The SERIES clinic: an interdisciplinary approach to the management of toxicities of EGFR inhibitors.
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Algorithms↗
Biomedical subjects
Surendra Basti
Publications and source records attributed to Surendra Basti.
Anterior lenticonus detected by wavefront aberrometry.
PURPOSE: To illustrate the utility of wavefront aberrometry in delineating a subtle lenticular abnormality responsible for decreased best-corrected visual acuity in a patient. DESIGN: Case report. METHODS: Clinical data, corneal topography, and wavefront aberrometry with separation of corneal and lenticular components of the higher-order aberrations are analyzed in a patient who presented for refractive surgery evaluation. RESULTS: Clinical evaluation indicated that the cause of visual loss was lenticular, and wavefront aberrometry indicated high negative spherical aberration, leading to the diagnosis of anterior lenticonus. CONCLUSIONS: Wavefront aberrometry has an adjunctive and distinctive role in the preoperative screening process for refractive surgery candidates and in those with subtle unexplained loss of best-corrected visual acuity.
Adult↗
Use of preservative-free lidocaine for cataract surgery in a patient allergic to "caines".
Although many patients have been labeled allergic to local anesthetics (LAs), true allergic reactions to LAs are rare. An 81-year-old woman with a history of procaine (Novocaine) allergy presented for cataract surgery. Skin testing showed sensitivity to amide and ester LAs. Further testing with preservative-free lidocaine was negative, suggesting the patient was allergic to ester LAs and preservatives found in amide anesthetic preparations. Cataract extraction was subsequently and uneventfully performed in both eyes with topical anesthesia using preservative-free lidocaine.
Aged↗
Secondary peripheral iris suture fixation of an acrylic IOL in megalocornea.
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Acrylic Resins↗
Predictive formula for calculating the probability of LASIK enhancement.
PURPOSE: To develop a formula to predict a patient's need for laser in situ keratomileusis (LASIK) enhancement. SETTING: Northwestern Laser Vision Center, Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. METHODS: In this retrospective study, charts of patients who received LASIK with the Visx Star excimer laser for myopia and myopic astigmatism were reviewed. Laser in situ keratomileusis enhancement was performed in 130 of 720 eyes. Variables such as age, keratometry, spherical power, power and axis of astigmatism, and surgeon factor were compared in patients who required retreatment and those who did not. Multivariate logistic regression analysis was used to determine a formula for the probability of enhancement surgery. RESULTS: Age (P<.0001), preoperative cycloplegic sphere (P<.0001), and surgeon (P<.0001) were the statistically significant factors for predicting retreatment. The predictive formula derived from these factors had a sensitivity of 79%, a specificity of 61%, and positive and negative predictive values of 31% and 93%, respectively. CONCLUSIONS: Older age, higher preoperative cycloplegic sphere, and surgeon significantly influenced a patient's likelihood for LASIK retreatment. A formula based on these predisposing factors helps to more accurately predict the need for retreatment.
Adolescent↗
Limbal stem cell transplantation.
The past two decades have witnessed remarkable progress in limbal stem cell transplantation. In addition to harvesting stem cells from a cadaver or a live related donor, it is now possible to cultivate limbal stem cells in vitro and then transplant them onto the recipient bed. A clear understanding of the basic disease pathology and a correct assessment of the extent of stem cell deficiency are essential. A holistic approach towards management of limbal stem cell deficiency is needed. This also includes management of the underlying systemic disease, ocular adnexal pathology and dry eye. Conjunctival limbal autografts from the healthy contralateral eye are performed for unilateral cases. In bilateral cases, tissue may be harvested from a cadaver or a living related donor; prolonged immunosuppression is needed to avoid allograft rejection in such cases. This review describes the surgical techniques, postoperative treatment regimes (including immunosuppression for allografts), the complications and their management. The short and long-term outcomes of the various modalities reported in the literature are also described.
Clinical Trials as Topic↗
Eye findings of diffuse unilateral subacute neuroretinitis and multiple choroidal infiltrates associated with neural larva migrans due to Bbaylisascaris procyonis.
