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Biomedical subjects

Rasik B Vajpayee

Publications and source records attributed to Rasik B Vajpayee.

At least 37 records · Page 2Linked to original sources
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

Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome.

We describe a new technique of aspiration of subluxated lens in young patients with Marfan's syndrome. Two small circular anterior capsulorhexis (1.5 mm to 2.0 mm) openings were created, and bimanual irrigation/aspiration was performed by introducing the irrigation cannula through 1 capsular opening and the aspiration cannula through the other. The irrigation cannula served the dual purpose of hydrating the lens matter and holding the lens in central position to ensure complete aspiration of the lens matter. The lens capsule was later removed and anterior vitrectomy performed by a vitrectomy cutter. This new technique of intralenticular irrigation/aspiration is effective and safe in performing lens aspiration in extensively dislocated crystalline lens in Marfan's syndrome.

Adolescent↗
PubMed2005

Refractive outcomes of laser in situ keratomileusis after flap complications.

PURPOSE: To study the refractive and visual outcomes, including surgically induced astigmatism, of laser in situ keratomileusis (LASIK) after flap buttonholes and incomplete flaps. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This was a retrospective case series of 15 patients (15 eyes) who had LASIK after flap complications (6 eyes with buttonholes and 9 with incomplete flaps). The second surgery was performed after the refraction was stable for 2 months. The refractive and visual outcomes were studied. RESULTS: After the flap complication, the spheroequivalent did not change significantly (P = .78) but the mean pachymetry changed from 523.6 microm +/- 23.14 (SD) to 530.4 +/- 23.96 microm (P = .04) and the mean absolute cylinder changed from 0.63 +/- 1.01 diopter (D) to 0.88 +/- 0.87 D (P = .026). The second surgery was performed at a mean interval of 6.2 months (range 3 to 17 months). Two eyes had flap complications (irregular flaps) again after the second surgery. At the 6-month follow-up, the mean spheroequivalent was -0.34 +/- 0.65 D and the mean cylinder was 0.15 +/- 0.19 D x 83.6. Thirteen eyes (86.66%) were within 0.5 D of the attempted correction. Post-LASIK complications included diffuse lamellar keratitis (1 eye), epithelial ingrowth (1 eye), and flap striae (2 eyes). After the flap complication, no eye lost 2 or more lines of best spectacle-corrected visual acuity (BSCVA); but after the second surgery at 6 months, 1 eye had lost 2 lines of BSCVA. Six months postoperatively, all eyes had a BSCVA of 20/40 or better. CONCLUSION: Laser in situ keratomileusis after flap complications is associated with good refractive and visual outcomes; however, there is a higher risk for intraoperative and postoperative complications after the second surgery.

Adult↗
PubMed2005

Amniotic membrane transplantation in refractory neurotrophic corneal ulcers: a randomized, controlled clinical trial.

PURPOSE: This study was designed to compare and evaluate the efficacy of amniotic membrane transplantation with the conventional management (tarsorrhaphy and bandage contact lens) in eyes with refractory neurotrophic corneal ulcers. METHODS: Thirty eyes of 30 patients (14 females and 16 males) with neurotrophic corneal ulcers refractory to medical management were included and divided randomly into group 1 (n = 15), who received conventional management with a tarsorrhaphy (n = 11) or bandage contact lens (n = 4), and group 2 (n = 15), who underwent Amniotic Membrane Transplantation. The outcome parameters evaluated were epithelialization time, duration of healing of corneal ulcers, and improvement in best corrected visual acuity. RESULTS: The mean age in our study was 37 +/- 14.71 years. At the end of 3 months follow-up, 10 of 15 patients (66.67%) in group 1 showed complete epithelialization and subsequent healing and 11 of 15 patients (73.33%) in group 2 showed complete epithelialization and healing (P > 0.05). The median time for complete epithelialization was 21 days in both groups. Both groups showed an improvement in the best-corrected visual acuity. CONCLUSIONS: Both amniotic membrane transplantation and conventional management (tarsorrhaphy or bandage contact lens) are effective treatment modalities for refractory neurotrophic corneal ulcers.

Adolescent↗
PubMed2005

Indications of penetrating keratoplasty in northern India.

PURPOSE: To identify the indications for penetrating keratoplasty in northern India. METHODS: All the eye bank records of penetrating keratoplasties performed during the period from June 1997 to November 2003 at Rajendra Prasad Center for Ophthalmic Sciences were reviewed. RESULTS: During this period, 2022 penetrating keratoplasties were performed. The leading indications for penetrating keratoplasty were corneal scarring (38.03%) followed by acute infectious keratitis (28.38%), regrafting (11.5%), aphakic bullous keratopathy (7.27%), pseudophakic bullous keratopathy (6.18%), and corneal dystrophy (3.85%). Healed infectious keratitis (19.83%) was the most common subcategory among the eyes with corneal scarring followed by traumatic corneal scars (16.71%). Healed (19.83%) and active keratitis (28.38%) together accounted for the majority of keratoplasties (48.21%). In cataract-related corneal edema (13.45%), aphakic bullous keratopathy (7.27%) was almost as frequent as compared with pseudophakic bullous keratopathy (6.18%). CONCLUSIONS: Corneal infections either active or healed are the most common indication for keratoplasty in northern India.

