Other articles by Rupesh Agrawal on PubMed

• Recurrent Anterior Uveitis and Healed Retinal Vasculitis Associated with Multiple Sclerosis Indian Journal of Ophthalmology. Mar, 2003  |   Pubmed ID: 12701867 We describe the occurrence of anterior uveitis with healed retinal vasculitis in an Asian-Indian woman. She had features of anterior uveitis and healed retinal vasculitis. This rare disease in India may be associated with intraocular inflammation.
• Mycophenolate Mofetil Therapy in Uveitis: Analysis of Eight Cases in a Tertiary Ophthalmic Care Centre in India International Ophthalmology. Apr, 2009  |   Pubmed ID: 18080093 Mycophenolate mofetil (MMF) is a relatively new immunomodulatory agent. The experience of MMF in inflammatory eye diseases is limited to a few case series. We report our experience of MMF in eight patients with uveitis. Control of inflammation was achieved in all patients. No patient had adverse side effects. Our study indicates that MMF is a safe and effective immunomodulatory agent.
• Current Approach in Diagnosis and Management of Anterior Uveitis Indian Journal of Ophthalmology. Jan-Feb, 2010  |   Pubmed ID: 20029142 Uveitis is composed of a diverse group of disease entities, which in total has been estimated to cause approximately 10% of blindness. Uveitis is broadly classified into anterior, intermediate, posterior and panuveitis based on the anatomical involvement of the eye. Anterior uveitis is, however, the commonest form of uveitis with varying incidences reported in worldwide literature. Anterior uveitis can be very benign to present with but often can lead to severe morbidity if not treated appropriately. The present article will assist ophthalmologists in accurately diagnosing anterior uveitis, improving the quality of care rendered to patients with anterior uveitis, minimizing the adverse effects of anterior uveitis, developing a decision-making strategy for management of patients at risk of permanent visual loss from anterior uveitis, informing and educating patients and other healthcare practitioners about the visual complications, risk factors, and treatment options associated with anterior uveitis.
• Nucleus Management with Blumenthal Technique: Anterior Chamber Maintainer Indian Journal of Ophthalmology. Jan-Feb, 2010  |   Pubmed ID: 20029159
• Wound Construction in Manual Small Incision Cataract Surgery Indian Journal of Ophthalmology. Jan-Feb, 2010  |   Pubmed ID: 20029160
• Prognostic Factors for Final Vision Outcome in Patients with Open Globe Injuries Indian Journal of Ophthalmology. May-Jun, 2011  |   Pubmed ID: 21586860
• Prognostic Factors for Vision Outcome After Surgical Repair of Open Globe Injuries Indian Journal of Ophthalmology. Nov-Dec, 2011  |   Pubmed ID: 22011491 To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries.
• Fish-hook Injury of the Eye International Ophthalmology. Jun, 2012  |   Pubmed ID: 22456795 The objective of this case report is to report two cases of fish-hook injury to the eye and ocular adnexa with review of literature. Both patients with fish-hook injuries were professional fishermen. The first subject was hit in his right eye by a hook which became embedded in the right cornea. He cut off the line but made no attempt to remove the hook and presented to the emergency department with the hook hanging from his right eye. Under general anaesthesia, the hook was rotated out without causing any further damage to the cornea and intraocular structures. The second subject was reeling the hook back to shore when it hit him in the face and embedded itself in the upper eyelid. He was immediately taken to the emergency department and after careful examination the eye was found to be unharmed and the hook was removed through a small incision under local anaesthesia. Fish-hook injuries, though rare, can result in visual morbidity. The hook should be removed under careful examination using the correct technique. The shaft of the hook should be left long and no attempt should be made by the subject or any non-trained person to remove it as doing so can result in further damage.
• Bilateral Endogenous Endophthalmitis Associated with Methicillin Sensitive Staphylococcus Aureus (MSSA) Related Tenosynovitis: Case Report Ocular Immunology and Inflammation. Jun, 2012  |   Pubmed ID: 22512341 Endogenous endophthalmitis is a rare, devastating intraocular infection associated with poor outcome often from late diagnosis. We present a case report of acute onset bilateral endogenous endophthalmitis caused by Methicillin Sensitive Staphylococcus Aureus causing tenosynovitis of carpometacarpal joint in a 64 year old man with Type II Diabetes Mellitus. To the best of our knowledge, this is the first case report of endogenous endophthalmitis following tenosynovitis. This case also highlights the fact that prompt diagnosis and treatment is the key for good outcome.
• Cataract Surgery in Uveitis International Journal of Inflammation. 2012  |   Pubmed ID: 22518338 Cataract surgery in uveitic eyes is often challenging and can result in intraoperative and postoperative complications. Most uveitic patients enjoy good vision despite potentially sight-threatening complications, including cataract development. In those patients who develop cataracts, successful surgery stems from educated patient selection, careful surgical technique, and aggressive preoperative and postoperative control of inflammation. With improved understanding of the disease processes, pre- and perioperative control of inflammation, modern surgical techniques, availability of biocompatible intraocular lens material and design, surgical experience in performing complicated cataract surgeries, and efficient management of postoperative complications have led to much better outcome. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation. Meticulous and careful cataract surgery in uveitic cataract is essential in optimizing the postoperative outcome. Management of postoperative complications, especially inflammation and glaucoma, earlier rather than later, has also contributed to improved outcomes. This manuscript is review of the existing literature and highlights the management pearls in tackling complicated cataract based on medline search of literature and experience of the authors.
• Predictive Factors for Final Outcome of Severely Traumatized Eyes with No Light Perception BMC Ophthalmology. Jun, 2012  |   Pubmed ID: 22712600 An eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes.
• Contaminated Intraocular Lens Solution Ophthalmology. Nov, 2012  |   Pubmed ID: 23122472
• Anterior Capsular Phimosis Syndrome Archives of Ophthalmology (Chicago, Ill. : 1960). Dec, 2012  |   Pubmed ID: 23229701
• Histopathologically Proven Siderotic Cataract with Disintegrated Intralenticular Foreign Body Indian Journal of Ophthalmology. Jan-Feb, 2013  |   Pubmed ID: 23275219 Cataract formation may be an indicator of early siderosis and has been associated with intralenticular foreign bodies. We report a unique case of histopathologically proven lens siderosis in a young man with a preceding history of trauma but no signs of retained intraocular foreign body. He presented with a total white cataract with brownish deposits on anterior capsule and underwent cataract surgery for same followed by histopathological staining of anterior capsule for iron deposits. This case illustrates the importance of close monitoring of patients with history of trauma or previous penetrating injury to the eye, albeit no intraocular foreign body, as they might develop ocular siderosis at a later stage.
• Controversies in Ocular Trauma Classification and Management: Review International Ophthalmology. Aug, 2013  |   Pubmed ID: 23338232 Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.
• Indocyanine Green Angiography in Posterior Uveitis Indian Journal of Ophthalmology. Apr, 2013  |   Pubmed ID: 23685486 Literature review for indocyanine green angiography and evaluate the role of indocyanine green angiogram (ICGA) in patients with posterior uveitis seen at a tertiary referral eye care centre. Detailed review of the literature on ICGA was performed. Retrospective review of medical records of patients with posterior uveitis and dual fundus and ICGA was done after institutional board approval. Eighteen patients (26 eyes) had serpiginous choroiditis out of which 12 patients had active choroiditis and six patients had healed choroiditis, six patients (12 eyes) had ampiginous choroiditis, six patients (12 eyes) had acute multifocal posterior placoid pigment epitheliopathy, eight patients (10 eyes) had multifocal choroiditis, four patients (eight eyes) had presumed ocular histoplasmosis syndrome, four patients (eight eyes) had presumed tuberculous choroiditis, two patients (four eyes) had multiple evanescent white dot syndrome and two patients (four eyes) had Vogt Koyanagi Harada (VKH) syndrome. The most characteristic feature noted on ICGA was the presence of different patterns of hypofluorescent dark spots, which were present at different stages of the angiogram. ICGA provides the clinician with a powerful adjunctive tool in choroidal inflammatory disorders. It is not meant to replace already proven modalities such as the fluorescein angiography, but it can provide additional information that is useful in establishing a more definitive diagnosis in inflammatory chorioretinal diseases associated with multiple spots. It still needs to be determined if ICGA can prove to be a follow up parameter to evaluate disease progression.
