Sharadini Vyas - Academia.edu (original) (raw)
Papers by Sharadini Vyas
Journal of Clinical Ophthalmology and Research, 2013
Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closur... more Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closure in ophthalmology. Each of the type of glue is unique in terms of its advantages as well as limitations and so is used in different indications. Although the presently available tissue adhesives are good enough for the procedures mentioned, there is still a demand for newer adhesives. The increasing acceptance of these adhesives by the clinicians promises this to be a standard procedure for surgical wound closure. The existing cyanoacrylate glue is mainly used as a corneal patch to seal acute corneal perforations and improve visual outcomes, with reduced enucleation rates and need for tectonic keratoplasty in many situations. Fibrin glue is a biological adhesive, which reduces the total surgical time. The multiple advantages has extended its use in all the superspeciality fields of ophthalmology like corneal and conjunctival surgeries; strabismus, cataract, refractive, glaucoma, and even retinal surgeries. A newer tissue adhesive like biodendrimers and photocrosslinkable ones has better biocompatibility, rapid sealing properties and increased binding forces. It promises to overcome the drawbacks and risks associated with the existing ones but still under research. The increasing acceptance of all these promises it to be a standard procedure for surgical wound closure and probably will introduce a newer modality for drug delivery. In this article, we tried to review the literature with internet and medlines search for the available adhesives, as well as the upcoming ones with promising applications in ophthalmology.
Journal of Refractive Surgery, 1994
Diclofenac is a nonsteroidal antiinflammatory drug (NSAID) that is widely used systemically and t... more Diclofenac is a nonsteroidal antiinflammatory drug (NSAID) that is widely used systemically and topically. We studied the effect of diclofenac on corneal reepithelialization and corneal sensitivity after excimer laser treatment in rabbits. Twelve New Zealand white rabbits were divided into four groups (A, B, C, and D). Groups A and B received diclofenac four times and eight times daily, respectively, following a central 5-millimeter epithelial debridement. Groups C (control) and D (diclofenac four times daily) underwent excimer laser ablation (30-micrometer depth) following manual debridement. Wound healing was compared between groups A and B and groups C and D. Sensitivity was recorded preoperatively and postoperatively 1 to 5 and 14 days in groups C and D until normal values were reestablished. Total time for corneal wound healing and epithelial migration rates was not delayed in any group receiving diclofenac (A, B, and D). Sensitivity after laser ablation reached a minimum of 15% to 20% in both groups C and D by day 2 and returned to normal (100%) by day 8. The decrease in sensitivity between group C, the controls, and group D, receiving diclofenac four times daily, was not statistically significant. Diclofenac can be used up to eight times daily in the rabbit without causing changes in corneal wound healing or epithelial migration rate. There was no significant, long-term reduction of sensitivity, and recovery was not affected by diclofenac.
Journal of Cataract & Refractive Surgery, 1995
Indian Journal of Ophthalmology, 2012
Corneal diseases such as scars, degenerations, dystrophies, bullous keratopathy, and band-shaped ... more Corneal diseases such as scars, degenerations, dystrophies, bullous keratopathy, and band-shaped keratopathy (BSK) are important causes of visual blindness; anterior stromal disease being superficial can be treated using various minimally invasive surgical procedures like lamellar keratoplasty (LKP) or superficial keratectomy or by excimer lasers, that is, phototherapeutic keratectomy (PTK). [1-11] PTK can be considered to be a bridge between medical and surgical management of corneal diseases. PTK can be used for therapeutic and / or refractive indications. This review deals with therapeutic indications for PTK. In this review, we highlight the indications of PTK, the technique, and management. Therapeutic Indications [Table 1] Spheroidal degeneration Spheroidal degeneration clinically presents in two forms; smooth fine gelatinous dew-drop appearance and yellow, raised spherules, with an irregular surface [Fig. 1]. The two forms may co-exist. The material is present in the sub-epithelial layer, Bowman's membrane, and superficial stroma. The irregularity affects the vision, and causes repeated epithelial breakdowns resulting in pain and
Cornea, 2010
Purpose: To study the outcome of phototherapeutic keratectomy (PTK) in children younger than 16 y... more Purpose: To study the outcome of phototherapeutic keratectomy (PTK) in children younger than 16 years, with corneal scars, dystrophies, and band-shaped keratopathy. Methods: Records of 18 eyes of 14 patients younger than 16 years who had undergone PTK were retrospectively reviewed. Pre-and post-PTK visual acuity, corneal clarity, and need for additional surgery were noted. Flying spot and broad beam laser machines were used for PTK. Results: PTK was performed on 18 eyes of 14 patients; PTK was performed to treat scars (n = 8 eyes), band-shaped keratopathy (n = 5 eyes), and granular dystrophy (n = 5 eyes) for reduced vision. In addition, 1 patient had irritation, watering, and photophobia. All these patients had a clear visual axis after PTK. Refraction was possible only in 6 eyes before PTK; with increased clarity of the visual axis, it was possible in 15 patients after PTK. Before PTK, mean bestcorrected logarithm of minimum angle of resolution visual acuity (Snellen equivalent) was 1.13 (20/250) and SD 0.92 (20/160); after PTK, it was 0.47 (20/60) and SD 0.37 (20/50) (P = 0.001). The primary disease recurred in 3 patients: granular dystrophy in 2 eyes, and scar along with Salzmann nodular degeneration in 1 eye. PTK was repeated in all 3 with good visual and symptomatic outcomes. None of these patients had infection or raised intraocular pressure. Conclusions: PTK is a safe and effective procedure in children. After PTK, corneal clarity is enhanced, facilitating accurate refraction and leading to improved visual acuity in most eyes. PTK can be safely repeated in case of recurrence.
