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1. Clinical outcomes of topography-guided versus wavefront-optimized LASIK for correction of myopia and compound myopic astigmatism

Author

Rani, Deeksha, Khokhar, Sudarshan, Rathod, Aishwarya, Nathiya, Venkatesh, Pujari, Amar, and Gupta, Tavish

Subjects
Laser in situ keratomileusis -- Methods -- Patient outcomes -- Comparative analysis, Astigmatism -- Care and treatment, Myopia -- Care and treatment
Abstract

Purpose: To compare the safety, efficacy, and visual outcomes of topography-guided (TG) LASIK ablation versus advanced ablation algorithm (AAA) on Zeiss Mel 90 on virgin eyes. Setting: A tertiary care hospital in north India. Design: A retrospective comparative study. Methods: Case sheets of 30 patients who underwent TG LASIK and 45 patients who underwent AAA LASIK between January 2021 and September 2022 were retrieved and reviewed. The TG group included 60 eyes of 30 patients, and the AAA group included age- and sex-matched 90 eyes of 45 patients. Both groups were compared for visual outcomes, residual refraction, and root-mean-square higher-order aberrations (rms HOA) at 1 week, 1 month, 3 months, and 6 months postoperatively and using unpaired t-test and Mann-Whitney U test. Results: The mean preoperative spherical equivalent in the TG group and AAA group was - 3.12 (1.67) and - 3.19 (1.61), respectively. The safety and efficacy of the treatment were 100% in both groups. The postoperative increase in rms HOA was comparable in both groups (P = 0.55). The ablation duration was significantly longer in topo-guided LASIK (P = 0.001). Conclusion: AAA LASIK on MEL 90 is comparable to topography-guided LASIK for the management of low myopia and myopic astigmatism. Keywords: AAA LASIK, LASIK, topo-guided LASIK, Author(s): Deeksha Rani (corresponding author) [1]; Sudarshan Khokhar [1]; Aishwarya Rathod [1]; Venkatesh Nathiya [1]; Amar Pujari [1]; Tavish Gupta [1] Laser-assisted in situ keratomileusis (LASIK) involves the use of [...]

Published
2024
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2. Management of traumatic incomplete lacerating rectus muscle injuries using multimodal imaging approach (ASOCT and CT/MRI).

Author

Pujari, Amar, Rathod, Aishwarya, Mounica, B., and Khokhar, Sudarshan

Subjects
*MUSCLE injuries, *MAGNETIC resonance imaging, *OPTICAL coherence tomography, *PENETRATING wounds, *TRAUMA surgery
Abstract

Purpose: To describe the pathophysiology, importance of multimodal imaging approach, and the clinical outcomes of incomplete lacerating rectus muscle injuries. Methods: A retrospective review was conducted to identify patients with ocular deviation secondary to rectus muscle injuries. Between 2019 and 2022, a total of 30 patients were identified, amongst whom eleven patients had incompletely lacerated rectus muscles (secondary to penetrating adnexal trauma and sino-orbital surgeries). Patients' demography, nature of injury, computed tomography/magnetic resonance imaging, anterior segment optical coherence tomography features, intra-operative findings, and post-operative outcomes were reviewed. Results: The mean age of 11 patients was 31.36 ± 14.38 years. All patients had external trauma which severed the muscle in its anterior portion. Five patients had isolated inferior rectus muscle injury (45.45%), three had inferior and medial rectus muscle injuries together (27.27%), two had isolated lateral rectus muscle injury (18.18%), and one remaining patient had isolated medial rectus muscle injury (9.05%). In ten patients (90.90%) CT/MRI revealed features suggestive of muscle injury, however details with respect to muscle insertion and scleral course were lacking. In this difficult scenario, ASOCT filled these lacunae in nearly 90% of the patients by providing surgically useful details. Moreover, when CT/MRI-ASOCT imaging features were combined, the management and outcomes were even more predictable. Conclusions: Penetrating rectus muscle injuries can be better identified as incompletely lacerated muscle using multimodal imaging approach. This simple image correlation process customizes the treatment approach and hence the clinical outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Cysticercosis in ophthalmology

