intraocular pressure (IOP) in cases with extensive synechial angle closure glaucoma. It is reported that glaucoma drainage surgery is needed in 12% of PACG cases after cataract surgery. Some experts combine cataract surgery with either goniosynechialysis (GSL) or endocyclophotocoagulation (ECP) to enhance IOP control. However, neither combination ensures complete success. We report three subjects with extensive synechia! angle closure in whom we facilitated a technique that combines lens extraction with ECP and endoscopic-GSL (PIECES). We demonstrated that this combined technique was a more effective and efficient method of achieving lower IOP in the presence of extensive synechial PACG. We believe that it addresses both the inflow and outflow of the aqueous humor simultaneously. Two out of three patients had good IOP control without medication and one patient needed one drop after a minimum 12 months of follow up. Furthermore, it may reduce the need for medical therapy and future more invasive glaucoma drainage surgery. Alaghband P, Rodrigues IAS, Goyal S. Phacoemulsification with Intraocular Implantation of Lens, Endocyclophotocoagulation, and Endoscopic-Goniosynechialysis (PIECES): A Combined Technique for the Management of Extensive Synechial Primary Angle Closure Glaucoma. J Curr Glaucoma Pract 2018;12(1):45-49.
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http://dx.doi.org/10.5005/jp-journals-10028-1243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981093PMC
March 2018

Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up.

Ophthalmology 2018 05 21;125(5):650-663. Epub 2018 Feb 21.

Department of Ophthalmology, University of California, Davis, Sacramento, California.

Purpose: To report 1-year treatment outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study.

Design: Multicenter, randomized clinical trial.

Participants: Two hundred forty-two eyes of 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery, including 125 in the tube group and 117 in the trabeculectomy group.

Methods: Patients were enrolled at 16 clinical centers and assigned randomly to treatment with a tube shunt (350-mm Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC; 0.4 mg/ml for 2 minutes).

Main Outcome Measures: Intraocular pressure (IOP), glaucoma medical therapy, visual acuity, visual fields, surgical complications, and failure (IOP of more than 21 mmHg or reduced by less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision).

Results: The cumulative probability of failure during the first year of follow-up was 17.3% in the tube group and 7.9% in the trabeculectomy group (P = 0.01; hazard ratio, 2.59; 95% confidence interval, 1.20-5.60). Mean ± standard deviation IOP was 13.8±4.1 mmHg in the tube group and 12.4±4.4 mmHg in the trabeculectomy group at 1 year (P = 0.01), and the number of glaucoma medications was 2.1±1.4 in the tube group and 0.9±1.4 in the trabeculectomy group (P < 0.001). Postoperative complications developed in 36 patients (29%) in the tube group and 48 patients (41%) in the trabeculectomy group (P = 0.06). Serious complications requiring reoperation or producing a loss of 2 Snellen lines or more occurred in 1 patient (1%) in the tube group and 8 patients (7%) in the trabeculectomy group (P = 0.03).

Conclusions: Trabeculectomy with MMC had a higher surgical success rate than tube shunt implantation after 1 year in the PTVT Study. Lower IOP with use of fewer glaucoma medications was achieved after trabeculectomy with MMC compared with tube shunt surgery during the first year of follow-up. The frequency of serious complications producing vision loss or requiring reoperation was lower after tube shunt surgery relative to trabeculectomy with MMC.
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http://dx.doi.org/10.1016/j.ophtha.2018.02.003DOI Listing
May 2018

Phacoemulsification plus endoscopic cyclophotocoagulation versus phacoemulsification alone in primary open-angle glaucoma.

Eur J Ophthalmol 2018 Mar;28(2):168-174

2 Department of Ophthalmology, St. Thomas' Hospital NHS Foundation Trust, London - UK.

Purpose: To examine the efficacy and safety of combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) compared to phacoemulsification alone in patients with primary open-angle glaucoma (POAG).

