Search

Hannah Khan,1 Aamir A Aziz,1 Humza Sulahria,2 Huma Khan,2 Abrahim Ahmed,3 Netan Choudhry,4– 7 Raja Narayanan,8,9 Carl Danzig,10 Arshad M Khanani1,2 1University of Nevada, Reno School of Medicine, Reno, NV, USA; 2Sierra Eye Associates, Reno, NV, USA; 3Morsani College of Medicine, University of South Florida, Tampa, FL, USA; 4Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 5Vitreous Retina Macula Specialists of Toronto, Etobicoke, Ontario, Canada; 6Cleveland Clinic Canada, Toronto, Ontario, Canada; 7Octane Imaging Lab, Toronto, Ontario, Canada; 8Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India; 9Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), Hyderabad, Telangana, India; 10Rand Eye Institute, Deerfield Beach, FL, USACorrespondence: Arshad M Khanani, Sierra Eye Associates, 950 Ryland Street, Reno, NV, USA, Tel +1 775 329-0286, Fax +1 775 329-0849, Email Arshad.khanani@gmail.comAbstract: Age-related macular degeneration (AMD) is characterized as a chronic, multifactorial disease and is the leading cause of irreversible blindness. Advanced AMD is classified as neovascular (wet) AMD and non-neovascular (dry) AMD. Dry AMD can progress to a more advanced form that manifests as geographic atrophy (GA), which significantly threatens vision, leading to progressive and irreversible loss of visual function. There are currently no approved therapeutics commercially available for GA patients. However, data from various clinical trials have demonstrated favorable results with significant reduction in GA lesion growth. Approaches to GA treatment vary from complement inhibitors to ocular gene therapy, some of which may delay disease progression, while others may reverse the disease. This review furthers the understanding of the pathophysiology of GA, as well as current clinical trial data on investigational therapeutics.Keywords: complement system, gene therapy, neuroprotective agents, personalized treatment, anti-inflammatory agents, intravitreal injection

Kiran Chandra Kedarisetti,1 Raja Narayanan,1,2 Michael W Stewart,3 Nikitha Reddy Gurram,1 Arshad M Khanani4,5 1Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India; 2Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), Hyderabad, Telangana, India; 3Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 4Department of Clinical research, Sierra Eye Associates, Reno, NV, USA; 5Department of Ophthalmology, The University of Nevada, Reno, NV, USACorrespondence: Raja Narayanan, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India, Tel +91-9177111975, Email narayanan@lvpei.orgAbstract: Macular telangiectasia Type 2 (MacTel) is a gradually progressive disease that affects the quality of life by impairing both distant and near vision. It had previously been considered a vascular condition, but recent evidence suggests a neurodegenerative etiology, with primary involvement of Muller cells. Retinal pigment epithelium (RPE) hyperplasia and subretinal neovascularization (SNV) are responsible for most of the vision loss in advanced cases. Neurotrophic factors in the non-proliferative phase and intravitreal anti-Vascular Endothelial growth factor (VEGF) in the proliferative phase have shown to retard the progression of the disease. This review will discuss the pathophysiology, clinical features, important diagnostic imaging studies and available treatment options for MacTel.Keywords: macular telangiectasia type 2, MacTel, CNTF, ciliary neurotrophic factor

Srikanta Kumar Padhy,1 Brijesh Takkar,2,3 Raja Narayanan,2 Pradeep Venkatesh,4 Subhadra Jalali2,5 1Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India; 2Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L.V. Prasad Eye Institute, Hyderabad, India; 3Center of Excellence for Rare Eye Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India; 4Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 5Jasti V. Ramanamma Childrens’ Eye Care Centre, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, IndiaCorrespondence: Brijesh TakkarSrimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, L.V. Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, IndiaTel +91-9868092215Fax +91-40-23548271Email britak.aiims@gmail.comAbstract: Gene therapy has now evolved as the upcoming modality for management of many disorders, both inheritable and non-inheritable. Knowledge of genetics pertaining to a disease has therefore become paramount for physicians across most specialities. Inheritable retinal dystrophies (IRDs) are notorious for progressive and relentless vision loss, frequently culminating in complete blindness in both eyes. Leber’s congenital amaurosis (LCA) is a typical example of an IRD that manifests very early in childhood. Research in gene therapy has led to the development and approval of voretigene neparvovec (VN) for use in patients of LCA with a deficient biallelic RPE65 gene. The procedure involves delivery of a recombinant virus vector that carries the RPE65 gene in the subretinal space. This comprehensive review reports the evidence thus far in support of gene therapy for LCA. We explore and compare the various gene targets including but not limited to RPE65, and discuss the choice of vector and method for ocular delivery. The review details the evolution of gene therapy with VN in a phased manner, concluding with the challenges that lie ahead for its translation for use in communities that differ much both genetically and economically.Keywords: gene therapy, voretigene neparvovec, Luxturna, Leber’s congenital amaurosis, retinal dystrophy

A hardware-based variant known as an automatic fire extinguisher is used to put out fires when they start accidentally. Boards made of calcium silicate that can endure extremely high temperatures are used to coat the shield. Thermocouple ends are heated to a cut-off temperature, over which the robot begins responding to the fire, to change the robot's sensitivity to temperature. The biggest plus to this is that it automatically switches on when it senses a fire in its immediate vicinity using a thermocouple and moves in that direction in an attempt to put it out. In extreme situations, the temperature sensor acts as a backup for the thermocouple, as it detects fire or heating temperature the extinguishing agent is released and it flows through the solenoid valve for extinguishment of fire. Both life and property at the same instance of time. our system reduce the risk factors of rescuing life and property by immediately extinguishing the fire at first foremost the incident happens and the DAF EXTINGUISHER automatically does all the work and extinguishing the fire.

