33 results on '"Srinivasan B"'
Search Results
2. Author's Response to Comments on "Depth, size of infiltrate, and the microbe - The trio that prognosticates the outcome of infective keratitis".
- Author
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Agarwal S, Srinivasan B, Iyer G, Pandey S, Agarwal M, Dhiman R, Surya J, and Anand AR
- Subjects
- Humans, Prognosis, Cornea microbiology, Cornea pathology, Corneal Ulcer microbiology, Corneal Ulcer diagnosis, Keratitis microbiology, Keratitis diagnosis, Bacteria isolation & purification, Eye Infections, Bacterial microbiology, Eye Infections, Bacterial diagnosis
- Published
- 2024
- Full Text
- View/download PDF
3. Aberration change after scleral lens wear in eyes with pellucid marginal degenerations.
- Author
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Dutta R, Iyer G, Srinivasan B, and Iqbal A
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Follow-Up Studies, Contact Lenses, Contrast Sensitivity physiology, Young Adult, Corneal Dystrophies, Hereditary physiopathology, Corneal Dystrophies, Hereditary diagnosis, Aberrometry, Prospective Studies, Cornea pathology, Cornea diagnostic imaging, Visual Acuity physiology, Sclera, Corneal Topography, Corneal Wavefront Aberration physiopathology, Corneal Wavefront Aberration diagnosis, Refraction, Ocular physiology
- Abstract
Purpose: To investigate the impact of scleral lenses (SLs) on higher-order aberrations (HOAs), corrected distance visual acuity (CDVA), and contrast sensitivity (CS) in pellucid marginal degeneration (PMD) eyes., Methods: SLs were fitted in 24 eyes diagnosed with PMD. CDVA, CS, and HOAs were measured at baseline and with the lens on the eye. The HOAs were measured using an i-Trace aberrometer., Results: A statistically significant improvement was noted in CDVA ( P < 0.001) with BSS lenses (0.05 ± 0.04) compared to baseline (0.42 ± 0.06). Front surface eccentricity 1 (FSE1) lens provided the best CDVA in most of the eyes. The baseline CS of 1.24 ± 0.74 improved to 1.58 ± 0.48 with SL and reported a statistically significant improvement ( P < 0.001) and a gain of 6 letters. The baseline higher order-root mean square (HO-RMS) was 0.89 ± 0.53 µm, which reduced to 0.38 ± 0.24 µm ( P < 0.001), and RMS coma of 0.45 ± 0.29 µm improved to 0.20 ± 0.12 µm ( P < 0.001). Though there was a marginal reduction from 0.04 ± 0.14 to 0.03 ± 0.07, RMS spherical aberration did not show any statistically significant difference ( P = 0.37). RMS secondary astigmatism reduced from 0.17 ± 0.15 µm to 0.08 ± 0.12 µm ( P = 0.007), and RMS trefoil reduced to 0.13 ± 0.09 µm from 0.64 ± 0.36 µm ( P < 0.001) with SLs and showed statistically significant improvement., Conclusion: SLs can be considered an effective option that corrects a significant amount of HOAs and enhances visual performances in PMD eyes., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)
- Published
- 2024
- Full Text
- View/download PDF
4. A case of granulomatosis with polyangiitis-associated scleritis presenting as conjunctivitis.
- Author
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Doshi A, Shah M, Srinivasan B, and Majumder PD
- Abstract
A 42-year-old male presented initially with conjunctivitis and was treated with topical medical medications without any improvement. He developed ocular pain subsequently and further examination revealed lid edema, conjunctival hyperemia with chemosis, matting of lashes with yellowish discharge, and deeper episcleral congestion which did not blanch with topical vasoconstrictor. Subsequent laboratory investigation revealed positive cytoplasmic-antineutrophil cytoplasmic antibody (Anti-PR 3 antibody). He continued to develop recurrences and finally responded to oral azathioprine. Granulomatosis with polyangitis may rarely present as conjunctivitis and subsequently manifest as scleritis., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Oman Ophthalmic Society.)
- Published
- 2024
- Full Text
- View/download PDF
5. Depth, size of infiltrate, and the microbe - The trio that prognosticates the outcome of infective keratitis.
- Author
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Agarwal S, Srinivasan B, Iyer G, Pandey S, Agarwal M, Dhiman R, Surya J, and Anand AR
- Subjects
- Humans, Ulcer, Retrospective Studies, Corneal Ulcer diagnosis, Corneal Ulcer microbiology, Eye Infections, Bacterial diagnosis, Eye Infections, Bacterial microbiology, Eye Infections, Fungal diagnosis, Eye Infections, Fungal microbiology, Acanthamoeba Keratitis
- Abstract
Purpose: To analyze the influence of infiltrate size, depth, and organism on the outcome of microbial keratitis., Design: Retrospective comparative study., Methods: Medical records of patients with infective keratitis, who reported from January 2015 to December 2019 to a tertiary eye care center, were analyzed. Size and depth of ulcer at presentation were the factors used to group patients, and the influence on the outcome of the organism causing it was analyzed. Grouping was as follows: group A: ulcer size <6 mm/anterior to midstromal infiltrate, group B: ulcer < 6 mm/full-thickness infiltrate, group C: ulcer >6 mm/anterior to midstromal infiltrate, group D: ulcer > 6 mm/full-thickness infiltrate. Patients with viral keratitis or unidentified organism were excluded. Response to treatment and best-corrected visual acuity (BCVA) at the final follow-up were the outcome measures., Results: In the study, 1117/6276 patients were included, with 60.8% patients in group A. A significant improvement in visual acuity was noted in groups A/B compared to groups C/D. Group A had the best response to medical management, irrespective of the organism. Higher risk for surgery was noted in group C compared to group B, with group A as the reference. Overall resolution with medical treatment was noted in 70% miscellaneous keratitis, 64.8% bacterial keratitis, 64.3% mixed keratitis, 62.5% acanthamoeba keratitis, 52.6% fungal keratitis, and 12.1% Pythium keratitis. Bacteria and acanthamoeba responded better to medical management than fungal keratitis, whereas Pythium had the highest risk for surgery., Conclusion: An interplay between virulence of the organism along with depth and size of the infiltrate determines the outcome of microbial keratitis., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)
