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Biomedical subjects

R B Vajpayee

Publications and source records attributed to R B Vajpayee.

At least 73 records · Page 4Linked to original sources
PubMed1998

Modified phacoemulsification in situ.

We describe a phacoemulsification technique for cataracts in eyes with anticipated weak zonular apparatus. After central sculpting, a crater 90% deep is made. A horizontal fracture is created with the phaco probe and chopper. The nucleus is chopped, dividing the inferior hemisection into 2 pie-shaped pieces, which are then emulsified. Without rotating the nucleus, a groove is made at the superior hemisection and a vertical fracture created with the chopper. The bevel of the phaco probe is then turned down to emulsify each quadrant separately. This technique is especially useful in eyes with weakened zonular apparatus such as those with hypermature cataract, uveitis, long-standing glaucoma, trauma, retinitis pigmentosa, and operated retinal detachments.

Cataract↗
PubMed1998

Conversion from phacoemulsification to extracapsular cataract extraction: incidence, risk factors, and visual outcome.

PURPOSE: To evaluate the incidence, risk factors, and visual outcome in cases converted from phacoemulsification to routine extracapsular cataract extraction (ECCE). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: A retrospective study was performed in 540 eyes that had clear corneal phacoemulsification performed by an experienced phacoemulsification surgeon. The cases in which phacoemulsification was initiated and then converted to ECCE were studied. The main parameters evaluated were the factors responsible for the conversion, corneal endothelial cell loss, and visual outcome. RESULTS: Twenty eyes (3.7%) required conversion to ECCE during phacoemulsification. Pupillary miosis (6 cases), posterior capsule rupture (5 cases), prolonged phaco time (4 cases), posterior extension of the capsulorhexis (2 cases), corneal thermal burn (1 case), subluxation of the lens (1 case), and malfunctioning of the ultrasonic handpiece (1 case) were the reasons for the conversion. The mean percentage of endothelial cell loss was 11.06% +/- 2.3 (SD); 18 cases (90.0%) achieved a visual acuity of 20/40 or better at 6 weeks. CONCLUSIONS: Intraoperative pupillary miosis, posterior capsule rupture, and very hard nuclear cataract causing prolonged phacoemulsification were the major risk factors for conversion to ECCE. Optimal preoperative preparation and prompt recognition of complications during phacoemulsification can lead to timely conversion to ECCE to achieve a good visual outcome.

Cell Count↗
PubMed1998

Topical pefloxacin in bacterial keratitis.

PROBLEM: To evaluate the clinical efficacy and safety of topical pefloxacin 0.3% drops as the sole antibiotic used to treat culture positive bacterial corneal ulcers. METHODS: Forty two consecutive Gram's smear-positive cases of bacterial corneal ulcers were enrolled for this prospective open labelled clinical trial. All patients underwent a complete clinical and microbiological work up and were put on topical 0.3% pefloxacin drops with supportive cycloplegic, vitamins and antiglaucoma therapy. Of 42 cases, 4 cases of mycotic keratitis and 6 culture negative cases were excluded from the study. RESULTS: Positive microbiologic cultures were obtained in 84.2% (32 of 38) cases. Staphylococcus aureus (14/32; 43.7%) and coagulase negative Staphylococci (12/32; 37.5%) were the two most common organisms isolated. Resolution of the corneal ulcer was achieved in 31 out of 32 cases (96.9%) with a mean duration of 9.3+/-5.3 days (range 3-21 days). Best corrected visual acuity of 20/200 or better was achieved in 65.6% of cases at 4 weeks post resolution. Corneal deposits were observed in one case which disappeared 8 days following discontinuation of therapy. CONCLUSIONS: Topical pefloxacin is effective as a single antibiotic agent for the treatment of bacterial keratitis.

Adolescent↗
PubMed1998

Corneal superinfection in acute hemorrhagic conjunctivitis.