Cornea, 2009
The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy... more The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy and amniotic membrane grafting in the management of painful symptomatic bullous keratopathy. Methods: We conducted a retrospective consecutive interventional case series. Combined phototherapeutic keratectomy and amniotic membrane grafting was performed in 18 eyes of 17 patients who were symptomatic because of bullous keratopathy. Data analysis was done for only 12 eyes that were followed up for more than 5 weeks and when the postoperative status of the amniotic membrane was known. Results: The mean preoperative duration of the symptoms was 164.17 6 179.39 weeks (range, 24-480 weeks). Eleven of 12 eyes (91.67%) were totally symptom-free during the entire postoperative follow-up period of 38.08 6 47.95 weeks (range, 5-156 weeks). One patient (8.33%) had mild irritation, which had started at his last postoperative follow up, at 8 months. His amniotic membrane had absorbed at 16 weeks. The amniotic membrane was completely absorbed in 58.33% (7 of 12 eyes) of eyes, partially absorbed in 33.33% eyes (4 of 12 eyes), and not absorbed at all in one eye (8.33 %). None of the patients required any repeat or additional procedure. Conclusion: Phototherapeutic keratectomy when combined with amniotic membrane grafting provides a viable alternative in the management of painful symptomatic bullous keratopathy.
Journal of Clinical Ophthalmology and Research, 2013
Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closur... more Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closure in ophthalmology. Each of the type of glue is unique in terms of its advantages as well as limitations and so is used in different indications. Although the presently available tissue adhesives are good enough for the procedures mentioned, there is still a demand for newer adhesives. The increasing acceptance of these adhesives by the clinicians promises this to be a standard procedure for surgical wound closure. The existing cyanoacrylate glue is mainly used as a corneal patch to seal acute corneal perforations and improve visual outcomes, with reduced enucleation rates and need for tectonic keratoplasty in many situations. Fibrin glue is a biological adhesive, which reduces the total surgical time. The multiple advantages has extended its use in all the superspeciality fields of ophthalmology like corneal and conjunctival surgeries; strabismus, cataract, refractive, glaucoma, and even retinal surgeries. A newer tissue adhesive like biodendrimers and photocrosslinkable ones has better biocompatibility, rapid sealing properties and increased binding forces. It promises to overcome the drawbacks and risks associated with the existing ones but still under research. The increasing acceptance of all these promises it to be a standard procedure for surgical wound closure and probably will introduce a newer modality for drug delivery. In this article, we tried to review the literature with internet and medlines search for the available adhesives, as well as the upcoming ones with promising applications in ophthalmology.
Journal of Refractive Surgery, 1994
Diclofenac is a nonsteroidal antiinflammatory drug (NSAID) that is widely used systemically and t... more Diclofenac is a nonsteroidal antiinflammatory drug (NSAID) that is widely used systemically and topically. We studied the effect of diclofenac on corneal reepithelialization and corneal sensitivity after excimer laser treatment in rabbits. Twelve New Zealand white rabbits were divided into four groups (A, B, C, and D). Groups A and B received diclofenac four times and eight times daily, respectively, following a central 5-millimeter epithelial debridement. Groups C (control) and D (diclofenac four times daily) underwent excimer laser ablation (30-micrometer depth) following manual debridement. Wound healing was compared between groups A and B and groups C and D. Sensitivity was recorded preoperatively and postoperatively 1 to 5 and 14 days in groups C and D until normal values were reestablished. Total time for corneal wound healing and epithelial migration rates was not delayed in any group receiving diclofenac (A, B, and D). Sensitivity after laser ablation reached a minimum of 15% to 20% in both groups C and D by day 2 and returned to normal (100%) by day 8. The decrease in sensitivity between group C, the controls, and group D, receiving diclofenac four times daily, was not statistically significant. Diclofenac can be used up to eight times daily in the rabbit without causing changes in corneal wound healing or epithelial migration rate. There was no significant, long-term reduction of sensitivity, and recovery was not affected by diclofenac.
