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Biomedical subjects

Namrata Sharma

Publications and source records attributed to Namrata Sharma.

At least 73 records · Page 4Linked to original sources
PubMed2002

Dislocation of the lens: a complication after cyclocryotherapy.

An unusual complication is reported of a case of complete dislocation of the lens after cyclocryotherapy in a patient with neovascular glaucoma. To the best of the authors' knowledge, no case of lens dislocation following cyclocryotherapy has previously been reported.

Cataract↗
PubMed2002

Postkeratoplasty endophthalmitis by Alcaligenes faecalis: a case report.

PURPOSE: To describe a postkeratoplasty endophthalmitis owing to Alcaligenes faecalis that resolved with medical management. METHODS: Case report and review of literature. RESULTS: To best of our knowledge, postkeratoplasty endophthalmitis caused by A. faecalis has not been reported in literature. The source of infection was found to be the donor tissue. The organism isolated was resistant to gentamicin, which was the only antibiotic present in the storage medium (McCarey and Kaufman medium). The patient was treated aggressively with topical, systemic and intravitreal antibiotics. The endophthalmitis resolved completely within two weeks. CONCLUSION: A. faecalis is a gram negative, non-spore forming rod that can cause endophthalmitis if donor tissue is contaminated with the organism. Clinical suspicion, review of bacterial culture and sensitivity report from donor tissue, anterior chamber and vitreous taps, along with early therapy with appropriate antibiotics can lead to resolution of infection.

Aged↗
PubMed2002

Intralamellar autopatch with lamellar keratoplasty for paracentral corneal perforations.

PURPOSE: To report a new technique of tectonic intralamellar autopatch with lamellar keratoplasty (LK) for paracentral corneal perforations. METHODS: A partial thickness lamellar dissection of the host was undertaken to remove the superficial epithelium and the anterior stroma. A second lamellar dissection began at the periphery to approximately 1 mm away from the perforation to fashion a hinge. The hinged autolamellar flap was reflected over the perforation and sutured to the host with interrupted sutures. Finally, the autolamellar patch graft was supported by a lamellar graft, which was secured in place with 16 interrupted sutures. This technique was undertaken in 4 eyes with paracentral perforation after trauma (2 eyes), after pterygium (1 eye), and inadvertent perforation during host bed dissection of large LK (1 eye). RESULTS: All eyes achieved a stable ocular surface and a postoperative visual acuity of more than 6/60. CONCLUSIONS: Intralamellar autopatch with lamellar keratoplasty provides adequate tectonic support in cases of paracentral corneal perforation and thereby maintaining the integrity of the globe. It also provides ambulatory visual acuity.

Adult↗
PubMed2002

Central lamellar keratoplasty with peripheral intralamellar tuck: a new surgical technique for keratoglobus.

PURPOSE: To report a new technique of lamellar keratoplasty in a case of keratoglobus. METHODS: A patient with bilateral keratoglobus with maximal thinning in the juxtalimbal periphery underwent a lamellar procedure in the right eye. The visual acuity was 3/60. Refraction was not possible due to severe irregular astigmatism, and the central pachymetry was 430 microm. A central 8.5 mm diameter lamellar dissection along with a peripheral intrastromal pocket up to the limbus was fashioned. The donor corneal button (12 mm) denuded of its endothelium was beveled at the periphery to create a flange. This flange was tucked into the peripheral pocket and the graft was sutured with interrupted nylon sutures. RESULTS: No intra-or postoperative complication was encountered. Reepithelialization was complete within 1 week. At 1 month postoperatively, the preoperative keratometric astigmatism of >12 D decreased to <2.75 D. The spectacle-corrected visual acuity at 1 month was 6/18. CONCLUSIONS: This new technique of central lamellar keratoplasty with intralamellar tucking of the peripheral flange for keratoglobus not only provides optical clarity and tectonic support but also helps in preservation of the host limbal stem cells.

Adult↗
PubMed2002

Presumed epithelial inclusion cyst of the iris seven years after radial keratotomy.

PURPOSE: To report a case of presumed epithelial inclusion cyst of the iris 7 years after radial keratotomy (RK) that was treated with double-frequency Nd:YAG laser (532 nm). METHODS: A young adult woman underwent bilateral RK for the correction of myopia of -4.50 Diopters 7 years prior to the development of a white mass in the anterior chamber of her left eye. There was no evidence of any other surgery or trauma to the eye during this period. An epithelial inclusion cyst of the iris was diagnosed, and double-frequency Nd:YAG laser (532 nm) was used to coagulate the cyst under topical anesthesia. RESULTS: The size of the cyst reduced significantly immediately following laser treatment, and the prelaser visual acuity of 6/12 was maintained at 6 months' follow-up without any recurrence. CONCLUSIONS: In the absence of evidence of any other surgery or trauma, the most likely cause of the epithelial inclusion cyst of the iris following RK is epithelial seeding from the original surgery, which is amenable to coagulation with double-frequency Nd:YAG laser.