PURPOSE: This study aimed to evaluate the clinical profile, microbial spectrum, management modalities, and visual outcome in cases of corneal superinfection that occurred after an epidemic of acute hemorrhagic conjunctivitis. METHOD: A retrospective analysis of 14 eyes of 13 patients who were referred to a tertiary eye-care center with corneal ulceration after an episode of acute hemorrhagic conjunctivitis was undertaken. The parameters analyzed were age, sex, prior use of topical medications, predisposing factors, ulcer characteristics, organisms isolated, success of medical therapy and surgery, and visual outcome. RESULTS: A definite history of topical corticosteroid use to treat acute hemorrhagic conjunctivitis was elicited in 12 (86%) eyes. Cultures were positive in 86% (12/14) eyes. Organisms isolated were Pseudomonas aeruginosa (three eyes, 25%), Fusarium species (three eyes, 25%), Aspergillus species (two eyes, 16%), and Staphylococcus aureus (two eyes, 16%). Mixed infection occurred in two patients. After discontinuation of topical corticosteroids, all patients received antimicrobial therapy. The keratitis resolved in seven eyes. Therapeutic penetrating keratoplasty was required in five eyes. Two patients were lost to follow-up. CONCLUSIONS: Corneal superinfection may occur after acute hemorrhagic conjunctivitis. Use of topical corticosteroids to treat acute hemorrhagic conjunctivitis may predispose an already compromised cornea to develop microbial keratitis and such a practice should be discouraged.

Adolescent↗
PubMed1998

Association between anterior and posterior keratoconus.

BACKGROUND/METHODS: We studied a 53-year-old male patient, presenting with a history of reduced vision since childhood in the right eye and since birth in the left eye. RESULTS: Ocular examination revealed the presence of anterior keratoconus in the right eye and posterior keratoconus in the left eye. CONCLUSION: To our knowledge, co-occurrence of both varieties of keratoconus in the same patient has not been previously reported.

Anterior Chamber↗
PubMed1996

Overcorrection after excimer laser treatment of myopia and myopic astigmatism. Melbourne Excimer Laser Group.

OBJECTIVE: To study the incidence and associations of overcorrection after excimer laser treatment of myopia and myopic astigmatism. METHODS: The study cohort consisted of 645 patients who had photorefractive or photoastigmatic refractive keratectomy done by an excimer laser during a 2-year period. Patients were assessed 1,3,6, and 12 months postoperatively. The variables evaluated were visual acuity, refraction, keratometry, and corneal clarity. RESULTS: At 1 month, overcorrection of more than +1 diopter spherical equivalent (SEQ) was seen in 22% of the eyes. This progressively regressed so that only 8.6% of the 140 eyes that were overcorrected at 1 month were overcorrected at 1 year. Overall, 2.2% of eyes were overcorrected at 1 year. The magnitude of attempted correction and use of topical nonsteroidal anti-inflammatory drugs disclosed a notable association with occurrence of overcorrection at 1, 3, and 6 months. The use of bandage contact lenses also was associated with overcorrection at 1 and 3 months. After controlling for myopia and use of contact lenses, the odds of overcorrection for use of topical nonsteroidal anti-inflammatory drugs at 1,3, and 6 months were 2.21 (95% confidence limits [CL]=1.49, 3.44), 1.69 (95% CL=0.88, 3.24), and 2.01 (95% CL=0.88, 4.56), respectively. The odds of overcorrection with bandage contact lenses were 1.79 (95% CL=1.05, 3.05) at 1 month and 2.42 (95% CL=1.23, 4.75) at the end of 3 months. No associations were seen between overcorrection and age, gender, surgical technique, or simultaneous astigmatic corrections. CONCLUSIONS: Overcorrection is common during the early postlaser treatment period and is associated with degree of myopia, use of nonsteroidal anti-inflammatory drugs, and bandage contact lens wear.

Adult↗
PubMed1996

Undercorrection after excimer laser refractive surgery. Excimer Laser Group.

PURPOSE: The incidence and correlations of undercorrection were studied for 1 year after excimer laser surgery for myopia or myuopic astigmatism. METHODS: A consecutive series of 645 eyes of 440 patients were studied. Eyes were examined preoperatively and at 1, 3, 6, and 12 months after surgery. The parameters evaluated were visual acuity, refraction, and corneal clarity. RESULTS: Following excimer laser surgery, undercorrection of > or = -1.00 diopters gradually increased from 10% at 1 month to 40% at 12 months. Increasing degree of preoperative myopia was significantly associated with increasing occurrence of undercorrection at 3 months (chi 2 = 17.3, P < .001), 6 months (chi 2 = 53.6, P < .001), and 12 months (chi 2 = 64.8, P < .001). Undercorrection was more common in eyes that had had photorefractive keratectomy than in those that had had photoastigmatic refractive keratectomy (odds ratio, 0.40; 95% confidence interval, 0.25 to 0.60). At 1 year, a loss of 2 or more lines of best-corrected visual acuity was recorded in 38% of undercorrected patients. Loss of 2 or more lines of best-corrected visual acuity was more common in patients undercorrected by -1.00 diopter or more (odds ratio, 8.8; 95% confidence interval, 5.4 to 14.6). No relationship was seen between corneal haze and loss of best-corrected visual acuity. Undercorrection was not associated with age, gender, use of nonsteroidal anti-inflammatory drugs, bandage contact lens wear, or corneal haze. Patients with lower degrees of myopia reached a stable refraction more quickly. At 6 months, 71% were within +/- 0.5 diopter of 1-year refraction. Of 17 patients with undercorrection who were treated with topical corticosteroids, only one patient showed a permanent beneficial change. CONCLUSION: Occurrence of undercorrection is more common in patients with severe myopia and when simultaneous astigmatic corrections are undertaken.