Raja Narayanan,1 Bhavik Panchal,1 Michael W Stewart,2 Taraprasad Das,1 Jay Chhablani,1 Subhadra Jalali,1 Mohd Hasnat Ali3 On behalf of MARVEL study group 1Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India; 2Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 3Department of Biostatistics, L V Prasad Eye Institute, Hyderabad, India Purpose: The purpose of this study was to prospectively study the efficacy of grid laser combined with intravitreal bevacizumab or ranibizumab in eyes with macular edema due to branch retinal vein occlusion.Patients and methods: Treatment-naïve eyes were enrolled to receive injections of ranibizumab or bevacizumab. During the first 6 months, patients were evaluated monthly and injected if the best-corrected visual acuity changed by five or more letters or fluid was noted on spectral domain optical coherence tomography (OCT); during the next 6 months, patients were evaluated bimonthly and injected only if the best-corrected visual acuity decreased by five or more letters with the associated fluid. Grid laser photocoagulation was performed if there was fluid on OCT and was repeated if patients were eligible after a minimum interval of 3 months.Results: The mean numbers of ranibizumab and bevacizumab injections were, respectively, 3.2±1.5 and 3.0±1.4 in the first 6 months and 0.3±0.6 and 0.3±0.6 in the last 6 months. ­Moreover, 55/75 (73.33%) participants did not receive any injections in the last 6 months. The mean reductions in central retinal thickness at 12 months were 165.67 µm (P

Animesh Jindal,1 Avinash Pathengay,1 Subhadra Jalali,2 Annie Mathai,2 Rajeev Reddy Pappuru,2 Raja Narayanan,2 Jay Chhablani,2 Savitri Sharma,3,4 Taraprasad Das,2,3 Harry W Flynn Jr51L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, India; 2Srimati Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, KAR Campus, Hyderabad, India; 3L V Prasad Eye Institute, Bhubaneswar Eye Institute, Bhubaneswar, Odisha, India; 4Jhaveri Microbiology Centre, L V Prasad Eye Institute, KAR Campus, Hyderabad, India; 5Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USAAbstract: The objective of this study was to evaluate the microbiological spectrum and antimicrobial susceptibility of isolates in delayed post-cataract surgery endophthalmitis. A retrospective review of 33 consecutive patients with culture proven delayed post-cataract surgery endophthalmitis was done from January 2006 to March 2013. There were 22 bacterial and eleven fungal cases. Common isolates were Streptococci (seven cases), coagulase-negative staphylococci (five), Gram-negative bacilli (seven), Nocardia (two), Aspergillus (five), Candida (five). Gram-positive cocci were most susceptible to vancomycin and gatifloxacin (91.7%). Gram-negative isolates were most susceptible to ofloxacin (85.7%). Fungi being slow growing organisms are an important cause of delayed post-cataract surgery endophthalmitis.Keywords: delayed endophthalmitis, microbiology, antibiotic sensitivity

Connor Chevli,1 Ramkishen Narayanan,1,2 Lisa Rambarran,1 Gregory Kubicek,3 K Kent Chevli,1,2 Michael Duff11Cancer Care of Western New York, Cheektowaga, NY, 2State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 3University of Pittsburgh School of Medicine, Pittsburgh, PA, USABackground: The aim of this study was to describe the effect of pretreatment prostate volume on urinary quality of life after intensity-modulated radiation therapy (IMRT) for clinically localized prostate cancer.Methods: A total of 368 men treated with prostate IMRT (77.4–81 Gy) were stratified into three gland volume groups, ie, 60 g (group 3). Post-IMRT urinary function was evaluated by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 genitourinary guidelines at one year post-IMRT, and surveyed by the International Prostate Symptom Score (IPSS) before treatment, and then at one month and one year post-IMRT.Results: Late (one year post-IMRT) CTCAE version 4.0 genitourinary toxicity occurred in 11/368 (3.0%) men, but was not severe (grade ≥ 3); total toxicity was similar between the prostate volume groups (P = 0.86). Continuous prostate volume neither correlated with (P = 0.50) nor predicted late genitourinary toxicity (univariate odds ratio 0.99, 95% confidence interval 0.96–1.02). The total IPSS cohort, group 1 (60 g) had the highest pretreatment IPSS, but uniquely showed a better urinary symptom trend than the smaller volume groups, with similar IPSS from baseline to one month post-IMRT (P = 0.88) and improved post-treatment IPSS from baseline at one year (P = 0.003).Conclusion: Pretreatment prostate volume and initial IPSS scores were not associated with increased late genitourinary toxicity after IMRT in our series. Patients with smaller prostates had an initial increase in urinary symptoms, but returned to baseline at one year. Larger prostate glands (>60 g) had comparatively worse pretreatment symptoms, but at one year showed an overall improvement in IPSS versus baseline.Keywords: prostate, volume, radiation, intensity-modulated radiation therapy, urinary, International Prostate Symptom Score, toxicity, Common Terminology Criteria for Adverse Events

We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months′ follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.