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Subhadra Jalali

Publications and source records attributed to Subhadra Jalali.

At least 19 recordsLinked to original sources

Premature truncation of a novel protein, RD3, exhibiting subnuclear localization is associated with retinal degeneration.

The rd3 mouse is one of the oldest identified models of early-onset retinal degeneration. Using the positional candidate approach, we have identified a C-->T substitution in a novel gene, Rd3, that encodes an evolutionarily conserved protein of 195 amino acids. The rd3 mutation results in a predicted stop codon after residue 106. This change is observed in four rd3 lines derived from the original collected mice but not in the nine wild-type mouse strains that were examined. Rd3 is preferentially expressed in the retina and exhibits increasing expression through early postnatal development. In transiently transfected COS-1 cells, the RD3-fusion protein shows subnuclear localization adjacent to promyelocytic leukemia-gene-product bodies. The truncated mutant RD3 protein is detectable in COS-1 cells but appears to get degraded rapidly. To explore potential association of the human RD3 gene at chromosome 1q32 with retinopathies, we performed a mutation screen of 881 probands from North America, India, and Europe. In addition to several alterations of uncertain significance, we identified a homozygous alteration in the invariant G nucleotide of the RD3 exon 2 donor splice site in two siblings with Leber congenital amaurosis. This mutation is predicted to result in premature truncation of the RD3 protein, segregates with the disease, and is not detected in 121 ethnically matched control individuals. We suggest that the retinopathy-associated RD3 protein is part of subnuclear protein complexes involved in diverse processes, such as transcription and splicing.

Amino Acid Sequence↗

Homozygous null mutations in the ABCA4 gene in two families with autosomal recessive retinal dystrophy.

PURPOSE: To identify the genes causing autosomal recessive retinal dystrophy in Indian families and to characterize the associated phenotypes. DESIGN: Experimental and observational. METHODS: Families with autosomal recessive nonsyndromic retinal dystrophies were recruited. Complete ophthalmic evaluation, including visual acuity, visual fields, fundus examinations, and electroretinography, was performed on all members. Genotyping of 14 families for two or more microsatellite markers flanking each of 21 different genes causing retinal dystrophy was done by standard methods to screen for the presence of homozygosity by descent. Mutational screening of the ABCA4 gene was carried out on 18 members (five affected) of two families by amplification and direct automated sequencing of exons and flanking sequences. Sequence alterations identified were tested for cosegregation with disease in the families and for presence in 100 unrelated normal controls. RESULTS: Two of 14 families showed homozygosity shared by affected individuals for markers flanking the ABCA4 locus. A homozygous nonsense mutation in the ABCA4 gene of Arg2030Stop was found in one family and a homozygous single base deletion leading to frameshift at Arg409 was found in the second family. Both of these mutations were found to cosegregate with disease. Five affected individuals from the two families had early-onset visual loss, diminished rod and cone electroretinographic responses, and widespread atrophy of the retinal pigment epithelium. CONCLUSION: Homozygous null mutations in ABCA4 produced a severe widespread retinal degeneration that showed marked central retinal involvement.

ATP-Binding Cassette Transporters↗

Modification of screening criteria for retinopathy of prematurity in India and other middle-income countries.

PURPOSE: To determine the gestational age and birth weight of premature babies who developed vision-threatening severe retinopathy of prematurity. DESIGN: Prospective observational study of babies at risk of blindness due to retinopathy of prematurity. METHODS: Data pertaining to all babies who underwent laser treatment or surgery for acute retinopathy of prematurity and those who had cicatricial retinopathy of prematurity were prospectively collected. The gestational age and birth weight were evaluated to establish screening criteria. RESULTS: In 120 babies, the mean gestational age was 29.6 weeks (range 26 to 36 weeks). The birth weight of 115 babies ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight was not available for five babies. Only one baby had a gestational age of >35 weeks. CONCLUSIONS: Ocular morbidity related to retinopathy of prematurity was seen in bigger and more mature babies. This study provides a scientific basis for establishing screening criteria for retinopathy of prematurity in South India and other middle-income countries.

