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Biomedical subjects

J S Saini

Publications and source records attributed to J S Saini.

At least 19 recordsLinked to original sources
PubMed2000

Limbal stem cell deficiency: concept, aetiology, clinical presentation, diagnosis and management.

Defects in renewal and repair of ocular surface as a result of limbal stem cell deficiency are now known to cause varying ocular surface morbidity including persistent photophobia, repeated and persistent surface breakdown and overt conjunctivalisation of the cornea. Ocular conditions with abnormalities of ocular surface repair include pterygium, limbal tumours, aniridia, severe scarring following burns, cicatricial pemphigoid and Stevens-Johnson Syndrome, sequelae of mustard gas exposure and Herpes simplex epithelial disease, radiation keratopathy, contact lens induced keratopathy, neuroparalytic keratitis and drug toxicity. Restoring ocular health in these eyes has traditionally been frustrating. An understanding of these intricate cell renewal and maintenance processes has spurred the evolution in recent years of new treatment methods for several blinding diseases of the anterior segment; many more exciting modalities are in the offing. However, there is inadequate awareness among ophthalmologists about the current principles of management of ocular surface disorders. The purpose of this article is to help elucidate the important principles and current treatment methods relevant to ocular surface disorders.

Cell Transplantation↗
PubMed2000

Intracystic tetracycline therapy for hypofunctioning cystic thyroid nodules.

OBJECTIVES: Hypofunctioning benign cystic thyroid nodules are a common occurrence in iodine deficient region. There are reports of resolution of recurrent thyroid cysts with tetracycline instillation. Hence we conducted a study in 20 patients with hypofunctioning benign cystic thyroid nodules to document response to intracystic instillation of tetracycline as a primary modality of treatment. METHODS: Twenty patients were thoroughly investigated for the presence of malignancy clinically, radiologically and cytologically. One milliliter of tetracycline was instilled under ultrasonographic guidance. Response to therapy was assessed clinically and ultrasonographically at one, three, six and 12 months. RESULTS: Study group comprised of five male and 15 female patients with mean age 30 +/- 8 years. Initial mean volume of nodules was 15 +/- 7 ml (6 to 27 ml), which was decreased to 3 +/- 3 ml at one month, 2 +/- 3 ml at three months, and 1 +/- 2 ml at six months. Maximum number of patients (75%) responded within three months, however two patients required reaspiration and reinstallation of tetracycline. Ultrasonography revealed fibrotic scar as thick wall with internal echodensities in six patients (30%) six month after sclerotherapy. There was high rate of patient satisfaction, as cosmetically tetracycline did not leave any scar, which was unavoidable with surgery. Six patients (30%) reported mild pain after injection, and one patient developed redness at the site of injection. CONCLUSIONS: Intracystic tetracycline sclerotherapy is highly effective as primary mode of treatment in hypofunctioning benign cystic thyroid nodule in selected group of patients not at high risk of malignancy.

Adult↗
PubMed2000

Tonometry in normal and scarred corneas, and in postkeratoplasty eyes: a comparative study of the Goldmann, the ProTon and the Schiotz tonometers.

PURPOSE: Clinical comparison of intraocular pressure (IOP) measured with the Goldmann applanation tonometer (GAT), the ProTon tonometer (PT), and the Schiotz tonometer (ST), in normal eyes, eyes with scarred corneas and postkeratoplasty eyes. MATERIAL AND METHODS: The IOP readings with GAT, PT, and ST were compared in 125 eyes with normal corneas (Group A), 17 eyes with scarred corneas (Group B), and in 21 postkeratoplasty eyes (Group C). The data were statistically analysed at 95% confidence interval; linear regression analysis and paired t-test were done. RESULTS: The mean differences and their standard deviation [SD] between GAT and PT readings, and GAT and ST readings respectively were: [1] in Group A: -0.23 [SD 2.75] mmHg and +0.24 [SD 3.18] mmHg respectively; [2] in Group B: -1.8 [SD 12.67] mmHg and -4.5 [SD 9.95 mmHg; and [3] in Group C: +0.24 [SD 8.72] mmHg and -0.12 [SD 8.7] mmHg. They were not statistically significant. In Group A the 95% confidence interval between GAT and PT readings was -5.27 mmHg to 5.73 mmHg, and between GAT and ST readings, -6.12 mmHg to 6.59 mmHg. Ninety six [77%] eyes with the PT and 84 [69%] eyes with ST measurements were within 3 mmHg of GAT pressure. The correlation coefficients [r] for PT and ST were 0.93 [P = 0.0000] and 0.88 [P = 0.0000] respectively. In Group B 95% confidence interval between GAT and PT readings was -27.17 mmHg to 23.51 mmHg, and between GAT and ST measurement, -24.37 mmHg to 15.44 mmHg. The correlation coefficients [r] for the PT and ST were 0.112 [P = 0.660] and 0.630 [P = 0.006] respectively. In group C, the 95% confidence interval between GAT and PT measurements was -17.20 mmHg to 17.67 mmHg, and between GAT and ST measurements, -17.51 mmHg to 17.27 mmHg. The correlation coefficients [r] for the PT and the ST were 0.780 [P = 0.0000] and 0.740 [P = 0.0001] respectively. CONCLUSIONS: In clinical practice PT appears to have a higher level of accuracy than ST in normal corneas. In scarred corneas and post-penetrating keratoplasty eyes, because of high SD for mean differences and wide confidence interval of 95%, both PT and ST are inaccurate in measuring IOP as compared to GAT in such eyes.

