Rashim Mannan

Purpose Transforming growth factor beta (TGFB) is an important candidate gene implicated in glaucoma pathogenesis because it affects retinal ganglionic cell survival. The present study assessed the genetic association of -509C > T variant in the TGFB promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a North Indian Punjabi population. Method A total of 867 subjects (307 POAG, 133 PACG cases and 427 controls) were recruited from the targeted population. Genotyping was done by PCR-RFLP method and the data was analyzed using PLINK software (v1.07). Logistic regression under different genetic models was applied and genotype phenotype correlation was assessed by one-way ANOVA. Result A statistically significant difference in the frequency of heterozygotes among PACG cases (53.16%) and controls (30.07%) (p = 0.0002) was observed. Genetic model analysis revealed that mutant “TT” genotype conferred 2-fold risk towards PACG development und...

BACKGROUND IL6 is an important candidate gene implicated in the pathogenesis of glaucoma. The present study assessed the genetic association of -174G > C and -572G > C polymorphisms in the IL6 promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a north Indian Punjabi cohort. METHODS 910 subjects (313 POAG, 148 PACG cases and 449 controls) were recruited. Genotyping was done by TaqMan assays. Genetic association was tested under different genetic models using Plink. Diplotype and linkage disequilibrium (LD) analysis was done through Haploview. Association of clinical parameters with the genotypes was assessed by one-way ANOVA. Adjustment for potential confounding variables was done by binary logistic regression. IL6 levels were measured in POAG patients and controls. RESULTS 572G > C variant showed marginal difference in genotype frequency between pooled cases and POAG subgroup with respect to controls (p = 0.042; OR = 1.33; and p = 0.041; OR = 1.37). The GC genotype conferred 1.37-fold protection under codominant model in POAG cases (p = 0.034, OR = 1.37, 95% CI = 1.02-1.85; pcorr = 0.025, OR = 1.45, 95% CI = 1.04-2.02). The mean value for IOP was elevated among cases having 'CC' genotype at the -572G > C locus (p = 0.037). Lower levels of IL6 were detected in POAG patients in plasma samples (p = 0.0001). CONCLUSION The study reports suggestive evidence for -572G > C variant in IL6 in affecting genetic susceptibility to POAG in the targeted North Indian Punjabi cohort. A correlation of IL6 levels in aqueous humor (AH) and systemic circulation in POAG was observed, the functional and diagnostic relevance of which may be further investigated.

Purpose: The aim of this study was to describe a poly-vinyl chloride air condition (PVC AC) curtain shield placed at the intervening space between the chin rest and the illuminating and optical arm of the slit lamp microscope (distal barrier) instead of the present position at the oculars (proximal barrier) to guard against severe acute respiratory syndrome Coronavirus 2. This experimental study was done to validate and compare the protection offered by the conventional breath shields and the one described by us in a simulated environment. Methods: In this experimental study, 12 puffs of fine mist were sprayed over a period of 1 minute using “magenta-colored dye” and “cyan-colored dye” for analyzing proximal barrier and distal barrier respectively. To access the amount of contamination of the slit lamp, caused by sprayed “magenta” and “cyan” colored dye, we covered the entire slit lamp with appropriately sized white-colored cotton sheet. The stained sheets were individually photographed and then the images were first cropped, then color threshold adjusted and then converted to binary and finally fraction of surface area stained was calculated using the ImageJ software. (Pn Surface Areamagenta fraction (%) during analysis of “proximal barrier” and Pn Surface Areacyan fraction (%) during the analysis of “distal barrier”, where Pn refers to various parts of slit lamp. Results: The entire surface area of the cloth covering the slit lamp was 9912.45 cm2. The surface area of the cloth which was stained when using the “proximal barrier” was 567.50 cm2 whereas when using the “distal barrier” was 222.93 cm2. When using proximal barrier, 97.71% of the staining was present on the slit lamp base, viewing arm, illumination arm and the pivot of the slit lamp. While using the distal breath shield no parts of the viewing arm, illumination arm, the pivot or the mechanical base with joystick were stained. Conclusion: The novel PVC AC curtain shield provides better barrier against the simulated contaminated stream of patient's breath directed towards the working parts of the slit lamp as compared to conventional slit lamp oculars mounted breath shields.