Methods: We performed a retrospective notes review of 99 consecutive clinical records of patients with POAG from 2 London eye departments. A total of 69 patients who underwent phaco-ECP and 30 sex- and age-matched control patients who underwent cataract surgery alone were included. Data on intraocular pressure (IOP), visual acuity (VA), number of ocular hypotensive medications, and postoperative complications were collected over 12 months. The primary outcome measure was defined as an IOP within normal limits (<21 mm Hg) and at least a 20% reduction in IOP from baseline.

Results: Mean IOP was significantly decreased in both groups after 1 year (p<0.001 from baseline). The success rate was significantly higher in the phaco-ECP group (69.6%) than in the phaco group (40%) after 1 year (p = 0.004). Reduction in mean IOP and number of medications was also greater in the phaco-ECP group after 1 year (IOP reduction: 4.5 ± 5.13 mm Hg vs 1.83 ± 3.61 mm Hg; p = 0.007; number of medications reduction: 0.73 ± 0.71 vs 0.23 ± 0.56; p = 0.001). Both groups achieved a similar improvement in VA. There was a higher incidence of minor and self-limiting complications in the phaco-ECP group (p<0.047).

Conclusions: Phaco-ECP resulted in a greater reduction in IOP and number of medications than phacoemulsification alone in POAG.
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http://dx.doi.org/10.5301/ejo.5001034DOI Listing
March 2018

Glaucoma Surgery in Scleromalacia: Using Endoscopic Cyclophotocoagulation where Conventional Filtration Surgery or Angle Procedures are contraindicated.

J Curr Glaucoma Pract 2017 May-Aug;11(2):73-75. Epub 2017 Aug 5.

Consultant, Department of Ophthalmology, St Thomas' Hospital, London United Kingdom.

Aim: To describe the surgical management of glaucoma in a patient with severe scleromalacia, and secondary angle closure.

Introduction: The management of glaucoma with coexisting scleromalacia plus secondary angle closure is challenging as most commonly performed incisional glaucoma surgery as well as minimally invasive glaucoma surgery (MIGS), which targets the drainage angle are all contraindicated.

Case Report: Medically refractory glaucoma in a 60-year-old male with a 30-year history of granulomatosis with polyangiitis resulting in extensive severe scleromalacia, cicatricial lower lid retraction with significant conjunctival exposure, and widespread synechial angle closure from chronic anterior uveitis was managed with combined phacoemulsification cataract surgery, and endoscopic cyclophotocoagulation (ECP). Careful postoperative management with intensive immunosuppression was used to successfully prevent complications related to the surgery, which resulted in improved visual acuity, and control of intraocular pressure (IOP).

Conclusion: The ECP is a minimally invasive procedure that targets inflow of aqueous, and can be safely and successfully used to control IOP in challenging patients with complex secondary glaucoma, where the use of traditional incisional surgery, and other MIGS procedures are all contraindicated.

Clinical Significance: The choice of surgical treatment for medically refractory glaucoma needs to be selected based on the circumstances of individual patients, and take into consideration the condition of the sclera, conjunctiva and drainage angle, against the safety and efficacy of possible treatments.

How To Cite This Article: Rodrigues IAS, Lindfield D, Stanford MR, Goyal S. Glaucoma Surgery in Scleromalacia: Using Endoscopic Cyclophotocoagulation where Conventional Filtration Surgery or Angle Procedures are contraindicated. J Curr Glaucoma Pract 2017;11(2):73-75.
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http://dx.doi.org/10.5005/jp-journals-10028-1227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577124PMC
August 2017

Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique.

J Curr Glaucoma Pract 2017 Jan-Apr;11(1):31-34. Epub 2017 Jan 18.

Consultant, Department of Ophthalmology, St Thomas' Hospital, London United Kingdom.

Aim: We present a novel surgical technique for repair of persistent and symptomatic cyclodialysis clefts refractory to conservative or minimally invasive treatment.

Background: Numerous surgical techniques have been described to close cyclodialysis clefts. The current standard approach involves intraocular repair of cyclodialysis clefts underneath a full-thickness scleral flap.