Birth Weight↗

Pilot study on in vivo evaluation of retinal vascular maturity in newborn infants in the context of retinopathy of prematurity.

PURPOSE: To study the extent of retinal vascularization at birth. DESIGN: Prospective masked observational case series. METHODS: One hundred ten neonates, at different weeks of gestation and birth weights (BWs), had dilated fundus evaluation for zone of retinal vascularization by a masked observer. Maternal and neonatal factors were ascertained by a masked pediatrician. RESULTS: Irrespective of risk factors, eight of nine babies who were born at <30 weeks of gestation and at <1500 g BW had immature retina. Those babies who were born at >34 weeks of gestational age and at >1700 g BW had mature retina. Babies who were born between 31 to 34 weeks of gestation and at 1501 to 1700 g BW had variable extent of retinal vascularization at birth. Vascularization was affected by maternal anemia and the need for oxygen for >48 hours. CONCLUSION: There exists considerable variability in the extent of retinal vascularization in infants who are born between 31 to 34 weeks of gestation. Modifiable maternal and fetal factors could influence extent of this vascularization birth.

Birth Weight↗

Ultrasonographic characteristics and treatment outcomes of surgery for vitreous hemorrhage in idiopathic polypoidal choroidal vasculopathy.

PURPOSE: To describe the ultrasonographic characteristics and treatment outcomes of surgery in vitreous hemorrhage (VH) associated with idiopathic polypoidal choroidal vasculopathy (IPCV). DESIGN: Retrospective interventional and observational case series. METHODS: Clinical, ultrasound, and surgical data of 10 consecutive patients operated for VH due to IPCV in a tertiary eye institute was studied by chart review. Data were analyzed to determine the clinical features, ultrasonographic characteristics, and surgical outcomes. An additional five patients with IPCV without VH were evaluated by ultrasound in various stages of the disease. RESULTS: Between January 1998 and March 2005, 10 eyes of 10 patients underwent vitreous surgery for VH associated with IPCV. Characteristic ultrasonographic features that helped the diagnosis preoperatively included focal choroidal thickening without excavation or acoustic hollowing with associated low reflective echoes of dispersed VH, or diffuse choroidal thickening and low-intensity echoes of dispersed hemorrhage on either side of the retinal spike, often without vitreous detachment spike. Oral corticosteroids were provided preoperatively to patients with associated exudative retinal detachment. Indocyanine green angiography (ICGA) confirmed IPCV postoperatively. Focal lesions were treated with laser photocoagulation. Anatomical success was seen in nine of 10 eyes. Visual acuity improved in five of 10 eyes but was limited by macular pathology in other five eyes. The most common complication was iatrogenic tears. Some eyes had recurrent IPCV lesions in follow-up. CONCLUSIONS: Characteristic ultrasonographic features could identify IPCV in eyes with VH. Anatomical and visual outcomes of our management approach were encouraging and need further study.

Adult↗

Retinal detachment in south India-presentation and treatment outcomes.

BACKGROUND: Although the presentation and treatment outcomes of retinal detachments in wealthy countries are well known, much less is known about retinal detachment in the developing world. This study reports the presentation and outcomes of 433 rhegmatogenous retinal detachments in South India. METHODS: Retrospective analysis was undertaken of all operated cases of retinal detachment in a tertiary care centre, from 1 January 2000 to 31 December 2000. RESULTS: Retinal detachments were treated in 433 eyes of 417 patients; 67 (16.1%) patients were children below 16 years and 60 (14.4%) patients were blind (visual acuity <6/60). The duration of symptoms was over 1 month in 192 (46.6%) eyes and, in 376 (86.8%), the macula was detached at presentation. Referral diagnosis was incorrect in 69 (22.4%) eyes. Cataract surgery was the predisposing factor in 152 (35.1%) eyes. Primary surgery included pars plana vitrectomy procedures in 235 eyes (53.9%) and scleral buckling in 197 (45.8%). The retina was re-attached with one operation in 281 eyes (71%) and with one or more operations in 333 (87%). Visual acuity of 6/60 or better was achieved in 260 (67.7%) eyes. CONCLUSIONS: The profile of retinal detachments in a tertiary eye care centre in south India includes many paediatric cases, late presentations and macula-off detachments, commonly related to cataract surgery. Despite complex pathology, two thirds of eyes regain useful vision after one or more surgical interventions.

