Article
Ophthalmology
Ludovico Iannetti, Marco Liberali, Marta Armentano, Ludovico Alisi, Giacomo Visioli, Davide Mastromarino, Edoardo Brauner, Giorgio Iannetti
Summary: This study provides a long-term follow-up of patients who underwent osteo-odonto-keratoprosthesis (OOKP) using the Strampelli original technique and describes the clinical, anatomical, and visual outcomes. The results demonstrate that the original OOKP is a durable surgical choice for restoring vision in end-stage corneal blindness patients.
AMERICAN JOURNAL OF OPHTHALMOLOGY
(2022)
Article
Ophthalmology
Pukhraj Rishi, Ekta Rishi, Pradeep Manchegowda, Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal
Summary: This study analyzed the incidence, microbiological profile, risk factors, and outcomes in eyes with osteo-odonto keratoprosthesis (OOKP) developing endophthalmitis. The results showed that endophthalmitis had a significant impact on OOKP eyes, with Steven-Johnson syndrome and laminar resorption being the most important risk factors.
OCULAR IMMUNOLOGY AND INFLAMMATION
(2022)
Review
Ophthalmology
Gustavo Ortiz-Morales, Denise Loya-Garcia, Maria F. Colorado-Zavala, Daniela E. Gomez-Elizondo, Matias Soifer, Bhaskar Srinivasan, Shweta Agarwal, Alejandro Rodriguez-Garcia, Victor L. Perez, Guillermo Amescua, Geetha Iyer
Summary: This article provides an analysis of the modified osteo-odonto-keratoprosthesis (MOOKP) using a comprehensive search of published case reports and series. The study examines various factors including demographic profile, indications for surgery, surgical techniques, postoperative management, outcomes, and complications. The findings demonstrate that MOOKP is a reliable option for visual rehabilitation in patients with bilateral corneal blindness and end-stage ocular surface disease, with high long-term success rates in both anatomical and functional aspects.
Article
Engineering, Biomedical
Venkata Avadhanam, Ganesh Ingavle, Yishan Zheng, Sandeep Kumar, Christopher Liu, Susan Sandeman
Summary: A hydrogel polymer composite was developed as a synthetic substitute for the OOKP skirt, mimicking the alveo-dental lamina by incorporating nano-crystalline hydroxyapatite (nHAp) coated PLGA microspheres. The IPN hydrogel combinations supported cell adhesion and proliferation, while also showing non-inflammatory potential, making them promising materials for OOKP skirt substitutes.
JOURNAL OF BIOMATERIALS APPLICATIONS
(2021)
Article
Medicine, General & Internal
Christine M. Bourke, Brendan K. Cummings, Daire J. Hurley, Conor C. Murphy, Sarah Chamney
Summary: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous reactions that can lead to severe ocular complications. This case report describes a rare presentation of isolated ocular SJS in a patient with ulcerative colitis being treated with Infliximab. The diagnosis was challenging as the causative agent had already been discontinued, but a conjunctival biopsy helped confirm the diagnosis. The treatment involved high-dose IV steroids and dual immunosuppression. This case contributes to the evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Ophthalmology
Alejandro Arboleda, Ragini Phansalkar, Guillermo Amescua, Wen-Shin Lee, James D. Brandt, Mark J. Mannis, Andrea L. Kossler, Charles C. Lin
Summary: This case discusses the successful visual restoration of a patient with severe keratinized ocular surface caused by end-stage Stevens-Johnson syndrome (SJS). The patient underwent a staged approach consisting of systemic methotrexate, minor salivary gland transplant, lid margin mucous membrane graft, and Boston type 1 keratoprosthesis. This multifaceted approach resulted in the restoration of vision to 20/60 and successful retention of the keratoprosthesis for over 2 years.
Review
Medicine, General & Internal
Thanachaporn Kittipibul, Vilavun Puangsricharern
Summary: The ocular surface microbiome is crucial for maintaining the homeostasis of the ocular surface, with abnormalities linked to various eye conditions. Research shows changes in the ocular microbiome structure in SJS patients, including alterations in the types and quantities of bacterial communities. Further studies will provide a better understanding of this disease.
