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Article ; Online: Mini-Review

Aastha Singh / Virender S. Sangwan

Frontiers in Medicine, Vol

Regenerating the Corneal Epithelium With Simple Limbal Epithelial Transplantation

2021 Volume 8

Abstract: Simple limbal epithelial transplantation (SLET) is an ingenious, low cost and effective technique of limbal stem cell transplantation (LSCT) that is increasingly being undertaken in practice across the world. Since it was first described a decade ago, ... ...

Abstract	Simple limbal epithelial transplantation (SLET) is an ingenious, low cost and effective technique of limbal stem cell transplantation (LSCT) that is increasingly being undertaken in practice across the world. Since it was first described a decade ago, the technique has been performed in a variety of cases of limbal stem cell deficiency (LSCD) and has underwent several innovative modifications. Published literature on SLET has progressively increased over time and successful outcomes in various clinical scenarios have been reported. This concise review attempts to present a crisp account of SLET covering the indications and contraindications of performing the procedure; detailed account of pre-operative work up and preparation; surgical technique and its modifications; post-operative course, care and possible complications as well as published outcomes of surgery from across the world. Comparative analysis of various techniques of LSCT have been discussed and common concerns of surgeons practising or those who are planning to start practising SLET have been addressed. The authors hope that the pragmatic insights and pearls given at the end of the review will aid the surgeons in performing this technique to provide maximum benefit to patients suffering from the potentially blinding condition of LSCD.
Keywords	limbal stem cells ; limbal stem cell deficiency ; limbal stem cell transplantation ; simple limbal epithelial transplantation ; corneal regeneration ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India

Swapna S. Shanbhag / Virender S. Sangwan / Aastha Singh / Pragnya R. Donthineni / Sayan Basu / Bhaskar Srinivasan / Shweta Agarwal / Geetha Iyer

Frontiers in Medicine, Vol

2021 Volume 8

Abstract: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of rare, severe immunological blistering skin reactions which are triggered by medication intake or infections. The acute phase is characterized by necrolysis of the skin and ... ...

Abstract	Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of rare, severe immunological blistering skin reactions which are triggered by medication intake or infections. The acute phase is characterized by necrolysis of the skin and desquamation of mucosa, primarily oral and ocular, with significant mortality rates. The chronic phase is characterized by multi-organ sequelae with increased rates of morbidity and reduced quality of life for patients who have survived the acute phase. Since the primary goal in the acute phase is saving the life of the patient, ocular involvement is often missed and a significant proportion of patients present to an ophthalmologist with the chronic ocular sequelae. In India, chronic ocular sequelae and low vision are observed in two-thirds of patients who present in the chronic phase of SJS/TEN. In the chronic phase of ocular involvement, there are definite windows of opportunity which if targeted with specific interventions such as scleral lenses and mucous membrane grafts can help reduce the incidence of corneal blindness and improve the quality of life for patients with SJS/TEN. Over the last decade, several studies from India have advanced the understanding of the natural course of ocular involvement in SJS/TEN and the outcomes of timely interventions in the chronic phase of the disease. We present an overview of the epidemiology of ocular complications of SJS/TEN in India, the specific challenges faced in the management of ocular complications in the acute stage and recent advances in management of the chronic ocular complications of the disease.
Keywords	Stevens-Johnson syndrome ; toxic epidermal necrolysis ; corneal blindness ; limbal stem cell deficiency ; lid margin keratinization ; amniotic membrane ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Growth of the human lens in the Indian adult population

Ashik Mohamed / Virender S Sangwan / Robert C Augusteyn

Indian Journal of Ophthalmology, Vol 60, Iss 6, Pp 511-

Preliminary observations

2012 Volume 515

Abstract: Context: The eye lens grows throughout life by the addition of new cells inside the surrounding capsule. How this growth affects the properties of the lens is essential for understanding disorders such as cataract and presbyopia. Aims: To examine growth ... ...