• Controversies in Traumatic Cataract Classification and Management: a Review Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie. Aug, 2013  |   Pubmed ID: 23931462 Traumatic cataract is one of the important causes of blindness after ocular trauma, either open or close globe. Visual outcome is unpredictable because it is not only lens that decides visual outcome. There is no standard classification, investigation, or treatment guidelines for the same. There are controversies regarding predictive models. We would like to highlight these controversies and try to reach certain guidelines that may help clinicians to manage traumatic cataracts.
• Cytokine Analysis of Aqueous Humor in HIV Patients with Cytomegalovirus Retinitis Cytokine. Nov, 2013  |   Pubmed ID: 24008078 Cytomegalovirus retinitis (CMVR) is the most common opportunistic ocular infection in patients with AIDS. Comprehensive analysis of aqueous humor for immunologic factors has yet to be performed in patients with CMVR. This study aims to perform comprehensive immune factor analysis of aqueous humor in CMVR patients to determine the presence of any characteristic immunological profile in the aqueous humor.
• Prognostic Factors for Open Globe Injuries and Correlation of Ocular Trauma Score at a Tertiary Referral Eye Care Centre in Singapore Indian Journal of Ophthalmology. Sep, 2013  |   Pubmed ID: 24104709 To evaluate the factors influencing final vision outcome after surgical repair of open globe injuries and to correlate the Ocular trauma score.
• Retinal Vascular Parameter Variations in Patients with Human Immunodeficiency Virus Investigative Ophthalmology & Visual Science. Dec, 2013  |   Pubmed ID: 24176899 To compare the retinal vascular parameters in patients with human immunodeficiency virus (HIV) infection with normal controls, and to determine the relationship between retinal vascular parameters and HIV-related blood biomarkers (CD4(+) T-lymphocytes count, presence of HIV RNA).
• Pre-operative Variables Affecting Final Vision Outcome with a Critical Review of Ocular Trauma Classification for Posterior Open Globe (zone III) Injury Indian Journal of Ophthalmology. Oct, 2013  |   Pubmed ID: 24212303 To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury.
• Cytokines and Biologics in Non-infectious Autoimmune Uveitis: Bench to Bedside Indian Journal of Ophthalmology. Jan, 2014  |   Pubmed ID: 24492505 Intraocular inflammatory eye disease is one of the important causes of ocular morbidity. Even though the prevalence of uveitis is less common in relation to diabetic retinopathy, glaucoma or age related macular degeneration, the complexity and heterogeneity of the disease makes it more unique. Putative uveitogenic retinal antigens incite innate immunity by the process of antigen mimicry and have been shown to be associated in patients with intraocular inflammatory disease by numerous experimental studies. Laboratory diagnostic tools to aid the etiologic association in intraocular inflammatory disease have evolved over the last two decades and we are entering into an era of molecular diagnostic tests. Sophisticated novel technologies such as multiplex bead assays to assess biological signatures have revolutionized the management of complex refractory uveitis. Nevertheless, there is still a long way to go to establish the causal relationship between these biomarkers and specific uveitic entities. Experimental studies have shown the supreme role of infliximab in the management of Behcet's disease. Despite significant experimental and case control studies, the deficiency of randomized clinical trials using these biologic agents has handicapped us in exploring them as a front line therapy in severe refractory uveitis. Studies still need to answer the safety of these potentially life threatening drugs in a selected group of patients and determine when to commence and for how long the treatment has to be given. This review article covers some basic concepts of cytokines in uveitis and their potential application for therapy in refractory uveitis.
• Desegmentation of Ozurdex Implant in Vitreous Cavity: Report of Two Cases The British Journal of Ophthalmology. Jul, 2014  |   Pubmed ID: 24648417 To report two cases of desegmentation or fracture of the Ozurdex implant observed immediately after routine intravitreal implantation for macular oedema.
• Choroidal Metastasis As the Presenting Feature of a Non-small Cell Lung Carcinoma with No Apparent Primary Lesion Identified by X-ray: A Case Report Oncology Letters. Oct, 2014  |   Pubmed ID: 25202431 The most common type of intraocular tumor in adults is the metastatic variety, with the choroid as the typical site of involvement. The case of a patient with non-small cell lung cancer, who presented with choroidal metastasis, is described in the current report. In addition, the limitation of using a chest X-ray to identify a large primary lung lesion is highlighted. A 71-year-old female that presented with a choroidal mass lesion is described in the current report. A chest X-ray was conducted and was considered to be normal following detailed investigation, however, a computed tomography (CT) scan of the thorax revealed a large lobulated mass in the right upper lobe. On further histopathological analysis, the patient was diagnosed with a non-small cell lung carcinoma. Thus, when a large choroidal lesion and overlying exudative retinal detachment is observed, a diagnosis of choroidal metastasis should be considered. X-ray images may appear to be normal even in the presence of a large pulmonary lesion. Therefore, in cases where there may be a metastatic lesion, a CT scan is proposed as the optimal diagnostic imaging technique.
• Immunopharmacotherapy of Non-infectious Uveitis: Where Do We Stand? Expert Opinion on Biological Therapy. Dec, 2014  |   Pubmed ID: 25244075 With ever-evolving concept of personalised medicine backed up with specific biomarkers for ocular inflammatory disease, there is a sudden surge of using biologics in non-infectious recalcitrant posterior uveitis. Have we understood these biologic agents enough to embark on this long enduring journey with the patient to optimise control of intraocular inflammation? On the other hand, there is still a strong inhibition of using these novel agents in management of uveitis even at tertiary referral centres. Immunopharmacotherapy of non-infectious uveitis poses a significant conundrum for both physicians and patients as it is like a two-edged sword effective to control inflammation but at the same time potentially toxic, suspected of causing long-term adverse effects. Systemic immunosuppressive therapy is used in a substantial number of most vision-threatening ocular inflammatory diseases. There is lack of randomised control trials establishing the safety of this therapy and our current practice pattern is based on retrospective studies and personal experience in using this treatment modality. This overview will highlight on the current dilemma faced by the clinicians in opting for steroid-sparing immunosuppressive therapy.
• A Case of Panuveitis with Hypopyon Due to Presumed Ocular Leishmaniasis in a HIV Patient Journal of Ophthalmic Inflammation and Infection. Dec, 2014  |   Pubmed ID: 26530344 Post-kala-azar dermal leishmaniasis is a well-known immunologic cutaneous reaction. There are few case reports of ocular leishmaniasis. It is a sight-threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. Ocular leishmaniasis panuveitis can present with severe inflammation in patients with highly active anti-retroviral therapy (HAART)-induced immune reconstitution syndrome.
• Optic Neuropathy Secondary to Linezolid for Multidrug-resistant Mycobacterial Spinal Tuberculosis Ocular Immunology and Inflammation. Feb, 2015  |   Pubmed ID: 24432953 To report a case of optic neuropathy secondary to Linezolid, second line anti tuberculosis agent.
• Diagnostic and Therapeutic Challenges Retina (Philadelphia, Pa.). Mar, 2015  |   Pubmed ID: 25077531
• The Role of Anti-tubercular Therapy in Patients with Presumed Ocular Tuberculosis Ocular Immunology and Inflammation. Feb, 2015  |   Pubmed ID: 25615809 To analyze the factors affecting the treatment outcome in patients with presumed ocular tuberculosis on anti-tubercular therapy (ATT).