Adult↗
PubMed2002

Tectonic grafts for corneal thinning and perforations.

PURPOSE: To evaluate the success of tectonic grafts in cases of corneal thinning and perforations. METHODS: We performed 42 tectonic grafts in 41 eyes of 40 patients. Three types of tectonic grafts were used in our treatment protocol. These were (a) full-thickness grafts, (b) mushroom grafts, and (c) lamellar grafts. The parameters evaluated were indications, visual acuity, location, size and type of graft, postoperative outcome, and complications, if any. RESULTS: The most common indication for tectonic grafts was corneal thinning and perforation subsequent to infection (12 eyes) followed by those due to immunologic causes (six eyes) and trauma (six eyes). Twenty-four full-thickness tectonic grafts, nine mushroom grafts, and nine lamellar patch grafts were performed. Anatomical success was achieved in 35 of 41 (85.4%) eyes. Visual acuity of 6/24 or better was obtained in 29 of 41 (70.73%) eyes. The mean of best-corrected visual acuity (expressed in decimal) improved from 0.2 +/- 0.26 to 0.34 +/- 0.26 at an average follow-up of 10.83 +/- 6.27 months. The major complications were peripheral anterior synechiae in four eyes (9.76%) and graft melting in five eyes (12.2%). CONCLUSIONS: Tectonic graft is a useful therapeutic option in selected cases of corneal thinning and perforations because it effectively restores the integrity of the eye and allows acceptable visual rehabilitation.

Adolescent↗
PubMed2002

Therapeutic keratoplasty for infectious keratitis: a review of the literature.

PURPOSE: This article provides a review of the literature on various aspects of therapeutic keratoplasty, including indications, techniques, complications and outcome, and its application in cases of infectious keratitis. METHODS: Various articles on therapeutic keratoplasty (including English- and non-English-language publications) were analyzed. Selection of the articles was based on a Medline search for articles using the key words therapeutic keratoplasty, penetrating keratoplasty, therapeutic keratoplasty for infectious keratitis, non-healing corneal ulcer, microbial keratitis, and perforated corneal ulcer. Abstracts in English were used for non-English articles. RESULTS: Therapeutic keratoplasty has a definitive role in the management of progressive bacterial, fungal, Acanthamoeba, and viral keratitis refractory to medical treatment. Management of bacterial keratitis has higher functional success and anatomic cure rate compared with fungal, viral and Acanthamoeba keratitis. Therapeutic keratoplasty offers a cure rate of up to 100% in bacterial and fungal keratitis, whereas the recurrence of infection after Acanthamoeba keratitis is frequent. Visual outcome depends on various factors such as the causative agent, timing of surgery, degree of inflammation, type of donor material used, and size of the graft used. For example, larger grafts have a higher incidence of graft rejection and failure compared to smaller grafts. The primary aim of the procedure is to reestablish the integrity of the globe and to eliminate the infectious disease process. Visual rehabilitation is a secondary outcome. CONCLUSIONS: This review helps to elucidate the various aspects of therapeutic keratoplasty, including indications, preoperative assessment, surgical techniques, postoperative management, complications, and anatomic and functional outcome.

Corneal Ulcer↗
PubMedDate not supplied

Infectious keratitis following keratoplasty.

Infectious keratitis following corneal transplantation is one of the leading causes of failure of a corneal graft. The incidence of graft infection is variable, with developing countries having a higher incidence. The majority of the graft infections occur within 1 year of the corneal transplantation. Suture-related problems and persistent epithelial defect are the most common risk factors predisposing to graft infection. Pneumococcus species and Staphylococcus aureus have been found to be the commonest microorganisms in the developed world, whereas Staphylococcus epidermidis is the most often detected microorganism in corneal graft infection in the developing world. The early identification of predisposing risk factors in patients and their appropriate management at the earliest may prevent the occurrence of graft infection and might improve graft survival. Visual prognosis in eyes with post-keratoplasty graft infection is poor even after optimal therapy and there is a high rate of graft decompensation.

Eye Infections, Bacterial↗
PubMedDate not supplied

Laser in-situ keratomileusis after penetrating keratoplasty.

Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.

Cornea↗
PubMedDate not supplied

Surgically induced astigmatism after laser in situ keratomileusis for spherical myopia.

