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Biomedical subjects

Rajesh Sinha

Publications and source records attributed to Rajesh Sinha.

At least 37 records · Page 2Linked to original sources
PubMed2004

Visual outcome of cataract surgery with pupillary sphincterotomy in eyes with coexisting corneal opacity.

BACKGROUND: To evaluate the visual outcome following cataract surgery with pupillary sphincterotomy in eyes with coexisting corneal opacity. METHODS: Patients with leucomatous corneal opacity with significant cataract were enrolled for the study. The uncorrected visual acuity and best-corrected visual acuity (BCVA) were recorded and the anterior segment was thoroughly evaluated by a slit lamp biomicroscope before the surgery. Only those patients who had some amount of clear peripheral cornea were selected. Posterior segment pathology was ruled out by indirect ophthalmoscopy after pupillary dilatation, if possible, or by B-scan ultrasonography. Conventional extracapsular cataract extraction with pupillary sphincterotomy was performed and an intraocular lens was implanted. Postoperatively, the eyes were evaluated on day 1, and 1 week and 6 weeks following surgery for similar parameters. RESULTS: Fourteen eyes of 14 patients were included in the study, of which 13 (92.85%) patients were male. The mean age of the patients was 47.85 +/- 7.37 years. All the eyes had a dense central leucomatous corneal opacity. Twelve (85.71%) eyes had two or more quadrants of deep vascularisation. Sphincterotomy was performed mostly (71.42%) in the nasal or inferonasal quadrant. The intraocular lens was implanted in 13 (92.85%) eyes, and one (7.1%) eye was left aphakic due to the occurrence of a large posterior capsular tear. Preoperatively, all eyes had BCVA < 6/60. At 6 weeks after surgery, all eyes had BCVA >or= 6/60 and four (28.57%) eyes had BCVA >or= 6/18. The mean BCVA preoperatively in these eyes was 0.015 +/- 0.009, which changed to 0.249 +/- 0.102 at 6 weeks following surgery. CONCLUSIONS: Extracapsular cataract extraction and intraocular lens implantation with pupillary sphincterotomy provides ambulatory and useful vision to patients of cataract with coexisting central leucomatous corneal opacity.

Cataract Extraction↗
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↗
PubMed2003

Sporadic enteric reactive arthritis and undifferentiated spondyloarthropathy: evidence for involvement of Salmonella typhimurium.

OBJECTIVE: To define the candidate bacterial trigger and cytokine profile of synovial fluid mononuclear cells (SFMC) in patients with sporadic enteric reactive arthritis (ReA) and undifferentiated spondyloarthropathy (uSpA). METHODS: The study group comprised 10 patients with ReA and 23 with uSpA who fulfilled European Spondylarthropathy Study Group criteria. Ten patients with rheumatoid arthritis (RA) served as disease controls. IgG, IgA, and IgM antibodies to Shigella flexneri, Salmonella typhimurium, and Yersinia enterocolitica were measured in sera and SF by ELISA. Peripheral blood mononuclear cell (PBMC) and SFMC proliferation assays were done in the presence or absence of crude bacterial lysates. Bacterial antigens and DNA in synovial cells were detected by indirect immunofluorescence and polymerase chain reaction, respectively. Interferon-g (IFN-g), interleukin 10 (IL-10), and IL-4 were measured in 18 h SFMC culture supernatants in presence of bacterial lysate. RESULTS: Antibodies to S. typhimurium were significantly elevated in the sera of 8 of 25 patients compared to controls (0/22; p < 0.05). The ratio of SF:serum anti-salmonella IgA was significantly higher in patients compared to controls (p < 0.0002). The ratio of SF:serum IgA antibodies to S. typhimurium was higher than that for S. flexneri (p < 0.007) and Y. enterocolitica (p < 0.05). Out of 25 patients, 8, 2, and none had elevated antigen-specific SFMC proliferation response to S. typhimurium, S. flexneri, and Y. enterocolitica, respectively, whereas no control had elevated response. Salmonella antigens were detected in the synovial cells of 4 out of 14 patients. There was significantly higher IFN-g production from SFMC of patients who had increased proliferative response to Salmonella (LTT+) in the presence of Salmonella antigens compared to antigen control. The mean +/- SD of the ratio of IFN-g:IL-10 in the LTT+ patients was significantly lower compared to controls. Conclusion. S. typhimurium is probably one of the triggers for enteric ReA and uSpA in our cohort of patients, and the immune response is characterized by increased production of both IL-10 and IFN-g.

Adolescent↗
PubMed2002

Pattern of pediatric ocular trauma in India.

OBJECTIVE: The aim of the study is to identify the causes, demographic and clinical profile and evaluate final visual outcome of pediatric ocular injuries. METHODS: Two hundred and four children aged fourteen years or less presenting to the emergency services of a tertiary care centre with ocular injury were included. Demographic data, nature and cause of injury, duration between injury and presentation to an ophthalmologist and the diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus were done. All patients were appropriately managed and followed up on days 1, 7, 1 month, 3 and 6 months. RESULT: Majority of injuries occurred in children of 5 years and older (87.7%). There were 133 (65.1%) boys and 71 (34.9%) girls. Forty-nine (24%) cases presented within 6 hours of injury while 70 (34.3%) presented after more than 24 hours after trauma. Most common cause of injury was bow and arrow (15.2%) followed by household appliances(14.3%). Closed globe injuries accounted for 42.2% injuries, open globe for 53.9% and 3.9% were chemical injuries. Best corrected visual acuity of 6/12 or better was achieved in 79 eyes (91.86%) in closed globe group. However, only 17 eyes (15.45%) in open globe group could achieve this. CONCLUSION: Most ocular injuries in children are preventable and occur from unsupervised games like bow and arrow and firecracker, which can lead to significant visual loss.

Adolescent↗
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

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

Complications of laser-in-situ-keratomileusis.

Laser-in-situ-keratomileusis (LASIK) has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased postoperative haze. Compared to photorefractive keratectomy (PRK), LASIK involves an additional procedure of creating a corneal flap. This may result in complications related to the flap, interface and underlying stromal bed. The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include undercorrection, regression, irregular astigmatism, decentration and visual aberrations. Honest and unbiased reporting is important to understand the aetiology and redefine the management.

Cornea↗
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

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↗