FRONTIERS IN MEDICINE
(2021)
Article
Immunology
Mayumi Ueta, Koji Hosomi, Jonguk Park, Kenji Mizuguchi, Chie Sotozono, Shigeru Kinoshita, Jun Kunisawa
Summary: The study revealed reduced diversity and different composition of the ocular microbiome in SJS/TEN patients with SOC compared to healthy controls, with certain bacteria enrichment potentially associated with ocular surface inflammation in these patients.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
Review
Ophthalmology
Supriya Sharma, Pragnya Rao Donthineni, Geetha Iyer, James Chodosh, Maria Fideliz de la Paz, Quresh Maskati, Bhaskar Srinivasan, Shweta Agarwal, Sayan Basu, Swapna S. Shanbhag
Summary: Treating bilateral corneal blindness with severe dry eye disease, total limbal stem cell deficiency, corneal stromal scarring, and vascularization, along with adnexal complications from chronic cicatrizing conjunctivitis is a complex situation. Traditional procedures are likely to fail, making keratoprosthesis (Kpro) or an artificial cornea the most viable option. Kpro eliminates corneal blindness even in eyes with autoimmune or nonautoimmune disorders, while also avoiding the need for systemic immunosuppression and allowing for early visual recovery.
INDIAN JOURNAL OF OPHTHALMOLOGY
(2023)
Article
Ophthalmology
Leangelo N. Hall, Swapna S. Shanbhag, Ramy Rashad, James Chodosh, Hajirah N. Saeed
Summary: The study evaluated the effect of systemic cyclosporine on ocular disease in SJS/TEN patients and found no significant association between the use of systemic cyclosporine and chronic ocular complications in this small cohort.
Review
Medicine, General & Internal
Tais Hitomi Wakamatsu, Myrna Serapiao dos Santos, Telma Pereira Barreiro, Ana Estela Besteti Pires Ponce Sant'Anna, Fabiola Murta, Alexandre Xavier da Costa, Leonardo Guedes C. Marculino, Rafael Jorge Alves de Alcantara, Charles Costa de Farias, Jose Alvaro Pereira Gomes
Summary: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory reactions triggered by specific medications and infections, with genetic variations increasing the risk. In Brazil, certain medications like cold medicine have been found to be most commonly associated with SJS/TEN, leading to severe ocular complications in patients of mixed African and European ancestry. Changes in conjunctival flora and new treatment options for ocular management in SJS/TEN patients have been highlighted, including the use of innovative techniques like amniotic membrane transplantation and minor salivary gland transplantation.
FRONTIERS IN MEDICINE
(2021)
Article
Medicine, General & Internal
David Hui-Kang Ma, Tsung-Ying Tsai, Li-Yen Pan, Shin-Yi Chen, Ching-Hsi Hsiao, Lung-Kun Yeh, Hsin-Yuan Tan, Chun-Wei Lu, Chun-Bing Chen, Wen-Hung Chung
Summary: Recent advancements in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have shown progress in improving ophthalmic outcomes. A study of 119 patients at Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020 revealed a high incidence of severe ocular complications (SOCs) in the acute stage, with antiepileptic drugs being a common cause. Furthermore, early treatment with etanercept and amniotic membrane transplantation (AMT) showed promising outcomes in reducing chronic ocular sequelae in SJS/TEN patients.
FRONTIERS IN MEDICINE
(2021)
Review
Medicine, General & Internal
Mayumi Ueta
Summary: Stevens-Johnson Syndrome is an acute inflammatory reaction that can cause vesiculobullous lesions on the skin and mucosa, with some patients also experiencing severe ocular complications. Research has shown that in Japanese patients, cold medicines are the main causative drugs for SJS/TEN with eye involvement, with genetic types differing between different ethnic groups.
FRONTIERS IN MEDICINE
(2021)
Review
Medicine, General & Internal
Mayumi Ueta
Summary: SJS/TEN with SOC is an acute inflammatory reaction that affects mucosa and skin, with cold medicines identified as the main causative drugs. Specific genes such as TLR3, PTGER3, and IKZF1 have been found to be significantly associated with SJS/TEN with SOC. In chronic stage, tear cytokines such as IL-8, IL-6, and IFN-gamma were upregulated, while IP-10 was downregulated, contributing to the chronic ocular surface inflammation in these patients.
FRONTIERS IN MEDICINE
(2021)
Review
Medicine, General & Internal
Derek Metcalfe, Omer Iqbal, James Chodosh, Charles S. Bouchard, Hajirah N. Saeed
Summary: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe immune-mediated mucocutaneous diseases that often involve the eyes and can result in corneal blindness. Early treatment is crucial in reducing the severity of chronic disease, with interventions such as amniotic membrane transplantation showing promise. However, aggressive acute treatment does not guarantee prevention of severe chronic ocular disease.