• Bilateral Diffuse Uveal Melanocytic Proliferation (BDUMP) Associated with B-cell Lymphoma: Report of a Rare Case BMC Cancer. Jan, 2015  |   Pubmed ID: 25633015 Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a paraneoplastic ocular syndrome occurring in patients with systemic, often occult but advanced carcinoma and is the hallmark of poor prognosis. Ocular signs precede manifestation of systemic carcinoma by 3-12 months, highlighting the need for appropriate index of suspicion and prompt evaluation. Treatment options for BDUMP are limited. Investigations are aimed at finding the occult primary malignancy, which can be challenging. Modalities for treatment of the ocular findings include corticosteroids, surgery, external beam radiotherapy, and treatment of the underlying malignant neoplasm. However, it is uncertain whether earlier intervention for the systemic malignancy will impact survival, as this paraneoplastic phenomenon is thought to occur in advanced malignancy.
• Strategies for Improving Early Detection and Diagnosis of Neovascular Age-related Macular Degeneration Clinical Ophthalmology (Auckland, N.Z.). 2015  |   Pubmed ID: 25733802 Treatment of the neovascular form of age-related macular degeneration (AMD) has been revolutionized by the introduction of such agents as ranibizumab, bevacizumab, and aflibercept. As a result, the incidence of legal blindness occurring secondary to AMD has fallen dramatically in recent years in many countries. While these agents have undoubtedly been successful in reducing visual impairment and blindness, patients with neovascular AMD typically lose some vision over time, and often lose the ability to read, drive, or perform other important activities of daily living. Efforts are therefore under way to develop strategies that allow for earlier detection and treatment of this disease. In this review, we begin by providing an overview of the rationale for, and the benefits of, early detection and treatment of neovascular AMD. To achieve this, we begin by providing an overview of the pathophysiology and natural history of choroidal neovascularization, before reviewing the evidence from both clinical trials and "real-world" outcome studies. We continue by highlighting an area that is often overlooked: the importance of patient education and awareness for early AMD detection. We conclude the review by reviewing an array of both established and emerging technologies for early detection of choroidal neovascularization, ranging from Amsler chart testing, to hyperacuity testing, to advanced imaging techniques, such as optical coherence tomography.
• Unilateral Acute Maculopathy Associated with Adult Onset Hand, Foot and Mouth Disease: Case Report and Review of Literature Journal of Ophthalmic Inflammation and Infection. 2015  |   Pubmed ID: 25774239 Acute maculopathy is a rare condition of unknown aetiology and Coxsackie virus is known to be associated with this macular chorioretinitis.
• Experimental Autoimmune Uveitis and Other Animal Models of Uveitis: An Update Indian Journal of Ophthalmology. Mar, 2015  |   Pubmed ID: 25971165 Over the past several decades, animal models of autoimmune uveitis directed at eye-specific antigens (Ags) have been developed. These have allowed researchers to understand the basic mechanisms that lead to these diseases and also recently helped the researchers in translational research for therapeutic interventions. Experimental autoimmune uveitis (EAU) is an animal disease model of human endogenous uveitis and can be induced in susceptible animals by immunization with retinal Ags. Ever since the first description of EAU in mice in 1988, several animal models of uveitis has been described by researchers. Disease-specific model for cytomegalovirus retinitis and tubercular uveitis has evolved our understanding of these complex entities. Endotoxin induced uveitis is another useful model for anterior uveitis, which is not an autoimmune process and is triggered by injection of bacterial endotoxin (lipopolysaccharides) resulting in a rapid short lasting uveitis. The current article will give an insight into the various EAU animal models and their current implications in translational research. The article will also highlight the different grading systems for EAU in the animal model.
• Paradoxical Worsening of Tuberculous Chorioretinitis in a Chinese Gentleman Journal of Ophthalmic Inflammation and Infection. 2015  |   Pubmed ID: 26180557 We report a case of paradoxical worsening of tuberculous chorioretinitis after initiation of anti-tuberculous therapy (ATT). The patient had left panuveitis with tuberculous chorioretinitis and was started on systemic ATT and oral steroids a week later. However, he developed paradoxical worsening 2 months after initiation of therapy. He was continued on ATT, oral steroids and intravitreal amikacin with resolution of the chorioretinal lesion subsequently. Ocular tuberculosis often poses a diagnostic challenge, and clinicians should be aware of the possibility of paradoxical worsening despite appropriate ATT. Clinicians should strongly consider starting oral steroids concurrently with ATT when managing ocular tuberculosis.
• Luminal and Stromal Areas of Choroid Determined by Binarization Method of Optical Coherence Tomographic Images American Journal of Ophthalmology. Aug, 2015  |   Pubmed ID: 26187882
• Ocular and Systemic Features of Sarcoidosis and Correlation with the International Workshop for Ocular Sarcoidosis Diagnostic Criteria Sarcoidosis, Vasculitis, and Diffuse Lung Diseases : Official Journal of WASOG. Sep, 2015  |   Pubmed ID: 26422569 To describe the ocular and systemic features in biopsy proven (definite) and non-biopsy proven (clinical) ocular sarcoidosis and to compare the ocular features with those proposed by the International Workshop for Ocular Sarcoidosis (IWOS).
• A Prospective Case-control Study to Investigate Retinal Microvascular Changes in Acute Dengue Infection Scientific Reports. Nov, 2015  |   Pubmed ID: 26603217 Dengue infection can affect the microcirculation by direct viral infection or activation of inflammation. We aimed to determine whether measured retinal vascular parameters were associated with acute dengue infection. Patients with acute dengue were recruited from Communicable Diseases Center, Singapore and age-gender-ethnicity matched healthy controls were selected from a population-based study. Retinal photographs were taken on recruitment and convalescence. A spectrum of quantitative retinal microvascular parameters (retinal vascular caliber, fractal dimension, tortuosity and branching angle) was measured using a semi-automated computer-based program. (Singapore I Vessel Assessment, version 3.0). We included 62 dengue patients and 127 controls. Dengue cases were more likely to have wider retinal arteriolar and venular calibers (158.3 μm vs 144.3 μm, p < 0.001; 227.7 μm vs 212.8 μm, p < 0.001; respectively), higher arteriolar and venular fractal dimensions (1.271 vs 1.249, p = 0.002; 1.268 vs. 1.230, p < 0.001, respectively), higher arteriolar and venular tortuosity (0.730 vs 0.546 [x10(4)], p < 0.001; 0.849 vs 0.658 [x10(4)], p < 0.001; respectively), compared to controls. Resolution of acute dengue coincided with decrease in retinal vascular calibers and venular fractal dimension. Dengue patients have altered microvascular network in the retina; these changes may reflect pathophysiological processes in the immune system.
• High Throughput Screening of Valganciclovir in Acidic Microenvironments of Polyester Thin Films Materials (Basel, Switzerland). Apr, 2015  |   Pubmed ID: 28788027 Ganciclovir and valganciclor are antiviral agents used for the treatment of cytomegalovirus retinitis. The conventional method for administering ganciclovir in cytomegalovirus retinitis patients is repeated intravitreal injections. In order to obviate the possible detrimental effects of repeated intraocular injections, to improve compliance and to eliminate systemic side-effects, we investigated the tuning of the ganciclovir pro-drug valganciclovir and the release from thin films of poly(lactic-co-glycolic acid) (PLGA), polycaprolactone (PCL), or mixtures of both, as a step towards prototyping periocular valganciclovir implants. To investigate the drug release, we established and evaluated a high throughput fluorescence-based quantification screening assay for the detection of valganciclovir. Our protocol allows quantifying as little as 20 ng of valganciclovir in 96-well polypropylene plates and a 50× faster analysis compared to traditional HPLC measurements. This improvement can hence be extrapolated to other polyester matrix thin film formulations using a high-throughput approach. The acidic microenvironment within the polyester matrix was found to protect valganciclovir from degradation with resultant increases in the half-life of the drug in the periocular implant to 100 days. Linear release profiles were obtained using the pure polyester polymers for 10 days and 60 days formulations; however, gross phase separations of PCL and acid-terminated PLGA prevented tuning within these timeframes due to the phase separation of the polymer, valganciclovir, or both.
