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Biomedical subjects

Jeewan S Titiyal

Publications and source records attributed to Jeewan S Titiyal.

At least 19 recordsLinked to original sources
PubMed2006

Contact lens rehabilitation following repaired corneal perforations.

BACKGROUND: Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. METHOD: Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. RESULTS: Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of > or = 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 +/- 0.13 while the same with contact lens was 0.58 +/- 0.26. All the patients showed an improvement of > or = 2 lines over spectacles in the snellen's acuity chart with contact lens. CONCLUSION: Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries.

Adolescent↗
PubMed2006

Automated lamellar therapeutic keratoplasty (ALTK) in the treatment of anterior to mid-stromal corneal pathologies.

PURPOSE: To evaluate the efficacy of automated lamellar therapeutic keratoplasty (ALTK) in the treatment of anterior to mid-stromal corneal pathologies. METHODS: A prospective clinical study was undertaken in 15 eyes of 15 patients who underwent ALTK using the ALTK System (Moria/Microtek Inc., Doylestown, Pennsylvania, USA). The parameters evaluated were uncorrected and best corrected visual acuity (BCVA), keratometry, pachymetry, contrast sensitivity, glare acuity, intraoperative surgical time and complications, postoperative time to epithelialization, graft clarity and postoperative complications. RESULTS: The mean surgical time was 46 +/- 9 mins. The BCVA, contrast sensitivity and glare acuity significantly improved at 6 months postoperatively. The mean decimal BCVA was 0.08 +/- 0.03 preoperatively, which improved to 0.33 +/- 0.30 at 6 months, when 11 eyes had BCVA > or = 6/18. The median epithelialization time was 3 days (range 1-10 days). CONCLUSIONS: Automated lamellar therapeutic keratoplasty appears to be safe and effective for diseases affecting the anterior to mid-stroma of the cornea.

Adult↗
PubMed2006

Retreatment of LASIK.

PURPOSE: To review the indications, techniques, and results of retreatment LASIK. METHODS: Review of the literature and the authors' experience. RESULTS: Patient selection is the key to successful LASIK enhancement. The enhancement procedure should generally be undertaken 3 months after the initial LASIK procedure. Relifting of the flap may be done easily within 1 year of previous LASIK surgery. A new LASIK flap is required in cases with previously complicated LASIK. LASIK retreatment by lifting the flap is an effective and safe procedure. Overall improvement is seen in uncorrected visual acuity (> or = 20/20 and > or = 20/40) and postoperative spherical equivalent refraction within +/- 0.5 D and +/- 1.0 D. CONCLUSIONS: LASIK retreatment is an effective modality to treat regressions and residual refractive errors.

Humans↗
PubMed2006

Need for optical and low vision services for children in schools for the blind in North India.

CONTEXT: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). AIM: To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. SETTING AND DESIGN: Cross-sectional study conducted in 13 blind schools in Delhi, North India. MATERIALS AND METHODS: Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. RESULTS: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. CONCLUSION: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.

Adolescent↗
PubMed2005

Indications and outcome of repeat penetrating keratoplasty in India.

BACKGROUND: Repeat penetrating keratoplasty is quite often required as there is high chance of failure of the primary graft particularly in the developing world. We planned a study to analyze the indications and outcome of repeat penetrating keratoplasty in a tertiary care centre in India. METHODS: A retrospective analysis of all the patients who underwent repeat penetrating keratoplasty, between January 1999 and December 2001 was performed. The parameters evaluated were indication for the primary penetrating keratoplasty, causes of failure of the previous graft, and final visual outcome and clarity of the repeat corneal grafts. RESULTS: Of fifty-three eyes of 50 patients with repeat penetrating keratoplasty (three patients underwent bilateral corneal regrafts), 37 eyes had undergone one regraft each, 14 eyes two regrafts and two eyes had three regrafts. The follow-up of the patients ranged from one to three years. The most common primary etiologic diagnosis was vascularized corneal scars (66%), of which the scars related to infection were most common (68.5%). Twenty-eight regrafts (52.8%) remained clear at a mean follow-up of 1.54 +/- 0.68 years, of which 25 were single regrafts (89.3%). The commonest cause of failure of regraft was infection to the corneal graft (recurrence of herpetic infection in 9 eyes and perforated graft ulcers in 3 eyes). Three (18.6%) of the 16 eyes with multiple corneal regrafts achieved a BCVA of 6/60. Overall, only five eyes (all with single regraft) achieved a BCVA of 6/18 or better at the end of follow-up. CONCLUSION: Graft infection is the leading cause of failure of repeat keratoplasty in this part of the world. Prognosis for visual recovery and graft survival is worse in eyes undergoing multiple regrafts.

