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Biomedical subjects

Deepak P Edward

Publications and source records attributed to Deepak P Edward.

At least 19 recordsLinked to original sources
PubMed2006

Clinical course of bimatoprost-induced periocular skin changes in Caucasians.

PURPOSE: To describe the demographic and clinical characteristics of bimatoprost-induced periocular skin hyperpigmentation in Caucasians. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Thirty-seven Caucasian patients (29 female, 8 male) with a diagnosis of primary open-angle glaucoma (n = 28) or ocular hypertension (n = 9) in whom cosmetically noticeable periocular skin pigmentation developed with bimatoprost therapy. METHODS: An unbiased examiner performed a retrospective chart analysis of patients in whom periocular skin hyperpigmentation developed after starting bimatoprost therapy. Data collected included patient demographics, diagnosis, medication history, dates of starting and stopping bimatoprost treatment, and subjective assessment of the periocular hyperpigmentation at initial detection and follow-up visits. MAIN OUTCOME MEASURES: Periocular hyperpigmentation was graded using an arbitrary scale from 0 to 3. The number of days to the onset of hyperpigmentation and to pigment resolution was determined and their associations to demographic and other clinical parameters were analyzed. RESULTS: Patients had variable grades of periocular hyperpigmentation at presentation (mean, 1.27+/-0.50; range, 1-2.5). Bimatoprost-induced periocular hyperpigmentation appeared most frequently between 3 and 6 months after initiation of bimatoprost therapy (277+/-138 days). Resolution of skin hyperpigmentation was noted most frequently between 3 and 12 months (205+/-97 days); however, there was a wide range of 61 to 472 days. Thirty-three of the 37 patients had complete resolution of the periocular hyperpigmentation. CONCLUSIONS: Bimatoprost use is associated with periocular skin hyperpigmentation in Caucasians with variable time of onset. The periocular hyperpigmentation appears gradually, but in this series was completely reversible on discontinuation of bimatoprost.

Aged↗
PubMed2006

Deep lamellar endothelial keratoplasty: histopathology of complications in initial cases.

PURPOSE: To report complications encountered after 2 initial cases of deep lamellar endothelial keratoplasty. METHODS: Review of clinical findings of 2 initial cases in which intraoperative and postoperative complications were encountered. Corneal buttons from the 2 cases were evaluated by light microscopy and transmission electron microscopy. RESULTS: Complications encountered were related to the graft-recipient interface and the lamellar dissection of the recipient and donor corneas. CONCLUSION: Deep lamellar endothelial keratoplasty is an evolving procedure that shows much promise. These 2 cases show that the procedure entails a separate skill set from penetrating keratoplasty and requires significant surgeon practice before being introduced into the individual's transplant practice.

Aged↗
PubMed2006

Filamentous fungal invasion of a methafilcon contact lens.

PURPOSE: To report a case of Fusarium species invasion of a methafilcon matrix soft contact lens in a first-time lens wearer. RESULTS: The authors describe the history and ocular examination of a 19-year-old woman with large fungal deposits on her contact lens. Culture of the contact lens grew Fusarium species. On histologic examination, fungal filaments were seen on both surfaces of the contact lens as well as invading the lens matrix. The fungal morphology changed as the fungus penetrated the contact lens. CONCLUSION: To our knowledge, this is the first documented case of fungal invasion of a methafilcon matrix lens and the second histologically documented case of Fusarium invasion of a contact lens.

Adult↗
PubMed2006

Long-term follow up of surgical repair of late bleb leaks after glaucoma filtering surgery.

PURPOSE: To study the long-term outcomes of surgical revision of leaking blebs after trabeculectomy and identify possible risk factors for failure. PATIENT AND METHODS: A retrospective, nonrandomized, noncomparative interventional study of 34 eyes with late bleb leaks after trabeculectomy that underwent bleb excision with conjunctival advancement. The primary outcome measure was successful repair and control of intraocular pressure (IOP). The other measures evaluated included change in visual acuity from baseline and complications such as recurrence of bleb leak, endophthalmitis or the need for additional antiglaucoma medication to control IOP. RESULTS: After a mean follow up of 36.2+/-23 months, the mean IOP at the last visit was 14.5+/-7.6 mm Hg. IOP in 58.8% of eyes was controlled without medication. Complications included early leaks (7/34), late recurrent or persistent leaks (1/34), and endophthalmitis (1/34). In all, 41.2% patients required additional medication at the last visit. Survival analysis at 22 months the probability of total and qualified success was 52% and 72%, respectively. However, this dropped to 10% and 15%, respectively, at 5 years. The probability of total and qualified success further dropped to 2.5% and 5% at 5 years when the IOP cut-off was lowered from 21 to 15 mm Hg. Cox regression analysis failed to identify risk factors for bleb failure. CONCLUSIONS: Surgical bleb revision seems to be effective in treating late bleb leaks with few postoperative complications. However, patients should be followed carefully as late failure of bleb function beyond 2 years is a significant possibility.