- Published
- 2024
- Full Text
- View/download PDF
6. Dry eye module - An application intelligence platform for diagnosing and monitoring dry eye disease.
- Author
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Iyer G, Srinivasan B, Agarwal S, Chatterjee S, Swarup R, and Srinivas P
- Subjects
- Humans, Tears, Cornea, Meibomian Glands, Dry Eye Syndromes diagnosis
- Abstract
Dry Eye Module (DEM), a software application, was developed to facilitate the streamlining of dry eye evaluation and documentation, to unify diagnostic jargon, and to analyze data input to generate a dry eye diagnostic report. This diagnostic report generated is based on the current understanding of dry eye diagnostic algorithms (Dry Eye Workshop 2 [DEWS2]/Asia Dry Eye Society [ADES]). Apart from its plausible role in aiding unprecedented multicentric dry eye demographic data collection, the application software can generate a customized referral letter to the rheumatologist, highlighting the salient ophthalmic features to be shared. DEM uses schematic illustrations to depict eyelid, conjunctival, and corneal parameters that impact the ocular surface in dry eyes that can be captured and compared during serial visits. Furthermore, DEM displays a symptom sign trend chart that graphically represents improvement/stability or worsening of the subjective and objective dry eye status. DEM can generate a curated prescription using preloaded advice templates. DEM includes facility for state-of-the-art advanced dry eye diagnostic reporting for super specialty use. The addition of DEM to the dry eye diagnostic armamentarium would help bridge the current unmet needs of dry eye evaluation. These are lack of uniform reporting, lack of multicentric data on a unified platform, the inability to ensure complete evaluation, inability to avoid lacunae during follow-up visits, and the lack of a simple patient-ophthalmologist and an ophthalmologist-rheumatologist interface., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
7. Keratoprosthesis in dry eye disease.
- Author
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Sharma S, Donthineni PR, Iyer G, Chodosh J, de la Paz MF, Maskati Q, Srinivasan B, Agarwal S, Basu S, and Shanbhag SS
- Subjects
- Humans, Cornea surgery, Cornea pathology, Prostheses and Implants adverse effects, Blindness surgery, Retrospective Studies, Prosthesis Implantation, Corneal Diseases diagnosis, Corneal Diseases surgery, Corneal Diseases etiology, Dry Eye Syndromes etiology, Dry Eye Syndromes surgery
- Abstract
Bilateral corneal blindness with severe dry eye disease (DED), total limbal stem cell deficiency with underlying corneal stromal scarring and vascularization, combined with adnexal complications secondary to chronic cicatrizing conjunctivitis is a highly complex situation to treat. In such eyes, procedures such as penetrating keratoplasty alone or combined with limbal stem cell transplantation are doomed to fail. In these eyes, keratoprosthesis (Kpro) or an artificial cornea is the most viable option, eliminating corneal blindness even in eyes with autoimmune disorders such as Stevens-Johnson syndrome, ocular mucous membrane pemphigoid, Sjogren's syndrome, and nonautoimmune disorders such as chemical/thermal ocular burns, all of which are complex pathologies. Performing a Kpro in these eyes also eliminates the need for systemic immunosuppression and may provide relatively early visual recovery. In such eyes, the donor cornea around the central cylinder of the Kpro needs to be covered with a second layer of protection to avoid desiccation and progressive stromal melt of the underlying cornea, which is a common complication in eyes with severe DED. In this review, we will focus on Kpro designs that have been developed to survive in eyes with the hostile environment of severe DED. Their outcomes in such eyes will be discussed., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
8. Aqueous deficiency dry eye in post conjunctivitis cicatrization - Effect of deep thermal punctal cautery.
- Author
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Agarwal M, Srinivasan B, Agarwal S, Pandey S, Kumar SPS, Sadhu S, Saranya S, and Iyer G
- Subjects
- Male, Humans, Adolescent, Young Adult, Adult, Female, Tears, Retrospective Studies, Cicatrix, Cautery adverse effects, Lacrimal Apparatus surgery, Dry Eye Syndromes diagnosis, Dry Eye Syndromes etiology, Dry Eye Syndromes surgery, Conjunctivitis
- Abstract
Purpose: To evaluate the effect of deep thermal punctal cautery in eyes with post-conjunctivitis cicatrization., Methods: This retrospective study consisted of patients who underwent deep thermal punctal cautery for post-conjunctivitis dry eye (PCDE). The diagnosis was based on a history suggestive of viral conjunctivitis in past followed by the onset of present clinical features of aqueous deficiency dry eye (ATD). All patients underwent a rheumatological evaluation to rule out underlying systemic collagen vascular disease as a cause for dry eye. The extent of cicatricial changes was noted. Best-corrected visual acuity (BCVA), Schirmer's test, and fluorescein staining score (FSS; total score of 9) were analyzed pre- and post-cautery., Results: Out of 65 patients (117 eyes), 42 were males. The mean age at presentation was 25.769 ± 12.03 years. Thirteen patients presented with unilateral dry eye. Pre-cautery BCVA (logarithm of the minimum angle of resolution [logMAR]) and Schirmer's test (mm) improved from 0.5251 ± 0.662 to 0.372 ± 0.595 (P value = 0.000, 95% confidence interval [CI]: 0.09-0.22), and 1.952 ± 2.763 to 4.929 ± 4.338 (P value = 0.000, 95% CI: -3.79--2.17); post-cautery, respectively. The pre-cautery FSS of 5.9 ± 2.82 reduced to 1.58 ± 2.38 (P value = 0.000, 95% CI: 3.46-5.17) post-cautery. The mean follow-up was 11.22 ± 13.32 months. No progression in cicatricial changes was noted in any eye during the follow-up. Re-canalization rate was 10.64%, and repeat cautery was performed with successful closure of puncta., Conclusion: Symptoms and clinical signs of ATD in PCDE patients improve with punctal cautery., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
