Publications by authors named "Subhendu Boral"

11 Publications

  • Page 1 of 1

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

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

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

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

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

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

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

Off-label intravitreal brolucizumab for recalcitrant diabetic macular edema: A real-world case series.

Am J Ophthalmol Case Rep 2021 Dec 1;24:101197. Epub 2021 Sep 1.

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

Purpose: To report the efficacy of intravitreal injection (IVI) of brolucizumab for recalcitrant diabetic macular edema (DME) in a real-world setting.

Observations: This was a single-center, prospective uncontrolled non-randomized case series. Three eyes with recalcitrant DME, who have received a minimum of ten intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, underwent IVI brolucizumab and were followed-up for minimum of 16 weeks. Patients underwent best-corrected visual acuity (BCVA) testing, ophthalmic examination, and optical coherence tomography at baseline and all the scheduled follow-up visits (Weeks 4, 8, 12, and 16). All three patients demonstrated notable improvement in BCVA and reduction in the fluid on SD-OCT lasting up to week 12. At week 16, all three eyes maintained the visual acuity gains. However, early increase in fluid was noted in all the three cases, for which second dose of IVI brolucizumab was planned. No ocular or systemic adverse events were noted in any of the cases.

Conclusions And Importance: In this real-world case series, treatment with IVI brolucizumab exhibited excellent visual acuity outcomes lasting up to 16 weeks for the treatment of recalcitrant DME. Single dose IVI brolucizumab achieves good anatomical improvement based on SD-OCT persisting up to 12 weeks, followed by early recurrence of fluid at week 16. The results did not show any ocular or systemic safety concerns for IVI brolucizumab.
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http://dx.doi.org/10.1016/j.ajoc.2021.101197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414050PMC
December 2021

Real-World Safety Outcomes of Intravitreal Ranibizumab Biosimilar (Razumab) Therapy for Chorioretinal Diseases.

Ophthalmol Ther 2021 Jun 17;10(2):337-348. Epub 2021 Apr 17.

Department of Vitreoretinal Services, Disha Eye Hospitals, Kolkata, 700120, India.

Introduction: To assess the safety profile of the intravitreal ranibizumab biosimilar molecule, Razumab (Intas Pharmaceuticals, Ahmedabad, India) in chorioretinal disorders under real-world conditions.

Methods: This was a multicenter, retrospective chart review which included patients from 15 centers receiving intravitreal Razumab (IVRz) injections from 2016 to 2020. Patient demographics, ocular examination data, and detailed safety information regarding serious adverse events (SAE) or serious adverse drug reactions (sADR), and non-serious AEs (nsAE) or non-serious ADRs (nsADR) occurring within 1 month of IVRz injections were compiled.

Results: A total of 6404 eyes of 6404 patients received 9406 IVRz injections [mean (± SD) = 1.49 (± 0.63)] during 4.25 years. Adverse events were reported after 1978 injections (21.03%): 64.16% nsAE, 32.96% nsADR, 2.37% sADR, and 0.51% SAE. The most frequent adverse events were subconjunctival hemorrhage (8.2% of total injections), transient blurring of vision (6.5% of total injections), and mild ocular pain (5.27% of total injections). Serious ocular (31 cases with retinal pigment epithelial tears [0.33%], two cases of non-infectious vitritis [0.02%], and one case of endophthalmitis [0.01%]) and systemic (seven patients with non-fatal myocardial infarction [0.12%] and six patients with non-fatal cerebrovascular accident [0.09%]) adverse events were infrequent.

Conclusion: The study reports the largest pooled safety data on IVRz use in a real-world scenario. The results did not raise any new ocular or systemic safety concerns for the biosimilar agent, with the incidence and spectrum of adverse reactions similar to those reported with other anti-vascular endothelial growth factor (anti-VEGF) drugs. The real-world evidence suggests that IVRz is a safe anti-VEGF agent in the management of chorioretinal disorders.
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http://dx.doi.org/10.1007/s40123-021-00345-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079600PMC
June 2021

Role of Small Gauge Proportionate Reflux (SGPR) assisted hydro-dissection in elevated symptomatic Vitreo Foveal Traction (VFT).

Retina 2021 Apr 2. Epub 2021 Apr 2.

Dept of Vitreoretina, Disha Eye Hospitals Pvt Ltd, 88(63A) Ghosh Para Road, Barrackpore, Kolkata.

Title: Role of Small Gauge Proportionate Reflux (SGPR) assisted hydro-dissection in elevated symptomatic Vitreo Foveal Traction (VFT).

Purpose: To describe a new technique to release the elevated symptomatic Vitreo-Foveal Traction (VFT).

