Parijat Chandra

Role of Intravenous Fluorescein Angiography in Early Detection and Regression of Retinopathy of Prematurity

PURPOSE To study the role of intravenous fluorescein angiography in early detection and regression of retinopathy of prematurity. METHODS The Retcam 120 (Massie Research Laboratories, Dublin, CA) was used to perform intravenous fluorescein angiography in 40 eyes of 20 children diagnosed as having treatable retinopathy of prematurity as per Early Treatment for Retinopathy of Prematurity Cooperative Group guidelines and treated with laser photocoagulation. RESULTS Fluorescein angiography enabled easy visualization of the retinal vasculature and helped to identify early flat neovascularization in zone 1/2 retinopathy of prematurity, detect previously missed areas of active retinopathy of prematurity in the peripheral retina, and identify skip areas following laser photocoagulation, which resulted in good management outcomes. There were no side effects related to sodium fluorescein or the procedure. CONCLUSIONS Retcam-assisted intravenous fluorescein angiography is safe and helps in the early diagnosis, prompt management, and complete regression of retinopathy of prematurity.

Valsalva and Purtscher's retinopathy with optic neuropathy in compressive thoracic injury.

Compressive thorax injury is commonly observed in road traffic accidents which leads to a variety of posterior segment ocular abnormalities, of which rarely seen are Purtscher’s retinopathy, Valsalva retinopathy, and traumatic optic neuropathy. We report a rare case with compressive chest injury which led to Purtscher’s retinopathy with traumatic optic neuropathy in one eye and Valsalva retinopathy in the other.

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity.

Purpose: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP).

Formalin-induced cataract in goat eyes as a surgical training model for phacoemulsification

&NA; We compared 2 techniques of inducing cataract in enucleated goat eyes as a training model for phacoemulsification. The cataract was induced using 0.2 to 0.5 mL of formalin 20%. In 10 eyes, formalin was injected through a clear corneal side port into the nucleus after capsulorhexis and in 10 eyes, through the pars plana before capsulorhexis. The pars plana technique achieved a cataract of different grades of nuclear hardness with the added advantage of anterior capsule elasticity closely simulating that of senile cataract but without compromising corneal clarity.

Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion.

Purpose: To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively. Conclusion: The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.

Profile of asymmetrical retinopathy of prematurity in twins.

Background: In twin births, both babies have the same gestational age and pre-natal conditions. However, twins may develop a varied retinopathy of prematurity (ROP) course depending on birth weight and other systemic factors. Objective: To study the profile of asymmetric ROP in twins Design: Retrospective study Setting: Tertiary ROP referral eye hospital. Materials and Methods: The profile of 56 pairs of twins with ROP were studied and analyzed for differences in zone or need for treatment, while studying possible causes for the varied outcome. Results: In 45 pairs of twins (80%) the disease progressed identically in both eyes, while in 11 pairs (20%) the ROP showed differences in zone or need for treatment. Four of these pairs were discordant. In 3 of these 4 pairs, the heavier birth weight twin had a more severe ROP course. Conclusions: Twins can present with asymmetric ROP course, and it is therefore essential to examine both twins as per screening protocols.

Ultra-wide field angiography in the management of Eales disease

Aims: This study aims to evaluate the use of ultra-wide field (UWF) angiography in patients with Eales disease (ED). Settings and Design: Prospective observational case series in tertiary eye care center. Subjects and Methods: This study involved 17 patients diagnosed with ED, who underwent UWF fluorescein angiography. The angiograms were analyzed to look for additional information as compared to Early Treatment Diabetic Retinopathy Study seven standard field. The impact of this information in the management of patients was analyzed. Results: 24 eyes of 17 patients with mean age of 26.3 years were diagnosed with ED and underwent UWF angiography. UWF fluorescein angiography was helpful in the documentation of peripheral retinal changes (in 67% of eyes), exact localization of capillary nonperfusion (CNP) (in 54% of eyes), and in determination of vascular involvement (in 21% of eyes). In 33% of eyes, immediate treatment plan changed because of changes picked up on UWF angiography. Conclusions: UWF angiography helped in the better documentation, exact quantification, and location of CNP areas and better determination of disease activity. UWF imaging may play an important part in the management of patients with ED.

Prevailing clinical practices regarding screening for retinopathy of prematurity among pediatricians in India: A pilot survey

Aims: To evaluate the prevailing practices for proper screening and referral scheme among Indian pediatricians for retinopathy of prematurity (ROP). Materials and Methods: Pediatricians registered with Indian Academy of Pediatrics from six states of India were selected randomly and were telephonically interviewed in accordance with a preformed questionnaire which comprised of questions regarding demographic factors, number of premature children seen per month, awareness and referral scheme to ophthalmologist; responses thus obtained were analyzed. Results: Hundred percent knowledge about ROP and need for screening in premature babies was observed among the respondents. However, only 135 (58%) pediatricians always referred for ROP screening, 19 (8%) referred only sometimes and 80 (34%) did not refer at all. Consistent referral protocols taking into account all plausible risk factors for ROP were followed by only 25% of those who always referred. Major deterrent in ROP screening was perceived as non-availability of trained ophthalmologists. Conclusions: Only 14.5% of total pediatricians contacted were following international recommendations for ROP referral. Screening for ROP remains dismal as observed in this pilot survey as a consequence of non-availability of trained ophthalmologists as well as inconsistent screening guidelines.

Ultra-wide field imaging in the diagnosis and management of adult-onset Coats' disease.

The conventional fundus imaging covers up to 60 degrees of retina only. Although various montaging techniques can significantly increase the area that can be imaged, it is still difficult to image and document the peripheral retina. The purpose of this study is to describe the use of ultra‐wide field imaging in the diagnosis and management of adult‐onset Coats’ disease.

Comparative evaluation of RetCam vs. gonioscopy images in congenital glaucoma

Purpose: To compare clarity, exposure and quality of anterior chamber angle visualization in congenital glaucoma patients, using RetCam and indirect gonioscopy images. Design: Cross-sectional study Participants. Congenital glaucoma patients over age of 5 years. Materials and Methods: A prospective consecutive pilot study was done in congenital glaucoma patients who were older than 5 years. Methods used are indirect gonioscopy and RetCam imaging. Clarity of the image, extent of angle visible and details of angle structures seen were graded for both methods, on digitally recorded images, in each eye, by two masked observers. Outcome Measures: Image clarity, interobserver agreement. Results: 40 eyes of 25 congenital glaucoma patients were studied. RetCam image had excellent clarity in 77.5% of patients versus 47.5% by gonioscopy. The extent of angle seen was similar by both methods. Agreement between RetCam and gonioscopy images regarding details of angle structures was 72.50% by observer 1 and 65.00% by observer 2. Conclusions: There was good agreement between RetCam and indirect gonioscopy images in detecting angle structures of congenital glaucoma patients. However, RetCam provided greater clarity, with better quality, and higher magnification images. RetCam can be a useful alternative to gonioscopy in infants and small children without the need for general anesthesia.