• Comparative Analysis of Anterior Chamber Flare Grading Between Clinicians with Different Levels of Experience and Semi-automated Laser Flare Photometry Ocular Immunology and Inflammation. 2016  |   Pubmed ID: 25541860 To assess correlation for anterior chamber flare grading between clinicians with different levels of experience and with semi-automated flare reading in a cohort of patients with heterogeneous uveitic entities.
• Ocular Tuberculosis--A Clinical Conundrum Ocular Immunology and Inflammation. 2016  |   Pubmed ID: 26110355
• Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients Ocular Immunology and Inflammation. 2016  |   Pubmed ID: 26134101 To describe the clinical and epidemiological characteristics of patients with posterior scleritis, and to analyze the response to treatment and time to relapse.
• Predictive Factors for Treatment Failure in Patients with Presumed Ocular Tuberculosis in an Area of Low Endemic Prevalence The British Journal of Ophthalmology. Mar, 2016  |   Pubmed ID: 26187952 To assess the impact of antitubercular therapy (ATT), oral steroids and steroid sparing immunosuppressive treatment on treatment success in cases with presumed ocular tuberculosis in an area of low endemic prevalence.
• Moxifloxacin: An Alternative to Ethambutol for the Treatment of Presumed Ocular Tuberculosis Ocular Immunology and Inflammation. Oct, 2016  |   Pubmed ID: 26222893 To present moxifloxacin as an alternative treatment option to ethambutol in an anti-tubercular therapy (ATT) regime in patients with presumed ocular tuberculosis (TB).
• NODULAR POSTERIOR SCLERITIS: Clinico-Sonographic Characteristics and Proposed Diagnostic Criteria Retina (Philadelphia, Pa.). Feb, 2016  |   Pubmed ID: 26296144 To report the clinical and ultrasound features and outcomes of a series of nodular posterior scleritis.
• Fundus Photography in the 21st Century--A Review of Recent Technological Advances and Their Implications for Worldwide Healthcare Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association. Mar, 2016  |   Pubmed ID: 26308281 The introduction of fundus photography has impacted retinal imaging and retinal screening programs significantly.
• Flurbiprofen: A Nonselective Cyclooxygenase (COX) Inhibitor for Treatment of Noninfectious, Non-necrotizing Anterior Scleritis Ocular Immunology and Inflammation. 2016  |   Pubmed ID: 26308394 To analyze the safety and efficacy of a nonselective cyclo-oxygenase (COX) inhibitor in the management of noninfectious, non-necrotizing anterior scleritis.
• Classification of Semi-automated Flare Readings Using the Kowa FM 700 Laser Cell Flare Meter in Patients with Uveitis Acta Ophthalmologica. Mar, 2016  |   Pubmed ID: 26408205 To propose a classification system to grade semi-automated flare readings and assess its correlation with clinical flare grading and also to explore the utility of an additional step in clinical flare assessment between grades 0 and 1.
• Bilateral Posterior Scleritis: Analysis of 18 Cases from a Large Cohort of Posterior Scleritis Ocular Immunology and Inflammation. 2016  |   Pubmed ID: 26471249 To describe the clinical and epidemiological characteristics of patients and analyze factors associated with bilateral posterior scleritis.
• Red Blood Cells in Retinal Vascular Disorders Blood Cells, Molecules & Diseases. Jan, 2016  |   Pubmed ID: 26603725 Microvascular circulation plays a vital role in regulating physiological functions, such as vascular resistance, and maintaining organ health. Pathologies such as hypertension, diabetes, or hematologic diseases affect the microcirculation posing a significant risk to human health. The retinal vasculature provides a unique window for non-invasive visualisation of the human circulation in vivo and retinal vascular image analysis has been established to predict the development of both clinical and subclinical cardiovascular, metabolic, renal and retinal disease in epidemiologic studies. Blood viscosity which was otherwise thought to play a negligible role in determining blood flow based on Poiseuille's law up to the 1970s has now been shown to play an equally if not a more important role in controlling microcirculation and quantifying blood flow. Understanding the hemodynamics/rheology of the microcirculation and its changes in diseased states remains a challenging task; this is due to the particulate nature of blood, the mechanical properties of the cells (such as deformability and aggregability) and the complex architecture of the microvasculature. In our review, we have tried to postulate a possible role of red blood cell (RBC) biomechanical properties and laid down future framework for research related to hemorrheological aspects of blood in patients with retinal vascular disorders.
• Systematic Evaluation of Optical Coherence Tomography Angiography in Retinal Vein Occlusion American Journal of Ophthalmology. Mar, 2016  |   Pubmed ID: 26621685 To evaluate the clinical utility of optical coherence tomography angiography (OCTA) in patients with retinal vein occlusion (RVO), and to systematically compare OCTA images with changes seen on color fundus photography and fluorescein angiography (FA).
• Controversies in the Pathophysiology and Management of Hyphema Survey of Ophthalmology. May-Jun, 2016  |   Pubmed ID: 26632664 Traumatic hyphemas present dilemmas to physicians. There are numerous controversies pertaining to the optimal approach to traumatic hyphema and no standardized guidelines for its management. We address some of these controversies and present a pragmatic approach. We discuss various medical agents and surgical techniques available for treatment, along with the indications for their use. We address the complications associated with hyphema and how to diagnose and manage them and consider the management of hyphema in special situations such as in children and sickle-cell anemia and in rare clinical syndromes such as recurrent hyphema after placement of anterior chamber intraocular lenses.
• Re: Mehta Et al.: Vitreous Evaluation: A diagnostic Challenge (Ophthalmology 2015;122:531-7) Ophthalmology. Jan, 2016  |   Pubmed ID: 26707440
• Choroidal Vascularity Index (CVI)--A Novel Optical Coherence Tomography Parameter for Monitoring Patients with Panuveitis? PloS One. 2016  |   Pubmed ID: 26751702 To compute choroidal vascularity index (CVI) using an image binarization tool on enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans as a non-invasive optical tool to monitor progression in panuveitis and to investigate the utility of volumetric data from EDI-OCT scans using custom image analysis software.
• Optical Coherence Tomography Angiography of Choroidal Neovascularization Associated with Tuberculous Serpiginous-like Choroiditis Ocular Immunology and Inflammation. Dec, 2016  |   Pubmed ID: 26829564 Choroidal neovascularization secondary to tuberculous serpiginous-like choroiditis (Tb-SLC) is uncommon and requires further invasive imaging, such as fluorescein and indocyanine green angiography. We evaluate the optical coherence tomography angiography (OCTA) findings in a patient with a Tb-SLC and present the use of this investigation as a non-invasive diagnostic and follow-up clinical tool in this disease.
• Choroidal Vascularity Index As a Measure of Vascular Status of the Choroid: Measurements in Healthy Eyes from a Population-based Study Scientific Reports. Feb, 2016  |   Pubmed ID: 26868048 The vascularity of the choroid has been implicated in the pathogenesis of various eye diseases. To date, no established quantifiable parameters to estimate vascular status of the choroid exists. Choroidal vascularity index (CVI) may potentially be used to assess vascular status of the choroid. We aimed to establish normative database for CVI and identify factors associated with CVI in healthy eyes. In this population-based study on 345 healthy eyes, choroidal enhanced depth imaging optical coherence tomography scans were segmented by modified image binarization technique. Total subfoveal choroidal area (TCA) was segmented into luminal (LA) and stromal (SA) area. CVI was calculated as the proportion of LA to TCA. Linear regression was used to identify ocular and systemic factors associated with CVI and subfoveal choroidal thickness (SFCT). Subfoveal CVI ranged from 60.07 to 71.27% with a mean value of 65.61 ± 2.33%. CVI was less variable than SFCT (coefficient of variation for CVI was 3.55 vs 40.30 for SFCT). Higher CVI was associated with thicker SFCT, but not associated with most physiological variables. CVI was elucidated as a significant determinant of SFCT. While SFCT was affected by many factors, CVI remained unaffected suggesting CVI to be a more robust marker of choroidal diseases.