Adult↗
PubMed1996

Evaluation of topical 0.03% flurbiprofen drops in the treatment of herpetic stromal keratitis.

PURPOSE: The management protocol for herpetic stromal keratitis (HSK) is still controversial. We have attempted to compare the relative efficacy of topical dexamethasone 0.01% and flurbiprofen 0.03% in combination with topical acyclovir 3% in HSK. METHODS: In this institutional, prospective, randomized, controlled, double-blind study, 45 clinically diagnosed cases of HSK were randomly distributed into three coded treatment groups--topical placebo, dexamethasone 0.01%, and flurbiprofen 0.03% each in tapering frequency and in combination with acyclovir 3% ointment five times per day for four weeks. Therapeutic response was assessed every third day for four weeks. Decoding of the treatment groups was done at the conclusion of the study and data analysed. RESULTS: Four-week success rate was 93.3% (14 of 15) in the dexamethasone-acyclovir treatment group, 66.7% (10 of 15) in the flurbiprofen-acyclovir treatment group and 20% (3 of 15) in the placebo-acyclovir treatment group. CONCLUSION: While dexamethasone in combination with acyclovir gives the best results in HSK with minimal side-effects, the role of topical flurbiprofen seems promising.

Acyclovir↗
PubMed1996

Association of keratoconus with granular corneal dystrophy.

A 23-year-old woman presented with a history of reduced vision and foreign body sensation in both her eyes. Ocular examination revealed the simultaneous presence of bilateral keratoconus and granular corneal dystrophy. To our knowledge, bilateral concurrent occurrence of keratoconus and typical granular corneal dystrophy has not been reported previously. In such a case, penetrating keratoplasty performed for keratoconus may also carry the risk of recurrence of the granular dystrophy.

Adult↗
PubMed1995

Capsulotomy for phacoemulsification in hypermature cataracts.

We describe a modified surgical technique of anterior capsulotomy and phacoemulsification for use in hypermature cataracts. Surgical steps included inferior linear capsulotomy with aspiration of milky cortex, inflation of the capsular sac with viscoelastic, a reverse triangular anterior capsulotomy with Vannas scissors, and in-the-bag bimanual sculpting of the nucleus. An oval 5 mm x 6 mm posterior chamber intraocular lens was used with single horizontal or no-stitch wound closure. The technique was used successfully in 20 cases of hypermature cataract. The mean time required to perform phacoemulsification was 3.46 minutes (range 1.2 to 6.3 minutes), with a standard deviation of 1.29. Visual acuity on the first postoperative day ranged from 20/20 to 20/60 (median 20/40). At one week, the mean astigmatism was 1.01 diopters (range 0.25 to 2.75 diopters). The mean endothelial cell loss was 13% (range 3.6% to 26.0%). Based on our results, the modified phacoemulsification technique merits consideration for use in hypermature cataracts.

Adult↗
PubMed1994

Combined keratoplasty, cataract extraction, and intraocular lens implantation after corneolenticular laceration in children.

Over a period of two years we performed combined penetrating keratoplasty, cataract extraction, and intraocular lens implantation in seven children between the ages of 2 and 12 years old. The interval between trauma and the surgery varied from six weeks to six months (3.5 +/- 1.6 months, mean +/- SD). All of the patients had undergone primary repair of corneal perforation. Fresh corneas preserved in McCarey-Kaufman medium were used. The graft size was 7.5 mm with 0.5 mm disparity. Posterior chamber polymethylmethacrylate C-loop lenses were used in all cases. The surgeon's average postkeratoplasty keratometry was used in the calculation of intraocular lens power. The follow-up period ranged from nine to 36 months (18 +/- 9.1 months, mean +/- SD). Six grafts remained clear at the final follow-up. The visual acuity ranged from 20/40 to 20/200 with final astigmatism ranging from 0.5 diopter to 2.0 diopters. One patient developed a retinal detachment 12 months after surgery, which was successfully reattached. One patient, who had preoperative corneal vascularization, had graft rejection, which was treated medically. Our limited series suggests that the triple ocular procedure is a good choice for the treatment of corneolenticular trauma in children. The proper postoperative treatment includes vigorous antiamblyopia therapy and Nd:YAG laser treatment of after-cataracts.

