PubMed Health⌕ Search

Biomedical subjects

V Lakhanpal

Publications and source records attributed to V Lakhanpal.

At least 19 recordsLinked to original sources
PubMed1993

Experimental and clinical observations on massive suprachoroidal hemorrhage.

We have been able to create a reproducible experimental model of nonexpulsive massive suprachoroidal hemorrhage in a rabbit eye. Massive suprachoroidal hemorrhage was demonstrated on echography and confirmed on histopathologic examination in all eyes. The natural course of the disease suggests that there is very little change in the size of the choroidal detachment in the first 7 days. Maximum liquefaction of the suprachoroidal hemorrhage clot was seen to occur between 7 and 14 days. However, increased retinal and ciliary body atrophy was also noted at 14 days. Therefore, the optimum time to drain massive suprachoroidal hemorrhage appears to be between 7 and 14 days. Immediate sclerotomy during the acute formation of massive suprachoroidal hemorrhage resulted in further increase in the suprachoroidal hemorrhage, with marked extension of the hemorrhage into the retina and vitreous. Therefore, in our opinion, immediate sclerotomy during massive suprachoroidal hemorrhage is detrimental to the eye. Our clinical data have shown that eyes with massive suprachoroidal hemorrhage can be treated successfully by secondary surgery, and the majority of the eyes can be salvaged with good visual results. No serious complications of this surgery were encountered in our cases. We advocate early surgical intervention between 7 and 14 days. Aggressive anterior and posterior segment reconstruction by anterior and posterior vitrectomy after sclerotomy drainage of the suprachoroidal hemorrhage is essential for better anatomic and visual results. Our animal data and clinical experience suggest that the optimum time of drainage of massive suprachoroidal hemorrhage is between 7 and 14 days. The results of our animal experiments in relation to human clinical application should be taken with caution. Furthermore, we had a small number of animals to study the various groups. In addition, longer follow-up may be needed for comparing controls with the treatment groups. Our animal model may help in such future studies on massive suprachoroidal hemorrhage.

Aged↗
PubMed1992

Posterior capsulotomy as a complication of indirect laser photocoagulation.

Two pseudophakic patients with posterior chamber intraocular lens implants and intact posterior capsules underwent indirect laser photocoagulation during their immediate postoperative period (24 and 72 hours postoperatively, respectively). Laser treatment was indicated for a retinal break noted after vitrectomy and scleral buckling in one patient and after peribulbar perforation during cataract extraction in the other patient. Ocular media were hazy because of vitreous haze and hemorrhage in both eyes and higher power laser settings were required to produce adequate chorioretinal burns during photocoagulation. Inadvertent large posterior capsulotomy as a complication was noted in both eyes. High-power settings and hazy ocular media are risk factors toward this complication. We recommend that slit-lamp examination be performed before, during, and after indirect laser treatment, especially when higher power settings are required.

Adult↗
PubMed1992

Episcleral pseudorheumatoid nodule with a choroidal mass simulating malignant melanoma.

A 47-year-old man had an injected episcleral mass, anterior uveitis, and a grayish white elevated choroidal mass with exudative retinal detachment. Excisional biopsy of the episcleral mass showed pseudorheumatoid nodule. All investigations for rheumatic diseases were negative. Treatment with topical corticosteroids resulted in disappearance of the choroidal mass and resolution of the uveitis. An 11-year follow-up showed no evidence of any rheumatic disease. To the best of our knowledge, this is the first histopathologically confirmed case report where an episcleral pseudorheumatoid nodule presented with a choroidal mass that simulated choroidal malignant melanoma.

Choroid Neoplasms↗
PubMed1991

Sympathetic ophthalmia associated with anterior chamber intraocular lens implantation.

We describe a rare case of sympathetic ophthalmia associated with intracapsular cataract extraction and anterior-chamber intraocular lens implantation. This occurred three months after an immediate postoperative complication of pupillary block, flat anterior chamber, and wound dehiscence with one of the lens haptics dissecting into the subconjunctival space. Both eyes developed granulomatous panuveitis, which partially responded to medical treatment. Removal of the anterior-chamber intraocular lens and pars plana vitrectomy resulted in control of the uveitis with significant visual improvement. A pathologic examination of material from the anterior chamber and vitreous showed lymphocytes, histiocytes, and pigment cells contributing to the diagnosis of sympathetic ophthalmia. To the best of our knowledge, this is the first report of an intraocular lens implicated as a cause of sympathetic ophthalmia.

Aged↗
PubMed1990

Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy.