9. E-PIX: An enhanced grading for acute ocular burns.
- Author
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Iyer G, Srinivasan B, Agarwal S, and Fogla R
- Subjects
- Humans, Visual Acuity, Cornea, Eye Burns chemically induced, Eye Burns diagnosis, Eye Diseases, Corneal Transplantation, Burns, Chemical diagnosis, Burns, Chemical surgery, Limbus Corneae
- Abstract
An enhanced online and manual grading system, based on the I's and E's, for acute ocular chemical injuries is being proposed. E-PIX is designed to be an online/manual grading system that includes all the parameters that adversely affect the outcome of acute chemical injuries. The importance of addressing the I's and E's in chemical burns cannot be underestimated. These include the need for the documentation and management of epithelial defect (E), intraocular pressure (P) (IOP), ischemia (scleral) (I), and exposure (X) (acronym - E-PIX). Epithelial defect includes that involving the limbus (L), along with conjunctival (C), corneal (K), and tarsal (T). These additional parameters are graded and represented as an annotation along with the limbal grade providing a comprehensive grading for the injury. A manual entry sheet and a freely accessible online grade generator are a part of the system. The proposed enhanced grading offers a final annotation that provides a clear understanding of all factors that can lead to vision-threatening complications ensuring their assessment and hence subsequently their addressal to improve outcomes, if abnormal. The prognostication continues to be based on the grade of limbal involvement. The additional annotations impact prognosis and outcome if not addressed. Including the laterality of injury provides, in addition, a futuristic understanding of available options. The grade generator retains the flexibility to be dynamic with changes reflecting upon the healing process in the acute stage. The proposed system aims to provide primary and tertiary caregivers alike with a uniform grading system., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
10. A comprehensive ocular profile using multimodal imaging systems and surgical outcome in a patient with Alport syndrome.
- Author
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Sadhu S, Balaji JJ, and Srinivasan B
- Abstract
Competing Interests: There are no conflicts of interest.
- Published
- 2022
- Full Text
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11. Commentary: Endothelial keratoplasty in congenital hereditary endothelial dystrophy - Benefits and challenges.
- Author
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Srinivasan B, Agarwal S, and Iyer G
- Subjects
- Humans, Corneal Dystrophies, Hereditary diagnosis, Corneal Dystrophies, Hereditary surgery, Corneal Transplantation
- Abstract
Competing Interests: None
- Published
- 2022
- Full Text
- View/download PDF
12. Perioperative nuances of cataract surgery in ocular surface disorders.
- Author
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Agarwal S, Srinivasan B, Harwani AA, Fogla R, and Iyer G
- Subjects
- Coloring Agents, Ecosystem, Humans, Refraction, Ocular, Retrospective Studies, Cataract complications, Cataract Extraction, Lenses, Intraocular
- Abstract
Ocular surface disorders (OSDs) constitute a varied spectrum of conditions that could be associated with dryness, compromised limbal status, varying grades of forniceal obliteration, corneal scars, and a possible underlying immune etiology. These associations adversely impact surgical outcomes in the eye. One of the treatable causes of decreased vision in these eyes is cataracts which could be secondary to the disease, its treatment, or age-related. The compromised ocular surface status can interfere with decision-making regarding the technique of cataract surgery, preoperative biometry for intraocular lens (IOL) power calculation, and intraoperative visibility, increasing the possibility of complications and compromising the final visual outcome. The postoperative course can be affected by complications, including melt and infection. Stabilization of the ocular surface by medical or surgical means, and appropriate management of underlying immune etiology, if any, helps improve and maintain a healthy ocular surface, optimizing cataract outcomes. With the help of pre, intra, and postoperative tools and means, such as punctal occlusion, ocular surface reconstruction, systemic immunosuppression, illuminators, capsule staining dyes, optical iridectomy, prosthetic replacement of the ocular surface ecosystem (PROSE) lenses, and others, the visual outcome post-cataract surgery in these eyes can be maximized. This article highlights the nuances of performing cataract surgery in various OSDs and the need to have a comprehensive stepwise approach is emphasized., Competing Interests: None