AimTo evaluate the effectiveness of bilateral use of topical anesthetic eye drops during phacoemulsification procedure as compared to use in one eye only.MethodsThis is a prospective double-blind randomized case study of 180 cases undergoing phacoemulsification under topical anesthesia using 0.5% proparacaine: Group 1 consisting of patients who had topical anesthetic eye drop instilled into the operating eye only and Group 2 consisting of patients who had both their eyes anesthetized using topical anesthetic eye drops. Phacoemulsification was done using standard surgical technique. Main parameters evaluated included number of intra-operative patient counseling score (IPCS), surgical comfort score (SCS), total phacoemulsification procedure time (TPPT) and total operation time (TOPT).ResultsA comparison of mean value of various variables between Group 1 (60; 33.3% cases) and Group 2 (120; 66.7% cases) using “t” test revealed that there was a statistically significant difference for mean SCS (78.38 ± 10.31 vs. 85.05 ± 8.70; p = 0.00), mean IPCS (12.60 ± 3.11 vs. 6.63 ± 1.74; p = 0.00) and mean TOPT (418.88 ± 89.59 vs. 341.64 ± 79.51; p = 0.00), respectively. However, no statistically significant difference existed for mean TPPT (143.57 ± 87.96 vs. 152.96 ± 78.99; p = 0.48).ConclusionSimultaneous instillation of topical anesthetic eye drops in both the eyes, i.e., operating eye and the fellow eye as against practice of instilling topical anesthetic eye drop in the operating eye only, helps in decreasing the total surgical time by primarily shortening the durations of pre- and post-ultrasonic periods of surgery where effective globe stabilization is wanted. This is achieved by better patient compliance, which in turn enhances surgeon’s comfort during phacoemulsification surgery.

Background Variants in CDKN2B/CDKN2B-AS1 have been reported to modulate glaucoma risk in several GWAS across different populations. CDKN2B/CDKN2A encodes tumor suppressor proteins p16INK4A/p15INK4B which influences cell proliferation/senescence in RGCs, the degeneration of which is a risk factor for glaucoma. CDKN2B-AS1 codes a long non-coding RNA in antisense direction and is involved in influencing nearby CDKN2A/CDKN2B via regulatory mechanisms. Methods Current study investigated four SNPs (rs2157719, rs3217992, rs4977756, rs1063192) of aforementioned genes in a case–control study in a North Indian cohort. Genotyping was done with Taqman chemistry. In addition, an updated meta-analysis was performed. Results Two SNPs, rs3217992 and rs2157719 were found to be significantly associated with the disease. The frequency of ‘T’ allele of rs3217992 was significantly lower in cases (POAG/PACG) [p = 0.045; OR = 0.80(CI = 0.65–0.99) and p = 0.024; OR = 0.73(CI = 0.55–0.96)], respectively tha...

MMP (Matrix metalloproteinase) 9 is reported to affect glaucoma pathogenesis by altering intraocular pressure (IOP) through its role in remodeling the extracellular matrix (ECM) in the trabecular meshwork. A genetic variant at the promoter region in the MMP9 gene (-1562C>T) has a putative role in regulating its transcription rate and hence can affect genetic predisposition to primary glaucoma. The present study examined the association of -1562C>T promoter polymorphism in the MMP9 gene with Primary Open Angle Glaucoma (POAG) and Primary Angle Closure Glaucoma (PACG) in a north Indian population. A total of 729 subjects (POAG = 224, PACG = 138 and 367 controls) were recruited for the study. Genotyping for the promoter sequence variant was done with PCR-RFLP method. Genotypic and allelic frequency distribution of the POAG and PACG data sets were compared to that of controls by chi-square test and genetic association was tested under different genetic models as implemented under ...

