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Biomedical subjects

R B Vajpayee

Publications and source records attributed to R B Vajpayee.

At least 37 records · Page 2Linked to original sources
PubMed2001

Oversized corneal grafts for corneal opacities with iridocorneal adhesions.

OBJECTIVE: To evaluate the efficacy of 1-mm oversized corneal grafts in patients with acquired corneal opacities and extensive peripheral iridocorneal adhesions. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Twenty patients (20 eyes) aged 15 years or older with unilateral or bilateral corneal opacification and a shallow anterior chamber. INTERVENTION: Penetrating keratoplasty was performed with donor corneal buttons oversized by 1 mm. MAIN OUTCOME MEASURES: The various parameters evaluated were visual acuity, graft clarity, keratometry, anterior chamber depth, intraocular pressure, and spherical equivalent refraction 12 months after surgery. RESULTS: The keratoplasties were performed in 15 eyes with a corneo-iridic scar after infectious keratitis (75%) and 5 eyes with failed graft (25%). At the final follow-up, a clear graft was achieved in 17 eyes (85%), and 14 eyes (70%) achieved a best-corrected visual acuity of 6/12 or better. Three of the grafts failed because of rejection. The average keratometry was 44.1 +/- 1.0 diopters (D), and the mean spherical equivalent was -3.23 +/- 2.86 D. The oversized grafts provided a mean anterior chamber depth of 2.36 +/- 0.42 mm, and the mean intraocular pressure at the 12 month follow-up was 16.38 +/- 2.09 mmHg. CONCLUSIONS: Corneal grafts oversized by 1 mm provide adequate anterior chamber depth and reduce the risk of peripheral anterior synechiae and secondary glaucoma in patients with corneal opacities and extensive peripheral iridocorneal adhesions.

Adolescent↗
PubMed2001

Crater-and-chop technique for phacoemulsification of hard cataracts.

We describe a technique of in-the-bag phacoemulsification of large, hard, leathery brown nuclear cataracts. A large crater approximately 6.0 mm diameter is created by down-slope sculpting up to 90% of nuclear thickness, leaving the outer nuclear rim intact. The edge of the crater is held with the phaco probe using high vacuum, and small wedge-shaped pieces are created with a chopper. These small pieces are emulsified in the space created by the crater. This technique permits in-the-bag phacoemulsification of large brown cataracts without complications.

Cataract↗
PubMed2001

Bimanual Sinskey hook technique to enlarge a preexisting capsulorhexis.

We describe a technique of enlarging a small primary capsulorhexis. Two Sinskey hooks are introduced through the side ports. One hook is placed above the anterior capsulorhexis margin with its tip pointing down, and the other is placed beneath the anterior capsulorhexis margin with its tip pointing up. A small nick is made between the tips of the 2 hooks, and the capsulorhexis is extended with a Utrata capsulorhexis forceps. This technique does not require additional instrumentation, impart zonular stress, or disturb wound architecture or integrity.

Capsulorhexis↗
PubMed2001

Topical ciprofloxacin-dexamethasone combination therapy after cataract surgery: randomized controlled clinical trial.

PURPOSE: To determine the efficacy of a combination of ciprofloxacin 0.3% and dexamethasone 0.1% eyedrops in controlling immediate inflammation after cataract surgery. SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences and Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. METHODS: This randomized controlled clinical trial comprised 61 patients, 31 of whom were treated with a combined ciprofloxacin-dexamethasone suspension (study group) and 30, with a standard formulation of betamethasone and neomycin eyedrops (control group). One and 7 days postoperatively, pain, lid edema, lacrimation, conjunctival congestion, aqueous flare and cells, and side effects were noted. A conjunctival swab for bacteria and a fungus culture were sent for evaluation 7 days postoperatively. RESULTS: At 7 days, there was no statistically significant difference between groups in lid edema, conjunctival congestion, anterior segment inflammation, lacrimation, or pain. Two patients in the ciprofloxacin-dexamethasone group noted white deposits in and around the eye that resolved after the dose was reduced to 4 times a day. No patient reported or developed an allergic reaction to either drug combination. CONCLUSION: A ciprofloxacin-dexamethasone combination was effective in controlling inflammation after cataract surgery.