Adolescent↗

Relationship between clinical presentation and visual outcome in postoperative and posttraumatic endophthalmitis in south central India.

PURPOSE: To determine risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis in a large referral center in south central India. METHODS: In this prospective observational series the authors examined 388 patients of postoperative (n= 206) and posttraumatic (n= 182) endophthalmitis at the L V Prasad Eye Institute in Hyderabad, India between 1991 and 1997. The analysis was confined to 236 patients-128 (62.1%) postoperative and 108 (59.3%) posttraumatic patients who were followed for a minimum period of 3 months. A detailed protocol was followed. Chi-square and logistic regression analysis were used to determine risk factors for visual outcome worse than 6/18 and worse than 6/120. RESULTS: Postoperative endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included intracapsular cataract surgery, poor presenting visual acuity, presence of vitreous cells, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In the multivariate analysis, visual acuity of less or equal light perception (LP) at presentation was associated with a 3-month postoperative visual acuity of < 6/18, with an odds ratio of 5.85 [1.25 - 27.42, 95% CI], and vitreous membranes seen on ultrasonography was associated with a final visual acuity of < 6/120, with an odds ratio of 2.47 [1.05 - 5.83, 95% CI]. Posttraumatic endophthalmitis: In univariate analysis the features associated with poor visual acuity (grouped as < 6/18 and < 6/120) included a retained intraocular foreign body (IOFB), trauma by needle (hypodermic or sewing), poor presenting visual acuity, inability to visualise the optic disc on indirect ophthalmoscopy, presence of vitreous membranes on ultrasonography, and a culture-positive vitreous biopsy. In multivariate analysis, IOFB was associated with a 3-month follow-up visual acuity of < 6/18, with an odds ratio of 5.90 [1.85 - 18.78, 95% CI], and trauma by a needle (hypodermic or sewing) and retained IOFB was associated with a final visual acuity of < 6/120, with an odds ratio of 4.47 [1.22 - 16.38, 95%CI] and 3.76 [1.36 - 10.37, 95% CI] respectively. CONCLUSION: This is the largest, single-centre, prospective study on risk factors for poor visual outcome in postoperative and posttraumatic endophthalmitis. The independent risk factor for 3-month follow-up visual acuity of < 6/18 was the presenting visual acuity of < or =LP in postoperative endophthalmitis and a retained IOFB in posttraumatic endophthalmitis. The independent risk factor for 3-month visual acuity of < 6/120 was the presence of vitreous membranes on ultrasonography in postoperative endophthalmitis, and trauma by a needle (hypodermic/ sewing) and retained IOFB in posttraumatic endophthalmitis.

Adolescent↗

Multiplex polymerase chain reaction for the detection of herpes simplex virus, varicella-zoster virus and cytomegalovirus in ocular specimens.