- Published
- 2022
- Full Text
- View/download PDF
13. Update on diagnosis and management of refractory corneal infections.
- Author
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Agarwal S, Khan TA, Vanathi M, Srinivasan B, Iyer G, and Tandon R
- Subjects
- Eye, Humans, Anti-Infective Agents, Corneal Perforation, Corneal Ulcer diagnosis, Corneal Ulcer drug therapy, Keratitis diagnosis, Keratitis drug therapy
- Abstract
Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to the emergence of resistant or refractory microorganisms has further worsened the prognosis. Coexisting ocular surface diseases, delay in diagnosis due to inadequate microbiological sample, a slow-growing/virulent organism, or systemic immunosuppressive state all contribute to the refractory response of the ulcer. With improved understanding of these varied ocular and systemic factors contributing to the refractory nature of the microbes, role of biofilm formation and recent research on improving the bioavailability of drugs along with the development of alternative therapies have helped provide the required multidimensional approach to effectively diagnose and manage cases of refractory corneal ulcers and prevent corneal perforations or further dissemination of disease. In this review, we explore the current literature and future directions of the diagnosis and treatment of refractory keratitis., Competing Interests: None
- Published
- 2022
- Full Text
- View/download PDF
14. Pythium insidiosum keratitis - A review.
- Author
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Gurnani B, Kaur K, Venugopal A, Srinivasan B, Bagga B, Iyer G, Christy J, Prajna L, Vanathi M, Garg P, Narayana S, Agarwal S, and Sahu S
- Subjects
- Agar therapeutic use, Animals, Humans, Corneal Ulcer diagnosis, Keratitis diagnosis, Keratitis drug therapy, Keratitis epidemiology, Pythiosis diagnosis, Pythiosis epidemiology, Pythiosis therapy, Pythium
- Abstract
Pythium insidiosum is an oomycete and is also called "parafungus" as it closely mimics fungal keratitis. The last decade saw an unprecedented surge in Pythium keratitis cases, especially from Asia and India, probably due to growing research on the microorganism and improved diagnostic and treatment modalities. The clinical features such as subepithelial infiltrate, cotton wool-like fluffy stromal infiltrate, satellite lesions, corneal perforation, endoexudates, and anterior chamber hypopyon closely resemble fungus. The classical clinical features of Pythium that distinguish it from other microorganisms are reticular dots, tentacular projections, peripheral furrowing, and early limbal spread, which require a high index of clinical suspicion. Pythium also exhibits morphological and microbiological resemblance to fungus on routine smearing, revealing perpendicular or obtuse septate or aseptate branching hyphae. Culture on blood agar or any other nutritional agar is the gold standard for diagnosis. It grows as cream-colored white colonies with zoospores formation, further confirmed using the leaf incarnation method. Due to limited laboratory diagnostic modalities and delayed growth on culture, there was a recent shift toward various molecular diagnostic modalities such as polymerase chain reaction, confocal microscopy, ELISA, and immunodiffusion. As corneal scraping (10% KOH, Gram) reveals fungal hyphae, antifungals are started before the culture results are available. Recent in vitro molecular studies have suggested antibacterials as the first-line drugs in the form of 0.2% linezolid and 1% azithromycin. Early therapeutic keratoplasty is warranted in nonresolving cases. This review aims to describe the epidemiology, clinical features, laboratory and molecular diagnosis, and treatment of Pythium insidiosum keratitis., Competing Interests: None
- Published
- 2022
- Full Text
- View/download PDF
15. Commentary: Tackling the "silent epidemic".
- Author
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Srinivasan B, Iyer G, and Agarwal S
- Subjects
- Humans, Epidemics
- Abstract
Competing Interests: None
- Published
- 2022
- Full Text
- View/download PDF
16. Clinical Significance of Talon Cusp in a Mixed Dentition Patient.
- Author
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Srinivasan B, Jegatheeswaran AG, Radhakrishnan S, Hayyan FMB, and Thangavelu A
- Abstract
Talon cusp is a developmental dental anomaly with supernumerary structure projecting from the dento-enamel junction towards the incisal edge of an anterior tooth. The etiology is usually unknown but studies states that talons cusp can occur due to the hyperactivity of the enamel organ during morph differentiation. The incidence is 0.04-10% and the prevalence is more in maxillary incisors than mandibular incisors and more in palatal aspect of the teeth. The most common complications are esthetics, increased risk for caries and occlusal accommodation. This article reports a case of talon cusp on the palatal surface of the permanent maxillary lateral incisor. Due to its clinical significance the dentist should be able to diagnose the supernumerary tooth and definitive treatment should be done., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)
- Published
- 2021
- Full Text
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17. Chlorhexidine: An Elixir for Periodontics.
- Author
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Thangavelu A, Kaspar SS, Kathirvelu RP, Srinivasan B, Srinivasan S, and Sundram R
- Abstract
Chlorhexidine is a cationic bisbiguanide with broad antibacterial activity, and wide spectrum of activity encompassing gram-positive and gram-negative bacteria, yeasts, dermatophytes and some lipophilic viruses. Its antibacterial action is due to the disruption of the bacterial cell membrane by the chlorhexidine molecules, increasing the permeability and resulting in cell lysis. Thus, chlorhexidine plays a key role in the dentistry and is used to treat or prevent periodontal disease, and has earned its eponym of the gold standard. This article reviews in detail about the mechanism of action, indications, forms and various studies related to chlorhexidine., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences.)
- Published
- 2020
- Full Text
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18. Severe acute onset dry eye following presumed Epstein.Barr viral infection.