• The Evaluation of Diabetic Macular Ischemia Using Optical Coherence Tomography Angiography Investigative Ophthalmology & Visual Science. Feb, 2016  |   Pubmed ID: 26903223 The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia.
• Diagnostic and Therapeutic Challenges Retina (Philadelphia, Pa.). Oct, 2016  |   Pubmed ID: 26919128
• Anti-tubercular Therapy for Intraocular Tuberculosis: A Systematic Review and Meta-analysis Survey of Ophthalmology. Sep-Oct, 2016  |   Pubmed ID: 26970263 Intraocular tuberculosis remains a diagnostic and management conundrum for both ophthalmologists and pulmonologists. We analyze the efficacy and safety of anti-tubercular therapy (ATT) in patients with intraocular tuberculosis and factors associated with favorable outcome. Twenty-eight studies are included in this review, with a total of 1,917 patients. Nonrecurrence of inflammation was observed in pooled estimate of 84% of ATT-treated patients (95% CI 79-89). There was minimal difference in the outcome between patients treated with ATT alone (85% successful outcome; 95% CI 25-100) and those with concomitant systemic corticosteroid (82%; 95% CI 73-90). The use of ATT may be of benefit to patients with suspected intraocular tuberculosis; however, this conclusion is limited by the lack of control group analysis and standardized recruitment and treatment protocols. We propose further prospective studies to better establish the efficacy of ATT and ascertain the factors associated with favorable treatment outcomes.
• Efficacy and Safety of Topical Ganciclovir in the Management of Cytomegalovirus (CMV)-related Anterior Uveitis Journal of Ophthalmic Inflammation and Infection. Dec, 2016  |   Pubmed ID: 26976016 The aim of this study was to evaluate the efficacy and safety of topical ganciclovir 0.15 % gel in the management of patients with cytomegalovirus (CMV) anterior uveitis.
• Assessment of Red Blood Cell Deformability in Type 2 Diabetes Mellitus and Diabetic Retinopathy by Dual Optical Tweezers Stretching Technique Scientific Reports. Mar, 2016  |   Pubmed ID: 26976672 A pilot cross sectional study was conducted to investigate the role of red blood cells (RBC) deformability in type 2 diabetes mellitus (T2DM) without and with diabetic retinopathy (DR) using a dual optical tweezers stretching technique. A dual optical tweezers was made by splitting and recombining a single Nd:YAG laser beam. RBCs were trapped directly (i.e., without microbead handles) in the dual optical tweezers where they were observed to adopt a "side-on" orientation. RBC initial and final lengths after stretching were measured by digital video microscopy, and a Deformability index (DI) calculated. Blood from 8 healthy controls, 5 T2DM and 7 DR patients with respective mean age of 52.4 yrs, 51.6 yrs and 52 yrs was analysed. Initial average length of RBCs for control group was 8.45 ± 0.25 μm, 8.68 ± 0.49 μm for DM RBCs and 8.82 ± 0.32 μm for DR RBCs (p < 0.001). The DI for control group was 0.0698 ± 0.0224, and that for DM RBCs was 0.0645 ± 0.03 and 0.0635 ± 0.028 (p < 0.001) for DR group. DI was inversely related to basal length of RBCs (p =  .02). DI of RBC from DM and DR patients was significantly lower in comparison with normal healthy controls. A dual optical tweezers method can hence be reliably used to assess RBC deformability.
• State of Science: Choroidal Thickness and Systemic Health Survey of Ophthalmology. Sep-Oct, 2016  |   Pubmed ID: 26980268 The choroid is a highly vascular structure; therefore, a wide range of systemic conditions can affect it. Conversely, choroid health may also give us insight into systemic health. With the emergence of optical coherence tomography, there has been a surge in the research on choroidal thickness and factors affecting it. Studies regarding the effect of systemic health on the choroid have largely been in the form of cross-sectional, prospective, and case studies. We offer a summary of recent findings on the topic.
• Discrepancies in Assessing Anterior Chamber Activity Among Uveitis Specialists Japanese Journal of Ophthalmology. May, 2016  |   Pubmed ID: 27020454 To evaluate current practices in anterior chamber (AC) inflammation assessment among uveitis specialists.
• Analysis and Outcomes of Cataract Surgery in Patients with Acquired Immunodeficiency Syndrome Ocular Immunology and Inflammation. Apr, 2016  |   Pubmed ID: 27082491 To investigate the surgical outcomes, complications and postoperative progression in HIV patients undergoing cataract surgery in a teaching hospital.
• Author's Response: Management of Hyphema in Patients with Sickle Cell Disease or Trait Survey of Ophthalmology. Sep-Oct, 2016  |   Pubmed ID: 27106682
• Re: Freitas-Neto Et al.: Increased Submacular Choroidal Thickness in Active, Isolated, Extramacular Toxoplasmosis (Ophthalmology 2016;123:222-4) Ophthalmology. May, 2016  |   Pubmed ID: 27107363
• CHOROIDAL VASCULARITY INDEX IN CENTRAL SEROUS CHORIORETINOPATHY Retina (Philadelphia, Pa.). Sep, 2016  |   Pubmed ID: 27124882 To evaluate choroidal vascularity index (CVI) in eyes with central serous chorioretinopathy (CSC) using an image binarization tool on enhanced depth imaging using spectral domain optical coherence tomography scans.
• Optical Coherence Tomography: A Potential Noninvasive Follow-up Tool in Multiple Sclerosis Investigative Ophthalmology & Visual Science. Apr, 2016  |   Pubmed ID: 27127931
• Choroidal Vascularity Index - a Novel Optical Coherence Tomography Parameter for Disease Monitoring in Diabetes Mellitus? Acta Ophthalmologica. Nov, 2016  |   Pubmed ID: 27151819 To propose the use of choroidal vascularity index (CVI) as a novel tool to assess vascular status of the choroid using image binarization of enhanced depth imaging (EDI) optical coherence tomography (OCT) scans in diabetes mellitus (DM).
• Tuberculosis or Sarcoidosis: Opposite Ends of the Same Disease Spectrum? Tuberculosis (Edinburgh, Scotland). May, 2016  |   Pubmed ID: 27156614 Tuberculosis and sarcoidosis are chronic systemic diseases that have similar pulmonary and extra-pulmonary manifestations. Multiple studies have found an epidemiological, molecular, and immunological link between the two. It has been suggested that mycobacterium tuberculosis could be a common pathophysiologic mechanism for tuberculosis and sarcoidosis, and that both clinical entities can trigger similar immunological response in patients. Due to this close association, together with possible coexistence in the same patient, the diagnosis of one disease from another may be difficult. In our paper, we suggest that tuberculosis and sarcoidosis are two ends of the same spectrum. Given the pathophysiological and clinical link between the two, we also propose a classification system for tuberculosis and sarcoidosis: Sarcoidosis (S); Sarcoid-Tuberculous (ST); Tuberculous Sarcoid (TS) and Tuberculosis (TB). More research and clinical trials should first be done to affirm the link between the two disease entities.
• Drug, Delivery and Devices for Diabetic Retinopathy (3Ds in DR) Expert Opinion on Drug Delivery. Nov, 2016  |   Pubmed ID: 27169870 Diabetic Retinopathy (DR) is one of the most common causes of blindness among the working population worldwide. Clearly, there is an unmet clinical need to find better treatment options for DR. Areas covered: The literature search was conducted on PubMed with no limitation on language or year of publication. The review focuses on the clinically used drugs/proteins along with a brief background on the pathophysiology of DR. The major focus of this review revolves around three treatment approaches involving drugs/proteins, drug delivery formulations and drug delivery devices. In each category, major advances are discussed along with the possible solutions. We have also discussed the various modes of administration that are currently being evaluated in the clinic. An attempt has been made to address the potential targeted site of action for DR drug delivery, and also to understand the role of Blood Retinal Barrier (BRB). Expert Opinion: In the current scenario, although there have been some advances in the drug delivery devices for delivering drugs/proteins, there are still challenges to be overcome with regard to the particulate systems. For long-term success of DR therapeutics, research options should consider taking into account the 3Ds (drug, delivery and devices).