PURPOSE: To report childhood infection with Baylisascaris procyonis (raccoon round worm) manifesting as diffuse unilateral subacute neuroretinitis (DUSN) and choroidal infiltrates in association with neurologic disease (neural larva migrans). METHOD: Observational case series, one with eye manifestations of DUSN, the other with choroidal infiltrates, both with severe neurologic degeneration. RESULTS: Indirect immunofluorescence assays on serum and cerebrospinal fluid were positive for B. procyonis in one and serially positive and increasing in the other. Both children had a history of pica and raccoon exposure. CONCLUSIONS: Baylisascaris procyonis infection is associated with two cases of severe neurologic degeneration with ocular lesions: DUSN and choroidal infiltrates. Although B. procyonis is known to cause DUSN, these cases indicate that concomitant ocular migration may accompany neural larva migrans. These are the third and forth cases in the US literature of neural larva migrans due to B. procyonis with eye findings.
Acute Disease↗
Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia.
Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.
Acute Disease↗
Posterior capsule dehiscence during phacoemulsification and manual extracapsular cataract extraction: comparison of outcomes.
PURPOSE: To compare the intraoperative behavior and postoperative outcomes of posterior capsule dehiscence during phacoemulsification and during manual extracapsular cataract extraction (ECCE). SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This study was a retrospective chart review of consecutive cases of posterior capsule dehiscence over 2 years in patients having phacoemulsification or manual ECCE. A chi-square test was used for statistical comparison of the results in the 2 groups. RESULTS: In the 127 eyes with posterior capsule dehiscence, the incidence of vitreous prolapse was comparable between the 2 groups (phacoemulsification, 61.6%; ECCE, 62.7%). In the phacoemulsification group, vitreous prolapse occurred more frequently if nuclear fragments were present at the time of posterior capsule dehiscence than if they were present during cortex removal (P =.05). Posterior dislocation of nuclear fragments occurred in 4 eyes in the phacoemulsification group. Increased anterior uveitis in the early postoperative period occurred more frequently in the ECCE group (P =.02). The visual outcomes were similar between the 2 groups. CONCLUSIONS: Even though differences existed between the intraoperative factors influencing the management of posterior capsule dehiscence during phacoemulsification and ECCE, the final anatomic and visual outcomes were comparable.
Capsulorhexis↗
Staining characteristics of preserved human amniotic membrane.
PURPOSE: Amniotic membrane is an ultra-thin cellophane-like membrane that is used in ocular surface reconstruction. We evaluated the staining characteristics of commonly available dyes on preserved human amniotic membrane to aid in handling of amniotic membrane during transplantation. METHODS: Five dyes, indocyanine green (2.5%, 1.0%, and 0.5%), fluorescein (0.25%), rose bengal (1%), lissamine green B (1%), and trypan blue (0.5%), were used to stain amniotic membrane. After staining, the specimens were observed under a dissecting microscope to evaluate for the uptake of the stains. Positively stained membranes were evaluated for the persistence of staining by placing them in 2 to 3 mL of balanced saline solution that was changed every 30 minutes over 6 hours. RESULTS: Preserved human amniotic membrane is stained by indocyanine green, rose bengal, lissamine green B, and trypan blue. Of these four dyes, only the membrane stained with 1% lissamine green B was free of stain after 120 minutes. Indocyanine green, rose bengal, and trypan blue continued to strongly stain the membrane after 24 hours. CONCLUSIONS: Indocyanine green, rose bengal, trypan blue, and lissamine green B all stain amniotic membrane. Lissamine green B appears to have advantages over the other dyes in that it will stain the membrane well, and in our model, dissipate in 120 minutes. Intraoperative staining with lissamine green B may be a simple and effective way to assist surgeons in the proper handling of amniotic membrane.
Amnion↗
Ocular surface squamous neoplasia: a review.
Even though ocular surface squamous neoplasia (OSSN) has been recognized for well over a century, the past decade has witnessed advances that have helped rewrite many of the paradigms for the diagnosis and management of these lesions. OSSN occurs predominantly in the elderly for whom they are the third most common oculoorbital tumors after melanoma and lymphoma. In addition to advanced age and male sex, other major risk factors linked to its pathogenesis are ultraviolet light, cigarette smoking, and the human papilloma virus. Although the latter has been linked to OSSN for nearly 4 decades, its identification and role in the pathogenesis of these tumors has been elucidated recently and is addressed in detail in this review. Newer techniques of impression cytology represent a noninvasive and reliable method of diagnosing OSSN and monitoring treated cases. The efficacy of chemotherapeutic agents such as mitomycin C and 5-fluorouracil have been proven in the recent past, making them a clear alternative to the time-tested treatment of surgical excision and cryotherapy. Early reports on the efficacy of topical Iterferon alpha 2b indicate significant promise in providing another alternative for the treatment of some of these neoplasms. These advances thus represent a minimally invasive and highly successful approach to the diagnosis and treatment of OSSN.