Methods: This was a retrospective, interventional case series where a new technique of hydro-dissection by Proportionate Reflux (PR) property of small gauge vitrectomy cutter was used in cases of elevated symptomatic VFT as evident on Optical Coherence Tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then the cutter tip was insinuated inside the hyaloid opening and the port opening was directed towards the tip of the fovea at its hyaloid attachment. The PR property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of VFT.

Results: Seven eyes of seven patients were operated by 27-Gauge (n=3) or 25-Gauge (n=4) vitrectomy system. Mean pre-operative and post-operative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11 respectively (p=0.23). Mean pre-operative foveal elevation was 560.86 ± 196.57 micron, which significantly decreased post-operatively to 251 ± 79.13 micron (p<0.01). VMTs were successfully released in all cases. Mean follow up was 184.00±80.32 days.

Conclusion: Small gauge PR assisted hydro-dissection is an innovative technique for management of elevated symptomatic cases of VFT.
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http://dx.doi.org/10.1097/IAE.0000000000003178DOI Listing
April 2021

A novel video overlay guided enlargement of area of ILM peeled versus inverted flap technique: A long-term study in large macular holes.

Eur J Ophthalmol 2020 Dec 14:1120672120979904. Epub 2020 Dec 14.

Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India.

Background/aim: To compare the intra-operative video overlay guided enlargement of Area of ILM peeled (AIP) more than three Disc Diameter (DD) versus the inverted flap technique in large (>400 µm ) Full Thickness Macular Holes (FTMH).

Methods: Retrospectively, 127 cases of large FTMHs divided into two groups (i) Group A ( = 62)-intra-operative video-overlay guided enlargement of AIP > 3DD performed and (ii) Group B ( = 65)-Inverted flap technique was done. Mean Best Corrected Visual Acuity (BCVA), hole closure rate and postoperative foveal anatomy were noted on Optical Coherence Tomography (OCT).

Results: Mean Minimal Diameter of Macular Hole (MDMH) were 632.05 ± 146.62 µm (A) and 677.24 ± 152.08 µm (B). Hole closure rate were 93.55% (A) and 96.92% (B). Mean preoperative BCVA was 1.07 ± 0.37 Log MAR (A) and 0.94 ± 0.23 Log MAR (B). Mean postoperative BCVA at 3 months were 0.73 ± 0.22 Log MAR (A) and 0.83 ± 0.24 Log MAR (B). One-way ANOVA test showed statistically better visual improvement in Group A at 3 months ( = 0.02), 6 months ( = 0.045), 12 months ( = 0.002), and 24 months ( = 0.011). Chi square test revealed Type I pattern of hole closure was statistically more in Group B ( < 0.001). Delayed Recovery of Outer Retinal Layers was more in group B (Pearson Chi square test,  = 0.039).

Conclusion: Anatomically, macular hole closure rate as well as closure pattern was better in Group B. But functional improvement was better in Group A.
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http://dx.doi.org/10.1177/1120672120979904DOI Listing
December 2020

Long-term clinical outcomes of submacular blood removal with isolated autologous retinal pigment epithelium-choroid patch graft transplantation in long-standing large-sized submacular hematomas: An Indian experience.

Indian J Ophthalmol 2020 10;68(10):2148-2153

Vitreo Retina Department, Disha Eye Hospitals Pvt Ltd, Barrackpore, West Bengal, Kolkata, West Bengal, India.

Purpose: To study the outcomes of submacular blood removal with isolated autologous full-thickness retinal pigment epithelial (RPE)-choroid patch graft transplantation in long-standing large-sized submacular hematomas in Indian population.

Methods: A retrospective study was done on eight consecutive patients of long-standing large-sized submacular hematoma from east India. In all cases, 23G vitrectomy was performed with the induction of retinal detachment (performed with or without 38G or 41G subretinal cannula) and a temporal 180° retinectomy was done. Submacular blood along with choroidal neovascular tissue was removed. A full-thickness RPE-choroid autologous patch graft was taken from a relatively healthy quadrant at the mid periphery and then the graft transferred under perfluorocarbon liquid (PFCL) to place it in the subfoveal area. Then, retina was re-attached using PFCL and laser completed. Silicone oil (5000 cst) was used as a tamponade. Post-operatively, wide-field fundus photographs (Optos), serial optical coherence tomography (OCT), indocyanine green angiography (ICGA), and multifocal electroretinography (ERG) were done.

Results: The mean age of the patients at presentation was 67.88 ± 10.03 years. Mean pre-operative best corrected visual acquity (BCVA) was 2.64 ± 0.3 log MAR and mean postoperative BCVA was 1.095 ± 0.27 log MAR (P < 0.05). The mean follow-up was 20 ± 16.57 months. ICG showed re-vascularization of translocated graft in all at 2 months. Multifocal ERG (after 6 months) showed some waveform in all. None of the cases developed re-bleed.

