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Biomedical subjects

Amod Gupta

Publications and source records attributed to Amod Gupta.

At least 37 records · Page 2Linked to original sources
PubMed2003

Traumatic optic neuropathy: visual outcome following combined therapy protocol.

OBJECTIVE: To assess the visual outcome in cases of traumatic optic neuropathy treated with a combined therapy protocol of methylprednisolone injections and endoscopic optic nerve decompression. DESIGN: Prospective, nonrandomized study. SETTING: Academic tertiary care referral center. PATIENTS: The study included 44 patients with posttraumatic indirect optic nerve injury. MAIN OUTCOME MEASURES: Visual acuity. RESULTS: Visual improvement was achieved in 31 patients (70%) when treatment was initiated within 7 days of injury, whereas only 10 patients (24%) showed improvement when the treatment was started after more than 7 days. The time lapse after injury and treatment, degree of visual loss, and computed tomographic evidence of canalicular and pericanalicular fractures were found to be significant prognostic factors. CONCLUSIONS: Endoscopic optic nerve decompression is a minimally invasive procedure that does not cause any adverse cosmetic effects. The risk-benefit ratio suggests that the combined therapy protocol of methylprednisolone injections and endoscopic optic nerve decompression results in a better visual outcome, without any major risks.

Adult↗
PubMed2003

Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations.

OBJECTIVE: To compare the efficacy of fibrin glue and N-butyl-2-cyanoacrylate in corneal perforations. DESIGN: Randomized, controlled clinical trial. PARTICIPANTS: Forty-one patients (41 eyes) with corneal perforations up to 3 mm in diameter with a positive Seidel's test were randomly assigned to two groups (1 and 2). INTERVENTION: Group 1 comprised 19 eyes treated with fibrin glue, and group 2 comprised 22 eyes treated with N-butyl-2-cyanoacrylate. MAIN OUTCOME MEASURES: Number of eyes with successful healing, time required for healing, status of corneal vascularization, and complications were compared in the two groups. Power calculation was performed at alpha = 0.05. RESULTS: Fifteen (79%) eyes had successful healing of corneal perforation in group 1, compared with 19 (86%) eyes in group 2 (P > 0.05) at 3 months' follow-up. The power to detect a difference between the two groups was 10%. Corneal perforation healed within 6 weeks in 12 (63%) eyes in group 1 and 7 (31.8%) eyes in group 2 (P < 0.05). Reapplication of glue was required in six (31.5%) eyes in group 1 and seven (31.4%) eyes in group 2 during the first 3 months of follow-up. The mean number of applications per eye was 1.37 in group 1 and 1.36 in group 2. An increase in deep corneal vascularization was observed in 2 (10.5%) eyes in group 1 and 10 (45.5%) eyes in group 2 (P < 0.05). Giant papillary conjunctivitis occurred in one (5%) eye in group 1 and eight (36.4%) eyes in group 2 (P < 0.05). CONCLUSIONS: Fibrin glue and cyanoacrylate tissue adhesive are both effective in the closure of corneal perforations up to 3 mm in diameter. Fibrin glue provides faster healing and induces significantly less corneal vascularization, but it requires a significantly longer time for adhesive plug formation.

Adolescent↗
PubMed2003

Presumed tubercular serpiginouslike choroiditis: clinical presentations and management.

PURPOSE: Choroiditis, choroidal tubercles, and tuberculomas are well known ocular manifestations of systemic tuberculosis. The present series aimed to report the occurrence of serpiginouslike choroiditis of presumed tubercular origin. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Eleven eyes in seven consecutive patients with a diagnosis of choroidal tuberculosis simulating serpiginous choroiditis were studied between 1997 and 2000. TESTING AND INTERVENTION: All patients had their fundus photographs taken at the time of initial presentation as well as during follow-up. All patients underwent a Mantoux skin test and chest radiography. In addition, five patients had their aqueous or vitreous humor subjected to polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Sputum examination, biopsy, or both were carried out whenever recommended by the pulmonologist. Systemic antituberculosis chemotherapy was instituted in combination with treatment for ocular inflammation. MAIN OUTCOME MEASURE: Therapeutic response and visual improvement. RESULTS: There were five men and two women ranging in age from 17 to 32 years. Clinical presentations included three morphologic variants; multifocal progressive choroiditis showing wavelike progression to confluent, diffuse lesions resembling serpiginous choroiditis (three eyes); diffuse choroiditis characterized by diffuse plaquelike choroiditis with an amoeboid pattern suggestive of serpiginous choroiditis at initial presentation (four eyes); and mixed variety where opposite eyes had mixed features (four eyes). All patients had strongly positive Mantoux skin test results and positive chest radiograph results. The PCR results from aqueous and vitreous humor in four samples was positive for Mycobacterium tuberculosis; one had sputum positive for acid-fast bacilli, whereas two had histopathologic evidence of tuberculosis from cervical or parahilar lymph nodes. Treatment was associated with resolution of choroidal lesions and visual improvement. Final visual acuity of 20/30 or better was achieved in five eyes. CONCLUSIONS: Choroidal tuberculosis may present as multifocal progressive or diffuse choroiditis resembling serpiginous choroiditis. It is important to recognize these presentations because these eyes show good response to systemic antituberculosis chemotherapy.