• Optical Coherence Tomography Angiography: a Non-invasive Tool to Image End-arterial System Expert Review of Medical Devices. Jun, 2016  |   Pubmed ID: 27176114
• Herpes Simplex Acute Retinal Necrosis Presenting As Unilateral Disc Swelling in Young Immunocompetent Patients Ocular Immunology and Inflammation. May, 2016  |   Pubmed ID: 27230575 To report two cases of young immunocompetent males with herpes simplex acute retinal necrosis (HSV ARN) with initial diagnosis of unilateral disc swelling.
• Aqueous Humor Immune Factors and Cytomegalovirus (CMV) Levels in CMV Retinitis Through Treatment - The CRIGSS Study Cytokine. Aug, 2016  |   Pubmed ID: 27239802 This study aims to perform comprehensive longitudinal immune factor analysis of aqueous humor in relation to the aqueous CMV viral load and systemic CD4 counts during treatment of patients with co-infection of HIV and CMVR.
• Choroidal Vascularity Index in Vogt-Koyanagi-Harada Disease: An EDI-OCT Derived Tool for Monitoring Disease Progression Translational Vision Science & Technology. Jul, 2016  |   Pubmed ID: 27525196 We assessed the application of the choroidal vascularity index (CVI) in the follow-up of Vogt-Koyanagi-Harada disease (VKH) patients derived from image binarization of enhanced depth imaging optical coherence tomography (EDI-OCT) images with Fiji software. Our secondary objective was to derive the retinochoroidal vascularity index based on en face fundus fluorescein and indocyanine green angiography (FFA and ICGA).
• Dataset of Aqueous Humor Cytokine Profile in HIV Patients with Cytomegalovirus (CMV) Retinitis Data in Brief. Sep, 2016  |   Pubmed ID: 27547803 The data shows the aqueous humor cytokine profiling results acquired in a small cohort of 17 HIV patients clinically diagnosed with Cytomegalovirus retinitis using the FlexMAP 3D (Luminex®) platform using the Milliplex Human Cytokine® kit. Aqueous humor samples were collected from these patients at different time points (pre-treatment and at 4-weekly intervals through the 12-week course of intravitreal ganciclovir treatment) and 41 cytokine levels were analyzed at each time point. CMV DNA viral load was assessed in 8 patients at different time points throughout the course of ganciclovir treatment. The data described herein is related to the research article entitled "Aqueous humor immune factors and cytomegalovirus (CMV) levels in CMV retinitis through treatment - The CRIGSS study" (Iyer et al., 2016) [1]. Cytokine levels against the different time points which indicate the response to the given treatment and against the CMV viral load were analyzed.
• A Distinct Cytokines Profile in Tear Film of Dry Eye Disease (DED) Patients with HIV Infection Cytokine. Dec, 2016  |   Pubmed ID: 27585367 To investigate the tear cytokine profile in HIV patients with dry eye disease (DED) and study the association between the severity of ocular inflammatory complications and tear cytokines levels. We postulate that HIV-mediated inflammation may be the underlying pathogenic mechanism for HIV-associated DED.
• Choroidal Structural Changes in Myopic Choroidal Neovascularization After Treatment With Antivascular Endothelial Growth Factor Over 1 Year Investigative Ophthalmology & Visual Science. Sep, 2016  |   Pubmed ID: 27654420 To evaluate choroidal structural changes in eyes with myopic choroidal neovascularization (mCNV) treated with anti-VEGF over 12 months.
• Recurrent Aspergillus Terreus Endophthalmitis from Focal Bronchiectasis Ocular Immunology and Inflammation. Aug, 2016  |   Pubmed ID: 27715366
• Disseminated Nontuberculous Mycobacterial Infection with Multifocal Retinitis and Vasculitis in an Immunocompromised Patient with Anti-IFN-ɣ Autoantibodies Journal of Ophthalmic Inflammation and Infection. Dec, 2016  |   Pubmed ID: 27771870 Nontuberculous mycobacteria (NTM) are found ubiquitously in the environment. Since exposure to NTM is universal, infection likely represents underlying host susceptibility factors. Anti-IFN-ɣ autoantibodies have been described previously in patients with NTM. Up to 88 % of patients with disseminated NTM or other opportunistic infections have high-titer anti-IFN-ɣ autoantibodies, compared with 2 % of patients with TB and healthy controls.
• Re: Raman Et al.: Five-year Incidence and Visual Outcomes in Postintravitreal Injection Endophthalmitis (Ophthalmology 2016;123:1162-4) Ophthalmology. Nov, 2016  |   Pubmed ID: 27772657
• A Case of Necrobiotic Xanthogranuloma Presenting As Bilateral Posterior Scleritis Ocular Immunology and Inflammation. Oct, 2016  |   Pubmed ID: 27775456
• Management of Noninfectious Posterior Uveitis with Intravitreal Drug Therapy Clinical Ophthalmology (Auckland, N.Z.). 2016  |   Pubmed ID: 27789936 Uveitis is an important cause of vision loss worldwide due to its sight-threatening complications, especially cystoid macular edema, as well as choroidal neovascularization, macular ischemia, cataract, and glaucoma. Systemic corticosteroids are the mainstay of therapy for noninfectious posterior uveitis; however, various systemic side effects can occur. Intravitreal medication achieves a therapeutic level in the vitreous while minimizing systemic complications and is thus used as an exciting alternative. Corticosteroids, antivascular endothelial growth factors, immunomodulators such as methotrexate and sirolimus, and nonsteroidal anti-inflammatory drugs are currently available for intravitreal therapy. This article reviews the existing literature for efficacy and safety of these various options for intravitreal drug therapy for the management of noninfectious uveitis (mainly intermediate, posterior, and panuveitis).
• Immune Recovery Uveitis in HIV Patients with Cytomegalovirus Retinitis in the Era of HAART Therapy-a 5-year Study from Singapore Journal of Ophthalmic Inflammation and Infection. Dec, 2016  |   Pubmed ID: 27822743 The aim of this study is to analyse the clinical features of HIV patients with cytomegalovirus retinitis (CMVR) developing immune recovery uveitis (IRU) while on highly active antiretroviral therapy (HAART) and to identify the risk factors, visual outcomes and complications of IRU.
• A Review of the Role of Intravitreal Corticosteroids As an Adjuvant to Antibiotics in Infectious Endophthalmitis Ocular Immunology and Inflammation. Nov, 2016  |   Pubmed ID: 27849402 Infectious endophthalmitis is an important cause of vision loss worldwide. This entity most often occurs as a complication of intraocular surgery especially following cataract surgery or intravitreal injection. Endophthalmitis is regarded as a serious complication following ocular surgery and the final visual outcome is fundamentally contingent on timely recognition and intervention. Intravitreal and oral antibiotics in combination with pars plana vitrectomy or vitreous aspiration remain the mainstay in the management of endophthalmitis. However, significant inflammation may persist even after sterilization of the intraocular cavities with appropriate antibiotics resulting in failure of treatment. This forms the basis for the use of intravitreal corticosteroids as an adjuvant to antibiotics in the management of infectious endophthalmitis. In the index manuscript, we review the existing literature to determine the role of intravitreal corticosteroids as an adjuvant to antibiotics in treating infectious endophthalmitis, and discuss their beneficial effects and controversial concerns.
• Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) - Report 1: Epidemiology and Classification Ocular Immunology and Inflammation. Dec, 2016  |   Pubmed ID: 27918224 To report the epidemiology and classification of ocular inflammation at a tertiary eye care center in Singapore.