Abstract	Context: The eye lens grows throughout life by the addition of new cells inside the surrounding capsule. How this growth affects the properties of the lens is essential for understanding disorders such as cataract and presbyopia. Aims: To examine growth of the human lens in the Indian population and compare this with the growth in Western populations by measuring in vitro dimensions together with wet and dry weights. Settings and Design: The study was conducted at the research wing of a tertiary eye care center in South India and the study design was prospective. Materials and Methods: Lenses were removed from eye bank eyes and their dimensions measured with a digital caliper. They were then carefully blotted dry and weighed before being placed in 5% buffered formalin. After 1 week fixation, the lenses were dried at 80 °C until constant weight was achieved. The constant weight was noted as the dry weight of the lens. Statistical Analysis Used: Lens parameters were analyzed as a function of age using linear and logarithmic regression methods. Results: Data were obtained for 251 lenses, aged 16-93 years, within a median postmortem time of 22 h. Both wet and dry weights increased linearly at 1.24 and 0.44 mg/year, respectively, throughout adult life. The dimensions also increased continuously throughout this time. Conclusions: Over the age range examined, lens growth in the Indian population is very similar to that in Western populations.
Keywords	Accommodation ; disaccommodation ; mydriasis ; phenylephrine hydrochloride ; pupil ; velocity ; Growth ; human adult ; lens diameter ; lens dry weight ; lens thickness ; lens wet weight ; Ophthalmology ; RE1-994 ; Medicine ; R
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Phototherapeutic keratectomy

Varsha M Rathi / Sharadini P Vyas / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 60, Iss 1, Pp 5-

2012 Volume 14

Abstract: Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this ... ...

Abstract	Phototherapeutic keratectomy (PTK) is done regularly for anterior corneal diseases such as corneal dystrophies, corneal degenerations, scars, and band-shaped keratopathy. The various indications include both therapeutic and visual. The aim of this article is to discuss the therapeutic indications for PTK, the specific technique pertaining to a specific etiology, the various other procedures like amniotic membrane graft combined with PTK or PTK being done for recurrences in the grafts, and PTK done before cataract surgery when the anterior corneal pathology coexists with the cataract. Post PTK management such as healing of an epithelial defect, use of steroids in the post PTK period, recurrences of primary disease pathology, and infections, will be discussed. Methods of literature search: A Medline search was carried out for articles in the English language, with the keywords, phototherapeutic keratectomy, band-shaped keratopathy, spheroidal degeneration, scars, bullous keratopathy, and corneal dystrophy. The relevant references are mentioned here.
Keywords	Band-shaped keratopathy ; corneal dystrophy ; phototherapeutic keratectomy ; phototherapeutic keratectomy with amniotic membrane grafts ; scar ; and Salzmann nodular degeneration ; Ophthalmology ; RE1-994 ; Medicine ; R
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes

Varsha M Rathi / Mukesh Taneja / Somasheila I Murthy / Bhupesh Bagga / Pravin Krishna Vaddavalli / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 64, Iss 2, Pp 140-

2016 Volume 144

Abstract: Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for ... ...

Abstract	Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best-corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Pre first PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.
Keywords	Granular corneal dystrophy ; keratoplasty ; phototherapeutic keratectomy ; recurrence ; Ophthalmology ; RE1-994 ; Medicine ; R
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Surgical management in patient with uveitis

Somasheila I Murthy / Rajeev Reddy Pappuru / K Madhavi Latha / Sripathi Kamat / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 61, Iss 6, Pp 284-

2013 Volume 290

Abstract: Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band ... ...

Abstract	Surgery in the management of uveitis can be divided based on indication: either for therapeutic or can be for diagnostic purposes or to manage complications. The commonest indications include: Visual rehabilitation: surgery for removal of cataract, band keratopathy, corneal scars, pupillary membranes, removal of dense vitreous membranes, management of complications: anti-glaucoma surgery, vitreous hemorrhage, retinal detachment and chronic hypotony and diagnostic: aqueous tap, vitreous biopsy, tissue biopsy (iris, choroid). In this review, we shall describe the surgical technique for visual rehabilitation and for management of complications.
Keywords	Algorithmic approach ; differential diagnosis ; naming and meshing ; uveitis ; Uveitis; imaging; fluorescein angiography; optical coherence tomography ; Angiotensin converting enzyme ; antitoxoplasma antibody ; laboratory test ; tuberculin test ; Corticosteroids ; immunosuppressives ; medical management ; Cataract surgery in uveitis ; glaucoma surgery in uveitis ; vitrectomy in uveitis ; Ophthalmology ; RE1-994 ; Medicine ; R
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India

Ujwala S Saboo / Manish Jain / Jagadesh C Reddy / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 61, Iss 9, Pp 486-

2013 Volume 489

Abstract: Purpose: To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India. Materials and Methods: Retrospective chart analysis of 468 patients of VKC seen from January 2006 to ... ...