Adolescent↗
PubMed2003

Necrosis of the eyelids and sclera after retrobulbar anesthesia.

A 52-year-old man had loss of vision and black discoloration of the lids of the right eye after a retrobulbar injection of 3 mL lidocaine hydrochloride 2% (Xylocaine). Examination of the right eye revealed no light perception with extensive necrosis of the lids. Anterior segment examination revealed conjunctival pallor, corneal edema, and necrosis of the sclera. This is a previously unreported complication of retrobulbar anesthesia comprising ophthalmic artery occlusion with scleral melt, ocular ischemia, and eyelid necrosis.

Anesthesia, Local↗
PubMed2003

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery.

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.

Acrylic Resins↗
PubMed2003

Role of prophylactic intravitreal antibiotics in open globe injuries.

PURPOSE: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. METHODS: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. RESULTS: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. CONCLUSIONS: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.

Adolescent↗
PubMed2003

Spectrum and clinical profile of post cataract surgery endophthalmitis in north India.

PURPOSE: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. METHODS: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. RESULTS: The mean age of the patients was 59.50 +/- 13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81 +/- 24.01) and the medium symptom-presentation interval 7.5 days (mean 14.19 +/- 19.13). Corneal infiltrates were seen in 29%, hypopyon in 62 (50%). Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%), bacterial 12 (10%), fungal 27 (21.5%), polymicrobial 8 (6.5%) and negative 55 (44%). 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. CONCLUSION: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.

Aged↗
PubMed2003

Posterior scleritis associated with systemic tuberculosis.

Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

Antitubercular Agents↗
PubMed2002

Clinical characteristics of serpiginous choroidopathy in North India.

PURPOSE: To describe clinical characteristics of serpiginous choroidopathy in the North Indian population. DESIGN: Retrospective cohort-based study. METHODS: Records of 86 patients who obtained a diagnosis of serpiginous choroidopathy at presentation or after a minimal follow-up of 2 years were retrieved. Group I included 62 patients who were diagnosed as having serpiginous choroidopathy at the initial presentation. Group II included 20 patients who initially presented as having multifocal placoid pigment epitheliopathy resembling acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and had progressed over years to serpiginous choroidopathy, while group III had 4 patients with mixed presentations. Statistical analysis was done using the chi-square and Mann-Whitney U test. A review of the clinical, historical, fundus photographic, and fluorescein angiographic features was performed. The demographic and clinical features, number of recurrences, final visual acuity, and final description of healed lesions were documented. RESULTS: The median age at presentation was 30 years in group I, 29 years in group II, and 31 years in group III. The disease was bilateral in five (15%) patients in group I, 12 (60%) in group II, and all four in group III. All the affected eyes in groups II and III and 58 eyes (87%) in group I had recurrences over 2 to 8 years of follow up. Compared with group I, group II was characterized by more bilaterality (P =.001), less central foveal involvement (P =.001), better final visual acuity (P =.001), the presence of healed multifocal scars (P =.001), and less subretinal fibrosis (P =.02). Four patients in group III showed mixed features. CONCLUSIONS: Serpiginous choroidopathy in our population was seen in young patients and had three distinct presentations that seemed to affect the choriocapillaris primarily. Our patients appeared to have a variation of serpiginous choroidopathy, typical of the Asian-Indian population, that had some important differences from that reported in Caucasians.

Adolescent↗
PubMed2002

Reliability of proton and goldmann applanation tonometers in normal and postkeratoplasty eyes.

OBJECTIVE: To compare the reliability of intraocular pressure (IOP) measurements with the ProTon tonometer and the Goldmann applanation tonometer (GAT) in normal and post-penetrating keratoplasty (post-PK) eyes. DESIGN: Prospective, nonrandomized, comparative case series. PARTICIPANTS: Twenty-four individuals (48 eyes) with no known ocular disorder and 59 patients (59 eyes) that had undergone penetrating keratoplasty (PK) were included in the normal and post-PK groups, respectively. METHODS: Three readings at 5-minute intervals each were obtained with GAT and ProTon in both the groups. Each reading with ProTon was a mean of five accepted readings with the highest accuracy (standard error of mean, <0.5 mmHg). In post-PK eyes with more than 3.00 diopters of astigmatism or with irregular astigmatism, the mean of two readings taken with GAT in the steepest and flattest axis was considered to be the IOP. MAIN OUTCOME MEASURES: The IOP measurements in all groups were compared using a two-tail paired t test. The coefficient of repeatability and Cronbach's coefficient alpha were calculated separately for the IOP measured using both instruments in each group. RESULTS: There was no significant difference in the second (r1) and third (r2) IOP reading using the GAT and ProTon tonometers in normal and post-PK eyes. The coefficients of repeatability for GAT and ProTon were 2.64 and 2.49 in normal versus 3.72 and 3.47 in the post-PK group. The Cronbach's alpha for GAT and ProTon was 0.94 and 0.95 in the normal group versus 0.95 for both GAT and ProTon in the post-PK group. CONCLUSIONS: The results of our study show that the ProTon tonometer is reliable and comparable with GAT for recording IOP in normal and post-PK eyes.