Technique: Our technique employs intraoperative use of a direct gonioscope to guide a nonpenetrating surgical repair. Subsequently, a significantly less invasive, nonpenetrating technique utilizing a partial-thickness scleral flap can be performed that reduces potential risks associated with intraocular surgery. The direct gonioscope is also used for confirmation of adequate surgical closure of the cyclodialysis cleft prior to completion of surgery. This technique has been successfully carried out to repair traumatic chronic cyclodialysis clefts associated with hypotony in two patients. There were no significant adverse events as a result of using this technique.

Conclusion: The novel technique described increases the likelihood of successful and permanent repair of cyclodialysis clefts with resolution of symptoms associated with hypotony, through direct intraoperative visualization of the cleft.

Clinical Significance: Gonioscopically guided nonpenetrating cyclodialysis cleft repair offers significant benefits over previously described techniques. Advantages of our technique include gonioscopic cleft visualization, enabling accurate localization of the area requiring repair, and subsequent confirmation of adequate closure of the cleft. Using a partial-thickness scleral flap is also less invasive and reduces risks associated with treatment of this potentially challenging complication of ocular trauma.

How To Cite This Article: Rodrigues IAS, Shah B, Goyal S, Lim S. Gonioscopically Guided Nonpenetrating Cyclodialysis Cleft Repair: A Novel Surgical Technique. J Curr Glaucoma Pract 2017;11(1):31-34.
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http://dx.doi.org/10.5005/jp-journals-10008-1218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263884PMC
January 2017

Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins.

Asian J Transfus Sci 2015 Jan-Jun;9(1):98-101

Department of Paediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi, India.

Allo-anti-M often has an immunoglobulin G (IgG) component but is rarely clinically significant. We report a case of hemolytic disease of the fetus and newborn along with prolonged anemia in newborn twins that persisted for up to 70 days postbirth. The aim was to diagnose and successfully manage hemolytic disease of newborn (HDN) due to maternal alloimmunization. Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific antihuman globulin cards and standard tube method. At presentation, the newborn twins (T1, T2) had HDN with resultant low reticulocyte count and prolonged anemia, which continued for up to 70 days of life. Blood group of the twins and the mother was O RhD positive. DAT of the both newborns at birth was negative. Anti-M was detected in mothers as well as newborns. Type of antibody in mother was IgG and IgM type whereas in twins it was IgG type only. M antigen negative blood was transfused thrice to twin-1 and twice to twin-2. Recurring reduction of the hematocrit along with low reticulocyte count and normal other cell line indicated a pure red cell aplastic state. Anti-M is capable of causing HDN as well as prolonged anemia (red cell aplasia) due to its ability to destroy the erythroid precursor cells. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis and its efficient management. Mother should be closely monitored for future pregnancies as well.
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http://dx.doi.org/10.4103/0973-6247.150968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339947PMC
February 2015

Calcification in hydrophilic intraocular lenses associated with injection of intraocular gas.

Am J Ophthalmol 2012 Jun 10;153(6):1154-60.e1. Epub 2012 Feb 10.

St Thomas' Hospital, London, United Kingdom.

Purpose: To report a distinct type of calcification in hydrophilic intraocular lenses in complicated, traumatized eyes with a history of intraocular gas use.

Design: Observational case series.

Methods: Three cases of hydrophilic intraocular lens (IOL) opacification confined to the pupillary area are reported from clinical practice in London, UK. Clinical details and analysis of the explanted intraocular lenses are provided with environmental scanning electron microscopy images and x-ray energy-dispersive spectroscopy results.

Results: All cases were associated with use of intraocular gas in complicated traumatized eyes, and had central areas of IOL opacification over the pupillary zone, confined to the anterior surface of the IOL. Analysis of the lenses showed the opacified areas to be composed of calcium and phosphate.

Conclusion: The areas of opacification in all 3 hydrophilic IOLs were attributable to calcification. We postulate that intraocular gas use and the altered blood-aqueous barrier of these complicated traumatized eyes co-act to trigger secondary IOL calcification. Further experimental testing is needed to confirm this clinical association.
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http://dx.doi.org/10.1016/j.ajo.2011.11.017DOI Listing
June 2012

Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial.