Adolescent↗
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↗
PubMed2004

Corneal topographic changes following retinal surgery.

BACKGROUND: To study the effect of retinal/ vitreoretinal surgeries on corneal elevations. METHODS: Patients who underwent retinal/ vitreoretinal surgeries were divided into 3 groups. Scleral buckling was performed in 11 eyes (Group 1). In 8 (25%) eyes, vitreoretinal surgery was performed along with scleral buckling (Group 2). In 12 eyes, pars plana vitrectomy was performed for vitreous hemorrhage (Group 3). An encircling element was used in all the eyes. The parameters evaluated were best-corrected visual acuity (BCVA), change in axial length, and corneal topographic changes on Orbscan topography system II, preoperative and at 12 weeks following surgery. RESULTS: There was a statistically significant increase in anterior corneal elevation in all the three groups after surgery (p = 0.003, p = 0.008 & p = 0.003 respectively). The increase in posterior corneal elevation was highly significant in all the three groups after surgery (p = 0.0000, p = 0.0001 & p = 0.0001 respectively). The increase in the posterior corneal elevation was more than the increase in the anterior elevation and was significant statistically in all the three groups (group I: p = 0.02; group II: p = 0.01; group III: p = 0.008). CONCLUSIONS: Retinal/ vitreoretinal surgeries cause a significant increase in the corneal elevations and have a greater effect on the posterior corneal surface.

Adolescent↗
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↗
PubMed2004

Bilateral serous macular detachment following laser in situ keratomileusis.

PURPOSE: To report a case of bilateral serous macular detachment following laser in situ keratomileusis (LASIK). DESIGN: Observational case report. METHODS: A 33-year-old man presented with sudden decrease of vision in both eyes 4 days following uncomplicated LASIK in both eyes for spherical equivalent of +5.00 diopters sph in the right eye and +7.00 diopters sph in the left eye. Detailed history with ocular and systemic examination, fluorescein angiography, and optical coherence tomography were done. Retinal examination had a documentation of retinal pigment epithelium atrophy in the macular region in both eyes pre-LASIK. RESULTS: A diagnosis of central serous chorioretinopathy (CSCR) was made in both eyes, with multifocal alterations in the retinal pigment epithelium and a pocket of serous retinal fluid in the macular region confirmed on OCT. Late venous phase of fluorescein angiogram demonstrated multiple hyperfluorescent foci of leakage, more in the right eye with areas of retinal pigment epithelium staining. CONCLUSIONS: Preexisting macular pathology, such as retinal pigment epithelium atrophy could be a new contraindication to LASIK for hypermetropia with possible development of CSCR, requiring a careful examination of the fundus pre-LASIK.

Adult↗
PubMed2004

Microbial keratitis following lamellar keratoplasty.

OBJECTIVE: To determine the predisposing factors, etiologic agents, and clinical and visual outcomes in infectious keratitis following lamellar keratoplasty (LK). METHODS: One hundred thirty-five eyes (135 patients) that had undergone LK were retrospectively analyzed for the occurrence of infectious keratitis following LK. The parameters evaluated were predisposing factors, seasonal variation, indications and type of LK, time interval between LK and infection, site and depth of infection, etiologic organisms, type of treatment, outcome in terms of graft status, secondary surgery, visual acuity, and the donor tissue profile. RESULTS: The incidence of infectious keratitis following LK was 11.11%. The most significant predisposing factor was persistent epithelial defect (3 eyes) and suture abscesses (3 eyes). Most cases occurred between May and August (9/15). Twelve cases developed infection within 2 weeks of surgery (80%). Seven cases (7/15) occurred with onlay grafts, 6 with inlay grafts, and 2 with large-diameter LK. Cultures of corneal scrapings were positive in 11 eyes (73.3%), and the most common isolated organism was coagulase-negative Staphylococcus (CNS). Only 2 eyes responded to medical therapy, and graft sloughing occurred in 9 cases. Six eyes underwent penetrating keratoplasty to either salvage the integrity of globe or for visual rehabilitation of cases where infection resulted in corneal opacity. CONCLUSIONS: Infections after LK may not be amenable to antimicrobial therapy and may necessitate the removal of the graft or a therapeutic penetrating keratoplasty.

Adult↗