Adolescent↗
PubMed1999

Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis.

PURPOSE: To compare the efficacy of supratarsal injection of short acting dexamethasone sodium phosphate versus intermediate acting triamcinolone acetonide as a new therapeutic modality for treating eyes with recalcitrant vernal keratoconjunctivitis (VKC). METHODS: The study was a prospective, randomized, double blind, case controlled trial, including 38 eyes of 19 patients with recalcitrant VKC. Except for two initial patients who received supratarsal injection of triamcinolone acetonide in both the eyes, one eye of each patient was randomly assigned to receive either 2 mg of dexamethasone sodium phosphate or 20 mg of triamcinolone acetonide. RESULTS: Both the drugs were equally effective with no statistically significant difference in the mean time of resolution of cobblestone papillae, limbal edema, shield ulcer, SPK and relief of symptoms. The recurrence rate of disease was, however, lower following triamcinolone acetonide injection. CONCLUSIONS: Supratarsal injection of corticosteroid is a cheap, effective and safe modality of treatment for managing eyes with recalcitrant VKC. Both short acting dexamethasone and intermediate acting triamcinolone acetonide are equally effective.

Adolescent↗
PubMed1998

Evaluation of endothelial function in postkeratoplasty eyes.

BACKGROUND AND OBJECTIVE: To evaluate corneal endothelium function in postkeratoplasty eyes. PATIENTS AND METHODS: Endothelial function was assessed in 23 clear corneal grafts. After a measurable corneal edema was induced by soft contact lens wear, serial pachometric readings were taken for 3 hours to arrive at the percentage recovery per hour (PRPH) index. RESULTS: The assessed PRPH values of the clear corneal grafts ranged from 24.6% to 73.0%, with a mean value of 51.8% +/- 12.2%. Of the six corneal grafts that demonstrated an initial PRPH value of less than 47.5%, four became edematous within 6 months of follow-up. CONCLUSIONS: Assessed PRPH, as an in vivo-measured index of endothelial function, is a valuable method for monitoring endothelial function in postkeratoplasty eyes. The low PRPH index identifies eyes at risk of spontaneous nonimmunologic failures.

Corneal Edema↗
PubMed1997

Cornea stress test--evaluation of corneal endothelial function in vivo by contact lens induced stress.

Reliable and valid assessment of corneal endothelial function is a critical input for diagnosing, prognosticating and monitoring progression of disorders affecting corneal endothelium. In 123 eyes, corneal endothelial function was assessed employing data from the corneal hydration recovery dynamics. Serial pachometric readings were recorded on Haag-Striet pachometer with Mishima-Hedbys modification before and after two hours of thick soft contact lens wear. Percentage Recovery Per Hour (PRPH) was derived from raw data as an index of endothelial function. Assessed PRPH in pseudophakic corneal oedema and Fuchs' endothelial dystrophy eyes (35.9 +/- 9.8%) was significantly lower than normal controls (61.9 +/- 10.5%). On employing receiver operation characteristics curve analysis the tested results demonstrated high sensitivity (87%) and specificity (92%) for detection of low endothelial function at PRPH cut off of 47.5%. Using this PRPH cut off, 80% of Fuchs' endothelial dystrophy and 93.3% of pseudophakic corneal oedema eyes could be demonstrated to have low endothelial function. A total of 66.7% of diabetic eyes also demonstrated PRPH of lower than 47.5%. Clear corneal grafts demonstrated PRPH values of 24.6% to 73.0%. Of 6 corneal grafts that demonstrated initial PRPH of lower than 47.5%, 4 failed within 4 to 6 months. Our data demonstrated high sensitivity and specificity of this corneal stress test. PRPH index was useful in quantifying endothelial function in clinical disorders including diabetes mellitus. The index PRPH was demonstrated to be useful in monitoring and prognosticating outcome of corneal grafts.

Contact Lenses, Hydrophilic↗
PubMed1996

In vivo assessment of corneal endothelial function in diabetes mellitus.