Seven eyes (7 patients) developed massive suprachoroidal hemorrhage (MSCH) during pars plana vitrectomy (PPV) for complicated retinal detachments. The MSCH developed late in the procedure following PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling in five of seven eyes. In two eyes, mild hemorrhagic choroidal detachments noted intraoperatively progressed to MSCH within 72 hours postoperatively. Diagnosis of MSCH was confirmed by echography and CT scan. Multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation were the main risk factors. Placement of a broad posterior scleral buckle with intraoperative hypotony and cryopexy were important precipitating factors. Visual results were poor, with six of seven eyes showing no light perception. The mean follow-up time was 12.8 months. Once acute MSCH is recognized intraoperatively, surgical decompression at that time should be avoided as MSCH itself may tamponade the choroidal bleed. Details of prevention and management are discussed.

Adult↗
PubMed1989

Crohn's disease complicated by idiopathic central serous chorioretinopathy with bullous retinal detachment.

A case of idiopathic central serous chorioretinopathy with bullous retinal detachment occurring in a patient with Crohn's disease is described. This rare eye condition (36 reported cases in the world's literature) has previously been seen in association with ulcerative colitis, and its occurrence in a patient with Crohn's disease suggests that it may represent another ophthalmologic complication of inflammatory bowel disease.

Adult↗
PubMed1989

A new modified vitreoretinal surgical approach in the management of massive suprachoroidal hemorrhage.

The authors describe a new surgical approach used in six consecutive patients referred to us between August 1986 and August 1988 with massive suprachoroidal hemorrhage (MSCH) during or after cataract extraction (4 patients), glaucoma filtering surgery (1 patient), or scleral buckling (1 patient). All patients had large hemorrhagic choroidal detachments with five eyes showing "kissing" detachments. Secondary surgery was delayed 7 to 25 days (mean, 14 days) to allow liquefaction of the blood clot and reduce intraocular inflammation. All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid infusion line pressure, followed by pars plana anterior and posterior vitrectomy in five of six eyes. Additionally, two eyes underwent secondary lens implantation during surgery and 6 months later, respectively. Mean follow-up was 10 months. Visual acuity improved in all eyes from a preoperative range of light perception-hand motions to hand motions-20/40. Advantages and disadvantages of this aggressive surgical approach in the management of MSCH are discussed.

Aged↗
PubMed1988

Laser treatment of macular holes.

Macular holes have not been treated with the laser because of the rarity of subsequent total retinal detachment (RD). The authors attempted to clear the subretinal fluid of the halo by laser coagulation of the rim of the hole. Eighteen eyes with visual acuity of 20/200 or less were treated with a laser and followed for a mean of 34.8 months. Ten eyes (55.6%) improved three to eight lines, five eyes (27.8%) remained the same, and the vision of three (16.6%) deteriorated three to five lines. The best visual results noted in three eyes (20/400-20/70, 20/200-20/80, and 20/200-20/60) correlated with the least late loss of pigment epithelium and pigment migration.

Aged↗
PubMed1987

Pseudophakic and aphakic retinal detachment mimicking cystoid macular edema.

Seventeen eyes of patients who were being followed by their ophthalmologists for aphakic (8 eyes) or pseudophakic (9 eyes) cystoid macular edema (CME) were examined on referral. All eyes showed retinal detachment (RD), and eight eyes had CME with RD. Most RDs were inferior and shallow. Proliferative vitreoretinopathy (PVR) was noted in 15 eyes (88.2%). There was history of vitreous loss during the last intraocular surgery in 88.2% eyes. Visual acuity ranged from 20/40 to hand movements. Fundus view was hazy in most eyes, and indirect ophthalmoscopy was most useful in detecting RD. Retinal reattachment with scleral buckling and/or vitrectomy was achieved in 16 eyes (94.1%). Postoperative visual recovery was jeopardized due to longstanding macular detachment of greater than 1 month in 11 eyes (64.7%). Eight eyes (47%) achieved 20/50 vision whereas 25% did not improve to better than 20/400. Factors leading to failure in making the correct diagnosis and their prevention are discussed.

Aged↗
PubMed1985

Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma and other refractory glaucomas. A long-term study.

Long-term follow-up results of the anterior chamber tube shunt to an encircling band (ACTSEB) procedure are reported. Thirty eyes of 28 patients with neovascular glaucoma (Group I) and five eyes with non-neovascular refractory glaucoma (Group II) underwent this procedure. In Group I, the average preoperative intraocular pressure (IOP) was 57.1 mmHg. After surgery and average followup of 25 months 96% of eyes had a successful outcome with an average IOP of 15.8 mmHg (P less than 0.001). In Group II, despite multiple glaucoma surgical procedures, the average preoperative IOP was 54 mmHg. After surgery and average followup of 20 months 80% of eyes had a successful outcome with an average IOP of 19.8 mmHg (P less than 0.01). Revisions in our surgical technique utilizing a small entry with a 25-gauge needle into the anterior chamber and use of Healon resulted in a fully formed anterior chamber by two days. Clinical and experimental evidence is presented which suggest that aqueous filters through the tube to a reservoir around the encircling band.

