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Biomedical subjects

S K Rao

Publications and source records attributed to S K Rao.

At least 19 recordsLinked to original sources
PubMed2000

Traumatic partial unfolding of laser in situ keratomileusis flap with severe epithelial ingrowth.

We report an unusual flap-related complication that occurred 11 months after uneventful laser in situ keratomileusis (LASIK) performed in the eye of a 50-year-old woman. She developed partial infolding of the LASIK flap in her left eye after blunt trauma. The initial diagnosis was partial flap loss and 4 weeks later, infolding of the flap was diagnosed after severe epithelial ingrowth. Surgical repositioning of the flap resulted in a best corrected visual acuity of 20/20. Clinical features that assist in the diagnosis of this unusual complication and guidelines for its management are described.

Cornea↗
PubMed2000

In situ tumbling of the AcrySof intraocular lens.

The small incision through which foldable acrylic intraocular lenses (IOLs) are implanted does not allow easy explantation of the lens in the event of intraoperative complications. Reversal of the IOL optic during insertion, although rare, can predispose to postoperative complications such as pupillary capture of the IOL, capsule bag distension syndrome, and refractive problems. Explanting the IOL can damage it, the cataract wound, or both. We describe a technique of in situ tumbling of the AcrySof IOL to correct reversed-optic implantation that preserves the integrity of the IOL and anterior segment structures.

Acrylic Resins↗
PubMed2000

Bilateral corneal infiltrates after excimer laser photorefractive keratectomy.

A 26-year-old man developed painless inferior subepithelial infiltrates away from the site of ablation in both eyes after excimer laser photorefractive keratectomy (PRK) for myopia. Clinical characteristics of the corneal infiltrates resembled staphylococcal-immune infiltrates. The condition responded to treatment with topical diluted steroids and antibiotics. There was no residual corneal scarring. The infiltrates did not affect the refractive outcome of the surgery. Recognition of this rare entity will help clinicians avoid aggressive investigative and treatment modalities that can affect the results of PRK.

Adult↗
PubMed2000

Scleral fixation of a capsular tension ring for severe ectopia lentis.

A 4-year-old boy with bilateral idiopathic and progressive ectopia lentis had phacoaspiration of the lens and capsular tension ring (CTR) insertion in his left eye. Postoperatively, lens capsule centration remained poor. Single-point scleral fixation of the CTR was performed and centration of the lens capsule achieved. In-the-capsule intraocular lens (IOL) implantation was tried, but excessive IOL manipulation sliced open the capsule at the equator. Anterior vitrectomy and scleral IOL fixation were required. A similar approach was adopted in the right eye with meticulous attention given to gentle maneuvers. The operation was uneventful, with good IOL centration. Three and 11 months after surgery in the right and left eye, respectively, best corrected visual acuity was 20/50 in both eyes. Scleral fixation of the CTR, accompanied by gentle IOL manipulation, is an option to improve IOL centration in patients with severe zonular deficiency.

Child, Preschool↗
PubMed2000

Pathogenesis and management of laser in situ keratomileusis flap buttonhole.

PURPOSE: To describe the clinical features and outcomes in patients who had a flap buttonhole during laser in situ keratomileusis (LASIK) and propose an etiopathogenic mechanism for this complication. SETTING: University Eye Center, Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. METHODS: Retrospective review of case records of 6 patients (6 eyes) who had a flap buttonhole during LASIK. RESULTS: The mean patient age was 38.2 years +/- 4.1 (SD) and the mean preoperative spherical equivalent (SE) refraction, -8.13 +/- 4.04 diopters (D). Mean keratometry was 44.20 +/- 1.30 D. Retreatment was performed after a mean interval of 9.2 +/- 3.2 months. Final postoperative SE refraction was -0.44 +/- 0.58 D after a mean follow-up of 59.0 +/- 5.3 weeks. No patient experienced loss of best spectacle-corrected visual acuity. CONCLUSIONS: Retreatment of eyes that have a flap buttonhole during LASIK is associated with good visual outcomes. Flap buttonholes can produce alterations in refraction, so retreatment is best performed after the refractive error has stabilized. Microkeratome malfunction may be responsible for the occurrence of a flap buttonhole during LASIK in eyes that do not have significant corneal steepening.

Adult↗
PubMed2000

Conjunctival rhinosporidiosis associated with scleral melting and staphyloma formation: diagnosis and management.

PURPOSE: Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation. METHODS: Retrospective review of case records of three patients with conjunctival rhinosporidiosis. RESULTS: Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey-white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma. CONCLUSION: Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

Adolescent↗
PubMed1999

Reduced capacity to inhibit elastase in abdominal aortic aneurysm.