OBJECTIVE: To evaluate in vivo corneal endothelial function in patients with non-insulin-dependent diabetes mellitus with or without diabetic retinopathy. METHODS: In age-matched samples of 45 eyes of diabetic patients and 15 eyes of healthy control subjects, corneal endothelial function was evaluated by using pachometric measurements of the cornea following hydrophilic contact lens wear of low oxygen transmissibility. Corneal deswelling regression was quantitated to arrive at the percentage recovery per hour as an index of endothelial function. The status of retinopathy was determined in diabetic patients by using standard criteria. RESULTS: In patients with diabetes mellitus and diabetic retinopathy, the assessed mean (+/- SD) value for the percentage recovery per hour following contact lens-induced edema was 40.03% +/- 7.27%, which was significantly lower than in eyes without changes of diabetic retinopathy (54.31% +/- 6.88%). Also, diabetic patients without retinopathy had a significantly lower percentage recovery per hour than did healthy control subjects (65.27% +/- 12.02%). CONCLUSIONS: This study demonstrates significantly lower corneal endothelial function in patients with non-insulin-dependent diabetes mellitus and thus suggests a higher potential to decompensate following any deleterious stress.

Blood Glucose↗
PubMed1996

In vivo quantification of corneal endothelium function.

Reliable and valid quantification of functional status of the corneal endothelium is a desirable input to optimize monitoring and intervention strategies in clinical disorders affecting endothelium. We examined the validity and clinical usefulness of an in vivo corneal stress test in an age and sex matched sample of 15 eyes each of normal controls, pseudophakic corneal edema and Fuchs' dystrophy. The test measures Percentage Recovery Per Hour (PRPH) as endothelial function by evaluating the deswelling response of cornea. In pseudophakic corneal edema assessed PRPH is significantly lower than in normal cornea (p < 0.01). At optimum critical cut off PRPH of 47.5%, the test has high specificity and sensitivity (93.3%) in pseudophakic corneal edema eyes, which validates the test. When baseline corneal thickness is more than 0.55 mm, PRPH is determined to be below the cut-off value in 100% of eyes. In eyes where baseline corneal thickness is less than 0.55 mm, PRPH ranges from 26.7% to 76.8%. We conclude that the in vivo corneal stress test quantifies endothelial function reliably and when compared to age specific normal eyes, it helps in identifying and monitoring low endothelial function.

Corneal Edema↗
PubMed1996

Donor corneal tissue evaluation.

Proper evaluation of donor cornea is critical to the success of corneal transplantation. Attention must be paid to the cause of death and ocular condition as several general and ocular diseases constitute contraindications for donor corneal usage. Death to enucleation time should be noted. Gross examination and slit lamp biomicroscopy are mandatory for the evaluation of the donor eye while specular microscopy adds another useful dimension to information regarding donor cornea. This article provides a comprehensive review of all the aspects of donor corneal evaluation as practised today worldwide.

Contraindications↗
PubMed1996

In vivo evaluation of corneal endothelial function following cataract surgery.

BACKGROUND AND OBJECTIVE: To quantify corneal endothelial function measured in vivo following extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC IOL) implantation. PATIENTS AND METHODS: Endothelial function was assessed in 18 patients using recovery of the corneal hydration rate following induced cornea swelling before and after ECCE and PC IOL implantation. RESULTS: The mean percentage recovery per hour (PRPH) showed a significant decrease at 12 and 24 weeks after surgery compared with before surgery (P < .01). A decrease in PRPH of more than 5% was observed in 55.6% and 66.7% of the eyes at 12 and 24 weeks after surgery, respectively. CONCLUSIONS: PRPH measured in vivo demonstrates decreased endothelial function following ECCE and PC IOL implantation. The PRPH measures even slight changes in endothelial function and could be useful in evaluating endothelial damage.

Adult↗
PubMed1996

Graded corneal sensitivity for screening of diabetic retinopathy.

Several alternative approaches to screen diabetics followed by referral of patients with retinopathy changes, are being investigated. The intent is to demonstrate usefulness of a cost effective, easy and valid screening test. We investigated in this report the efficacy of graded corneal sensitivity for screening presence of diabetic retinopathy. In 105 randomly chosen subjects with (70 subjects) and without (35 subjects) diabetes mellitus, corneal aesthesiometry and status of retinopathy was determined independently. Corneal sensitivity in subjects of diabetes mellitus without retinopathy (1.17 +/- 0.29 gm/mm2) was significantly different when compared to healthy controls (0.99 +/- 0.04 gm/mm2) (p < 0.01). Also corneal sensitivity in eyes with any type of retinopathy was significantly worse (1.94 +/- 1.33 gm/mm2) when compared to eyes without retinopathy. At a cut off value of 1.20 gm/mm2 the sensitivity and specificity of corneal hypoesthesia as a test to detect diabetic retinopathy was 86% and 74%, respectively. For detecting presence of proliferative diabetic retinopathy at a cut off value of 1.49 gm/mm2 the sensitivity and specificity were 89% and 80% respectively. These observations indicate that corneal hypoesthesia may be a reasonable indication of the presence of diabetic retinopathy and could be used to screen diabetic populations for retinopathy, after its validity is confirmed in larger studies.

Cornea↗