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To study the outcomes of successful reenclavation of subluxated iris-fixated phakic intraocular lenses (pIOLs). Tertiary eyecare referral center. Interventional case series comprised eyes with a subluxated Verisyse pIOL that had successful reenclavation of 1 haptic. A comparison of outcomes between primary pIOL implantation surgery and subsequent reenclavation was performed. The parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuity and the quantitative endothelial changes preoperatively and postoperatively at 1 week and 1, 3, and 6 months. Nine eyes of 6 patients were evaluated. Disenclavation was spontaneous in 6 eyes (66.6%) and posttraumatic in 3 eyes (33.3%). The mean UDVA and CDVA at 6 months were comparable between primary surgery and reenclavation. The subluxation and subsequent reenclavation did not cause statistically significant endothelial cell loss; endothelial cell loss after reenclavation was comparable to that after primary surgery (P = .953). Successful subluxation of iris-fixated pIOLs did not cause significant damage to the ocular structures or lead to serious complications.

To evaluate the efficacy, safety, predictability, and stability of iris-fixated phakic intraocular lenses (pIOLs) to correct high myopia in an Asian-Indian population. Tertiary eyecare center. Interventional case series. Eyes with myopia from -5.5 to -24.0 diopters (D) had pIOL implantation and were examined postoperatively at 1 day, 1 week, 1, 3, and 6 months, and yearly for 5 years. Parameters evaluated were postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability, efficacy, stability of mean spherical equivalent (SE), and endothelial cell loss. The study enrolled 85 eyes (44 patients). The mean CDVA improved from 6/10 preoperatively to 6/7 postoperatively and the mean UDVA, from 6/319 to 6/9. Postoperatively, the mean SE was -0.63 ± 0.55 D. Of the 51 eyes completing a 4-year follow-up; 19 (37.3%) had a mean SE of 0.50 D or less and 37 (72.5%) had a mean SE of 1.00 D or less. The CDVA improved 1 line or more in 35 eyes (68.6%); 14 eyes (27.5%) had postoperative CDVA similar to the preoperative CDVA. At 4 years, the safety index was 1.46 and the efficacy index, 0.96. Thirty-six eyes (70.6%) had a postoperative UDVA better than the preoperative CDVA. The mean endothelial cell loss at 1, 3, 6, 12, 24, 36, and 48 months was 4.3%, 5.7%, 7.1%, 7.6%, 8.7%, 9.2%, 11.07%, and 12.4% respectively. Twenty eyes (23.5%) had reenclavation for spontaneous or traumatic disenclavation. Postsurgical refractive outcomes of iris-fixated pIOL implantation for myopia were fairly predictable and stable in an Asian-Indian population. No author has a financial or proprietary interest in any material or method mentioned.

The objective was to study the incidence and risk factors for an early rise in intraocular pressure (IOP) following pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) and to correlate its impact on visual outcome. This was a longitudinal prospective study. IOP and best corrected visual acuity (BCVA) for 73 cases of PDR (52 males and 21 females) who underwent PPV were recorded at day 1, week 1, and months 1, 3, and 6. Risk factors for the early IOP rise, defined as IOP ≥ 30 mmHg at day 1, were evaluated using cross-tabulation and the t-test. Mean IOP at day 1 was 21.8 ± 9.8 mmHg with 15 cases (20.5%) having an early rise in IOP. Risk factors for the early IOP rise included intraoperative fibrovascular frond removal (P = 0.003), lens removal (P = 0.043), and intraoperative vitreous bleed (P = 0.008). The early rise in IOP was also associated with consistently raised IOP (P = 0.02), defined as IOP > 21 mmHg during first three consecutive follow-up visits. Further, difference in BCVA at 6 months among the two groups, i.e., with and without an early IOP rise was statistically significant (3.11 ± 1.52 logMAR vs. 2.11 ± 1.49 logMAR; P = 0.025). An early rise in IOP is a significant risk factor which compromises the visual outcome of patients undergoing diabetic vitrectomy.