PURPOSE: To study risk factors for surgically induced astigmatism (SIA) after laser in situ keratomileusis (LASIK). METHODS: In a retrospective case control study of 104 eyes (52 patients) that underwent LASIK for myopia (spherical ablation alone), two groups were studied: 42/104 eyes with SIA, and controls (62/104 eyes). The main variables studied were preoperative refraction, corneal thickness, preoperative keratometric power, amount of ablation, ablation zone diameter, flap thickness, flap size, and the presence of complications. The effect of SIA on visual performance was also evaluated. RESULTS: The mean myopia for which LASIK was undertaken was -4.50 +/- 2.04 D. Mean scalar astigmatism induced was 0.35 +/- 0.50 D at 1 month, 0.33 +/- 0.40 D at 3 months, and 0.16 +/- 0.60 D at 6 months. SIA based on refractive cylinder was 0.66 +/- 0.29 D at 1 month, 0.54 +/- 0.32 D at 3 months, and 0.49 +/- 0.34 D at 6 months. Mean axis of vector induced astigmatism was 82.5 degrees +/- 57 degrees at 1 month, 98.86 degrees +/- 52.4 degrees at 3 months, and 113.9 degrees +/- 62.6 degrees at 6 months. Risk factors associated with the occurrence of SIA were preoperative keratometric power of >44 D [OR (95% CI); 1.97 (0.62 to 6.26)], ablation zone diameter of <6 mm [OR (95 % CI) 2.76; (0.6 to 12.6)], and suction ring diameter of 8.5 mm [OR (95% CI) 12.46; (2.0 to 77.38)]. The occurrence of SIA had no significant effect on uncorrected Snellen high contrast visual acuity, contrast sensitivity, and glare in comparison with controls. CONCLUSION: Surgically induced astigmatism was more likely to occur with the use of smaller suction rings of 8.5 mm and in ablation zones less than 6 mm. Parameters for visual performance were not affected by the presence of surgically induced astigmatism.

Adult↗
PubMedDate not supplied

Intraoperative arcuate transverse keratotomy with phacoemulsification.

PURPOSE: To evaluate the efficacy of paired intraoperative arcuate transverse keratotomy at a 7-mm-diameter zone along with a 3.5-mm clear corneal phaco tunnel in the steeper axis to correct pre-existing astigmatism. METHODS: A prospective randomized case-control study was conducted on 34 eyes of 28 patients with immature senile cataract. They were divided into two groups; in one group (17 eyes) intraoperative arcuate keratotomy was coupled with phacoemulsification in the steeper meridian (arcuate keratotomy group; mean preoperative astigmatism 2.28 +/- 0.89 D) and the other group (17 eyes) phacoemulsification was performed in the steeper meridian without arcuate keratotomy (control group; mean preoperative astigmatism 2.04 +/- 0.50 D). The patients were examined at 1 day, and 1, 4, and 8 weeks postoperatively. Correction of keratometric astigmatism, surgically induced refractive changes, magnitude and axis of cylinder, spherical equivalent refraction, with and against the wound change, and coupling ratio were evaluated. RESULTS: Mean reduction in keratometric astigmatism in the keratotomy group was 1.26 +/- 0.54 D (P = .0067) and in the control group was 0.48 +/- 0.60 D (P = .0423). The difference in reduction of keratometric astigmatism between the two groups was statistically significant (P = .0296). Surgically induced refractive change at 8 weeks follow-up was 2.15 +/- 1.13 D in the keratotomy group and 1.50 +/- 1.32 D in the control group (P = .046). Coupling ratio was -1.10 +/- 0.43 in the keratotomy group at 8 weeks after surgery while the control group was -0.82 +/- 0.38. CONCLUSION: A combination of intraoperative arcuate keratotomy with steep axis phacoemulsification incision is more effective than steep axis phacoemulsification incision alone in reducing pre-existing astigmatism.

Aged↗
PubMedDate not supplied

Outcomes after laser in situ keratomileusis retreatment in high myopes.

PURPOSE: To evaluate the refractive and visual performance after laser in situ keratomileusis (LASIK) retreatment. METHODS: A retrospective study was performed on 33 eyes of 23 patients who underwent LASIK (Bausch & Lomb Technolas 217C) retreatment for residual myopia with or without astigmatism. Parameters evaluated were uncorrected and best spectacle-corrected visual acuity, spherical equivalent refraction, contrast sensitivity, glare acuity, and pachymetry, preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: The mean spherical equivalent refraction before primary LASIK was -9.89 +/- 4.00 D and before retreatment was -2.85 +/- 2.17 D. Although contrast sensitivity and glare acuity decreased significantly after primary LASIK (P<.05), no significant change in these parameters was observed after retreatment. Smaller ablation zones were associated with decreased contrast sensitivity and glare acuity after primary LASIK as well as following retreatment. Contrast sensitivity and glare acuity following primary LASIK were significantly better in eyes with ablation zones > or = 5 mm than those with < 5 mm (P<.05). Eyes in which the ablation zone was the same as that for primary LASIK had significantly better contrast sensitivity than those with different ablation zones (increased or decreased) during retreatment. Attempted refractive correction during primary LASIK and retreatment had a significant negative correlation with contrast sensitivity and glare acuity following primary LASIK as well as retreatment. CONCLUSION: The ablation zones following primary LASIK and retreatment should be > or = 5.00 mm and remain unchanged to improve visual performance.

Adolescent↗