Adolescent↗
PubMed2006

Nerve fiber layer thickness in glaucoma patients with asymmetric hemifield visual field loss.

PURPOSE: To investigate the presence of retinal nerve fiber layer (RNFL) thinning and determine the relationship between RNFL thickness and visual field sensitivity loss in glaucoma patients with asymmetric hemifield visual field loss. PATIENTS AND METHODS: Thirty glaucoma patients with asymmetric hemifield visual field loss and 30 normal control subjects were included in the study. RNFL thickness was measured by optical coherence tomography and visual field sensitivity was measured by automated perimetry. Glaucoma patients with advanced visual field loss restricted to 1 hemifield and early or absent glaucomatous field loss in the other hemifield on the basis of the visual field data were included. Visual field sensitivity and mean deviation (MD) were averaged separately in each of the 2 hemifields. The hemifields in each eye were categorized as early (MD>or=-6 dB) and advanced (MD<-6 dB) glaucomatous hemifields. RESULTS: RNFL thickness measurements in corresponding (eg, superior peripapillary quadrant with inferior hemifield) advanced glaucomatous hemifields (59+/-16 microm) were significantly (P<0.001) lower than in corresponding early glaucomatous hemifields (90+/-25 microm). The mean RNFL thickness in corresponding advanced and early glaucomatous hemifields were significantly lower than in normal control subjects (P<0.0001). On the basis of the normative database supplied by optical coherence tomography software, 100% and 43% of eyes had abnormal RNFL thickness in corresponding advanced and early glaucomatous hemifields, respectively. A linear correlation was found between RNFL thickness and MD in the early (r=0.6; P<0.001) and advanced (r=0.5; P=0.007) glaucomatous hemifields. CONCLUSIONS: RNFL thinning was present in corresponding hemifields of glaucomatous eyes with minimal visual field defect and correlated with visual field sensitivity loss. Measurement of RNFL thickness has potential for detection of early nerve fiber loss owing to glaucoma.

Aged↗
PubMed2006

Of mice and men: tyrosinase modification of congenital glaucoma in mice but not in humans.

PURPOSE: Primary congenital glaucoma (PCG) is an autosomal recessive ocular trait caused by mutations in the gene for cytochrome P4501B1 (CYP1B1). Although PCG is often considered to be fully penetrant, the disease shows 50% penetrance in some Saudi Arabian families. The familial segregation of the nonpenetrance suggests a genetic modifier. Recently, tyrosinase (Tyr) deficiency was found to worsen the drainage structure/ocular dysgenesis phenotype of Cyp1b1-/- mice, suggesting that Tyr is a modifier of the phenotype. In the current study, tyrosinase (TYR) was investigated in human PCG. METHODS: A genome-wide screen, a single nucleotide polymorphism (SNP) analysis in the TYR chromosomal region 11q13-q21, and sequencing of the TYR gene was performed with individuals from Saudi Arabian families with multiple, clinically confirmed, molecularly proven, nonpenetrant members. RESULTS: The study outcome did not support TYR as a modifier of the PCG phenotype in this population. The sequencing data showed no TYR mutations in the nonpenetrant family members and no difference in polymorphism frequencies between nonpenetrant or fully penetrant families. CONCLUSIONS: TYR is not a modifier of the CYP1B1-associated PCG phenotype in the Saudi Arabian population.

Adolescent↗
PubMed2006

Methotrexate reduces the complications of endophthalmitis resulting from intravitreal injection compared with dexamethasone in a rabbit model.