To report two cases of corneal infection after Descemet stripping automated endothelial keratoplasty (DSAEK). Two eyes of two patients demonstrated varying clinical presentations of microbial keratitis after DSAEK. At the initial presentation, the keratitis involved the host cornea alone in case 1, whereas in case 2, the posterior lamellar disk alone was involved. A pair of microvitrectomy scissors was used in case 2 from the side port to obtain a 2-mm sample of the posterior lamellar disk for microbiologic evaluation. The keratitis did not respond to medical therapy, and therapeutic penetrating keratoplasty was performed to resolve the infection in both the eyes. The main outcome measures were resolution of infection, absence of recurrence of keratitis, graft clarity, and visual outcome. There was complete resolution of infection after full thickness therapeutic grafts with best-corrected visual acuities of 20/60 and 20/40, respectively. Initial presentation of microbial keratitis after DSAEK may involve either the host or the posterior lamellar disk alone. A microvitrectomy scissors through the side port may be used for biopsy of posterior lamellar disk in recalcitrant infection.

To describe a case of spontaneous wound dehiscence (WD) after complete suture removal in a patient with macular dystrophy who underwent deep anterior lamellar keratoplasty (DALK). A 47-year-old man with macular corneal dystrophy underwent DALK. Intraoperative Descemet membrane perforation was noted. The postoperative period was complicated by corneal edema and high astigmatism. Videokeratography-guided suture removal was carried out, and all sutures were removed by the end of 5 months after which the patient developed spontaneous 270° WD within 6 days. Visual acuity at the time of presentation in the affected eye was counting fingers, anterior chamber was formed, and intraocular pressure was normal. The wound was resutured with 17 interrupted sutures using 10-0 monofilament nylon under topical anesthesia. Three months after resuturing, the best-corrected visual acuity was 6/9, and the graft-host junction was well apposed. A spontaneous WD can be seen after complete removal of nonabsorbable suture during early months after DALK. Timely management can give good visual results.

To describe a surgical technique of deep anterior lamellar keratoplasty (DALK) to treat patients with descemetocele. Twelve eyes of 12 patients with central or paracentral descemetocele after resolved microbial keratitis underwent viscoelastic-assisted DALK. The mean follow-up of the cases was 19.91 ± 15.80 months (range: 6-48 months). In all the eyes, a successful DALK could be performed without any intraoperative complications. At the last follow-up visit, all but 1 eye showed significant improvement in visual acuity compared with preoperative visual acuity. The postoperative best-corrected visual acuity did not improve in 1 patient because of glaucomatous optic atrophy, which was present preoperatively. Eight eyes had best-corrected visual acuity of ≥ 20/80, and all but 2 patients had clear grafts at the final follow-up. None of the patients had any evidence of graft infection. Viscoelastic-assisted DALK is a useful therapeutic option in selected cases of descemetocele after resolved microbial keratitis.

To report a case of Descemet membrane detachment (DMD) after cataract surgery in an operated case of deep anterior lamellar keratoplasty (DALK). Phacoemulsification surgery with intraocular lens implantation was performed in the left eye of a 65-year-old woman who had previously undergone DALK. DMD was noted intraoperatively, for which intracameral injection of air was done at the end of surgery. On the first postoperative day, DMD was seen, and hence, intracameral 20% sulfur hexafluoride (SF(6)) gas was injected. Because the DMD did not resolve, intracameral 14% C(3)F(8) gas was injected on the seventh postoperative day. At the 3-week follow-up, complete resolution of DMD was seen. DMD that occurs during phacoemulsification in a case that has previously undergone DALK can be effectively and safely resolved using intracameral C(3)F(8) gas injection.