Abstract	Purpose: To study the demographic and clinical profile of patients with vernal keratoconjunctivitis (VKC) at a tertiary eye care center in India. Materials and Methods: Retrospective chart analysis of 468 patients of VKC seen from January 2006 to December 2006. Results: Mean age at presentation was 12 years. Majority of the patients had mixed pattern disease (72%). Chronic perennial disease was seen in 36% patients. Personal or family history of allergies was noted in 5% patients. Severe disease based on clinical grading was present in 37% patients. Moderate to severe vision loss was seen in 12% of total population. Persistent disease beyond 20 years of age was found in 12% patients. VKC-related complications such as corneal scarring (11%), shield ulcer (3%), keratoconus (6%), and limbal stem cell deficiency (1.2%) were seen. Treatment-related complications like corticosteroid-induced cataract and glaucoma were seen in 6% and 4% of patients, respectively. Conclusion: Clinical pattern of VKC seen in the tropical climate of India is essentially similar to that seen in other tropical countries. Few distinct features that we noted represent chronic perennial disease, low association with atopy, and higher propensity for disease and treatment-related complications.
Keywords	Chemotherapy ; focal treatment ; retinoblastoma ; Allergic eye disease ; papillae ; shield ulcer ; vernal keratoconjunctivitis ; Ophthalmology ; RE1-994 ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Keratoglobus

Varsha M Rathi / Somasheila I Murthy / Bhupesh Bagga / Mukesh Taneja / Sunita Chaurasia / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 63, Iss 3, Pp 233-

An experience at a tertiary eye care center in India

2015 Volume 238

Abstract: Context: This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease. Aims: We report ... ...

Abstract	Context: This study was carried out as a part of an internal audit and is the largest series of patients having keratoglobus, published in the literature. Poor visual acuity of the patients indicates the blinding nature of the disease. Aims: We report our experience with patients having keratoglobus at a tertiary eye care center in India. Settings and Design : Retrospective study. Materials and Methods: We analyzed adults and pediatric patients (<16 years) with keratoglobus, seen during 2008-2012. The age, gender, consanguinity, presenting ocular signs, ocular and systemic associations, visual acuity, corneal topography, and surgeries were documented. Results: Forty-eight patients (mean age 22 ± 15 years, 31 males) having keratoglobus were analyzed. 21 patients (42 eyes) were <16 years. Twelve eyes (16 events) had positive history of trauma. The presenting clinical signs were corneal scars/scars of tear repair (15 eyes), hydrops, healed and acute (14 eyes) and corneal or globe rupture (9 eyes). Best-corrected visual acuity was >20/40 in 6/42 (14.3%) pediatric eyes and 15/53 (28.30%) adults. Visual acuity ranging from counting of fingers to no light perception was noted in 20/53 (37.74%) adults and 21/42 (50%) pediatric patients; 13/20 (65%) with blue sclera and 8/22 eyes (36.37%) without blue sclera. Vernal keratoconjunctivitis was present in one pediatric patient. Choroidal osteoma, retinitis pigmentosa, and retinal detachment were present in adults. Surgeries performed were corneal tear repair (5 eyes), tissue adhesive application (2 eyes), descematopexy (4 eyes) and penetrating keratoplasty (PK - 8 eyes: Three had post-PK glaucoma, graft failure-one eye, 4 patients wore scleral lens - prosthetic replacement of the ocular surface ecosystem). Conclusions: About 50% of pediatric eyes (65% having blue sclera) had no functional vision. Trivial trauma was responsible for corneal rupture indicating need for protective glasses. About 50% patients had post-PK glaucoma though grafts were clear.
Keywords	Intraocular ; lymphoma ; retina ; vitreous ; Conjunctiva ; cornea ; melanoma ; ocular surface ; ocular surface squamous neoplasia ; tumor ; Brachytherapy ; chemotherapy ; cryopexy ; intra ocular tumors ; photocoagulation ; Animal uveitis model ; cytomegalovirus retinitis animal model ; endotoxin-induced uveitis ; experimental autoimmune uveitis ; spontaneous ; tubercular uveitis animal model ; India ; genetics ; retinoblastoma ; review ; Glaucoma ; heavy silicone oil ; light silicone oil ; ocular hypertension ; retinal detachment ; standard silicone oil ; Adults ; blue sclera ; keratoglobus ; management ; pediatric patients ; Ophthalmology ; RE1-994 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Short-term outcome of Boston Type 1 keratoprosthesis for bilateral limbal stem cell deficiency

Sayan Basu / Mukesh Taneja / Raja Narayanan / Sirisha Senthil / Virender S Sangwan

Indian Journal of Ophthalmology, Vol 60, Iss 2, Pp 151-

2012 Volume 153

Abstract: This study reports the short-term functional and anatomical outcome of Boston Type 1 keratoprosthesis (Boston Kpro) implantation for bilateral limbal stem cell deficiency (LCSD). Retrospective analysis was done on eight eyes of eight patients who ... ...