Author

Pujari, Amar, Bhaskaran, Karthika, Modaboyina, Sujeeth, Das, Deepshekhar, Saluja, Gunjan, Samdani, Asha, Singh, Pallavi, Bajaj, Mandeep S, and Sharma, Namrata

Published
2022
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9. Rectus muscle pseudo-adherence syndrome

Author

Pujari, Amar, Virani, Baiju, Chauhan, Nidhi, Mahalingam, Karthikeyan, Thangavel, Rajeswari, and Saxena, Rohit

Subjects
Eye diseases -- Diagnosis -- Care and treatment, Eye -- Surgery, Health
Abstract

Byline: Amar. Pujari, Baiju. Virani, Nidhi. Chauhan, Karthikeyan. Mahalingam, Rajeswari. Thangavel, Rohit. Saxena Purpose: To describe a clinical entity called 'rectus muscle pseudo-adherence syndrome' following buckling surgery. Methods: A retrospective [...]

Published
2023

13. Visual axis opacification after pediatric cataract surgery - An analysis of morphology and etiology.

Author

Khokhar, Sudarshan, Chandel, Lekha, Rani, Deeksha, Rathod, Aishwarya, Nathiya, Venkatesh, and Pujari, Amar

Subjects
POSTERIOR capsulotomy, PEDIATRIC surgery, CATARACT surgery, PEOPLE with visual disabilities, VITRECTOMY
Abstract

Purpose: To investigate the morphological types and delineate the clinical and surgical variables associated with VAO in children undergoing pediatric cataract surgery. Methods: We included 33 eyes of 28 children who developed clinically significant visual axis opacification (VAO) after congenital or developmental cataract surgery. All eyes underwent a comprehensive examination under anesthesia followed by a membranectomy to clear the visual axis. We classified VAO into three subgroups: fibrotic, proliferative, and combined morphologies. We reviewed and analyzed the retrospective data and the findings during membranectomy to identify the etiological variables associated with various morphologies of VAO. Results: The median age at primary surgery was 7 (2-96) months. The median interval from primary surgery to the first documentation of VAO was 6 (1-22) months. Younger children developed VAO sooner than older children. VAO was fibrotic in 11 eyes (33%), proliferative in 18 eyes (54.5%), and combined in four eyes (12.12%). Most children with fibrotic VAO belonged to economically disadvantaged sections of society (P = 0.04). Conclusion: Lower age at primary surgery was the predominant risk factor for the development of VAO. Besides primary posterior capsulotomy and adequate anterior vitrectomy, a strict adherence to anti-inflammatory measures and follow up in necessary to prevent the occurrence of VAO. A close follow-up facilitates early detection and management, which can prevent the onset of visually impairing amblyopia. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Commentary: Smart click for amblyogenic risk factor screening

Author

Pujari, Amar and Sharma, Pradeep

Subjects
Vision disorders in children -- Diagnosis, Photography, Medical -- Research, Electronic cameras -- Usage, Amblyopia -- Diagnosis, Smart phones -- Usage, Pediatric research, Smart phone, Digital camera, Health
Abstract

Byline: Amar. Pujari, Pradeep. Sharma In the article, the authors have evaluated the clinical role of CP TX-1 camera in identifying the amblyogenic risk factors in pediatric age groups.[1] The [...]

Published
2022

23. Evaluation of reinforced plication as an alternative to resection in exotropia

Author

Daga, Darshana, Pujari, Amar, Sharma, Pradeep, Phuljhele, Swati, and Saxena, Rohit

Subjects
Strabismus -- Care and treatment -- Patient outcomes, Eye -- Surgery, Health
Abstract

Byline: Darshana. Daga, Amar. Pujari, Pradeep. Sharma, Swati. Phuljhele, Rohit. Saxena Purpose: To evaluate the surgical efficacy of reinforced plication of the medial rectus muscle to resection as an effective [...]

Published
2022

29. A simple do-it-yourself model of phacoemulsification for resident training

Author

Saluja, Gunjan, Sujeeth, M., Bhaskaran, Karthika, and Pujari, Amar

Subjects
Do-it-yourself work -- Methods, Ophthalmologists -- Training, Residents (Medicine) -- Training, Phacoemulsification -- Methods -- Models, Health
Abstract

Byline: Gunjan. Saluja, M. Sujeeth, Karthika. Bhaskaran, Amar. Pujari COVID-19 has immensely affected the training of ophthalmology residents; wet-lab training thus becomes of utmost importance. A simple cost-effective model for [...]

