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Biomedical subjects

Tushar Agarwal

Publications and source records attributed to Tushar Agarwal.

15 recordsLinked to original sources
PubMed2006

Severe ocular injury resulting from chuna packets.

OBJECTIVE: To describe a mechanism of severe ocular alkali burns occurring as a result of bursting of chuna packets (edible calcium hydroxide paste), a popular additive to chewing tobacco in India. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-one patients (25 eyes) who experienced ocular burns as a result of bursting of chuna packets. INTERVENTION: Patients were treated medically or with 1 or more of the following surgeries: symblepharon release, amniotic membrane grafting, allograft or autograft stem cell transplantation, or both, and large diameter lamellar keratoplasty. MAIN OUTCOME MEASURES: The main outcome measures were time interval between the injury and presentation, presenting visual acuity, grade of injury, management (medical therapy or surgical intervention), and final visual outcome at the last follow-up. RESULTS: The average age at time of injury was 8.4+/-5.5 years. The median visual acuity at presentation was light perception with projection. The ocular burns were grade 4 in 23 eyes. Eight of 25 eyes were treated medically, and the rest underwent 1 or more surgeries in the form of symblepharon release (n = 6), amniotic membrane grafting (n = 3), allograft or autograft stem cell transplantation (n = 6), and large diameter lamellar keratoplasty (n = 6). At the final follow-up (mean, 637+/-592 days), median visual acuity was 1/60. CONCLUSIONS: Bursting of chuna packets can cause severe ocular alkali burns in children. These patients carry a poor visual prognosis with both medical and surgical therapy.

Adolescent↗
PubMed2006

Down in the mumps.

A 10-week-old female infant presented with a right-sided facial swelling without any constitutional symptoms. The swelling was nontender, nonfluctuant, with no erythema or induration. On the basis of the clinical picture, magnetic resonance imaging findings and serology, a diagnosis of unilateral mumps parotitis was made. The United Kingdom is currently experiencing a mumps epidemic with a 28-fold rise in the number of cases over the last 10 years. Infants are being increasingly affected. Mumps parotitis, which was previously unreported in infants, needs to be considered as part of the differential diagnosis when a small child presents with swelling of the parotid gland.

Disease Outbreaks↗
PubMed2006

Modification in descemet-stripping automated endothelial keratoplasty: "Hitch suture" technique.

PURPOSE: To describe a new modification in Descemet-stripping automated endothelial keratoplasty, using a "hitch suture" to unfold the donor lenticule inside the recipient's eye. METHODS: The technique was used in 2 eyes of 2 patients with bullous keratopathy after complicated cataract surgery. A hitch suture was created in both the donor lenticules before inserting the folded graft in the recipient's anterior chamber. The hitch suture was pulled through a limbal stab incision to unfold the donor lenticule in both cases. RESULTS: No intraoperative problems were encountered. The grafts were well centered with corneal edema. The central part of the graft cleared over a period of 10 to 14 days. CONCLUSION: The technique of using a hitch suture to unfold the graft eliminates the problems associated with this difficult step of the surgery. The hitch loop can be easily made at the edge of the graft and can be pulled using a Sinskey hook through 1 of the stab incisions. We believe that this simple modification in this surgery would help simplify the learning curve of the procedure and increase its chances of success.

Corneal Diseases↗
PubMed2006

Laparoscopic resection of mucinous cystadenoma of appendix: a careful decision.

Appendiceal mucoceles are mainly due to cystadenoma or cystadenocarcinoma. Definite diagnosis is difficult preoperatively and is usually peroperatively. Surgical excision, either by laparoscopy or by laparotomy, is the mainstay of treatment. Rupture of the lesion causes pseudomyxoma peritonei. We present a case to highlight this point and especially deplore the use of laparoscopy if the tumor clearly extends beyond the appendix.

Aged, 80 and over↗
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

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↗
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↗
PubMed2002

Resection of soft tissue sarcomas with intra-operative magnetic resonance guidance.

PURPOSE: To report on a preliminary series of magnetic resonance (MR)-guided sarcoma resections. MATERIALS AND METHODS: Three patients with the skin sarcoma dermatofibrosarcoma protuberans underwent MR-guided resection. RESULTS: The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using short Tau inversion recovery (STIR) sequences and intra-operative imaging was used to confirm complete tumor excision. Histological examination confirmed clear surgical margins of at least 1 cm in each case. CONCLUSION: We believe this technique may reduce the incidence of specimen margins positive for tumor following resection, and consequently reduce the need for further excisional surgery.

Adult↗
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

Microbial keratitis after laser in situ keratomileusis.

PURPOSE AND METHOD: To review the literature on microbial keratitis reported after laser in situ keratomileusis (LASIK). RESULTS: Forty-one eyes have been reported to have microbial keratitis after LASIK. The causative organisms vary from gram positive bacteria to atypical mycobacteria, fungal, and viral pathogens. The infection is usually acquired intraoperatively, but may also be caused by postoperative contamination. A majority of the patients present within 72 hours of the surgery with an acute onset of symptoms. Management of microbial keratitis after LASIK includes aggressive topical fortified antibiotic therapy, irrigation of stromal bed with antibiotic solution after lifting the flap, and sending the scraping of the infiltrate for microbiological evaluation. The keratitis heals with scarring and a best spectacle-corrected visual acuity of 20/40 or better can be obtained in the majority of the patients. CONCLUSION: Microbial keratitis is a sight-threatening complication of LASIK.

Anti-Bacterial Agents↗