PURPOSE: The incidence of infectious endophthalmitis associated with intravitreal injection (IVI) of steroid has been reported to be as high as 0.87%. This study was designed to investigate whether the antimicrobial activity of intravitreal methotrexate (MTX) alters the incidence or course of bacterial endophthalmitis associated with IVI in a rabbit model. METHODS: A rabbit model of endophthalmitis induced by Staphylococcus epidermidis (S) was established. Six groups of rabbits had IVI of sterile balanced salt solution (BSS), MTX (400 microg), dexamethasone (Dex, 200 microg), S, S and MTX (S-MTX), or S and dexamethasone (S-Dex). On days 0, 1, 3, 6, 10, and 14, total intraocular inflammation was measured in each animal. Vitritis was graded by the degree of vitreal haze. An intravitreal tap was performed on two animals from groups S, S-Dex, and S-MTX. A histopathologic study was performed on day 14. RESULTS: No endophthalmitis was observed in the control groups BSS, MTX, and Dex. Group S-Dex had the highest and group S-MTX had the least total ocular inflammation and vitritis scores from days 3 to 14. The difference in total inflammation and vitritis among groups S, S-Dex, and S-MTX is significant (P = 0.046 and P = 0.001, respectively). Live bacteria were isolated only from groups S and S-Dex. Pathology revealed severe ocular destruction in groups S and S-Dex and intact structures in group S-MTX. CONCLUSIONS: MTX appears to reduce the risk of development of bacterial endophthalmitis and ocular destruction associated with IVI compared with Dex. IVI of MTX may be a safer alternative than steroid injection in treating noninfectious uveitis.

Animals↗
PubMed2005

Side-effect profile of brimonidine tartrate in children.

PURPOSE: To investigate brimonidine-related side effects and the efficacy of brimonidine in lowering intraocular pressure (IOP) in children with primary infantile and secondary glaucoma. STUDY DESIGN: Single-center, prospective, interventional, noncomparative case series. PARTICIPANTS: Eighty-three children (mean age, 7.84 years) met the inclusion criteria. METHODS: Medical records were reviewed to identify children with primary infantile or other forms of secondary pediatric glaucoma from birth to 15 years who received brimonidine as adjunctive therapy for glaucoma. The parents of the children who met the inclusion criteria completed a detailed questionnaire-based interview. The children were examined to assess weight, major systemic effects, and efficacy of adjunctive brimonidine therapy. MAIN OUTCOME MEASURES: Questionnaire-based interview of parents to assess side effects of brimonidine and IOP-lowering effect of adjunctive brimonidine. RESULTS: Parents reported symptoms in 70 of 83 children (84%). The most common side effects were excessive sleepiness and lethargy (76%), eye itching and rubbing (49%), and stinging and burning of the eyes (39%). Logistic regression analysis showed a statistically significant independent association between age and weight with lethargy and sleepiness. In symptomatic patients, symptoms' frequency increased with low weight (<20 kg) and in the young (<6 years). Mean IOP reduction after initiation of brimonidine, mainly as an adjunct, was 5+/-6.7 mmHg (P<0.001). CONCLUSIONS: Side effects after the use of brimonidine in children were frequent. The weight and age of the child were important factors in predicting central nervous system side effects, especially excessive sleepiness and lethargy. Although brimonidine is effective in lowering IOP in children, alternative glaucoma therapy should be considered especially in children weighing <20 kg and those younger than 6 years.

Adolescent↗
PubMed2005

Immunolocalization of CYP1B1 in normal, human, fetal and adult eyes.

CYP1B1 is a cytochrome P450 enzyme implicated in autosomal recessive primary congenital glaucoma (PCG). The mechanism and function of CYP1B1 in the development of the PCG phenotype is unknown. Previously, investigators have reported detection of Cyp1b1 mRNA in the ciliary body and epithelium and neuroepithelium in the developing mouse eye, employing in situ hybridization techniques. Similarly, additional investigators have detected CYP1B1 mRNA in the iris, ciliary body, non-pigmented ciliary epithelial line, cornea, retinal-pigment epithelium, and retina in the human adult eye, using Northern blotting. This study was designed to immunolocalize CYP1B1 protein in the various ocular structures of normal, human fetal and adult eyes. Normal fetal and adult eyes were immunolabeled with a polyclonal antibody against human CYP1B1 using indirect immunofluorescence, and then compared with appropriate controls. The intensity of immunolabeling of the various ocular structures was assessed by qualitative and semi-quantitative techniques. In the anterior segment anti-CYP1B1 immunoreactivity (IR) was detected early in fetal development in the primitive ciliary epithelium. As well, the most intense CYP1B1 IR was in the non-pigmented ciliary epithelium. In addition, CYP1B1 IR was also present in the corneal epithelium and keratocytes, both layers of the iris pigmented epithelium, and retina. However, CYP1B1 IR was absent in the trabecular meshwork in all of the samples. In general, CYP1B1 immunolabeling in the human fetal eyes was more intense when compared to adult eyes. CYP1B1 IR was primarily immunolocalized to the non-pigmented ciliary epithelium and early in fetal development. In addition, CYP1B1 IR was not detected in the trabecular meshwork. These findings suggest that the abnormalities in the development of the trabecular meshwork in PCG may result from diminished or absent metabolism of important endogenous substrates in the ciliary epithelium due to non-functional CYP1B1 enzyme.