• Treatment Outcome in Patients with Presumed Tubercular Uveitis at a Tertiary Referral Eye Care Centre in Singapore International Ophthalmology. Dec, 2016  |   Pubmed ID: 28035499 To report the clinical features and outcome of patients with presumed tubercular uveitis (TBU).
• The 21(st) Century Doctor: A Clinician-scientist? Indian Journal of Ophthalmology. Dec, 2016  |   Pubmed ID: 28112124
• Abiotropia Defectiva-Related Endophthalmitis in an Immunocompromised Patient and Application of 16s RRNA in Microbiologic Diagnosis Ocular Immunology and Inflammation. Apr, 2017  |   Pubmed ID: 26731379
• Spectrum of Choroidal Involvement in Presumed Ocular Tuberculosis: Report from a Population with Low Endemic Setting for Tuberculosis Ocular Immunology and Inflammation. Feb, 2017  |   Pubmed ID: 26807675 To describe the clinical spectrum and outcome of patients with presumed tubercular uveitis and choroidal involvement.
• PERIPHERAL RETINAL VASCULITIS: Analysis of 110 Consecutive Cases and a Contemporary Reappraisal of Tubercular Etiology Retina (Philadelphia, Pa.). Jan, 2017  |   Pubmed ID: 27491042 Describe the clinical features and outcomes of patients with peripheral retinal vasculitis (RV) and describe clinical characteristics of presumed tubercular RV in a nonendemic setting.
• Assessment of Retinal Vascular Calibres As a Biomarker of Disease Activity in Birdshot Chorioretinopathy Acta Ophthalmologica. Mar, 2017  |   Pubmed ID: 27494951 Birdshot chorioretinopathy (BCR) is a potentially blinding ocular disorder involving the retinal vasculature and choroid without any systemic manifestations. The objective of the study was to describe vascular calibre changes in BCR and analyse the possibility of this optical biomarker for staging and monitoring disease activity in BCR.
• CHOROIDAL VASCULARITY INDEX: A Novel Optical Coherence Tomography Based Parameter in Patients With Exudative Age-Related Macular Degeneration Retina (Philadelphia, Pa.). Jun, 2017  |   Pubmed ID: 27632714 To evaluate choroidal structural changes in exudative age-related macular degeneration (AMD) using choroidal vascularity index computed from image binarization on spectral domain optical coherence tomography with enhanced depth imaging.
• Protein Delivery to the Back of the Eye: Barriers, Carriers and Stability of Anti-VEGF Proteins Drug Discovery Today. Feb, 2017  |   Pubmed ID: 27818255 Utilization of the full clinical potential of many novel therapeutic proteins designed for diseases affecting the posterior segment of the eye has often been limited because of their inherent instability and the difficulty in overcoming various ocular barriers. Intravitreal injection is currently the only approved mode of administration, although it is suboptimal because it is painful and has to be done every 1-2 months as a result of high protein clearance rates from the vitreous humor. In this review, we discuss the status of protein drug delivery to back of the eye in terms of novel protein drugs developed, physiological barriers encountered, strategies for carrier design to overcome these limitations, and protein stability. We focus on the most promising approaches as well as on current shortcomings.
• Reply to Choroidal Thickness, Correlations, and Systemic Disease Survey of Ophthalmology. Mar - Apr, 2017  |   Pubmed ID: 27840090
• Dataset of Tear Film Cytokine Levels in Dry Eye Disease (DED) Patients with and Without HIV Infection Data in Brief. Feb, 2017  |   Pubmed ID: 27942559 The tear film cytokine profiling data in this article was obtained from a prospective case-control study with a sample size of 34 dry eye disease (DED) patients with HIV infection and 32 DED patients without HIV infection, see "A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection" (R. Agrawal, P.K. Balne, A. Veerappan, V.B. Au, B. Lee, E. Loo, A. Ghosh, L. Tong, S.C. Teoh, J. Connolly, P. Tan, 2016) [1]. Tear samples were collected from all the subjects using Schirmer׳s strips and cytokine profiling was done using the Luminex bead based multiplex assay with a panel of 41 analytes. The cytokine level differences in each group of subjects were analyzed using logistic regression models.
• Multimodal Imaging in Sympathetic Ophthalmia Ocular Immunology and Inflammation. Apr, 2017  |   Pubmed ID: 27960610 To show the current status of multimodal imaging and its role in supporting an early diagnosis of sympathetic ophthalmia.
• Viral Posterior Uveitis Survey of Ophthalmology. Jul - Aug, 2017  |   Pubmed ID: 28012878 The causes of posterior uveitis can be divided into infectious, autoimmune, or masquerade syndromes. Viral infections, a significant cause of sight-threatening ocular diseases in the posterior segment, include human herpesviruses, measles, rubella, and arboviruses such as dengue, West Nile, and chikungunya virus. Viral posterior uveitis may occur as an isolated ocular disease in congenital or acquired infections or as part of a systemic viral illness. Many viruses remain latent in the infected host with a risk of reactivation that depends on various factors, including virulence and host immunity, age, and comorbidities. Although some viral illnesses are self-limiting and have a good visual prognosis, others, such as cytomegalovirus retinitis or acute retinal necrosis, may result in serious complications and profound vision loss. Since some of these infections may respond well to antiviral therapy, it is important to work up all cases of posterior uveitis to rule out an infectious etiology. We review the clinical features, diagnostic tools, treatment regimens, and long-term outcomes for each of these viral posterior uveitides.
• Characterisation of Choroidal Morphological and Vascular Features in Diabetes and Diabetic Retinopathy The British Journal of Ophthalmology. Jan, 2017  |   Pubmed ID: 28057647 We aimed to characterise specific morphological and vascular features of the choroid in Indian adults with diabetes and diabetic retinopathy (DR).
• Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS)-report 4: Analysis and Outcome of Scleritis in an East Asian Population Journal of Ophthalmic Inflammation and Infection. Dec, 2017  |   Pubmed ID: 28205148 The purpose of this study is to evaluate the spectrum of scleritis from database of Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) at a tertiary eye referral eye institute in Singapore. Clinical records of 120 patients with scleritis from a database of 2200 patients from Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) were reviewed.
• Optical Coherence Tomographic Angiography in Type 2 Diabetes and Diabetic Retinopathy JAMA Ophthalmology. Apr, 2017  |   Pubmed ID: 28208170 Optical coherence tomographic angiography (OCT-A) is able to visualize retinal microvasculature without the need for injection of fluorescein contrast dye. Nevertheless, it is only able to capture a limited view of macula and does not show leakage.
• Dataset of Longitudinal Analysis of Tear Cytokine Levels, CD4, CD8 Counts and HIV Viral Load in Dry Eye Patients with HIV Infection Data in Brief. Apr, 2017  |   Pubmed ID: 28224132 The data presented in this article shows the longitudinal analysis of tear fluid cytokine profiles, blood CD4 and CD8 counts and HIV viral load in 34 dry eye patients with HIV infection during the HAART therapy. Clinical samples were collected from HIV patients with dry eye disease at the time of presentation to the clinic (visit 1), three months (visit 2) and 6 months (visit 3) after the presentation. At each time point tear samples were evaluated for 41 cytokines using Luminex bead based multiplex assay and blood samples were tested for HIV viral load and CD4 and CD8 counts.
• Pediatric Ocular Trauma Score As a Prognostic Tool in the Management of Pediatric Traumatic Cataracts Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie. May, 2017  |   Pubmed ID: 28224290 To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves.
• Multiple Choroidal Ruptures in a Patient With Angioid Streaks JAMA Ophthalmology. Mar, 2017  |   Pubmed ID: 28278344
• Visual Morbidity and Ocular Complications in Presumed Intraocular Tuberculosis: An Analysis of 354 Cases from a Non-Endemic Population Ocular Immunology and Inflammation. Mar, 2017  |   Pubmed ID: 28318349 To describe the visual morbidity associated with intraocular tuberculosis (TB) and to report ocular complications of intraocular TB.
