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Biomedical subjects

V K Dada

Publications and source records attributed to V K Dada.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2000

Sterile central disciform keratopathy after LASIK.

PURPOSE: To report a case with bilateral disciform keratopathy after laser in situ keratomileusis (LASIK). RESULTS: A 28-year-old man was referred to us with complaints of progressive painless diminution of vision, 5 days after having undergone bilateral simultaneous LASIK for hyperopia. The surgery was performed on the Chiron Technolas 217 excimer laser machine along with the hansatome, in which previously used blades were installed. Slit-lamp biomicroscopy revealed bilateral translucent disc-shaped lesions in the central cornea of both eyes. The lesions resolved after intense topical steroid therapy over a period of 3 weeks. CONCLUSION: Reuse of the microkeratome blade may have been the cause of this complication. The use of a new blade and meticulous cleaning of the microkeratome prior to use in each eye may help to prevent this complication.

Adult↗
PubMed1999

Phacoemulsification of white hypermature cataract.

PURPOSE: To evaluate the safety of phacoemulsification of white hypermature cataract, which is common in developing countries. SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: In a teaching hospital setting, a prospective evaluation of phacoemulsification in 25 eyes of 25 consecutive patients with hypermature cataract was done. Patients with good pupil dilation, optimal endothelial cell count, and disease-free ocular and systemic status were included. High magnification, sodium hyaluronate, and a Utrata capsulorhexis forceps were used to perform continuous curvilinear capsulorhexis (CCC). The stop and chop technique was used for nuclear emulsification. A 5.5 mm optic allpoly(methyl methacrylate) intraocular lens (IOL) was implanted, and wound closure was sutureless. RESULTS: Successful CCC was performed in 23 of 25 cases. In 2 cases, the CCC edge extended toward the periphery and a Vannas scissors was used to achieve an even cut. No complications were seen during nuclear emulsification and IOL implantation. Eighty percent of the patients had a visual acuity of 20/40 or better on the first postoperative day. Five patients had significant corneal edema that resolved within 1 week in all cases. CONCLUSION: Phacoemulsification was successfully and safely performed in appropriately selected patients with white hypermature cataract.

Aged↗
PubMed1999

Complications of pediatric cataract surgery and intraocular lens implantation.

PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.

Capsulorhexis↗
PubMed1999

Comparative evaluation of plate haptic lenses with smaller and larger positioning holes.

PURPOSE: To evaluate the visual outcome, intraoperative problems and postoperative complications of plate haptic intraocular lenses with smaller foot plate positioning holes and larger holes. METHODS: Fifty eyes of 50 patients underwent clear corneal phacoemulsification with implantation of either small hole plate haptics (25 eyes) or large hole plate haptic lenses (25 eyes). The intraoperative complications were noted and the postoperative parameters were evaluated on the first day, 1 week, 1 month, 3 months, 6 months and 12 months. These included the best corrected visual acuities, intraocular lens (IOL) decentring, diameter of anterior capsulorhexis and posterior capsule opacification. RESULTS: The mean duration of follow-up was 14.8+/-2.1 months in the group with the small foot plate positioning holes (Chiron C10UB) lens and 15.6+/-3.2 months in the group with the large feet plate positioning holes (Chiron C11UB) lens. The was no significant difference in the visual acuities of the two groups. The mean IOL decentring was 0.42+/-0.28 mm in the C10UB lenses and 0.24+/-0.10 mm in the C11UB lenses (P = 0.05). The mean diameter of the anterior capsulorhexis was 4.68+/-0.23 mm in the former, while it was 4.21+/-0.68 mm in the latter (P = 0.0027). The posterior capsule opacification was significantly increased in the C11UB group (P = 0.0298). Neodymium : yttrium aluminium garnet (Nd: YAG) laser capsulotomy was required in 8% of the C10UB group, compared to 28% in the C11UB group. CONCLUSION: Results are similar with the two types of plate haptic lenses. The lenses with larger holes have a significantly higher posterior capsule opacification and more anterior capsulorhexis contracture, although the IOL decentring is less with these lenses.

Aged↗
PubMed1999

Management of cataract--a revolutionary change that occurred during last two decades.

In the field of ophthalmology, perhaps no other surgery has undergone such rapid changes in the past few decades, as the surgery for cataract. Over these years there has been an emergence of small incision cataract surgery, especially by phaco-emulsification. It offers a number of attractive benefits to both the surgeon and the patient. Phaco has now captured the centre stage in the surgical management of cataract. With the advent of phaco it became imperative to design incision in a valvular manner to provide water tight anterior chamber, to design phacoprofile intra-ocular lenses specifically foldable intra-ocular lenses, instruments for precision and better control, better visco-elastic material and irrigating fluids. These advancements in this field have revolutionised the management of cataract surgery and have facilitated achieving new peaks in quality of surgery and recovery of visual acuity to precataract stage and correction of pre-existing astigmatism.