Adult↗
PubMed2005

Bimatoprost-induced periocular skin hyperpigmentation: histopathological study.

OBJECTIVE: To investigate light microscopic and ultrastructural changes in bimatoprost-induced skin hyperpigmentation. METHODS: Eyelid biopsy specimens from bimatoprost-treated patients and matched controls were examined by light microscopy and transmission electron microscopy. Using an image analyzer, melanin granules were counted on Fontana-Masson-stained sections, and melanosomes were counted on electron micrographs. Immunohistochemical analysis was performed with antibodies against S100 and CD3. Positively labeled cells were counted. RESULTS: By light microscopy, a marked increase in the number of melanin granules was noted in the bimatoprost-treated specimens. Electron microscopy demonstrated dermal melanocytes with prominent rough endoplasmic reticulum and abundant normal-sized melanosomes in different stages of maturation as compared with control specimens. Furthermore, the keratinocytes of the bimatoprost-treated specimens showed abundant mature melanosomes when compared with controls. Also of note, atypical melanocytes were absent in both specimens. The S100-positive melanocytes were comparable in bimatoprost-treated and control specimens. Few CD3- and CD68-positive cells in the bimatoprost-treated specimens were noted in both groups. CONCLUSION: Bimatoprost-induced periocular hyperpigmentation is caused by increased melanogenesis. There was no evidence of melanocyte proliferation or prostaglandin-induced inflammation in the specimens that were examined.

Aged↗
PubMed2005

Pyogenic granulomas after silicone punctal plugs: a clinical and histopathologic study.

PURPOSE: To describe clinical findings, histopathologic changes, and risk factors for pyogenic granuloma formation complicating silicone punctal plug therapy. DESIGN: Retrospective observational case series. METHODS: Between November 2000 and April 2004, 903 silicone punctal plugs of the same brand were inserted in 404 subjects. Cases associated with pyogenic granuloma formation were identified and reviewed. Granulation tissue was obtained from 10 patients for histopathologic examination. Multiple risk regression analyses identified factors related to pyogenic granuloma development and factors associated with histologic patterns. RESULTS: Pyogenic granuloma development led to the extrusion of 4.2% of all plugs placed in a median time period of 141 days. All patients presented with varying degrees of plug extrusion. Similar distributions of partial and complete plug extrusions, as well as bilateral and unilateral plug extrusions, were seen. Findings at presentation ranged from a subclinical pyogenic granuloma causing partial plug extrusion to a pyogenic granuloma in the punctum with a ring of fibrovascular tissue retaining a completely extruded plug. Histopathologic examination revealed two patterns, representing either acute pyogenic granuloma or involuting pyogenic granuloma. Pyogenic granulomas resolved after 3.1 +/- 1.3 weeks in all patients after plug removal. Multiple regression analysis revealed that large plug size was associated with increased pyogenic granuloma formation (P < .0001). Partial or complete plug extrusion was associated with active or involuting pyogenic granuloma, respectively (P = .023). CONCLUSION: Pyogenic granuloma-related spontaneous plug extrusions may be more common than previously thought and can present with a range of clinical findings. The degree of plug extrusion correlates with the histopathologic pattern. Larger plug size and sharp edges in plug geometry may be responsible for pyogenic granuloma formation.

Adult↗
PubMed2005

Femtosecond laser photodisruption of human trabecular meshwork: an in vitro study.