Conclusion: Removal of submacular blood and neovascular membrane with autologous RPE-choroid graft is a viable option in cases with long-standing large submacular hematomas.
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http://dx.doi.org/10.4103/ijo.IJO_1729_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727931PMC
October 2020

A Simple Modified Way of Glueless, Sutureless Scleral Fixation of an IOL: A Retrospective Case Series.

Am J Ophthalmol 2020 10 25;218:314-319. Epub 2020 Mar 25.

Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, West Bengal, India.

Purpose: To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL).

Design: Retrospective interventional case series.

Methods: A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3 mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt.

Results: Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P < 0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt.

Conclusions: This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.
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http://dx.doi.org/10.1016/j.ajo.2020.03.021DOI Listing
October 2020

Variable clinical profile of foveal hypoplasia in albinism.

Indian J Ophthalmol 2020 04;68(4):649-651

Department of Vitreo.Retina, Disha Eye Hospital, Kolkata, West Bengal, India.

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http://dx.doi.org/10.4103/ijo.IJO_905_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210865PMC
April 2020

A novel standardized reproducible method to calculate the area of internal limiting membrane peeled intra-operatively in macular hole surgery by using a video overlay-A long-term study in cases of idiopathic macular holes.

Indian J Ophthalmol 2020 01;68(1):157-161

Disha Eye Hospitals Private Limited, Kolkata, West Bengal, India.

Purpose: To calculate AIP and to find correlation between hole closure pattern with AIP in idiopathic full thickness macular hole (FTMH) cases.

Methods: In this prospective, non-randomized, interventional single blind study, 105 eyes of symptomatic FTMH (<6 month duration) were operated. Minimal diameter of macular hole (MDMH) was calculated on OCT, divided into Group I (>400μ, n = 75) and Group II (<400μ, n = 30). 23G vitrectomy with ILM peeling and gas injection were done in all and recorded. Final area of ILM peeled (AIP) was calculated using Adobe Photoshop CS2 (PSD format) in disc diameters (DD) from still frame. Follow up was done at 6 monthly interval up to a maximum of 5 years after surgery.

Results: Macular holes were closed in 92.38% eyes. In Group I, mean pre-operative BCVA was 1.14 ± 0.39 log MAR and was improved to 0.79 ± 0.26 log MAR post-operatively at 6 months. In Group II, mean pre-operative BCVA was 0.95 ± 0.44 log MAR and was improved to 0.60 ± 0.24 log MAR after surgery. When AIP was more than 3DD, Type I and Type II closure were 72.77% and 27.27% in Group I (P value <0.01) and 84.21% and 15.79% in Group II (P value <0.01).

Conclusion: AIP can be calculated using Adobe Photoshop CS2. Type I closure was significantly high with AIP >3DD in both groups. Intra-operatively using video overlay, surgeons can increase the diameter of AIP to get better closure pattern.
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http://dx.doi.org/10.4103/ijo.IJO_589_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6951151PMC
January 2020

Ultra-widefield image of a toxocara granuloma with an adjacent retinal break and retinal detachment.

Indian J Ophthalmol 2019 11;67(11):1884

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

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http://dx.doi.org/10.4103/ijo.IJO_1294_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836581PMC
November 2019

New Innovative Approaches for Difficult Retained Intraocular Foreign Bodies.

Ophthalmologica 2018 10;240(3):179-180. Epub 2018 Apr 10.

Disha Eye Hospitals, Sheoraphully, India.

Purpose: To describe innovative ways of removal of complicated difficult large retained intraocular foreign bodies (RIOFBs).

Settings: Both cases were treated at Disha Eye Hospitals, Kolkata, a tertiary eye hospital in eastern India.

Methods: Innovative approaches were taken to remove 2 difficult RIOFBs. In the first case, a large RIOFB was just beyond the posterior exit wound, trapped in the sclera. A 23-G MVR blade was used to create multiple radial releasing scleral nicks and bimanually moving the RIOFB into the vitreous cavity using a bent-tip 24G needle and magnet, and the RIOFB was removed through the limbal section. In the second case, a 21-mm long thick nail was deeply embedded in the superior sclera with partial localised retinal detachment with its bulbous end just behind the clear lens. A lasso technique was used to remove the RIOFB without lens touch.

Results: In the first case, the patient finally achieved logMAR 0.2 vision after silicone oil removal and glued scleral fixation of the intraocular lens. In the second case, the patient finally achieved logMAR 0.3 vision after silicone oil removal and phacoemulsification with intraocular lens implantation.

Conclusion: Each case of RIOFB is unique and challenging. Here, innovative techniques are helpful to rescue these difficult RIOFB situations, which can result in excellent outcomes.
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http://dx.doi.org/10.1159/000487549DOI Listing
October 2018
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