Anjli Hussain

Variants in the 10q26 gene cluster (LOC387715 and HTRA1) exhibit enhanced risk of age-related macular degeneration along with CFH in Indian patients.

PURPOSEnSingle nucleotide polymorphisms (SNPs) in the LOC387715 (rs10490924), HTRA1 (rs11200638), and CFH (rs1061170) genes have been implicated in age-related macular degeneration (AMD). The present study was undertaken to determine the involvement of the LOC387715 and HTRA1 in an AMD cohort from India.nnnMETHODSnThe coding region of LOC387715 (exon 1) and the promoter of HTRA1 were screened by resequencing in AMD cases and normal controls. Odds ratios were calculated to assess the risk of individual genotypes. Linkage disequilibrium (LD) and haplotype frequencies were estimated with Haploview software. Population attributable risk (PAR %) for the associated SNPs and their combined effects were calculated.nnnRESULTSnResequencing revealed seven different SNPs in these genes, of which significant associations were noted with the risk alleles of rs10490924 (T allele; P = 5.34 x 10(-12)) in LOC387715, and rs11200638 (A allele; P = 4.32 x 10(-12)) and rs2672598 (C allele; P = 3.39 x 10(-11)) in HTRA1 among the cases. Correspondingly, the homozygous risk genotypes TT, AA, and CC in these SNPs exhibited higher disease odds and PAR %. rs10490924 and rs11200638 were in tight LD (D, 0.90; 95% CI, 0.84-0.93). G-C-T-A-C was the risk haplotype (P = 8.04 x 10(-15)), whereas the G-C-G-G-T haplotype was protective (P = 2.01 x 10(-4)). The combined effect of the CFH (CC) and LOC387715 (TT) risk genotypes exhibited a PAR of 93.7% (OR, 73.89; 95% CI, 8.69-628.13).nnnCONCLUSIONSnThe present data provided an independent validation of the association of LOC387715 and HTRA1 SNPs, along with their risk estimates among Indian patients with AMD. These associations underscore their significant involvement in AMD susceptibility, which may be useful for predictive testing.

Outcomes of a Protocol-Based Management for Zone 1 Retinopathy of Prematurity: The Indian Twin Cities ROP Screening Program Report Number 2

PURPOSEnTo report the outcomes of zone 1 aggressive posterior retinopathy of prematurity (ROP) treated with aggressive laser photocoagulation by a protocol-based approach over a 10-year period.nnnDESIGNnProspective, interventional case series.nnnMETHODSnnnnSETTINGnTertiary eye institute and neonatal intensive care units in the twin cities of Hyderabad and Secunderabad in South India.nnnSTUDY POPULATIONnBabies screened under the Indian Twin Cities Retinopathy of Prematurity Screening (ITCROPS) program between January 1, 1997 and March 31, 2007.nnnINTERVENTIONnMultiple sessions of laser photocoagulation at any sign of plus disease with abnormal shunt vessels with or without neovascularization in zone 1.nnnOUTCOME MEASUREnBased on the anatomic status of the retina at the final follow-up, the outcome was classified into good (completely regressed with no vitreoretinal changes), fair (regression with vitreoretinal distortion), or poor (progression into partial or total retinal detachment involving macula). Descriptive statistics (mean and range) were used for gestational age at birth, birth weight, and post-conceptional age at first presentation and at the first intervention. Trends in incidence of zone 1 ROP over 1 decade were analyzed. Outcomes were expressed in terms of proportions and 95% confidence interval (CI).nnnRESULTSnOf the 3654 babies screened, 227 eyes of 115 babies were detected to have zone 1 aggressive disease, defined as zone 1 retinal vessels having abnormal closed-loop shunts, dilation and tortuosity, flat new vessels, or rapid progression. Laser was performed in 169 eyes. Disease regressed with good outcome in 142 eyes (84%) (95% CI, 77.6-89.2) and progressed to poor outcome in 13 eyes (7.69%) (95% CI, 4.1-12.8), while fair outcome was seen in 6 eyes (3.55%) (95% CI, 1.3-7.5). Thus 148 babies (87.5%) (95% CI, 81.6-92.14) had a favorable outcome. The outcomes in 8 treated eyes (4.7%) lost to follow-up were unknown.nnnCONCLUSIONSnZone 1 aggressive ROP has a good outcome if the screening is done early; intervention is prompt and adequate, with frequent follow-up until complete regression is achieved.

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

PURPOSEnTo evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series.nnnMATERIALS AND METHODSnWe retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002.nnnRESULTSnNine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin.nnnCONCLUSIONnPDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.

Transpupillary thermotherapy for chronic central serous chorioretinopathy.

PurposeTo determine whether transpupillary thermotherapy (TTT) causes resolution of neurosensory detachment associated with chronic central serous chorioretinopathy (CSCR).MethodsThe study was a prospective interventional pilot study. All patients underwent Snellen visual acuity measurement (converted to LogMAR for analysis), slitlamp biomicroscopy, fundus examination, colour fundus photography, fluorescein and indocyanine green (ICG) angiography and optical coherence tomography (OCT). Follow-up was scheduled at 1, 2 and 3 months. Success was defined as resolution of neurosensory detachment on OCT at 3 months, and failure as persistence of the same. The primary outcome measure was resolution of OCT-measured neurosensory detachment and secondary outcome measure was change in visual acuity at the end of 3 months.ResultsFourteen eyes of 13 patients were included in the study. Twelve patients were male. The left eye was affected in seven of 14 eyes. The patients mean age was 42.7±4.5 years (range 38–54 years). TTT parameters were as follows: power 156±47.8xa0mW; spot size 2.2±1.1xa0mm; duration 39.6±7.5xa0s. Following treatment, complete resolution of neurosensory detachment on OCT was seen in nine eyes (64.3%) at monthxa01 (P=0.004) and 11 eyes (78.6%) at monthsxa02 and 3 (P=0.001). Three eyes (21.4%) had persistent subretinal fluid at monthxa03. Eight eyes (52.7%) had ≥3 lines of improvement (two eyes: five lines and six eyes three lines) at the final visit.ConclusionTranspupillary thermotherapy could be a therapeutic option in patients with chronic CSCR.