Age Distribution↗
Allelic and locus heterogeneity in autosomal recessive gelatinous drop-like corneal dystrophy.
Gelatinous drop-like corneal dystrophy (GDLD) is a rare autosomal recessive disease characterized by the deposition of amyloid beneath the corneal epithelium and by severely impaired visual acuity leading to blindness. Although gelatinous corneal dystrophy has previously been mapped to chromosome 1p and seems to be associated with mutations in the M1S1 gene, molecular genetic studies have been limited to Japanese patients. To investigate the cause of GDLD in patients with diverse ethnic backgrounds, we performed linkage analyses in eight unrelated GDLD families from India, USA, Europe, and Tunisia. In seven of these families, the disease locus mapped to a 16-cM interval on the short arm of chromosome 1 between markers D1S519 and D1S2835, a region including the M1S1 gene. In addition, a 1.2-kb fragment containing the entire coding region of M1S1 gene was sequenced in affected individuals. Seven novel mutations (M1R, 8-bp ins., Q118 E, V194 E, C119 S, 870delC, and 1117delA) were identified in six families and two unrelated individuals. No sequence abnormalities were detected in a single family in which the GDLD locus was also excluded from the M1S1 region by linkage analysis. These findings demonstrate allelic and locus heterogeneity for GDLD.
Alleles↗
When may the posterior capsule be preserved in pediatric intraocular lens surgery?
PURPOSE: To refine indications for primary posterior capsulotomy (PPC) in conjunction with posterior chamber intraocular lens (PCIOL) implantation for cataract in childhood. DESIGN: Noncomparative case series. PARTICIPANTS: Patients 1 to 13 years old who underwent cataract extraction with intent to preserve the posterior lens capsule and PCIOL implantation between January 1992 and December 1998 at a pediatric hospital. METHODS: Medical records were reviewed to determine the frequency and timing of posterior capsule opacification (PCO) after PCIOL surgery with preservation of an intact posterior capsule. Comparison of pseudophakic PCO rates for groups defined by age and several possible risk factors. Assessment of safety and efficacy for PPC with anterior vitrectomy performed through a limbal incision in cases where the posterior capsule could not be preserved. MAIN OUTCOME MEASURES: Need for neodymium:yttrium-aluminum-garnet laser capsulotomy or surgical membranectomy to treat PCO. RESULTS: PCO occurred in 40% of 30 eyes with intact posterior capsule. Mean follow-up duration was 22 months for eyes that had PCO develop and 24 months for those in which the posterior capsule remained clear. Laser capsulotomy was required for 64% of 14 eyes in the 1- to 6-year-old age range but for only 19% of 16 in the 6- to 13-year-old range (P < 0.05). Mean time from surgery to PCO was 7 months for the younger group and 13 months for the older group. A need for repeated capsulotomy (one eye) or membranectomy with anterior vitrectomy (two eyes) was found only in the younger age group. There was no association of PCO with trauma history, cataract type, residual lens cortex, IOL position, or postoperative fibrin clot. Final vision was possibly compromised as a result of PCO in one eye with amblyopia. None of 24 eyes in which PPC with anterior vitrectomy was performed out of intraoperative necessity before primary PCIOL implantation had secondary opacification develop. No reduction in postoperative vision was attributable to PPC. CONCLUSIONS: PPC seems to be advisable for children less than 6 years old when cataract extraction with PCIOL implantation is performed. Preservation of the posterior capsule remains appropriate for older children with pseudophakia.
Adolescent↗
The itching, burning eye: diagnostic algorithm and management options.
The healthy ocular surface is a complex, composite unit that is essential for patient comfort and visual function. A number of components need to work in an integrated manner to ensure that this is achieved, and a variety of causes can result in the final common symptom complex that can be termed the itching, burning eye. Many of these causes may be due to relatively common and simple issues related to lid disease, allergies, tear dysfunction, excessive computer use, exposure to polluted environment, and convergence problems. However, a smaller group may have potentially more serious pathology due to causes such as underlying immune dysfunction, or tumors; rarely, intraocular conditions and some neurological causes may present with ocular redness and grittiness. Failure or delay in the diagnosis of these latter entities can result in significant morbidity to the eye. This article will clarify issues related to the functioning of the ocular surface, provide a diagnostic algorithm for managing these patients, and discuss the current knowledge in the management of these conditions once they are diagnosed. It is targeted at the practicing ophthalmologist and should help him or her to manage this problem effectively.
Algorithms↗