• Zika Virus and Eye Ocular Immunology and Inflammation. Mar, 2017  |   Pubmed ID: 28318359 Zika virus (ZIKV), a mosquito-borne flavivirus, is the latest global health concern. Transmission is mainly via Aedes mosquitoes and the infection can be diagnosed on molecular or serologic testings. It typically causes a mild self-remitting illness of low-grade fever, maculopapular rash, and myalgia, but when severe, it is associated with neurological deficits and congenital structural defects. Ocular manifestations are usually mild like nonpurulent conjunctivitis in adults, though it may be linked to uveitis, maculopathy, and hypertensive iridocyclitis. Ocular signs seem to be more significant in congenital ZIKV-macular pigment mottling, neuroretinal atrophy with macular involvement, iris coloboma, and changes in retinal vasculature are noted in infants with infected mothers. Risk factors include ZIKV infection in first trimester and smaller cephalic diameter at birth. Hence, ophthalmic examination in newborns is now recommended. Currently, prevention and active surveillance are integral as there is no known vaccine, and treatment is only symptomatic.
• Re: Jaffe Et al.: Injectable Fluocinolone Acetonide Long-acting Implant for Noninfectious Intermediate Uveitis, Posterior Uveitis, and Panuveitis: Two-year Results (Ophthalmology. 2016;123:1940-1948) Ophthalmology. Apr, 2017  |   Pubmed ID: 28335961
• Choroidal Vascular Changes in Age-related Macular Degeneration Acta Ophthalmologica. Apr, 2017  |   Pubmed ID: 28391615 To assess the choroidal vascular changes using choroidal vascularity index (CVI) in patients with age-related macular degeneration (AMD) compared to controls.
• Re: Pasquale Et al.: Prospective Study of Oral Health and Risk of Primary Open-angle Glaucoma in Men: Data from the Health Professionals Follow-up Study (Ophthalmology. 2016;123:2318-2327) Ophthalmology. May, 2017  |   Pubmed ID: 28433138
• Influence of Scanning Area on Choroidal Vascularity Index Measurement Using Optical Coherence Tomography Acta Ophthalmologica. May, 2017  |   Pubmed ID: 28470942 Recently, choroidal vascularity index (CVI) is proposed as a novel tool to evaluate the choroidal vasculature. In this study, we investigate the impact of scanning area on CVI measurement using spectral-domain optical coherence tomography (SD-OCT).
• Morphometric Features on Enhanced Depth Imaging Optical Coherence Tomography Scans in Idiopathic Posterior Uveitis or Panuveitis International Ophthalmology. Jun, 2017  |   Pubmed ID: 28585111 Enhanced depth imaging (EDI) optical coherence tomography (OCT) has emerged as a novel tool for qualitative and quantitative choroidal assessment in posterior uveitis. The objective of this study was to investigate the role of EDI-OCT to assess the choroidal and retinal changes in posterior uveitis.
• Author's Response Survey of Ophthalmology. Jun, 2017  |   Pubmed ID: 28606632
• Author's Reply: Zika Virus Infection and Ophthalmic Examination in Newborn Ocular Immunology and Inflammation. Jun, 2017  |   Pubmed ID: 28622059
• Reply Retina (Philadelphia, Pa.). Jul, 2017  |   Pubmed ID: 28632580
• Modulating Release of Ranibizumab and Aflibercept from Thiolated Chitosan-based Hydrogels for Potential Treatment of Ocular Neovascularization Expert Opinion on Drug Delivery. Jun, 2017  |   Pubmed ID: 28643528 This paper describes the synthesis of thiolated chitosan-based hydrogels with varying degrees of crosslinking that has been utilized to modulate release kinetics of two clinically relevant FDA-approved anti-VEGF protein drugs, ranibizumab and aflibercept. These hydrogels have been fabricated into disc shaped structures for potential use as patches on ocular surface.
• Multimodal Imaging in Retinal Vasculitis Ocular Immunology and Inflammation. Jun, 2017  |   Pubmed ID: 28696172 Retinal vasculitis presents with inflammation involving the retinal vasculature as an isolated disease or in combination with other ocular or systemic conditions. This entity may be associated with a wide variety of clinical manifestations such as vascular sheathing, cotton-wool spots, retinal ischemia, and neovascularization. Often, retinal vasculitis and its complications lead to diagnostic challenges in identifying the exact etiology of the inflammation. Ancillary investigations such as fundus photography, fluorescein angiography, and more recently, adaptive optics imaging and optical coherence tomography angiography, may provide valuable information that help in establishing the exact diagnosis and initiation of appropriate therapy. In the index review, multimodal imaging features of retinal vasculitis are described. In addition, detection of vascular inflammation using novel noncontact imaging techniques has been highlighted.
• Choroidal and Retinal Anatomical Responses Following Systemic Corticosteroid Therapy in Vogt-Koyanagi-Harada Disease Using Swept-Source Optical Coherence Tomography Ocular Immunology and Inflammation. Jul, 2017  |   Pubmed ID: 28700251 To assess structural changes in retina and choroid after systemic corticosteroid therapy in Vogt-Koyanagi-Harada (VKH) disease using swept-source optical coherence tomography (SS-OCT).
• Choroidal Remodeling in Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: A 12-month Prospective Study Scientific Reports. Aug, 2017  |   Pubmed ID: 28801615 Choroid thinning occurs in age-related macular degeneration (AMD). However, it remains unclear whether the reduction is due to reduction in choroidal vessels or shrinkage of choroidal stroma, or both. The purpose of this study was to evaluate the changes of the choroidal vascular and stromal area in 118 patients with typical AMD (t-AMD) and polypoidal choroidal vasculopathy (PCV) over a 12-month period. We used spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode to measure the subfoveal choroidal thickness (CT), central retinal thickness (CRT) and choroidal vascularity index (CVI - ratio of luminal area to total choroidal area). At baseline, PCV eyes had higher CRT (471.6 µm vs 439.1 µm, p = 0.02), but comparable subfoveal CT and CVI, compared to t-AMD. Eyes with high CVI at baseline showed marked reduction in stromal area compared with eyes with average or low CVI. Over 12 months, CRT and subfoveal CT significantly decreased (p 
• Systematic Analysis of Ocular Trauma by a New Proposed Ocular Trauma Classification Indian Journal of Ophthalmology. Aug, 2017  |   Pubmed ID: 28820158 The current classification of ocular trauma does not incorporate adnexal trauma, injuries that are attributable to a nonmechanical cause and destructive globe injuries. This study proposes a new classification system of ocular trauma which is broader-based to allow for the classification of a wider range of ocular injuries not covered by the current classification.
• Persistence of Zika Virus in Conjunctival Fluid of Convalescence Patients Scientific Reports. Sep, 2017  |   Pubmed ID: 28894118 A widespread epidemic of Zika fever, caused by Zika virus (ZIKAV) has spread throughout the Pacific islands, the Americas and Southeast Asia. The increased incidences of ocular anomalies observed in ZIKAV-infected infants and adults may be associated with the rapid spread of ZIKAV. The objective of this study was to check if ZIKAV could be detected in human tears after the first week of infection. Twenty-nine patients with PCR confirmed ZIKAV infection during the Singapore August 2016 ZIKAV outbreak were enrolled for the study. Detection and quantification of ZIKAV RNA was performed on conjunctival swabs collected from both eyes of these patients at the late convalescent phase (30 days post-illness). Efficiency of viral isolation from swab samples was confirmed by the limit of detection (as low as 0.1 PFU/µL, equivalent to copy number of 4.9) in spiked swabs with different concentrations of ZIKAV (PFU/µL). Samples from three patients were found positive by qRT-PCR for ZIKAV and the viral RNA copy numbers detected in conjunctival swabs ranged from 5.2 to 9.3 copies respectively. ZIKAV could persist in the tears of infected patients for up to 30 days post-illness, and may therefore possess a potential public health risk of transmission.