Administration, Topical↗
PubMed2001

Indications for lamellar keratoplasty in India.

PURPOSE: To study the indications for lamellar keratoplasty (LK) in a tertiary eye care hospital in northern India. METHODS: A retrospective analysis of 71 eyes that had undergone LK between January 1995 and December 1999 was performed. The parameters evaluated included demographic data, the diagnosis at admission, the laterality of involvement, and the graft size. RESULTS: The mean age of the patients was 31 +/- 21.8 years (range, 1-73 years). Forty-one male patients and 30 female patients underwent LK. Thirty-three patients (47%) lived in rural areas, and 38 patients (53%) were urban dwellers. LK was performed for optical indications in 63 eyes (88.7%), for tectonic purposes in six eyes (8.4%), and for therapeutic purposes in two eyes (2.8%). Chemical injuries (18%) were the most common indication for LK and were followed by trachomatous keratopathy (14%) and dermoids (14%). CONCLUSION: Chemical injuries, trachomatous keratopathy, and dermoids constitute the major indications for LK in India.

Adolescent↗
PubMed2001

Evaluation of techniques of single continuous suturing in penetrating keratoplasty.

AIM: To evaluate the three techniques of single continuous suturing-namely, torque, antitorque, and no torque in penetrating keratoplasty. METHODS: 53 eyes of 53 patients underwent penetrating keratoplasty using torque (17 patients), antitorque (18 patients), and no torque (18 patients) suturing techniques in this prospective study. Patients were followed up at 4 weeks, 3 months, and 6 months. Keratometric, videokeratographic, refractive astigmatism, and best corrected visual acuity were determined in all the three groups at each follow up visit. Post-keratoplasty suture adjustment was done at 4 weeks, if the astigmatism was >3 dioptres. RESULTS: The initial astigmatism in the torque group was higher than in the other two groups, although it was not statistically significant. Following suture adjustment, there was a significant decrease in astigmatism in all the three groups (p<0.0001). However, no significant difference in the postoperative astigmatism at 3 months and at 6 months was seen among the three groups. CONCLUSIONS: The three techniques of single continuous suturing-that is, torque, antitorque, and no torque produce a similar final astigmatic results. Suture adjustment is an effective method of reducing post-penetrating keratoplasty astigmatism.

Adult↗
PubMed2001

Neurotrophic keratopathy.

PURPOSE: To review the causes, clinical features, course, histopathological and biochemical changes, diagnosis, andtreatmentof neurotrophic keratopathy. METHODS: We reviewed the literature on neurotrophic keratopathy. RESULTS AND CONCLUSIONS: Neurotrophic keratopathy is a clinical entity which involves all degrees of degenerative corneal and conjunctival changes secondary to loss of sensory function in the nasociliary branch of the trigeminal nerve with or without decreased tear production. One of the commonest causes of loss of corneal sensation is herpes virus infection. The clinical course of neurotrophic keratopathy varies considerably. The corneal epithelium becomes diseased and breakdown occurs even in the absence of dessication, infection, and trauma. This stage, if not treated aggressively with ocular lubricants, tarsorrhaphy, or a bandage soft contact lens, will result in stromal lysis with or without perforation. Depending on the size and location of corneal perforation, procedures like the application of cyanoacrylate glue, penetrating keratoplasty, or conjunctival flap may be required.

Cornea↗
PubMed2001

Visual performance of rigid gas permeable contact lenses in patients with corneal opacity.

PURPOSE: To evaluate the visual performance of rigid gas permeable (RGP) contact lenses in patients with nebular and nebulo-macular corneal opacity and correlate the improvement in visual acuity with other visual parameters. METHODS: In a prospective study, visual performance of RGP contact lenses was evaluated in eyes with corneal opacity involving the pupillary area. The baseline visual acuity and other visual parameters with glasses were compared with those recorded with RGP contact lenses. The visual functions evaluated were visual acuity, contrast sensitivity, glare acuity, and mesopic vision. Binocular status with RGP contact lenses was assessed. All patients were followed up for 3 months. RESULTS: Twenty-eight eyes (26 patients) with nebular or nebulo-macular corneal opacity were included in this study. All eyes (100%) achieved significantly better visual performance with RGP contact lenses than with glasses (P< 0.0020). Visual acuity of 6/9 or better was achieved in 50% of patients with RGP contact lenses compared to none with glasses. RGP contact lenses improved the visual acuity by 0.27 decimals over the baseline value with glasses, butthe improvement for mesopic vision and glare acuity was significantly lower at 0.15 and 0.06 decimals respectively. Similarly, contrast sensitivity did not improve to the same extent as visual acuity. Stereopsis was present only in patients with best corrected visual acuity of 6/9 or better with RGP lenses. CONCLUSION: RGP contact lenses improved the visual acuity and other visual performance in patients with reduced vision due to nebular or nebulo-macular corneal opacity. However, contrast sensitivity, glare acuity, and mesopic vision did not improve to the same extent as visual acuity.