Corneal Diseases↗
PubMed2005

Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns.

PURPOSE: To evaluate the role of amniotic membrane transplantation (AMT) in acute ocular burns. DESIGN: Prospective, randomized, controlled clinical trial. PARTICIPANTS AND CONTROLS: Patients with grade II to IV ocular burns within 3 weeks of injury were recruited. Thirty-seven patients, 7 of whom had bilateral involvement (total, 44 eyes), participated in the trial. Twenty eyes were included in group A (AMT) and 24 eyes were included in group B (controls). INTERVENTION: The eyes in the AMT group underwent AMT in addition to conventional medical therapy. In the control group, only conventional medical therapy was instituted. MAIN OUTCOME MEASURES: The patients' subjective assessments of relief of ocular discomfort, healing of the corneal epithelial defect, visual acuity, extent of corneal vascularization, formation of symblepharon, and tear function tests. RESULTS: At day 1, subjective ocular discomfort scores were reduced significantly in eyes with moderate burns in the AMT group compared with controls (P = 0.05), but there was no difference between the 2 groups in eyes with severe burns. The log mean percentage reduction in size of epithelial defect by day 7 was 7.43+/-0.89 after AMT and 6.23+/-1.10 with medical treatment alone in moderate grade burns at day 7 (P = 0.01), but there was no difference between the 2 groups in eyes with severe burns. There was no overall difference in the final visual acuity, symblepharon formation, corneal vascularization, and tear function tests between the 2 groups over the next 3 months and further follow-up. There was a high dropout rate for long-term follow-up. CONCLUSIONS: Amniotic membrane transplantation in eyes with acute ocular burns has advantages in terms of reduction of pain and promotion of early epithelialization in patients with moderate grade burns, but not so in severe burns. There seems to be no definite advantage to AMT over medical therapy alone in terms of improvement in visual acuity, appearance of symblepharon, corneal vascularization, and results of tear function tests on short-term follow-up.

Acute Disease↗
PubMed2005

Comparative evaluation of efficacy and safety of ophthalmic viscosurgical devices in phacoemulsification [ISRCTN34957881].

BACKGROUND: Various ophthalmic viscosurgical devices (OVD) are used to perform phacoemulsification and other intraocular surgeries. We performed a study to compare the efficacy and safety of three ophthalmic viscosurgical devices that are routinely used in phacoemulsification. METHODS: Fifty-six patients of immature senile cataract with hard nucleus (grade 3 and 4) who underwent phacoemulsification were included. Depending upon the type of OVD, patients were randomly allocated into three groups; group 1 (n = 19), Viscoat was used; group 2 (n = 19), Healon GV was used; group 3 (n = 18), Healon 5 was used. Parameters evaluated were uncorrected and best corrected visual acuity, specular microscopy, intraocular pressure and pachymetry both preoperatively and postoperatively on day 1, 1 week, 1 month and 3 months and development of any complication both intraoperative and postoperative were also noted. RESULTS: The mean increase in central corneal thickness was 15.17% (group 1); 17.26% (group 2) and 16.21% (group 3) on first postoperative day and was comparable in the three groups. The density of endothelial cells decreased postoperatively (day 1) by 12.54% (group 1), 13.76% (group 2) and 13.06% (group 3) and was comparable. The mean preoperative intraocular pressure in groups 1, 2 and 3 were 13.3 +/- 2.0, 14.0 +/- 2.2 and 13.2 +/- 3.2 mmHg respectively, which changed to 16.0 +/- 4.7, 12.2 +/- 4.7 and 12.3 +/- 4.8 respectively on first postoperative day and the change in intraocular pressure was significantly higher in group 1 (1 vs 2 & 1 vs 3; p = 0.02; oneway ANOVA). CONCLUSION: Viscoat, Healon GV and Healon 5 give comparable results in terms of efficacy and safety in performing phacoemulsification.