Published
2021

34. Necrotizing scleritis following uncomplicated strabismus surgery

Author

Pujari, Amar, Chaniyara, Manthan, Sharma, Pradeep, and Sharma, Namrata

Subjects
Diagnosis, Care and treatment, Complications and side effects, Case studies, Patient outcomes, Scleritis -- Diagnosis -- Care and treatment -- Case studies, Eye surgery -- Patient outcomes -- Complications and side effects, Strabismus -- Care and treatment, Eye -- Surgery
Published
2020

40. Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures.

Author

Khokhar, Sudarshan, Rani, Deeksha, Rathod, Aishwarya, Nathiya, Venkatesh, Nayak, Shreya, Pujari, Amar, Kumar, Saumya, and Sharma, Tushar

Subjects
LASIK, FEMTOSECOND lasers, ANTHROPOMETRY
Abstract

Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a single-center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS-LASIK (femtosecond laser-assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side-facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty-three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep-set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep-set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry. [ABSTRACT FROM AUTHOR]

Published
2023
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43. Intraoperative Optical Coherence Tomography Guided Ocular Surgeries: Critical Analysis of Clinical Role and Future Perspectives

Author

Pujari, Amar, Agarwal, Divya, Chawla, Rohan, Kumar, Atul, and Sharma, Namrata

Subjects
iOCT, genetic structures, intraoperative optical coherence tomography, hand-held optical coherence tomography and intraoperative microscope integrated optical coherence tomography, sense organs, Review, eye diseases
Abstract

Intraoperative imaging of ocular tissues for diagnostic and therapeutic applications has gained immense admiration in recent years. The real time cross-sectional imaging, as well as three and four dimensional reconstruction abilities of intraoperative optical coherence tomography (iOCT), has enhanced our knowledge on many fronts in surgical maneuvers. In this review, we discuss the iOCT discovered constructive knowledge in the cornea, cataract, refractive, glaucoma, pediatric ocular, and various retinal conditions. The practical utility with decision modifying aspects along the specified ocular tissues and with respect to specific ocular entities have been narrated. Moreover, limitations and future directions have also been emphasized to make ophthalmic care more comprehensive in the future.

Published
2020

44. Novel Inferior Oblique Muscle Y Splitting Procedure to Minimize the Anti-Elevation Syndrome: A Pilot Study

Author

Pujari,Amar, Modaboyina,Sujeeth, Thangavel,Rajeswari, Yadav,Monika, Phuljhele,Swati, Saxena,Rohit, Pujari,Amar, Modaboyina,Sujeeth, Thangavel,Rajeswari, Yadav,Monika, Phuljhele,Swati, and Saxena,Rohit

Abstract

Amar Pujari, Sujeeth Modaboyina, Rajeswari Thangavel, Monika Yadav, Swati Phuljhele, Rohit Saxena Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe novel Y splitting procedure of inferior oblique muscle to mitigate the anti-elevation syndrome.Methods: A pilot, prospective interventional study was undertaken to assess the effect of inferior oblique muscle Y-splitting in patients with unilateral 3+ or more overaction. To correct primary gaze hypertropia and the excyclotorsion, a Y-splitting procedure was performed (along with routine horizontal muscle surgery as per the deviation) in 14 subjects. The effect of surgery was assessed at baseline and at 6 months post-intervention.Results: The mean age of 14 subjects was 25.14± 7.70 years. The mean pre-operative hypertropia, excyclotorsion and inferior oblique muscle over-action was 18.42± 3.50 PD, 14.14± 2.65 degrees, and +3.21± 0.42 respectively. Following surgery, this was reduced to 1.57± 1.74 PD of residual hypertropia (a net correction of 16.85± 2.31 PD, p = 0.005), 3.85± 1.46 degrees of residual excyclotorsion (a net correction of 10.28± 1.72 degrees, p < 0.05), and +0.28± 0.46 of residual inferior oblique over-action (a net correction ∼+3) at the end of 6 months. Amongst fourteen patients, three patients still experienced residual/variable anti-elevation effect, and during the study period none of them experienced any adverse event and none of them required any additional surgeries.Conclusion: While anteriorizing the inferior oblique muscle to correct primary gaze hypertropia and the excyclotorsion, a novel “Y splitting&rdquo