Abstract	This study reports the short-term functional and anatomical outcome of Boston Type 1 keratoprosthesis (Boston Kpro) implantation for bilateral limbal stem cell deficiency (LCSD). Retrospective analysis was done on eight eyes of eight patients who underwent Boston Kpro implantation between July 2009 and October 2009. The best corrected visual acuity (BCVA) and slit-lamp biomicroscopy findings were assessed at 1, 3 and 6 months postoperatively. All eight eyes retained the prosthesis. BCVA of 20/40 or better was achieved in 8, 6, and 5 eyes at 1, 3, and 6 months, respectively, postoperatively. One patient each developed epithelial defect, sterile stromal melt and fungal keratitis in the late postoperative period associated with antecedent loss of the soft contact lens from the eye. Boston Kpro has good short-term visual and anatomical outcome in patients with bilateral LSCD, provided compliance with postoperative care can be ensured.
Keywords	Orbit ; proptosis ; thyroid ; Hyperhomocysteinemia ; retinal arterial occlusions ; systemic associations ; young age ; Illumination ; letter charts ; visual acuity ; Dacryocystorhinostomy ; intraocular pressure ; systemic effects ; timolol maleate ; Accommodation ; dynamic retinoscopy ; ophthalmoscopy ; photorefraction ; photoretinoscopy ; Apoptosis ; corneal epithelium ; formulation ; sphingosine-1 phosphate ; Digital camera ; external photograph ; photography ; Android ; eye handbook ; iPhone ; smart phone ; testing tools ; Anterior chamber intraocular lens ; gyrate atrophy ; posterior dislocation of intraocular lens ; psuedophakia ; Conjunctival ulcer ; conjunctivitis ; Stenotrophomonas maltophilia ; Adrenergic blocker ; imipramine ; intraoperative floppy iris syndrome ; iris hooks ; phacoemulsification ; Corneal ectasia ; deep anterior lamellar keratoplasty ; hexagonal keratotomy ; hyperopia ; Intravitreal triamcinolone acetonide ; retinochoroiditis ; toxoplasmosis ; Capsulorrhexis ; completion rates ; pediatric cataract surgery ; Complications ; knotless scleral fixated intraocular lens ; technique ; Bilateral abducens nerve ; delayed onset paresis ; head injury ; Boston keratoprosthesis ; limbal stem cell deficiency ; Ophthalmology ; RE1-994 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2012-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Transforming ocular surface stem cell research into successful clinical practice

Virender S Sangwan / Rajat Jain / Sayan Basu / Anupam B Bagadi / Shraddha Sureka / Indumathi Mariappan / Sheila MacNeil

Indian Journal of Ophthalmology, Vol 62, Iss 1, Pp 29-

2014 Volume 40

Abstract: It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus ... ...

Abstract	It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus maintaining a stable and uniformly refractive corneal surface. Establishing this hitherto unknown association between ocular surface disease and limbal dysfunction helped usher in therapeutic approaches that successfully addressed blinding conditions such as ocular burns, which were previously considered incurable. Subsequent advances in ocular surface biology through basic science research have translated into innovations that have made the surgical technique of limbal stem cell transplantation simpler and more predictable. This review recapitulates the basic biology of the limbus and the rationale and principles of limbal stem cell transplantation in ocular surface disease. An evidence-based algorithm is presented, which is tailored to clinical considerations such as laterality of affliction, severity of limbal damage and concurrent need for other procedures. Additionally, novel findings in the form of factors influencing the survival and function of limbal stem cells after transplantation and the possibility of substituting limbal cells with epithelial stem cells of other lineages is also discussed. Finally this review focuses on the future directions in which both basic science and clinical research in this field is headed.
Keywords	Lasik ; corneal scars ; corneoplastique ; premium cataract surgery ; refractive complications ; radial keratotomy ; pterygium ; pinguecula ; astigmatism ; Antioxidants ; electromagnetic ration ; glutathione ; lens ; oxidative stress ; 2-ethylpyridine ; apoptosis ; ARPE-19 cells ; cigarette smoke toxicant ; mitochondrial membrane potential ; reactive oxygen/nitrogen species ; Intacs ; keratoconus ; nomogram ; Allograft ; autograft ; cell-based therapy ; limbus ; limbal stem cell deficiency ; limbal transplantation ; niche ; stem cells ; Ophthalmology ; RE1-994 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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