Adult↗
PubMed1984

Transient myopia and accommodative paresis following retinal cryotherapy and panretinal photocoagulation.

Loss of accommodation, transient myopia, or both, were complications following retinal cryotherapy in two eyes and after panretinal photocoagulation in six eyes (seven patients). A 17-year-old young man had these refractive difficulties one week after cryotherapy for retinal holes. His accommodative amplitude measured 1.0 D in the treated eye and 8.0 D in the untreated eye. One week later he received cryotherapy to the previously untreated eye, reducing that accommodative amplitude to 2.5 D. Accommodative paresis and transient myopia resolved without treatment within five weeks. Six other patients (six eyes, seven episodes) with an average age of 33 years demonstrated accommodative loss (40% to 92% decrease, average decrease 64%), transient myopia, or both, after panretinal photocoagulation for proliferative diabetic retinopathy. All patients recovered without treatment within six weeks (average, 22 days). All young patients should be made aware of this transient, but troublesome complication before treatment.

Accommodation, Ocular↗
PubMed1984

Deferoxamine (Desferal)-induced toxic retinal pigmentary degeneration and presumed optic neuropathy.

Eight patients (16 eyes) developed ocular toxicity while undergoing intravenous deferoxamine mesylate (Desferal) chelation therapy for transfusional hemosiderosis. Presenting symptoms included decreased visual acuity, color vision abnormalities, and night blindness. Six patients presented as presumed retrobulbar optic neuropathy demonstrating central scotomas and color vision abnormalities. The remaining two patients presented with pigmentary changes confined either to the macula or equator. Following cessation of therapy, vision improved in all but four eyes, which did not attain their pretreatment visual acuity. Optic neuropathy resolved in all cases. However, follow-up revealed development of retinal pigmentary degeneration in seven patients, involving the macula in six and the equatorial retina in one. Fluorescein angiography and electrophysiological tests suggested toxicity at the level of retinal pigment epithelium and photoreceptors.

Aged↗
PubMed1983

Clindamycin in the treatment of toxoplasmic retinochoroiditis.

We treated 26 patients with acute toxoplasmic retinochoroiditis with clindamycin between 1974 and 1982. Four patients were treated with clindamycin alone and 17 with clindamycin and prednisolone. Five patients received clindamycin and prednisolone, sulfadiazine, pyrimethamine, or cryocoagulation, or a combination of these. All patients with the acute disease had the characteristic foci and a positive titer on the Sabin-Feldman dye test of at least 1:16. Other causes of retinochoroiditis were excluded. All but two patients, who developed diarrhea after two weeks, received clindamycin for a minimum of three weeks. All patients improved after two weeks of treatment, but two patients with lesions larger than 2 disk diameters required an additional six weeks of treatment to heal completely. During follow-up periods ranging from 18 months to seven years (mean, three years) there have been only two recurrences (7.7%). Complications with clindamycin treatment were limited to gastrointestinal upsets, diarrhea, and skin rash. There were no cases of pseudomembranous colitis, the most serious reported complication of clindamycin use.

Acute Disease↗
PubMed1983

Ongoing prospective clinical study of radial keratotomy.

The ongoing prospective clinical study of radial keratotomy at the University of Maryland now includes 58 eyes of 33 patients. Fifty-two eyes underwent a single operation, whereas six eyes underwent two operations. Follow-up was a minimum of six months and a mean of 19 months. Preoperative vision was 20/400 or less in 74% of eyes. Postoperative vision was 20/40 or better in 48% of eyes. There was an average myopia decrease of 2.70 diopters and an average corneal flattening of 1.51 diopters. Patients with preoperative refractive errors of 5 diopters or less achieved 20/40 or better vision in 65% of eyes, as compared to only 19% in eyes with preoperative refractive errors greater than 5 diopters. This is highly significant (P less than 0.005). There was no difference in the results achieved by our first 33 eyes when compared to our second 25 eyes. The decrease in myopia did not correlate with corneal curvature, or whether 8 or 16 incisions had been used. No microperforations were seen and only one case of endothelial cell loss was observed. Glare and fluctuating vision was not a significant problem in our series.

Adolescent↗