The goal of this in vitro study was to test the feasibility of using femtosecond (fsec) laser pulses to fistulize the human trabecular meshwork (TM), and to determine the minimum exposure time and energy dosage needed to create an ablation channel. Corneo-scleral rims were obtained from tissue used for penetrating keratoplasty. Four millimeter tissue strips hydrated in Optisol-GS were used to create partial thickness fistulas in the human TM by focusing a Ti:Sapphire laser beam (45 fsec, 1 kHz, 800 nm) with various pulse energies (7.2 and 14.4 microJ) and exposure times (0.25, 0.5, 1, and 2 sec) on the inner surface of the TM. Two-photon images of the lesions were obtained with a multiphoton microscope, using an ultrafast Ti:Sapphire light source. In addition, sections of fixed tissue were examined by light microscopy. Diameters and lengths of the lesions were determined from the hematoxylin and eosin (H&E) stained sections, and the collagen structure surrounding the lesion was evaluated from the two-photon images. All selected time points (except for 0.25 sec) and energies achieved the desired photodisruption of the TM. Incisions created with 0.5 sec/14.4 microJ irradiation appeared to be the most suitable because they were able to achieve consistent full thickness trabecular ablation. Incisions created at 1 sec /14.4 microJ/pulse and 2 sec/14.4 microJ/pulse were deeper than those at shorter time points with the same pulse energy. Longer exposure times and higher pulse energies were usually more variable and associated with deeper and larger incisions and slight collateral damage. Our results indicate that, with appropriate exposure time and pulse energy, fsec photodisruption can be employed to create lesions in the human TM without damaging the surrounding tissues. This study demonstrates that fsec laser treatments may have future potential for the surgical treatment of glaucoma.

Feasibility Studies↗
PubMed2005

Orbital schwannoma and neurofibroma: role of imaging.

Schwannomas are well-circumscribed ovoid masses that most commonly present in the superior orbit. Although it may be difficult to differentiate these benign masses from other orbital tumors on radiologic imaging, the CT and, in particular, the MR imaging characteristics can sometimes point to the diagnosis of a nerve sheath tumor. A definitive diagnosis can be made through correlation with histopathologic findings, however. In most cases, schwannomas have low malignant potential, and with total excision, recurrence is rare.

Diagnosis, Differential↗
PubMed2005

Medulloepithelioma of the ciliary body and optic nerve: clinicopathologic, CT, and MR imaging features.

The definitive diagnosis of medulloepitheliomas of the ciliary body and optic nerve is made by histopathologic examination. Familiarity with rare tumors aids clinicians in accurately diagnosing this rare neoplasm. CT and MR imaging findings can be helpful, especially if the mass is confined in an area of the ciliary body without involvement of the retina. The characteristic findings of cystic changes and possible calcification are suggestive of medulloepithelioma rather than melanoma. The more common and ominous retinoblastoma shares some radiologic features with medulloepithelioma, however, and is thus often a consideration. Clinical diagnosis of medulloepitheliomas of the optic nerve and central nervous system (CNS) is more challenging. The diagnosis is often made by histopathologic examination. Lastly, coexisting CNS tumors and anomalies have been reported in association with intraocular medulloepitheliomas and should be recognized.

Ciliary Body↗
PubMed2005

Driving performance of glaucoma patients correlates with peripheral visual field loss.

PURPOSE: To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age- and sex-equivalent individuals without eye disease. PATIENTS: Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. METHODS: Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. MAIN OUTCOME MEASURES: Driving simulator performance and real-world, self-reported accident involvement. RESULTS: The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (rho = -0.47, P = 0.01), total horizontal extent (rho = -0.49, P = 0.007), and total peripheral extent (rho = -0.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). CONCLUSIONS: Visual field reduced to less than 100 degrees of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.

Adult↗
PubMed2004

Foreign body granulomas secondary to retained sponge fragment following mitomycin C trabeculectomy.

BACKGROUND: Bleb related inflammation following trabeculectomy is usually seen in the late post operative period and is unusual in the first 6 months after surgery We report the clinical findings and course of two patients with early bleb related inflammation secondary to retained cellulose sponge fragments used to apply mitomycin C on the scleral surface. METHODS: Retrospective review of medical records of two patients and pathology from one patient. RESULTS: Both patients developed bleb related inflammation four months after a combined fornix based trabeculectomy and cataract procedure in which mitomycin C was applied using filter paper discs (Whatman filter paper #1). Material suggestive of cellulose fragments was noted in the filtering bleb in both patients. Patient 1 had a bleb leak at time of presentation and pathologic examination of foreign body material obtained from the site of the leak demonstrated a granulomatous reaction surrounding cellulose fibers. The foreign body material was removed in both patients. This led to resolution of the bleb leak in the first patient and at one year following the procedure both patients had functioning blebs in the affected eye. CONCLUSIONS: Retention of sponge fragments is rare but may be a cause of bleb inflammation as a result of a foreign body granulomatous reaction. The choice of sponge material that does not shred may help in avoiding this unusual complication.

Aged↗