Adolescent↗
PubMed2001

A simple alternative method for rapid detection of slime produced by Staphylococcus epidermidis isolates in bacterial keratitis.

BACKGROUND & OBJECTIVES: Slime is a known virulence factor of Staphylococcus epidermidis. The conventional Christensen's method for detection of slime in the laboratory takes at least 48 h. We, therefore, tried to evaluate the efficacy of the Congo red agar method as a routine procedure for detecting slime among isolates from corneal ulcers. METHODS: A total of 244 isolates from corneal ulcers were identified as S. epidermidis by the standard procedures. Slime was detected both by the conventional Christensen's method as well as by the Congo red agar method. RESULTS: Ninety two (37.7%) isolates were positive and 86 (35.2%) were negative for slime by both the techniques. Fifty four (22.1%) isolates were positive in Congo red agar, but negative by Christensen's method; whereas only 12 (4.9%) were negative by Congo red but positive by Christensen's method. Detection of slime by Congo red agar method was rapid i.e., all the 146 strains were positive within 24 h of incubation. On the other hand, Christensen's method had a delayed response; 42.3 per cent (44/104) strains being negative during the first 24 h of incubation. INTERPRETATION & CONCLUSION: Our results suggested that culture on Congo red agar was a sensitive and rapid test for detecting slime. This might help in the quick identification in a routine laboratory of slime positive isolates in bacterial keratitis.

Bacteriological Techniques↗
PubMed2000

Large-diameter lamellar keratoplasty in severe ocular alkali burns: A technique of stem cell transplantation.

PURPOSE: To evaluate the efficacy of large-diameter lamellar keratoplasty in cases of severe ocular alkali burns. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Nine eyes of nine patients with severe ocular alkali burns (grade III/IV) exhibiting corneal vascularization, conjunctivalization, and chronic inflammation were recruited from the Cornea Clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye care center. INTERVENTION: Large-diameter lamellar keratoplasty was performed using McCarey-Kaufman media-preserved donor corneas. The patients were followed up for a minimum of 6 months. MAIN OUTCOME MEASURES: Symptomatic relief, time to epithelialization, best-corrected visual acuity, Schirmer I, tear film break-up time, and central corneal clarity were the parameters evaluated. RESULTS: The mean duration between the injury and surgery was 29.5 +/- 19.4 months. No intraoperative complications were seen. Successful epithelialization of the ocular surface was achieved in all but one eye, and the mean time to epithelialization was 5.2 +/- 4.9 days. One eye had a persistent epithelial defect which was managed with a bandage soft contact lens. All patients achieved symptomatic relief. The preoperative best-corrected visual acuity was </=1/60 in all the patients. There was a significant improvement in vision in six eyes postoperatively (P = 0.013). The corneal clarity was grade 2+ or better in five eyes and 1+ in four eyes. No recurrence of corneal vascularization or signs of rejection were seen in any eye during the mean follow-up of 7.4 +/- 3.2 months. Causes of no improvement of vision included the presence of subepithelial nebulomacular haze in one eye caused by persistent epithelial defect and residual stromal haze. CONCLUSIONS: Large-diameter lamellar keratoplasty is a useful therapeutic modality in cases of severe alkali burns. It is a single-stage procedure that provides a stable ocular surface because of stem cell supplementation and may visually rehabilitate the patient.

Adolescent↗
PubMed2000

Phaco-chop versus stop-and-chop nucleotomy for phacoemulsification.