Cataract Extraction↗
PubMed1998

Modified phacoemulsification in situ.

We describe a phacoemulsification technique for cataracts in eyes with anticipated weak zonular apparatus. After central sculpting, a crater 90% deep is made. A horizontal fracture is created with the phaco probe and chopper. The nucleus is chopped, dividing the inferior hemisection into 2 pie-shaped pieces, which are then emulsified. Without rotating the nucleus, a groove is made at the superior hemisection and a vertical fracture created with the chopper. The bevel of the phaco probe is then turned down to emulsify each quadrant separately. This technique is especially useful in eyes with weakened zonular apparatus such as those with hypermature cataract, uveitis, long-standing glaucoma, trauma, retinitis pigmentosa, and operated retinal detachments.

Cataract↗
PubMed1998

Conversion from phacoemulsification to extracapsular cataract extraction: incidence, risk factors, and visual outcome.

PURPOSE: To evaluate the incidence, risk factors, and visual outcome in cases converted from phacoemulsification to routine extracapsular cataract extraction (ECCE). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: A retrospective study was performed in 540 eyes that had clear corneal phacoemulsification performed by an experienced phacoemulsification surgeon. The cases in which phacoemulsification was initiated and then converted to ECCE were studied. The main parameters evaluated were the factors responsible for the conversion, corneal endothelial cell loss, and visual outcome. RESULTS: Twenty eyes (3.7%) required conversion to ECCE during phacoemulsification. Pupillary miosis (6 cases), posterior capsule rupture (5 cases), prolonged phaco time (4 cases), posterior extension of the capsulorhexis (2 cases), corneal thermal burn (1 case), subluxation of the lens (1 case), and malfunctioning of the ultrasonic handpiece (1 case) were the reasons for the conversion. The mean percentage of endothelial cell loss was 11.06% +/- 2.3 (SD); 18 cases (90.0%) achieved a visual acuity of 20/40 or better at 6 weeks. CONCLUSIONS: Intraoperative pupillary miosis, posterior capsule rupture, and very hard nuclear cataract causing prolonged phacoemulsification were the major risk factors for conversion to ECCE. Optimal preoperative preparation and prompt recognition of complications during phacoemulsification can lead to timely conversion to ECCE to achieve a good visual outcome.

Cell Count↗
PubMed1994

Postoperative intraocular pressure changes with use of different viscoelastics.

Sixty eyes with age-related cataract underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation under similar conditions using hydroxypropyl methylcellulose (HPMC) (Oculose) (n = 20), sodium hyaluronate (Healon) (n = 20), or hyaluronic acid (IAL) (n = 20) as the viscoelastic (VE). Postoperative evaluation was performed for intraocular pressure (IOP), corneal thickness, and anterior chamber reaction at 6, 24, 48, 72 hours, and 10 days. Statistically-significant rises in IOP with IAL and Healon were observed at 6 and 24 hours; no such rises were observed with Oculose (P < .05). Seven eyes in the IAL group and six in the Healon group had IOPs greater than 22 mm Hg at 6 hours (range: 22 to 38 mm Hg and 22 to 28 mm Hg, respectively). A significant increase in average corneal thickness was observed in all of the 60 patients at 6 hours (18.5%). The average thickness decreased to 6.8% by day 10, with no intergroup variations. There were significantly fewer anterior chamber cells at 6 hours in the Healon group. We conclude that all three viscoelastics are equally useful for routine ECCE with PC-IOL implantation. However, IAL and Healon do cause an early postoperative IOP increase, which, though transient, should be treated.

Anterior Chamber↗
PubMed1994

Comparative efficacy of diclofenac and flurbiprofen for maintenance of pupillary dilatation during cataract surgery.

A double-blind, prospective, randomized clinical study was undertaken to evaluate the relative efficacy of flurbiprofen 0.03% and diclofenac 0.1% eye drops, in combination with routinely used mydriatics, in maintaining pupillary dilatation during extracapsular cataract surgery with intraocular lens implantation. The effectiveness of administering systemic flurbiprofen along with the topical drugs in enhancing maintenance of pupillary dilatation also was assessed. Pupillary diameter, as measured at various surgical stages, was significantly greater in the patients receiving diclofenac or flurbiprofen eye drops as compared with those in a control group who did not (P < .001). While the maintenance of pupillary dilatation was consistently better with diclofenac than with flurbiprofen, the difference was not statistically significant. Furthermore, though maintenance of pupillary dilatation was better in cases in which systemic flurbiprofen was added to the preoperative drug regime, again, the difference was not significant.

Administration, Topical↗