Acrylic Resins↗
PubMed2005

Postage stamp multiple anterior capsulorhexisotomies in pediatric cataract surgery.

BACKGROUND: Capsule related complications are common following pediatric cataract surgery. We report a new technique of multiple anterior capsulorhexisotomies after lens aspiration and intraocular lens (IOL) implantation. METHODS: After performing automated lens aspiration, an IOL was implanted into the capsular bag. A bent 26 gauge needle was introduced through one side port and multiple small cuts were made in one half of the circumference of the anterior capsular rim by making a radial movement of the needle tip centripetally over the margin of the anterior capsular rim. The needle was again introduced through the other side port and multiple similar cuts were made in the other half thereby creating nearly 20 - 30 cuts at the margin of the anterior capsular rim. RESULTS: The mean size of the primary capsulorhexis was 4.33 +/- 0.20 mm. A uniform enlargement of the capsulorhexis could be performed in all the eyes without peripheral extension in any of the eyes. There was no damage to the posterior capsule and no scratch mark on the IOL. In one eye, the primary capsulorhexis was slightly eccentric, though it was covering the IOL optic all around. The rhexisotomies in this eye were limited to the capsular rim that was overlapping more on the IOL optic (sectoral anterior capsulorhexisotomies). CONCLUSION: The technique of postage stamp anterior capsulorhexisotomies is a feasible technique in pediatric cataracts.

Capsulorhexis↗
PubMed2005

Post-LASIK infectious crystalline keratopathy caused by Alternaria.

PURPOSE: To describe a case of infectious crystalline keratopathy (ICK) after laser in situ keratomileusis (LASIK) caused by Alternaria species. METHODS: A case report of a 29-year-old woman who presented with clinical features of ICK 3 weeks after LASIK surgery. RESULTS: Medical therapy failed to control and resolve the corneal infection. Penetrating keratoplasty was performed, which controlled the infection and aided in visual recovery of 20/30. The culture of the corneal button revealed the presence of Alternaria species fungus. CONCLUSIONS: Alternaria species fungus may cause ICK after LASIK.

Adult↗
PubMed2005

Central penetrating keratoplasty with peripheral intrastromal tuck.

PURPOSE: To report a new technique of central penetrating keratoplasty with peripheral intrastromal tuck in cases of chronic corneal decompensation. METHODS: Central penetrating keratoplasty with peripheral intrastromal tuck was undertaken in 8 eyes with chronic corneal decompensation. An 8-mm donor tissue with a peripheral flange of 2 mm was fashioned and sutured into a 7.5-mm recipient bed having a 2-mm intralamellar pocket. Sixteen full-thickness interrupted sutures were passed. Suture removal was possible as early as 1 month, and all sutures were removed by 4 months. RESULTS: Postoperative BCVA improved to 20/40 to 20/80 in all eyes, and astigmatism was <4 diopters in all cases at the last follow-up, which ranged from 5 to 16 months. CONCLUSIONS: Central penetrating keratoplasty with peripheral intrastromal tuck is a useful technique because it allows early suture removal and visual rehabilitation.

Adult↗
PubMed2005

Posterior corneal ectasia following LASIK.