To evaluate the structural and functional outcomes of eyes with perforated corneal ulcers undergoing penetrating keratoplasty (PKP) under topical anesthesia. A prospective analysis of 17 consecutive cases that underwent PKP under topical anesthesia, where infiltrative anesthesia was contraindicated or general anesthesia could not be given for medical reasons or was not available for logistical reasons. Seventeen eyes of 15 patients with a mean age of 47.3 ± 16.2 years underwent a PKP for treating perforated corneal ulcers under topical anesthesia. Perforation involved the pupillary zone in 13 (76.5%) cases. Preoperatively, 8 patients (47.1%) were phakic, 8 (47.1%) were pseudophakic, and 1 (5.9%) was aphakic. The PKP was completed successfully in all the eyes. An anterior capsular tear occurred in 3 eyes (17.6%). A posterior chamber intraocular implant was put in 1 eye, and 2 eyes were found to be aphakic. The patients reported mild to moderate discomfort and tolerated the procedure ...

To study the outcomes of successful reenclavation of subluxated iris-fixated phakic intraocular lenses (pIOLs). Tertiary eyecare referral center. Interventional case series comprised eyes with a subluxated Verisyse pIOL that had successful reenclavation of 1 haptic. A comparison of outcomes between primary pIOL implantation surgery and subsequent reenclavation was performed. The parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuity and the quantitative endothelial changes preoperatively and postoperatively at 1 week and 1, 3, and 6 months. Nine eyes of 6 patients were evaluated. Disenclavation was spontaneous in 6 eyes (66.6%) and posttraumatic in 3 eyes (33.3%). The mean UDVA and CDVA at 6 months were comparable between primary surgery and reenclavation. The subluxation and subsequent reenclavation did not cause statistically significant endothelial cell loss; endothelial cell loss after reenclavation was comparable to that after primary surgery (P = .953). Successful subluxation of iris-fixated pIOLs did not cause significant damage to the ocular structures or lead to serious complications.

To evaluate the efficacy, safety, predictability, and stability of iris-fixated phakic intraocular lenses (pIOLs) to correct high myopia in an Asian-Indian population. Tertiary eyecare center. Interventional case series. Eyes with myopia from -5.5 to -24.0 diopters (D) had pIOL implantation and were examined postoperatively at 1 day, 1 week, 1, 3, and 6 months, and yearly for 5 years. Parameters evaluated were postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability, efficacy, stability of mean spherical equivalent (SE), and endothelial cell loss. The study enrolled 85 eyes (44 patients). The mean CDVA improved from 6/10 preoperatively to 6/7 postoperatively and the mean UDVA, from 6/319 to 6/9. Postoperatively, the mean SE was -0.63 ± 0.55 D. Of the 51 eyes completing a 4-year follow-up; 19 (37.3%) had a mean SE of 0.50 D or less and 37 (72.5%) had a mean SE of 1.00 D or less. The CDVA improved 1 line or more in 35 eyes (68.6%); 14 eyes (27.5%) had postoperative CDVA similar to the preoperative CDVA. At 4 years, the safety index was 1.46 and the efficacy index, 0.96. Thirty-six eyes (70.6%) had a postoperative UDVA better than the preoperative CDVA. The mean endothelial cell loss at 1, 3, 6, 12, 24, 36, and 48 months was 4.3%, 5.7%, 7.1%, 7.6%, 8.7%, 9.2%, 11.07%, and 12.4% respectively. Twenty eyes (23.5%) had reenclavation for spontaneous or traumatic disenclavation. Postsurgical refractive outcomes of iris-fixated pIOL implantation for myopia were fairly predictable and stable in an Asian-Indian population. No author has a financial or proprietary interest in any material or method mentioned.