Journal of Cataract & Refractive Surgery, 1995
Indian Journal of Ophthalmology, 2012
Corneal diseases such as scars, degenerations, dystrophies, bullous keratopathy, and band-shaped ... more Corneal diseases such as scars, degenerations, dystrophies, bullous keratopathy, and band-shaped keratopathy (BSK) are important causes of visual blindness; anterior stromal disease being superficial can be treated using various minimally invasive surgical procedures like lamellar keratoplasty (LKP) or superficial keratectomy or by excimer lasers, that is, phototherapeutic keratectomy (PTK). [1-11] PTK can be considered to be a bridge between medical and surgical management of corneal diseases. PTK can be used for therapeutic and / or refractive indications. This review deals with therapeutic indications for PTK. In this review, we highlight the indications of PTK, the technique, and management. Therapeutic Indications [Table 1] Spheroidal degeneration Spheroidal degeneration clinically presents in two forms; smooth fine gelatinous dew-drop appearance and yellow, raised spherules, with an irregular surface [Fig. 1]. The two forms may co-exist. The material is present in the sub-epithelial layer, Bowman's membrane, and superficial stroma. The irregularity affects the vision, and causes repeated epithelial breakdowns resulting in pain and
Cornea, 2010
Purpose: To study the outcome of phototherapeutic keratectomy (PTK) in children younger than 16 y... more Purpose: To study the outcome of phototherapeutic keratectomy (PTK) in children younger than 16 years, with corneal scars, dystrophies, and band-shaped keratopathy. Methods: Records of 18 eyes of 14 patients younger than 16 years who had undergone PTK were retrospectively reviewed. Pre-and post-PTK visual acuity, corneal clarity, and need for additional surgery were noted. Flying spot and broad beam laser machines were used for PTK. Results: PTK was performed on 18 eyes of 14 patients; PTK was performed to treat scars (n = 8 eyes), band-shaped keratopathy (n = 5 eyes), and granular dystrophy (n = 5 eyes) for reduced vision. In addition, 1 patient had irritation, watering, and photophobia. All these patients had a clear visual axis after PTK. Refraction was possible only in 6 eyes before PTK; with increased clarity of the visual axis, it was possible in 15 patients after PTK. Before PTK, mean bestcorrected logarithm of minimum angle of resolution visual acuity (Snellen equivalent) was 1.13 (20/250) and SD 0.92 (20/160); after PTK, it was 0.47 (20/60) and SD 0.37 (20/50) (P = 0.001). The primary disease recurred in 3 patients: granular dystrophy in 2 eyes, and scar along with Salzmann nodular degeneration in 1 eye. PTK was repeated in all 3 with good visual and symptomatic outcomes. None of these patients had infection or raised intraocular pressure. Conclusions: PTK is a safe and effective procedure in children. After PTK, corneal clarity is enhanced, facilitating accurate refraction and leading to improved visual acuity in most eyes. PTK can be safely repeated in case of recurrence.
Cornea, 2009
The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy... more The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy and amniotic membrane grafting in the management of painful symptomatic bullous keratopathy. Methods: We conducted a retrospective consecutive interventional case series. Combined phototherapeutic keratectomy and amniotic membrane grafting was performed in 18 eyes of 17 patients who were symptomatic because of bullous keratopathy. Data analysis was done for only 12 eyes that were followed up for more than 5 weeks and when the postoperative status of the amniotic membrane was known. Results: The mean preoperative duration of the symptoms was 164.17 6 179.39 weeks (range, 24-480 weeks). Eleven of 12 eyes (91.67%) were totally symptom-free during the entire postoperative follow-up period of 38.08 6 47.95 weeks (range, 5-156 weeks). One patient (8.33%) had mild irritation, which had started at his last postoperative follow up, at 8 months. His amniotic membrane had absorbed at 16 weeks. The amniotic membrane was completely absorbed in 58.33% (7 of 12 eyes) of eyes, partially absorbed in 33.33% eyes (4 of 12 eyes), and not absorbed at all in one eye (8.33 %). None of the patients required any repeat or additional procedure. Conclusion: Phototherapeutic keratectomy when combined with amniotic membrane grafting provides a viable alternative in the management of painful symptomatic bullous keratopathy.