- Author
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Chatterjee S, Iyer G, Srinivasan B, Agarwal S, and Kuila J
- Subjects
- DNA, Viral, Humans, Polymerase Chain Reaction, Dry Eye Syndromes diagnosis, Dry Eye Syndromes etiology, Virus Diseases
- Abstract
Competing Interests: None
- Published
- 2020
- Full Text
- View/download PDF
19. Late onset Descemet's membrane detachment: 15 years after limbal lensectomy with vitrectomy for ROP.
- Author
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Rishi E, Srinivasan B, Singh N, and Gopal L
- Subjects
- Corneal Diseases diagnosis, Corneal Diseases surgery, Follow-Up Studies, Humans, Infant, Newborn, Male, Postoperative Complications, Reoperation, Retinopathy of Prematurity diagnosis, Tomography, Optical Coherence, Visual Acuity, Corneal Diseases etiology, Descemet Membrane pathology, Descemet Stripping Endothelial Keratoplasty methods, Forecasting, Phacoemulsification adverse effects, Retinopathy of Prematurity surgery, Vitrectomy adverse effects
- Abstract
A case of stage 4B retinopathy of prematurity (ROP) after successful retinal reattachment surgery with maintained vision presented with hazy cornea with spontaneous Descemet's membrane detachment (DMD) 15 years after the surgery, requiring Descemet Stripping Endothelial Keratoplasty (DSEK) to restore vision. There are reports of late spontaneous DMD after phacoemulsification or previous corneal surgeries. This report is unique as there is no published literature of spontaneous DMD after limbal surgery for ROP when searched in PubMed. The immature Descemet's membrane (DM), surgical intervention and changes in immature DM with age would have contributed to spontaneous DMD and warrant a long-term follow-up of premature kids., Competing Interests: None
- Published
- 2019
- Full Text
- View/download PDF
20. Isolation of acid from eye drop bottles being used by patients presenting with presumed scleritis.
- Author
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Iyer G, Agarwal S, Srinivasan B, and Narayanasamy A
- Subjects
- Acids analysis, Aged, Burns, Chemical diagnosis, Burns, Chemical etiology, Eye Burns chemically induced, Eye Burns diagnosis, Female, Follow-Up Studies, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Retrospective Studies, Sclera drug effects, Acids isolation & purification, Burns, Chemical drug therapy, Drug Packaging, Eye Burns drug therapy, Ophthalmic Solutions chemistry, Sclera pathology, Scleritis drug therapy
- Abstract
Purpose: The aim of the study was to report the occurrence of contamination/replacement of ophthalmic eye drops with liquids of acidic nature in patients treated for nonresponding scleritis., Methods: This was a retrospective interventional case series study., Results: Of the three patients (4 eyes) referred as necrotizing scleritis, two were found to have acid as the content in the bottle/s being used as eye drops, confirmed using biochemical tests. All four eyes had tarsal ischemia and tarsal conjunctival defect in addition to severe scleral ischemia involving the inferior bulbar area. All four eyes required tenonplasty with amniotic membrane transplant more than once for the ocular surface to heal. Two of the three patients were on systemic immunosuppressives including pulse cyclophosphamide for refractory necrotizing scleritis. Sulfuric and hydrochloric acid was isolated from the bottles of 2
nd and 3rd patient using confirmatory biochemical tests., Conclusion: It is important to be aware of the possibility of contaminating or replacing contents of eye drops with harmful agents of acidic nature and should be considered in situations that resemble the clinical picture described herein., Competing Interests: There are no conflicts of interest- Published
- 2018
- Full Text
- View/download PDF
21. Vernal keratoconjunctivitis in human immunodeficiency virus - The possible role of T-helper 1-T-helper 2 shift.
- Author
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Agarwal S, Srinivasan B, Iyer G, Sudharshan S, and Kalaivani K
- Subjects
- CD4 Lymphocyte Count, Child, Conjunctivitis, Allergic diagnosis, Conjunctivitis, Allergic immunology, HIV Infections immunology, Humans, Male, Visual Acuity, Conjunctivitis, Allergic complications, HIV, HIV Infections complications, Immunity, Cellular, Th1 Cells immunology, Th2 Cells immunology
- Abstract
Human immunodeficiency virus infection (HIV) is associated with a reduced T-helper (Th) 1 response, and vernal keratoconjunctivitis (VKC) occurs secondary to a heightened Th2 response. VKC has been reported to occur in patients with HIV. In all probability, a Th1-Th2 shift occurs in the immune response in progressive HIV patients with a decreasing CD4 count. This shift could be the probable cause for the initiation and gradual worsening of the VKC in our patient that corresponded to the dropping CD4 counts. VKC resolved only after a change in antiretroviral therapy for HIV that caused a demonstrable increase in the CD4 counts possibly by reversing the shift., Competing Interests: There are no conflicts of interest
- Published
- 2018
- Full Text
- View/download PDF
22. Keratoprosthesis: Current global scenario and a broad Indian perspective.
- Author
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Iyer G, Srinivasan B, Agarwal S, Talele D, Rishi E, Rishi P, Krishnamurthy S, Vijaya L, Subramanian N, and Somasundaram S
- Subjects
- Blindness etiology, Corneal Diseases complications, Humans, India, Artificial Organs, Blindness surgery, Cornea surgery, Corneal Diseases surgery, Prostheses and Implants
- Abstract
Keratoprosthesis (Kpro) forms the last resort for bilateral end-stage corneal blindness. The Boston Type 1 and 2 Kpros, the modified osteo-odonto Kpro and the osteo-Kpro are the more frequently and commonly performed Kpros, and this review attempts to compile the current data available on these Kpros worldwide from large single-center studies and compare the indications and outcomes with Kpros in the Indian scenario. Although the indications have significantly expanded over the years and the complications have reduced with modifications in design and postoperative regimen, these are procedures that require an exclusive setup, and a commitment toward long-term follow-up and post-Kpro care. The last decade has seen a surge in the number of Kpro procedures performed worldwide as well as in India. There is a growing need in our country among ophthalmologists to be aware of the indications for Kpro to facilitate appropriate referral as well as of the procedure to enable basic evaluation during follow-ups in case the need arises, and among corneal specialists interested to pursue the field of Kpros in understanding the nuances of these surgeries and to make a judicious decision regarding patient and Kpro selection and more importantly deferral., Competing Interests: There are no conflicts of interest