Published
2022

45. Defining the Clinical Role of Swept-Source Anterior Segment Optical Coherence Tomography in Eyes Undergoing Strabismus Surgery

Author

Pujari,Amar, Patil,Vinay, Chauhan,Nidhi, Thangavel,Rajeswari, Phuljhele,Swati, Saxena,Rohit, Pujari,Amar, Patil,Vinay, Chauhan,Nidhi, Thangavel,Rajeswari, Phuljhele,Swati, and Saxena,Rohit

Abstract

Amar Pujari, Vinay Patil, Nidhi Chauhan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe the clinical role of swept-source anterior segment optical coherence tomography in extraocular muscle imaging in various strabismic conditions.Study Design: Prospective observational study.Participants: A total of 1104 extraocular muscles of 150 subjects were imaged. Normal eyes (640 muscles), eyes undergoing re-operation (240 muscles), paralytic strabismic eyes (16 muscles), non-paralytic strabismic eyes (20 muscles), post-traumatic strabismic eyes (64 muscles), eyes with thyroid disease (64 muscles), and other atypical cases (60 muscles) were imaged. In all cases, up to four recti muscles were evaluated in a given eye depending on the need.Results: The mean age was 38.15 ± 16.25 years. Overall, muscle insertion was identified in over 90% of the subjects. Apart from normal muscles (n = 860, 93.68%), the location was identified in previously operated eyes (n = 54, 90%), in traumatic muscle slippage (n = 2, 11.11%), in ocular coat ectasia (n = 11, 91.66%), in thyroid muscle hypertrophy, in operated scleral fixated intraocular lens with strabismus, and other challenging cases. In all circumstances, clinically useful information was obtained from the anterior 4– 14 millimetres of the rectus muscle, which in turn helped in active surgical planning and overall management.Conclusion: The SS-ASOCT with its wider and deeper scanning abilities was able to locate the extraocular muscle insertion in a variety of strabismic conditions. Therefore, this tool can be used in the preoperative periods for optimal surgical planning and management.Keywords: swept source an

Published
2022

46. Myopia in India

Author

Pujari,Amar, Modaboyina,Sujeeth, Agarwal,Divya, Saluja,Gunjan, Thangavel,Rajeswari, Rakheja,Vaishali, Saxena,Rohit, Sharma,Namrata, Titiyal,Jeewan S, Kumar,Atul, Pujari,Amar, Modaboyina,Sujeeth, Agarwal,Divya, Saluja,Gunjan, Thangavel,Rajeswari, Rakheja,Vaishali, Saxena,Rohit, Sharma,Namrata, Titiyal,Jeewan S, and Kumar,Atul

Abstract

Amar Pujari, Sujeeth Modaboyina, Divya Agarwal, Gunjan Saluja, Rajeswari Thangavel, Vaishali Rakheja, Rohit Saxena, Namrata Sharma, Jeewan S Titiyal, Atul Kumar Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comAbstract: India is a culturally and geographically diverse nation. Its vast demographic nature does not allow a single definition for any of the given medical conditions in its territory. One important clinical condition which has created an uproar in the rest of the world is myopia. Its cause, prevalence, etiopathogenesis and other factors are being explored constantly; however, data with respect to Indian subcontinent are genuinely missing. Hence, in this review, we enumerate the country’s myopia journey from last 4 decades. The epidemiology, genetics, ocular/systemic association, quality of life, imaging, and management in myopia with necessary future directives are discussed to augment the overall management in future.Keywords: myopia, India, myopia in India, atropine therapy in myopia, genetics and myopia, retinopathy of prematurity and myopia, imaging in myopia, management of myopia

Published
2022

49. Myopia in India

Author

Pujari, Amar, primary, Modaboyina, Sujeeth, additional, Agarwal, Divya, additional, Saluja, Gunjan, additional, Thangavel, Rajeswari, additional, Rakheja, Vaishali, additional, Saxena, Rohit, additional, Sharma, Namrata, additional, Titiyal, Jeewan S, additional, and Kumar, Atul, additional

Published
2022
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