Adolescent↗
PubMed2002

Ocular explosion after peribulbar anesthesia.

We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.

Adult↗
PubMed2002

Aspergillus niger endophthalmitis after cataract surgery.

We report a 65-year-old diabetic woman who developed Aspergillus niger endophthalmitis after cataract surgery. She presented 9 weeks after extracapsular cataract extraction with a black growth covering the cornea and moderate echoes in the vitreous on ultrasonography. After microbiological confirmation of fungal endophthalmitis, the patient received intravitreal amphoterecin B 5 micro g, topical natamycin 5% hourly, atropine 1% 3 times, and oral antifungal therapy. The patient was told the visual prognosis and was advised to have penetrating keratoplasty and vitrectomy, which she refused.

Aged↗
PubMed2002

Phacoemulsification in patients with Fuchs' heterochromic uveitis.

PURPOSE: To evaluate the results of phacoemulsification with capsular bag fixation of a poly(methyl methacrylate) (PMMA), acrylic, or silicone intraocular lens (IOL) in patients with complicated cataract resulting from Fuchs' heterochromic uveitis (FHU). SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study evaluated 20 eyes of 19 patients with FHU and cataract who had uneventful phacoemulsification with endocapsular implantation of an IOL and completed a 1-year follow-up. RESULTS: Preoperatively, loss of the iris collarette and fine keratic precipitates were seen in all 20 eyes, iris heterochromia in 16, iris atrophy in 12, and iris nodules in 2. Fourteen eyes had mild or negligible preoperative anterior chamber inflammation. No eye had increased intraocular pressure. An acrylic IOL was implanted in 10 eyes, a silicone IOL in 4, and a PMMA IOL in 6. There were no significant differences in outcomes among the 3 IOL groups. Three patients had intraoperative hyphema that resolved spontaneously. Postoperatively, 16 eyes had mild anterior chamber reaction. Four patients had significant anterior chamber inflammation necessitating the use of frequent topical steroids. No case had secondary glaucoma or posterior synechias. The best corrected visual acuity was 6/5 in 6 eyes, 6/6 in 11, and 6/9 in 3. CONCLUSIONS: Uneventful phacoemulsification with endocapsular IOL implantation visually rehabilitated patients with FHU. All 3 IOLs yielded similar results except for increased early postoperative inflammation and late dense anterior capsule opacification in the silicone group. Further studies comparing the outcome of different IOL materials are required to determine their effectiveness in patients with FHU.

Acrylates↗
PubMed2002

Outcomes of phacoemulsification in patients with dry eye.

PURPOSE: To evaluate the outcomes of phacoemulsification in patients with dry eye. SETTING: Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study included 25 eyes of 23 patients with dry eye having phacoemulsification. Dry eye was defined as Schirmer I with lidocaine hydrochloride (Xylocaine) score of 5.0 mm after 5 minutes, a tear-film breakup time (TFBUT) of less than 5 seconds, or both. Data were retrospectively analyzed for preoperative and postoperative tear function, postoperative complications, and final visual outcomes. RESULTS: Of the 23 patients, 18 had age-related dry eye and 5 had secondary Sjögren's syndrome. Twenty-two eyes had predominant aqueous deficiency (Schirmer I with Xylocaine score of 5.0 mm or less), and 3 had a Schirmer score between 6.0 mm and 9.0 mm. The TFBUT was 5 seconds or less in 17 eyes and between 6 seconds and 9 seconds in 8 eyes. The mean preoperative Schirmer score was 4.80 mm +/- 2.01 (SD) (range 2.0 to 9.0 mm) and the mean postoperative score, 3.80 +/- 2.40 mm (range 0 to 7.0 mm). The mean preoperative TFBUT was 4.00 +/- 1.87 seconds (range 0 to 9 seconds) and the mean score at the last follow-up, 3.40 +/- 1.60 seconds (range 0 to 8 seconds). Postoperatively, 8 eyes had superficial punctate keratopathy and 8 had an epithelial defect. The final visual acuity was 6/6 in 13 eyes, 6/9 to 6/12 in 8 eyes, and 6/18 to 6/60 in 4 eyes. CONCLUSION: Phacoemulsification was safe and led to minimal complications in patients with age-related dry eye with or without associated systemic disorders.

Adult↗