FRONTIERS IN MEDICINE
(2021)
Article
Ophthalmology
Pukhraj Rishi, Ekta Rishi, Pradeep Manchegowda, Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal
Summary: This study analyzed the incidence, microbiological profile, risk factors, and outcomes in eyes with osteo-odonto keratoprosthesis (OOKP) developing endophthalmitis. The results showed that endophthalmitis had a significant impact on OOKP eyes, with Steven-Johnson syndrome and laminar resorption being the most important risk factors.
OCULAR IMMUNOLOGY AND INFLAMMATION
(2022)
Article
Ophthalmology
Mamta Agarwal, Gazal Patnaik, Shweta Agarwal, Geetha Iyer, A. R. Anand, Gayathri Ar, Jyotirmay Biswas, Manfred Zierhut
Summary: Necrotizing sclerokeratitis in a patient with multidrug-resistant tuberculosis posed challenges in diagnosis and management of anterior tuberculous scleritis. Therapeutic failure due to delayed diagnosis or drug resistance highlighted the importance of early detection.
OCULAR IMMUNOLOGY AND INFLAMMATION
(2022)
Article
Ophthalmology
Bhaskar Srinivasan, Manokamna Agarwal, Geetha Iyer, Shweta Agarwal, Prema Padmanabhan
Summary: This study reported the technique and outcome of Descemet membrane endothelial keratoplasty (DMEK) in pediatric patients older than 6 years of age. The results showed promising early outcomes in terms of visual acuity improvement, corneal clarity, and reduction in pachymetry, with a high surgical success rate but a notable rate of eyes requiring rebubbling.
AMERICAN JOURNAL OF OPHTHALMOLOGY
(2021)
Article
Ophthalmology
Sona Paul, Bhaskar Srinivasan, Geetha K. Iyer
CLINICAL AND EXPERIMENTAL OPTOMETRY
(2022)
Letter
Ophthalmology
Richa Dhaman, Shweta Agarwal, Appakkudal R. Anand, Dhanurekha Lakshmipathy, Bhaskar Srinivasan, Geetha Iyer
Summary: This study reported a case of bilateral ocular microsporidiosis with simultaneous fungal infection. The findings highlight the importance of accurate diagnosis and the need for awareness of potential coexistence of different pathogens in eye infections.
OCULAR IMMUNOLOGY AND INFLAMMATION
(2022)
Review
Medicine, General & Internal
Swapna S. Shanbhag, Virender S. Sangwan, Aastha Singh, Pragnya R. Donthineni, Sayan Basu, Bhaskar Srinivasan, Shweta Agarwal, Geetha Iyer
Summary: SJS/TEN is a rare and severe immunological blistering skin reaction disease, with high mortality rates in the acute phase and impact on quality of life in the chronic phase. Two-thirds of patients in India experience chronic ocular sequelae in the chronic phase. Targeted interventions such as scleral lenses and mucous membrane grafts can reduce corneal blindness and improve quality of life for patients with SJS/TEN.
FRONTIERS IN MEDICINE
(2021)
Article
Ophthalmology
Vignesh Menta, Shweta Agarwal, Ujjalkumar Subhash Das, Laxmi Moksha, Gurumurthy Srividya, Amrutha M. Anandan, Bhaskar Srinivasan, Geetha Iyer, Thirumurthy Velpandian, Narayanasamy Angayarkanni
Summary: This study found altered sphingolipid metabolism in the ocular surface of patients with vernal keratoconjunctivitis (VKC), resulting in decreased levels of specific metabolites in tears. The study also showed increased gene expression of relevant receptors and proteins in mast cells treated with IgE. This novel finding opens up new targets for intervention in VKC.
BRITISH JOURNAL OF OPHTHALMOLOGY
(2023)
Letter
Ophthalmology
Mamta Agarwal, S. Gayatri, Geetha Iyer, Subramanian KrishnaKumar, Emmett T. Cunningham
Summary: This study reported a rare case of extranodal Rosai-Dorfman disease (RDD) presenting initially as bilateral scleritis and progressing to multifocal epibulbar masses. Tissue biopsy with immunohistochemical analysis aided in the diagnosis of RDD.