- Published
- 2018
- Full Text
- View/download PDF
23. Scleral necrosis in congenital erythropoietic porphyria: A case report and review of the literature.
- Author
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Agarwal S, Majumder PD, Srinivasan B, and Iyer G
- Abstract
A 28-year-old presented with complaints of severe pain and redness in the left eye since 2 weeks. He had similar complaints in the right eye 2 years back for which he had undergone a scleral patch graft. Best corrected visual acuity was 20/20 in both eyes. The right had a well vascularized scleral graft and rest of the anterior segment was normal. The left eye had inferior conjunctival congestion with an area of the scleral melt with uveal show just temporal to the limbus in the interpalbebral area. The cornea was clear and anterior chamber was quiet in the left eye. Applanation tonometry and fundus evaluation were normal in both eyes. Physical examination revealed hyperpigmented skin lesion, hypertrichosis and absorption of distal phalanges. Laboratory, ocular and physical findings confirmed the diagnosis of congenital erythropoietic porphyria. He was on oral steroids 40 mg/day since 2 weeks and topical antibiotics and lubricants. He was advised to continue the same and was taken up for scleral patch graft with fibrin glue in the left eye. Postoperatively he was continued on topical and oral steroids and lubricants.3 weeks later the left eye had stabilized however patient came with a melt in the right eye. Since it was an early melt, we went ahead with cyanoacrylate glue and bandage contact lens in the right eye and started him on topical steroids for the right eye also. Three months later both the eyes were stable, and the patient was gradually tapered off the steroids.
- Published
- 2015
- Full Text
- View/download PDF
24. The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: A randomized clinical trial.
- Author
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Sudhakar V, Vinodhini TS, Mohan AM, Srinivasan B, and Rajkumar BK
- Abstract
Introduction: Pain-free treatment to the patients is considered as an important treatment objective for orthodontic health care providers. However, many orthodontists underestimate the degree of pain experienced by the patients. Hence, this study was conducted as a randomized, double-blinded clinical trial with the following objectives., Objective: To study the pain characteristics after separator placement; to compare the efficacy of various commonly used analgesics in pain management and to determine the efficacy of pre- and post-operative analgesics in pain management., Subjects and Methods: Data were collected from 154 patients (77 males and 77 females, age group of 14-21 years, with mean age of 18.8 years) who reported to Department of Orthodontics. Patients were randomly divided in to four groups. Group 1: Paracetamol 650 mg, Group 2: Ibuprofen 400 mg, Group 3: Aspirin 300 mg, Group 4: Placebo and the study were conducted as a randomized, double-blinded clinical trial. The patients were instructed to take two tablets, one tablet 1 h before separator placement, and the other one after 6 h. The pain evaluations were made by the patients, when teeth not touching (TNT), biting back teeth together, chewing food (CF) using a 100-mm visual analogue scale for 7 days after separator placement. Patients were advised to record the severity of pain., Results: Group 3 (Aspirin 300 mg) showed lowest pain values, followed by Group 2 (ibuprofen 400 mg), and Group 1 (paracetamol 650 mg). All NSAID's achieved good pain control compared to Group 4 (placebo), where the intensity pain was maximum., Conclusion: Pre- and post-operative analgesics were found to be more effective in controlling orthodontic pain, after separator placement at all-time intervals.
- Published
- 2014
- Full Text
- View/download PDF
25. Curriculum for pharmacology in pharmacy institutions in India: opportunities and challenges.
- Author
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Goyal RK, Bhise SB, Srinivasan BP, Rao CM, Sen T, and Koneri R
- Subjects
- Curriculum, Humans, India, Pharmacists, Teaching, Pharmacology education, Schools, Pharmacy
- Abstract
The curriculum of pharmacy institutions in India is regulated by the All India Council for Technical Education (AICTE) and the Pharmacy Council of India (PCI) at degree and diploma levels. However, it has been over two decades that the syllabi have been revised by these regulatory agencies. Considering the dynamic character of pharmacology, it is essential to prepare a syllabus that caters to the contemporary needs of the academic institutions and pharmaceutical industry, the community. Pharmacists are also witnessing a greater role in community pharmacy practice as well as in several healthcare sectors. Considering these facts, a panel discussion was held at IPSCON 2013, (the Annual Conference of Indian Pharmacological Society) at Bangalore. The discussion saw several recommendations for syllabi for institutions offering various pharmacy courses to meet the objectives of teaching, learning and research in Pharmacology. This article documents a summary of the discussion. For B. Pharm. course, a balance between industry-oriented pharmacology and clinical pharmacy has been recommended. Redundant animal experiments should be replaced with the simulation experiments or those which are feasible in the light of stringent regulations of the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA). It is recommended that the M. Pharm curriculum should focus on preclinical research with the inclusion of molecular biology and experiments on gene expression, proteomics, pharmacogenomics, cell culture and tissue culture. In general, at all levels, exposure of students to hospitals and clinicians is needed. Pharm. D., syllabus too should lay lesser emphasis on experimental pharmacology. Present experiments in the D. Pharm. course have no relevance to the program objectives and hence, only experiments through demonstrations or simulated preparations or interactive videos maybe undertaken. Regulatory bodies as well as universities should design a comprehensive syllabus and plan an effective pedagogy to prepare graduates who are competent and capable of bringing positive changes in the community and healthcare in India.