PURPOSE: To evaluate the cases of posterior corneal ectasia following laser in situ keratomileusis. MATERIAL AND METHODS: Thirteen eyes of 7 patients, that were diagnosed to have posterior corneal ectasia (ł0.060 mm) on Orbscan topographic system following LASIK, were identified. The parameters evaluated were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, contrast sensitivity, glare, corneal topography, keratometry and pachymetry. The preoperative and postoperative data at day 1, 1 week, 1 month, 3 months, 6 months and 1 year were retrospectively analyzed. RESULTS: The mean UCVA of the patients before LASIK surgery was 0.032 +/- 0.04. It was 0.320 +/- 0.159 in follow-up of LASIK surgery after 1 year. The mean Pre-LASIK BCVA was 0.59 +/- 0.11. There was no change in mean BCVA at 1 year. The mean preoperative spherical equivalent was -14.25 +/- 2.91 D except in 2 hyperopic eyes in which the mean spherical equivalent preoperatively was +5.75 +/- 0.35 D. The mean postoperative spherical equivalent after 1 year of LASIK surgery in last follow-up (+/- enhancement) was - 3.45 +/- 2.08 in the myopic eyes and + 1.0 +/- 0.70 in the two hyperopic eyes. The mean preoperative posterior corneal elevation was 0.022 +/- 0.011 mm, which at the end of 1 week following LASIK was 0.067 +/- 0.009 and at 1 year/ last follow-up following LASIK, it was 0.068 +/- 0.006 mm. CONCLUSIONS: Higher amplitudes of refractive correction may lead to the occurrence of posterior corneal ectasia.

Adolescent↗
PubMed2003

Contact lens fitting for post-radial-keratotomy residual myopia.

PURPOSE: To formulate guidelines for contact lens fitting following radial keratotomy and to achieve a relationship between contact lens fitting parameters and refractive and keratometric parameters. METHODS: Thirty-five eyes of 30 patients who had post-radial-keratotomy residual myopia were evaluated for contact lens fitting. The base curve was selected by 'hit and trial' method until a proper fit was achieved, following which an over-refraction was done and final power of the contact lens obtained. RESULTS: The mean contact lens base curve was 43.04 +/- 1.62 D, which was steeper than the postoperative keratometry by 2.35 +/- 0.74 D. The base curve and the postoperative keratometry were correlated by regression analysis (r = 0.895, P < 0.001). The mean overall diameter of the contact lenses was 9.64 +/- 0.08 mm. The mean contact lens power was 5.81 +/- 3.07 D, which was more myopic than the residual myopia by 2.79 +/- 1.67 D. Regression analysis showed definite correlation between the contact lens power and postoperative myopia (r = 0.854, P < 0.001). CONCLUSION: For correction of post-radial-keratotomy residual myopia, contact lens fitting parameters can be determined by a regression formula using keratometric and refractive values.

Adult↗
PubMed2003

Study of corneal topographic patterns with single continuous suturing techniques in penetrating keratoplasty.

PURPOSE: To study the corneal topographic patterns following three different types of single continuous suturing techniques in penetrating keratoplasty. METHODS: One hundred forty-eight maps obtained from 40 patients who underwent penetrating keratoplasty with single continuous suturing were retrospectively analyzed at a tertiary eye care center. The videokeratograph maps were obtained on the Eye Sys System 2000 at 1, 3, and 6 months after surgery. Suture adjustment was done for cases with astigmatism greater than 3 diopters, and maps were also obtained after suture adjustment. The maps were classified according to the corneal profile and the astigmatic pattern seen in the topographic maps. RESULTS: Combined prolate patterns were seen most frequently, and their proportion was significantly higher at 1 month ( p= 0.009), 3 months ( p= 0.0004), and 6 months ( p= 0.0008). The simulated keratometric astigmatism was significantly higher in the prolate group compared with the other groups at 1 month ( p= 0.0021). However, all the topographic patterns showed comparable magnitude of astigmatism after suture adjustment and at 3 and 6 months. The antitorque suturing technique showed a higher proportion of prolate maps compared with the other suturing techniques. CONCLUSIONS: Prolate patterns of the cornea are the most frequently seen patterns after single continuous suturing, which is the normal physiological pattern of the cornea. The initial astigmatism is higher in the prolate pattern, which can be successfully reduced with suture adjustment.

Astigmatism↗