To evaluate the efficacy of a novel technique of intrascleral reverse pocket approach of transconjunctival transscleral (TC-TS) sulcus fixation of intraocular lens (IOL) implants in posttraumatic eyes. A prospective case series of 12 patients who had ocular trauma underwent TC-TS fixation of intraocular implants (including posterior chamber IOLs, rigid or foldable and capsular tension ring) were examined for any intraoperative complications, postoperative best-corrected visual acuity (BCVA), status of conjunctiva, and other potential complications. Twelve eyes of 12 patients (8 men and 4 women) with a mean follow-up of 14.5±7.25 months were included in the analysis. In no case was any intraoperative deroofing of the tunnel or buttonholing of the conjunctiva performed. The mean final BCVA (in Snellen Equivalent [SE]) showed significant improvement from preoperative levels (0.48±0.29 SE vs. 0.65±0.19 SE, respectively; P=0.049). One case showed a single line drop in the BCVA at final follow-up. Another case had a dispersed vitreous hemorrhage in the immediate postoperative period that cleared in 3 weeks' time. One eye demonstrated a clinically detectable IOL tilt, which was corrected by astigmatic prescription in the spectacle glass. None of the cases exhibited postoperative suture knot erosion or breakage of polypropylene sutures until the last follow-up. The technique of intrascleral reverse pocket approach of TC-TS fixation is a successful method of sulcus fixation, which can obviate the need for conjunctival peritomy, thus helping in salvaging the conjunctiva for any future trabeculectomy in posttraumatic eyes predisposed to developing glaucoma.

The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy and amniotic membrane grafting in the management of painful symptomatic bullous keratopathy. We conducted a retrospective consecutive interventional case series. Combined phototherapeutic keratectomy and amniotic membrane grafting was performed in 18 eyes of 17 patients who were symptomatic because of bullous keratopathy. Data analysis was done for only 12 eyes that were followed up for more than 5 weeks and when the postoperative status of the amniotic membrane was known. The mean preoperative duration of the symptoms was 164.17 +/- 179.39 weeks (range, 24-480 weeks). Eleven of 12 eyes (91.67%) were totally symptom-free during the entire postoperative follow-up period of 38.08 +/- 47.95 weeks (range, 5-156 weeks). One patient (8.33%) had mild irritation, which had started at his last postoperative follow up, at 8 months. His amniotic membrane had absorbed at 16 weeks. The amniotic membrane was completely absorbed in 58.33% (7 of 12 eyes) of eyes, partially absorbed in 33.33% eyes (4 of 12 eyes), and not absorbed at all in one eye (8.33 %). None of the patients required any repeat or additional procedure. Phototherapeutic keratectomy when combined with amniotic membrane grafting provides a viable alternative in the management of painful symptomatic bullous keratopathy.

To find an effective and reliable method to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. This interventional case series included 14 eyes of 14 patients with keratoconus (12 males) undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of GRS for the 5 initial cases consisted of only relaxing incisions at the steep meridian in the graft-host interface down to Descemet membrane. For the rest, the relaxing incisions at the steep meridian were accompanied by simultaneous suturing and the effect of the relaxing incisions was controlled through selective suture removal starting a few days after the operation. The main outcomes were uncorrected and corrected visual acuity and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Mean patient age was 29.36 +/- 6.2 years. Mean time interval from complete suture removal to GRS and follow-up period were 4.5 +/- 2.0 months and 12.0 +/- 7.4 months, respectively. Mean preoperative best-corrected visual acuity was 0.29 +/- 0.1, increasing to 0.22 +/- 0.1 logarithm of minimum angle of resolution after the operation (P = 0.007). Average keratometric astigmatism was reduced by 3.8 and 5.5 diopters measured with subtraction and vector analysis methods, respectively. Four of 5 eyes that had only relaxing incisions initially required suturing of the incisions because of overcorrection, whereas preliminary results showed none of the 9 patients undergoing simultaneous relaxing incisions and suturing required further intervention. Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus.

To report a case of nonresolution of acute hydrops despite treatment with intracameral perfluoropropane (C3F8) gas because of fish egging of the gas bubble. An acute hydrops in a 25-year-old female patient with keratoconus was treated with intracameral injection of 0.15 mL of isoexpansile C3F8 (14%). Slit-lamp examination showed multiple small bubbles trapped inside the intrastromal cleft and persistence of corneal edema. Intraoperative fish egging of the C3F8 gas bubble can lead to intrastromal migration of the gas, which may prevent the closure of the intrastromal cleft and hence may impede the resolution of acute hydrops.