Br J Ophthalmol 2010 Nov 14;94(11):1443-7. Epub 2010 May 14.

Department of Ophthalmology, St Thomas' Hospital, London, UK.

Purpose: To investigate the effect of 180° versus 360° primary selective laser trabeculoplasty (SLT) on tonographic outflow facility and intraocular pressure (IOP).

Design: Prospective, single masked randomised clinical trial.

Participants: Patients with untreated primary open angle glaucoma or ocular hypertension both with IOP > 21-35 mmHg.

Methods: 40 patients randomly treated with 180° or 360° SLT after baseline tonographic outflow facility (electronic Schiøtz tonography) and IOP measurements were repeated after 1 month. One eye from each patient was randomly selected for analysis. Eight untreated eyes were included as a control group.

Main Outcome Measures: Tonographic outflow facility and IOP difference. Responders were defined as having at least a 20% reduction in IOP.

Results: Three patients were excluded due to poor tonography. There were 18 eyes in the 180° group and 19 eyes in the 360° group. Tonographic outflow facility increased significantly (180° p = 0.003, 360° p = 0.005) and IOP decreased significantly (180° and 360° p < 0.001) from baseline. There were no significant differences between the two groups as regards the increase in tonographic outflow facility (180° group 37.5%, 360° group 41%, p = 0.23) and decrease in IOP (180° group 24%, 360° group 35%, p = 0.35). There were similar number of responders in 180° group (72%) as compared to 360° group (89.5%, p = 0.23). Tonographic outflow facility and IOP did not change significantly from baseline in the control group (tonographic outflow facility: 8% increase p = 0.48, IOP: 4% decrease p = 0.33).

Conclusions: Primary SLT significantly increased the tonographic outflow facility and decreased IOP in patients with primary open angle glaucoma and ocular hypertension but no statistically significant differences were found between the 360° and 180° groups. The level of IOP reduction due to primary SLT treatment could not be explained by the increase in tonographic outflow facility alone. Clinical trial registration ISRCTN66330584, Current Controlled Trials. 1/11/2006.
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http://dx.doi.org/10.1136/bjo.2009.176024DOI Listing
November 2010

Iris vascular tuft causing recurrent hyphema and raised IOP: a new indication for laser photocoagulation, angiographic follow-up, and review of laser outcomes.

J Glaucoma 2010 Jun-Jul;19(5):336-8

Moorfields Eye Hospital, London, UK.

We report the first case of iris vascular tuft (Cobb's tuft) causing recurrent spontaneous hyphema and raised intraocular pressure that underwent laser photocoagulation (LaP). For the first time, we report fluorescein angiogram guided LaP of the lesion and feeder vessels and 1 year angiographic follow up. We also review indications and outcomes of LaP of iris vascular tufts in the literature.
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http://dx.doi.org/10.1097/IJG.0b013e3181bd899bDOI Listing
September 2010

Orbital haemorrhage with loss of vision in a patient with disseminated intravascular coagulation and prostatic carcinoma.

Orbit 2004 Sep;23(3):193-7

Department of Ophthalmology, Kings College Hospital, London, UK.

A 65-year-old man with sudden profound loss of vision in his right eye due to sub-periosteal orbital haemorrhage was found to have disseminated intravascular coagulation (DIC) secondary to metastatic prostatic carcinoma. CT-scan did not reveal any orbital metastases. A lateral canthotomy did not help to restore the vision. Orbital haemorrhage is known to occur with DIC due to different causes. To the best of our knowledge this is the first report of orbital haemorrhage with DIC related to prostatic carcinoma. This case emphasises the importance of considering systemic factors in cases of non-traumatic haemorrhage, along with imaging studies to rule out any co-existing vascular anomaly.
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http://dx.doi.org/10.1080/01676830490504197DOI Listing
September 2004