BACKGROUND: Loss of elastin in the aortic wall is an early event in abdominal aortic aneurysm (AAA). An imbalance in the protease-antiprotease system is proposed to be one of the factors that promote connective tissue destruction. We hypothesize that plasma from AAA patients will have a reduced inhibitory capacity in comparison to normal controls. MATERIALS AND METHODS: Using an assay we developed, plasma (10 microliters), collected from AAA patients (n = 14) and normal controls (n = 13), was added to the elastase inhibition assay containing succinylated elastin substrate. The reaction was initiated with 13.9 units porcine pancreatic elastase (PPE). Elastase activity in the presence and absence of plasma was compared. Plasma elastase was also determined using the Merck PMN-elastase kit. RESULTS: The relative activity of exogenous elastase (%) in the presence of AAA plasma (n = 14, mean age 73.4 years +/- 1.7 SEM) was 42.59% +/- 4.3 SEM, while that in the presence of control plasma (n = 13, mean age 73.9 years +/- 2.1 SEM) was 10.23% +/- 2.1 SEM (P < 0.0001). Analysis of plasma elastase (microgram/L) indicated that there was no significant difference between normal (n = 9, 207.33 microgram/L +/- 58.67 SEM) and AAA (n = 9, 145.34 microgram/L +/- 29.54 SEM) (P = 0.359). CONCLUSION: There is a significant reduction in the plasma inhibitory capacity of elastase in AAA patients in comparison to normal controls, though plasma elastase level was not significantly different. The data presented here give experimental evidence to the protease-antiprotease imbalance in AAA patient plasma and may lead to the development of a measurable parameter to monitor AAA.

Aged↗
PubMed1999

Limbal allografting from related live donors for corneal surface reconstruction.

OBJECTIVE: To report the results of limbal allograft transplantation, from human leukocyte antigen (HLA)-matched and -unmatched related live donors, in patients with ocular surface disease due to chemical burns and Stevens-Johnson syndrome. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eight patients (nine eyes) with severe chemical burns (n = 7 eyes) and Stevens-Johnson syndrome (n = 2 eyes). INTERVENTION: Recipient eyes were treated with excision of cicatricial tissues. Transplantation of superior and inferior limbal grafts was performed from related live HLA-matched (n = 7) and -unmatched donors (n = 2). Systemic cyclosporine was not used in any of the recipients. MAIN OUTCOME MEASURES: Reconstruction of corneal surface epithelium, restoration of avascularity, increase in ocular comfort, and improvement in visual acuity. RESULTS: With a mean observation period of 17.2 months, phenotypically corneal epithelium, decreased vascularization of the corneal surface, and improved ocular comfort were seen in seven (77.8%) eyes. In all seven eyes, gradual recurrence of peripheral corneal vascularization occurred during the follow-up period. Features of graft rejection developed in three (42.9%) of these seven eyes. In two eyes, limbal transplantation from HLA-unmatched donors failed to reconstitute the corneal surface. Limbal allograft transplantation resulted in visual acuity of 20/400 or greater in only two (22.2%) eyes at last follow-up. Corneal grafts performed 7 and 16 months after successful limbal transplantation in two eyes developed recurrent epithelial breakdown and superficial corneal scarring. None of the donor eyes in this study had any complication. CONCLUSION: Transplantation of limbal tissue from related live donors successfully reconstructs the corneal surface in HLA-matched recipients. Recurrence of vascularization on long-term follow-up probably results from inadequate stem cell transfer, immune-mediated stem cell damage, or both. Limbal allografting is best performed by transplanting the entire limbus from a cadaveric donor eye with systemic immunosuppression of the recipient, even if the donor is HLA-compatible.

Adolescent↗
PubMed1999

Management of severe flap wrinkling or dislodgment after laser in situ keratomileusis.

PURPOSE: To review the management and results of cases with severe flap wrinkling or dislodgment after laser in situ keratomileusis (LASIK). SETTING: University Eye Center, Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong. METHODS: Four patients with severe flap wrinkling or dislodgment after LASIK are described. Surgical repositioning of the flap was performed in all cases. Flap status, refractive changes, and final uncorrected and best corrected visual acuities were used to evaluate the outcome of flap repositioning. RESULTS: Flap repositioning required suturing in 2 patients, 1 of whom developed severe epithelial ingrowth with melting of the corneal flap and stromal bed and eventually required flap removal. The stromal inflammation resolved, and the corneal surface re-epithelialized after flap excision. In 2 other patients, wedge-shaped tissue excision (1.0 x 1.5 mm) from the superior portion of the corneal flap was necessary to allow better flap realignment. In 1 of these patients, the corneal flap was eventually converted to a free cap to correct residual wrinkling. At a mean follow-up of 15 months, the postoperative uncorrected visual acuity ranged from 20/20 to 20/60, and the best spectacle-corrected visual acuity (BSCVA) was 20/30 or better in all patients. In 1 patient, BSCVA decreased by 1 line. CONCLUSIONS: Flap dislodgment and wrinkling are serious postoperative complications of LASIK. Early recognition of these complications and prompt surgical management are crucial to achieve a successful surgical and visual outcome.

Adult↗