- Published
- 2014
- Full Text
- View/download PDF
26. Ahmed glaucoma valve in eyes with preexisting episcleral encircling element.
- Author
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Choudhari NS, George R, Shantha B, Neog A, Tripathi S, Srinivasan B, and Vijaya L
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, Follow-Up Studies, Glaucoma physiopathology, Humans, Intraocular Pressure, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Treatment Outcome, Visual Acuity, Young Adult, Glaucoma surgery, Glaucoma Drainage Implants, Sclera surgery, Scleral Buckling methods
- Abstract
Background: To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element., Materials and Methods: This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010., Results: The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the final postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P < 0.001). The complications observed over the follow-up period did include corneal graft failure in three eyes, tube erosion in two eyes and rhegmatogenous retinal detachment in one eye., Conclusion: AGV is an effective option in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of significant postoperative complications.
- Published
- 2014
- Full Text
- View/download PDF
27. Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus.
- Author
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Padmanabhan P, Radhakrishnan A, Venkataraman AP, Gupta N, and Srinivasan B
- Subjects
- Adolescent, Adult, Cornea metabolism, Cornea surgery, Female, Follow-Up Studies, Humans, Keratoconus pathology, Keratoconus physiopathology, Male, Photochemotherapy, Photosensitizing Agents therapeutic use, Prospective Studies, Visual Acuity, Young Adult, Collagen metabolism, Cornea pathology, Corneal Topography methods, Cross-Linking Reagents therapeutic use, Keratoconus surgery, Laser Therapy methods, Surgery, Computer-Assisted methods
- Abstract
Purpose: To compare the outcome of Collagen cross-linking (CXL) with that following topography-guided customized ablation treatment (T-CAT) with simultaneous CXL in eyes with progressive keratoconus., Materials and Methods: This was a prospective, non-randomized single centre study of 66 eyes with progressive keratoconus. Of these, 40 eyes underwent CXL and 26 eyes underwent T-CAT + CXL. The refractive, topographic, tomographic and aberrometric changes measured at baseline, 1, 3 and 6 months post-operatively were compared between both groups., Results: After a mean follow-up of 7.7 ± 1.3 months, the mean retinoscopic cylinder decreased by 1.02 ± 3.16 D in the CXL group ( P = 0.1) and 2.87 ± 3.22 D in the T-CAT + CXL group ( P = 0.04). The Best corrected visual acuity increased by 2 lines or more in 10% of eyes in the CXL group and in 23.3% of eyes in the T-CAT + CXL group. The mean steepest-K reduced by 0.40 ± 3.71 D ( P = 0.77) in the CXL group and by 2.91 ± 2.01D ( P = 0.03) in the T-CAT + CXL group. The sag factor and surface asymmetry index showed no significant change in the CXL group but reduced by 3.59 ± 5.94 D ( P = 0.01) and 0.72 ± 1.18 ( P = 0.02) respectively in the T-CAT + CXL group. There was a significant increase in the highest posterior corneal elevation in both groups (9.57 ± 14.93 μ in the CXL group and 7.85 ± 9.25 μ in the T-CAT + CXL group, P ≤ 0.001 for both). There was significantly greater reduction of mean coma ( P < 0.001) and mean higher-order aberrations ( P = 0.01) following T-CAT + CXL compared to CXL., Conclusions: CAT + CXL is an effective approach to confer biomechanical stability and to improve the corneal contour in eyes with keratoconus and results in better refractive, topographic and aberrometric outcomes than CXL alone.
- Published
- 2014
- Full Text
- View/download PDF
28. Authors' reply.
- Author
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Choudhari NS, Neog A, Sharma A, Iyer GK, and Srinivasan B
- Subjects
- Female, Humans, Male, Fibrin Tissue Adhesive pharmacology, Glaucoma surgery, Glaucoma Drainage Implants, Prosthesis Implantation methods
- Published
- 2013
29. Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve.
- Author
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Choudhari NS, Neog A, Sharma A, Iyer GK, and Srinivasan B
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Conjunctiva surgery, Female, Follow-Up Studies, Glaucoma physiopathology, Humans, Infant, Intraocular Pressure, Male, Middle Aged, Retrospective Studies, Sclera surgery, Tissue Adhesives pharmacology, Treatment Outcome, Young Adult, Fibrin Tissue Adhesive pharmacology, Glaucoma surgery, Glaucoma Drainage Implants, Prosthesis Implantation methods
- Abstract
Aim: To report our experience with the fibrin sealant as a suture substitute for securing the human scleral patch graft during implantation of Ahmed glaucoma valve (AGV)., Materials and Methods: A retrospective, non-comparative study of 12 eyes of 12 patients who underwent an AGV implantation with fibrin sealant for part of the procedure during June 2009 to September 2010., Results: The mean patient age was 21.5 ± 20.6 years. Male: Female ratio was 2 : 1. Seven (58.3%) patients were monocular. The indications for AGV were varied. The mean number of intra-ocular surgeries prior to an implantation of AGV was 1.8. The mean follow-up duration was 24.5 ± 17.9 weeks. There was a statistically significant reduction in the mean IOP and in the mean number of anti-glaucoma medications at the final visit compared to the pre-operative values (P < 0.01, paired t test). Conjunctival retraction was seen in 1 (8.3%) case. The scleral patch graft was retracted posteriorly in another (8.3%) case. There was no case of AGV tube exposure, tube-cornea touch, or conjunctival erosion. Vision threatening complication viz. late post-operative rhegmatogenous retinal detachment, unlikely to be related to the use of the fibrin sealant, occurred in 2 (16.6%) eyes., Conclusion: The fibrin sealant offers the advantages of safety and convenience to the placement of a scleral patch graft during an AGV implantation.