Amblyopia↗
PubMed1994

Pre-existing posterior capsule breaks from perforating ocular injuries.

We analyzed the characteristic features and intraoperative behavior of pre-existing posterior capsule breaks in 12 cases of traumatic cataract caused by perforating ocular trauma. The interval between the occurrence of trauma and cataract surgery ranged from three days to one year. Two distinct types of posterior capsule breaks were found: one had thick, fibrous, opaque margins with associated posterior capsule opacification (type I); the other had thin, transparent margins (type II). Type I breaks did not enlarge intraoperatively, whereas type II breaks behaved as fresh breaks by enlarging during irrigation/aspiration and had to be managed by viscoelastic plugging, dry aspiration, and adequate vitrectomy. Primary posterior capsulectomy was required in all cases with type I breaks because of posterior capsule opacification. The difference in the two types of breaks appeared to be time-dependent: cases with delayed surgical intervention (one month to one year) showed type I breaks with clinical evidence of attempted healing of the defect; cases with early surgical intervention (three days to one week) exhibited type II breaks, which did not differ from fresh intraoperative breaks.

Adult↗
PubMed1994

Protection of the iris by lamellar dissection of corneal layers. A technique in penetrating keratoplasty.

Adherent leukomatous corneal opacities constitute the bulk of cases undergoing keratoplasty in developing countries. Surgical trauma to the iris resulting in a large iris coloboma, iridodialysis, and bleeding are the imminent intraoperative complications in such cases. We have evolved a technique of lamellar separation of corneal layers and gentle separation of adherent iris after partial trephination in such cases. We have successfully used this technique in six cases of adherent leukoma. No intra-or postoperative complication related to lamellar separation was encountered, and all the grafts remained clear at the end of 3 months.

Adolescent↗
PubMed1993

Nd:YAG "sweeping"--an indirect technique for clearing intraocular lens deposits.

Corticosteroid-resistant deposits on the anterior surface of intraocular lenses (IOLs) in 11 patients who had complained of poor vision were "swept" with a Neodymium:YAG laser beam. As contrasted with previous "direct hit" methods, our method is indirect, using a low-power, defocused beam to generate an acoustic shock-wave, which then sweeps the lens surface clear of deposits. The deposits were cleared in all 11 patients, with no damage to the IOL or any other postlaser complications. Improvement in visual acuity ranged from 1 to 3 lines, and all the patients reported alleviation of symptoms.

Adolescent↗
PubMed1993

Laboratory diagnosis of keratomycosis: comparative evaluation of direct microscopy and culture results.

In a prospective study, we evaluated the sensitivities of direct microscopy using potassium hydroxide 10% wet-mount preparations and culture for definitive diagnosis of keratomycosis in 171 clinically suspected fungal corneal ulcers. Although cultures were positive in 88 eyes (51.46%), the fungus could be demonstrated by KOH preparation in 94.3% (83 of 88) of the culture-proved cases and 93.6% (160 of 171) of the overall eyes. Direct microscopic examination of a KOH wet-mount preparation is a rapid, reliable, and superior technique of laboratory diagnosis. It is particularly important for the early initiation of antifungal treatment in mycotic keratitis.

Adolescent↗
PubMed1992

Direct scleral fixation of posterior chamber intraocular lenses using a special needle-holder.

We report a modified technique of direct scleral fixation of a posterior chamber intraocular lens (PC-IOL) using a specially designed intraocular needle-holder. The procedure was carried out in three eyes with posttraumatic subluxated cataracts; one with aphakic bullous keratopathy and with an accidental posterior capsular rent, and one with a superior zonulodialysis. The needle-holder greatly facilitated the procedure, enabling us to place the PC-IOL precisely in the ciliary sulcus with no subsequent decentration. This method avoids iris fixation and provides more secure scleral fixation of the PC-IOL.

Adult↗