PURPOSE: A majority of ocular viral diseases are caused by herpes group of viruses. Such infections, especially atypical herpetic keratitis, iridocyclitis and intra-ocular inflammations, can often present with overlapping clinical manifestations misleading the diagnosis. Molecular techniques are most useful in such instances for an accurate and rapid diagnosis since conventional methods are time consuming and less sensitive. A multiplex PCR was developed and used for the detection of herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in ocular samples. METHODS: One hundred and forty six ocular samples (corneal scrapings - 52, aqueous fluid - 36, vitreous fluid - 31, tissues - 26, skin vesicle scraping - 1) were included in the study. The sensitivity of the assay was determined using serial dilutions of standard strains of HSV, VZV, and CMV vis-à-vis plaque forming assay. RESULTS: The sensitivity of the assay was 4, 4 and 12 PFU/ml or 20, 20 and 60 genome copy numbers of HSV, VZV and CMV respectively. Using DNA from various sources (fungal, bacterial, human leukocytes, tissues) along with standard positive controls, the assay was found to be highly specific. HSV DNA was detected in majority of the clinical samples (33.6%), most frequent being corneal samples. Comparatively, VZV and CMV infections were detected in small number of samples (VZV-3, CMV-2). CONCLUSIONS: We found the assay very useful in our set-up whenever a differential diagnosis of herpetic infections was suggested by the ophthalmologist. The multiplex PCR we have described here can be of greater value in clinics with larger number of patients suspected of having HSV, VZV or CMV infections.

Cytomegalovirus↗

von Hippel angioma in South Indian subjects--a clinical study.

PURPOSE: To assess the management strategies for retinal capillary hemangioma in von Hippel-Lindau disease. STUDY DESIGN: A retrospective, nonconsecutive case series of 12 patients. METHODS: We reviewed the records of patients diagnosed with retinal capillary hemangioma from January 1996 to June 2002. Age at diagnosis, visual acuity, tumor pattern and location, associated clinical features, type of treatment, and visual and anatomical outcomes were analyzed. RESULTS: None of the patients had evidence of extraocular hemangiomas. The patients were observed for 2 to 24 months. Ten of 12 hemangiomas were endophytic. Subretinal exudation was present in all patients. Cryotherapy was the most common treatment option with successful anatomical (7 of 8 patients) and visual (5 of 8 patients) outcomes. Photocoagulation was successful in 1 of 2 patients. Two patients in the cryotherapy group and two in the photocoagulation group had complications, including macular scar, macular hole, epimacular membrane, and combined traction and rhegmatogenous retinal detachment. Two patients were lost to follow-up after cryotherapy. Seven of 10 patients with a minimum follow-up of 2 months had improved visual acuity. CONCLUSIONS: Endophytic peripheral retinal capillary hemangioma with subretinal exudation was the commonest presentation in this series. Although cryotherapy and photocoagulation regress the tumor, these treatment modalities are associated with complications that may require surgical intervention. Retinal detachments in this group of patients are amenable to surgical intervention.

Adolescent↗

Programme planning and screening strategy in retinopathy of prematurity.

Retinopathy of Prematurity (ROP) is one of the major emerging causes of childhood blindness. A well organised screening strategy and timely intervention can to a large extent prevent blindness due to ROP. This communication proposes a screening strategy and management plan to develop a model for the care of babies with ROP.

Blindness↗

Management of vitreous haemorrhage.

Vitreous hemorrhage is one of the most common differential diagnoses for sudden painless decrease in vision. Often, it is caused by retinal vascular disorders secondary to common systemic ailments such as diabetes mellitus, systemic hypertension and haematological abnormalities. Sometimes it may be the beginning of a retinal tear and consequent retinal detachment that can be vision threatening if not operated early. This paper lays out practical guidelines for a tailored approach needed to arrive at the aetiology of vitreous haemorrhage so that appropriate, timely treatment can be planned.

Cryotherapy↗

Screening for homozygosity by descent in families with autosomal recessive retinitis pigmentosa.

Retinitis pigmentosa (RP) is a genetically heterogeneous disease and an important cause of blindness in the state of Andhra Pradesh in India. In an attempt to identify the disease locus in families with the recessive form of the disease, we used the approach of screening for homozygosity by descent in offspring of consanguineous and nonconsanguineous families with RP. Microsatellite markers closely flanking 21 known candidate genes for RP were genotyped in parents and affected offspring to determine whether there was homozygosity at these loci that was shared by affected individuals of a family. This screening approach may be a rapid preliminary method to test known loci for possible cosegregation with disease.

Genes, Recessive↗