PURPOSE: To perform a comparative evaluation of phaco-chop versus stop-and-chop nucleotomy techniques of phacoemulsification. SETTING: Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi, India. METHODS: Forty eyes of 40 patients with immature senile cataract were included in the study. Twenty eyes each were randomly assigned to have phaco-chop (Group 1) or stop-and-chop (Group 2) nucleotomy during phacoemulsification. The main parameters were corneal endothelial count, effective phaco time, volume of infusion fluid used, central corneal pachymetry, best corrected visual acuity (BCVA), and intraoperative complications during nucleotomy. Follow-up visits were scheduled at 1, 4, and 12 weeks. RESULTS: The mean effective phaco time was 27 seconds +/- 18 (SD) in Group 1 and 28 +/- 16 seconds in Group 2. The mean corneal endothelial cell loss was 6.89% and 7.17%, respectively, at the end of 12 weeks. The difference between groups was not significant. An anterior capsule tear occurred in 3 eyes in Group 1 and 1 eye in Group 2. All eyes achieved a BCVA of 20/20 at the end of 4 weeks. There were no significant between-group differences in any intraoperative or postoperative parameter. CONCLUSIONS: The phaco-chop and the stop-and-chop nucleotomy techniques were equally efficacious for nuclear management during phacoemulsification.

Cell Count↗
PubMed2000

Pneumococcal keratitis after laser in situ keratomileusis.

A 20-year-old man developed keratitis in his right eye 2 days after laser in situ keratomileusis (LASIK). The patient had rubbed the eye with unclean fingers the night before the onset of symptoms. Examination showed an inferior corneal ulcer with dense infiltration at the junction of the lamellar flap and the surrounding cornea associated with a hypopyon. Streptococcus pneumoniae was isolated on culture. The ulcer resolved with combination therapy of cephazolin 5% and tobramycin 1.3% eyedrops. Patients having LASIK should be instructed that inadequate patient hygiene may predispose to bacterial keratitis.

Adult↗
PubMed2000

Primary posterior capsulorhexis with optic capture and intracameral heparin in paediatric cataract surgery.

PURPOSE: To study the efficacy of using a primary posterior capsulorhexis with optic capture and intracameral heparin in preventing secondary posterior capsule opacification, in paediatric cataract surgery. METHODS: Primary posterior capsulorhexis and optic capture with a heparin-coated intraocular lens (IOL) was performed after lens aspiration in 14 cataractous eyes of 13 children (group I). Ten international units of heparin were added in the irrigating solution. The results were compared with 14 eyes of 11 children who underwent a similar surgical procedure but without a posterior capsulorhexis (group 2). RESULTS: The mean age of the patients in group I was 4.2+/-1.5 years (mean +/- SD) and in group 2 was 4.5+/-1.8 years (range 3-6 years in both the groups). The mean duration of follow up was 36+/-6.4 months in group I and 38+/-8.1 months in group 2. A best corrected visual acuity of 6/24 or better was achieved in 12 eyes in group I and II eyes in group 2. The visual axis remained clear in all the eyes in group I, while 8 eyes (57.14%) in group 2 developed posterior capsule opacification (P = 0.0034) which required a neodymium:yttrium-aluminum-garnet laser capsulotomy. CONCLUSIONS: Lens aspiration using intracameral heparin, combined with primary posterior capsulorhexis and optic capture of a heparin-coated IOL, is a useful technique to prevent secondary visual axis opacification in paediatric cataracts.

Anterior Chamber↗
PubMed2000

Acute haemorrhagic keratoconjunctivitis following laser in situ keratomileusis.

We report two cases of acute haemorrhagic keratoconjunctivitis which occurred following laser in situ keratomileusis (LASIK) during an ongoing epidemic. Both cases underwent preoperative investigation and surgery on the same day. The possible sources of contamination include the paramedical staff, the contact instruments used for performing preoperative investigation, surgeon, nurse, surgical instruments and eye drops. However, the flap was intact with no haze or regression and at 1 year follow up, the visual acuity was maintained at 6/6 in both the patients. We recommend greater caution while performing contact investigations and strict surgical asepsis during LASIK surgery, routinely as well as during epidemics of conjunctivitis.

Acute Disease↗