OCULAR IMMUNOLOGY AND INFLAMMATION
(2023)
Article
Ophthalmology
Geetha Iyer, Bhaskar Srinivasan, Richa Dhiman, Manokamna Agarwal, Rama Rajagopal
Summary: The study reported preliminary outcomes of primary alloSLET for ocular surface reconstruction after tumor excision, showing reduced symblepharon formation and limbal stem cell deficiency. It may be an alternative option for extensive ocular surface tumors in eyes.
Editorial Material
Ophthalmology
Rama Rajagopal, Bhaskar Srinivasan, Geetha Iyer, Manokamna Agarwal
Summary: This article reports a rare case of bilateral ocular surface disease in a patient with Xeroderma pigmentosum and its successful management. Multiple ocular surface issues can coexist in Xeroderma pigmentosum, and sequential management can lead to successful outcomes.
EUROPEAN JOURNAL OF OPHTHALMOLOGY
(2023)
Review
Ophthalmology
Gustavo Ortiz-Morales, Denise Loya-Garcia, Maria F. Colorado-Zavala, Daniela E. Gomez-Elizondo, Matias Soifer, Bhaskar Srinivasan, Shweta Agarwal, Alejandro Rodriguez-Garcia, Victor L. Perez, Guillermo Amescua, Geetha Iyer
Summary: This article provides an analysis of the modified osteo-odonto-keratoprosthesis (MOOKP) using a comprehensive search of published case reports and series. The study examines various factors including demographic profile, indications for surgery, surgical techniques, postoperative management, outcomes, and complications. The findings demonstrate that MOOKP is a reliable option for visual rehabilitation in patients with bilateral corneal blindness and end-stage ocular surface disease, with high long-term success rates in both anatomical and functional aspects.
Review
Ophthalmology
Bharat Gurnani, Kirandeep Kaur, Shweta Agarwal, Vaitheeswaran G. Lalgudi, Nakul S. Shekhawat, Anitha Venugopal, Koushik Tripathy, Bhaskar Srinivasan, Geetha Iyer, Joseph Gubert
Summary: Pythium insidiosum (PI) is an oomycete that causes vision-threatening keratitis. PI keratitis closely mimics fungal keratitis and has seen a significant increase in cases, particularly in India. The diagnosis of PI keratitis requires a high index of clinical suspicion, as its clinical features differentiate it from other microorganisms. PCR is currently the gold standard for diagnosis, and treatment often involves antibacterials or therapeutic keratoplasty.
OPHTHALMOLOGY AND THERAPY
(2022)
Review
Ophthalmology
Bharat Gurnani, Kirandeep Kaur, Anitha Venugopal, Bhaskar Srinivasan, Bhupesh Bagga, Geetha Iyer, Josephine Christy, Lalitha Prajna, Murugesan Vanathi, Prashant Garg, Shivanand Narayana, Shweta Agarwal, Srikant Sahu
Summary: Pythium insidiosum keratitis, also known as parafungus, is a type of oomycete infection that closely resembles fungal keratitis. Over the past decade, there has been a significant increase in cases, particularly in Asia and India, possibly due to increased research on the microorganism and improved diagnostic and treatment methods. The clinical features of Pythium keratitis closely resemble those of fungal keratitis, but there are also distinguishing features that require a high index of suspicion for accurate diagnosis. The gold standard for diagnosis is culture on blood agar, but molecular diagnostic methods are also being increasingly used. Recent studies have suggested the use of antibacterials as first-line drugs for treatment.
INDIAN JOURNAL OF OPHTHALMOLOGY
(2022)
Review
Ophthalmology
Shweta Agarwal, Tanveer Khan, Murugesan Vanathi, Bhaskar Srinivasan, Geetha Iyer, Radhika Tandon
Summary: Infectious keratitis is a medical emergency that can cause significant visual morbidity. The indiscriminate use of antimicrobials has led to the emergence of resistant microorganisms, worsening the prognosis. Various factors, such as coexisting ocular surface diseases, delayed diagnosis, and virulent organisms, contribute to the refractory response of the ulcer. Understanding these factors and the role of biofilm formation and improving drug bioavailability has led to the development of alternative therapies for the diagnosis and treatment of refractory keratitis.
INDIAN JOURNAL OF OPHTHALMOLOGY
(2022)
Letter
Ophthalmology
Shweta Agarwal, Bhaskar Srinivasan, Rishi Gupta, Geetha Iyer
AMERICAN JOURNAL OF OPHTHALMOLOGY
(2021)