- Published
- 2013
- Full Text
- View/download PDF
30. Boston keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma.
- Author
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Srinivasan B, Choudhari NS, Neog A, Latka S, and Iyer GK
- Subjects
- Cornea abnormalities, Corneal Diseases diagnosis, Corneal Diseases surgery, Follow-Up Studies, Glaucoma congenital, Glaucoma diagnosis, Humans, Infant, Intraocular Pressure, Male, Prosthesis Design, Visual Acuity, Cornea surgery, Corneal Diseases congenital, Glaucoma surgery, Glaucoma Drainage Implants, Keratoplasty, Penetrating instrumentation, Prostheses and Implants
- Abstract
Congenital anterior staphyloma entails grave visual prognosis. The majority of reported patients have undergone enucleation. We report a promising result of staphylectomy with implantation of a keratoprosthesis and a glaucoma drainage device in a seven-month-old child with a large, congenital anterior staphyloma.
- Published
- 2012
- Full Text
- View/download PDF
31. Klinefelter's syndrome (mosaic) with chromosome 9 inv and schizophrenia.
- Author
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Ponnudurai R, Srinivasan B, Sumitha R, Koshy T, Paul SS, Thiruvikraman, and Rani A
- Abstract
Klinefelter's syndrome is a sex chromosome abnormality with low androgen level. The varied manifestations of the mental symptoms in some of them, that are inexplicable based on their genotype alone, has fascinated the researchers. We present here a case of Klinefelter's syndrome having a karyotype of mos 47, XXY, and also inversion in 9(th) chromosome, with schizophrenia. Despite the view that inv 9 is a normal variant, it is still worthwhile to explore whether it has any role in the etiology of schizophrenia especially when it occurs with other genotypic aberrations that are suspected to have relevance to psychiatric disorders including the Klinefelter's syndrome.
- Published
- 2012
- Full Text
- View/download PDF
32. The study of aqueous extract of Pterocarpus marsupium Roxb. on cytokine TNF-α in type 2 diabetic rats.
- Author
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Halagappa K, Girish HN, and Srinivasan BP
- Abstract
Objective: This study was designed to investigate the effect of aqueous extract of Pterocarpus marsupium Roxb. on elevated inflammatory cytokine, tumor necrosis factor (TNF)-α in type 2 diabetic rats., Materials and Methods: Type 2 diabetes was induced by administering streptozotocin (90 mg/kg, i.p.) in a neonatal rat model. Aqueous extract of P. marsupium at a dose of 100 and 200 mg/kg was given orally to desired group of animals for a period of 4 weeks. After 4 weeks of drug treatment, parameters such as fasting blood glucose, postprandial blood glucose, and TNF-α in serum were analyzed., Results: Aqueous extract of P. marsupium at both doses, i.e., 100 and 200 mg/kg, decreased the fasting and postprandial blood glucose in type 2 diabetic rats. The 200 mg/kg had more pronounced effect on postprandial hyperglycemia. The drug also improved the body weight of diabetic animals. Cytokine TNF-α was found to be elevated in untreated diabetic rats due to chronic systemic inflammation. The aqueous extract at both doses significantly (P < 0.001) decreased the elevated TNF-α level in type 2 diabetic rats., Conclusion: Modulation of cytokine TNF-α by the rasayana drug P. marsupium is related with its potential anti-diabetic activity.
- Published
- 2010
- Full Text
- View/download PDF
33. Trichosanthes cucumerina Linn. improves glucose tolerance and tissue glycogen in non insulin dependent diabetes mellitus induced rats.
- Author
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Kirana H and Srinivasan BP
- Abstract
Objective: To study the effect of Trichosanthes cucumerina Linn. on non insulin dependent diabetes mellitus induced rats., Materials and Methods: Non Insulin Dependent Diabetes Mellitus (NIDDM) was induced by administering streptozotocin (90 mg/kg, i.p.) in neonatal rat model. NIDDM animals were treated with aqueous extract of Trichosanthes cucumerina (100 mg/kg/day) orally for six weeks. Parameters such as fasting blood glucose, Oral Glucose Tolerance Test (OGTT) and tissue glycogen content were evaluated., Results: Aqueous extract of Trichosanthes cucumerina significantly (P<0.01) decreased the elevated blood glucose of NIDDM induced rats. OGTT of NIDDM animals showed glucose intolerance. Blood glucose of diabetic animals reached peak at 45 min and remains high even after 2h. In case of Trichosanthes cucumerina treated group, the blood glucose reached peak level at 30 min, followed by decrease in glucose level up to 2h. The drug has significantly (P<0.01) reduced the postprandial blood glucose of diabetic animals. Glycogen content of insulin dependent tissues such as liver and skeletal muscle was found to be improved by 62% and 58.8% respectively with Trichosanthes cucumerina as compared to NIDDM control., Conclusion: Studies revealed that, Trichosanthes cucumerina possess antidiabetic activity. The drug improved the oral glucose tolerance of NIDDM subjects. Increase in tissue glycogen content indicates the effect of the drug on the uptake of glucose by the peripheral tissues to reduce insulin resistance of NIDDM.
- Published
- 2008
- Full Text
- View/download PDF
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