Case control analyses of acute endophthalmitis after cataract surgery in South India associated with technique, patient care, and socioeconomic status.

Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (P = 0.054). Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety.

Comparison of mean macular thickness using optical coherence tomography and visual acuity in diabetic retinopathy

Background:u2002 The purpose of the present study was to quantitatively assess the mean macular thickness in diabetic patients using optical coherence tomography and its correlation with visual acuity.

Diametric measurement of foveal avascular zone in healthy young adults using optical coherence tomography angiography

BackgroundThe objective of this study is to measure the diameter size of foveal avascular zone (FAZ) in both eyes of healthy young adults using optical coherence tomography (OCT) angiography.MethodsA cross sectional study to measure the foveal avascular zone in healthy young adults. Subjects underwent OCT angiography using Zeiss AngioPlex OCT angiography in both eyes.Results30 eyes of 15 healthy young adults were evaluated. The mean horizontal FAZ diameter of superficial vascular plexus was 661.166xa0±xa0119.99 microns and mean vertical FAZ diameter was 660.033xa0±xa096.169 microns (Pxa0=xa00.9442). The mean horizontal FAZ diameter of deep vascular plexus was 1011.2xa0±xa0154.526 microns and the mean vertical FAZ diameter of deep vascular plexus was 818.033xa0±xa0102.108 microns. There was no difference between the contralateral eyes of subjects in FAZ diameter of both superficial and deep capillary plexuses.ConclusionThe mean diametric size of FAZ in superficial capillary plexus is 660.599xa0±xa00.801 microns and deep capillary plexus is 914.616xa0±xa0136.589 microns. There was no significant difference with the contralateral eyes.

Mutation spectrum of NDP, FZD4 and TSPAN12 genes in Indian patients with retinopathy of prematurity

Aim Retinopathy of prematurity (ROP) is a vasoproliferative eye disease in preterm infants. Based on its phenotypic similarities with familial exudative vitreo retinopathy (FEVR), the present study was conducted to screen the Norrin signalling pathway genes (already been implicated in FEVR) for understanding their involvement among Indian patients with ROP. Methods The study cohort consisted of patients with ROP (n=246) and controls (n=300) that included full term (n=110) and preterm babies devoid of ROP (n=190). Screening of the NDP, FZD4, TSPAN12 genes were accomplished by resequencing the entire coding and untranslated regions (UTR). The genotype data of the patients with ROP were analysed in the background of their clinical manifestations and further analysed in conjunction with other available data on these genes worldwide. Results Two novel variants in intron 1 (IVS1 +16A>G) and 3′UTR (c.5 22T>C) along with a previously reported change in the 5′UTR (c.395_409del14bp) were observed in the NDP gene in three patients with ROP. Screening of the FZD4 revealed four heterozygous variants, p.(Pro33Ser), p.(Pro168Ser), p.(Ile192Ile) and p.(Ile360Val), a compound heterozygous (p.(Pro33Ser)/p.(Pro168Ser)) and a 3′UTR (c*G>T) variants in the study cohort. Variants p.(Pro33Ser) and p.(Pro168Ser) were found to be significantly associated with ROP. A heterozygous variant p.(Leu119Arg) in TSPAN12 gene was observed in a patient with threshold ROP. However, a formal genotype–phenotype correlation could not be established due to the low frequencies of the variant alleles in these genes. Conclusions This is a first study that revealed association of few variants in Norrin signalling genes among Indian patients with ROP that warrants further detailed investigation worldwide.

Successful closure of treatment-naïve, flat edge (Type II), full-thickness macular hole using inverted internal limiting membrane flap technique

Objective The objective of this study was to present the outcome of the internal limiting membrane (ILM) peeling flap technique for a treatment-naïve, flat edge (Type II), full-thickness macular hole (MH). Methods A 52-year-old man presented with complaints of decreased vision and seeing black spot. He was diagnosed to have a flat edge, full-thickness MH, which was confirmed by optical coherence tomography (OCT). He underwent 23G vitrectomy with brilliant blue G-assisted inverted ILM peeling with an inverted flap over the hole followed by fluid gas exchange. Results Postoperative follow-up until 3 months showed successful closure of the MH, which was confirmed by OCT. The best-corrected visual acuity improved from baseline 6/60 to 6/12 at the final follow-up. Conclusion Using the inverted ILM flap technique, a treatment-naïve, flat edge (Type II), full thickness MH achieved successful anatomical and functional outcomes.

Retino-choroidal ischemia in central retinal vein occlusion

A 41-year-old gentleman with insulin dependent diabetes had decreased vision in the right eye due to non-ischemic central retinal vein occlusion with macular edema. One month following intravitreal ranibizumab, he developed retino-choroidal ischemia with further loss of vision. Authors show the fluorescein angiographic transition from non-ischemic central retinal vein occlusion to retino-choroidal ischemia.