Sushmita Kaushik - Academia.edu (original) (raw)

Papers by Sushmita Kaushik

BMC Ophthalmology, Jul 7, 2006

Background: Bilateral simultaneous angle closure glaucoma is a rare entity. To our knowledge this... more Background: Bilateral simultaneous angle closure glaucoma is a rare entity. To our knowledge this is the first reported case of bilateral acute angle-closure glaucoma secondary to isolated microspherophakia in an adult. Case presentation: A 45-year-old woman presented with bilateral acute angle closure glaucoma, with a patent iridotomy in one eye. Prolonged miotic use prior to presentation had worsened the pupillary block. The diagnosis was not initially suspected, and the patient was subjected to parsplana lensectomy and anterior vitrectomy for a presumed ciliary block glaucoma. The small spherical lens was detected intraoperatively, and spherophakia was diagnosed in retrospect. She had no systemic features of any of the known conditions associated with spherophakia. Pars-plana lensectomy both eyes controlled the intraocular pressure successfully. Conclusion: This case demonstrates the importance of considering the diagnosis of isolated microspherophakia in any case of bilateral acute angle closure glaucoma. Lensectomy appears to be an effective first-line strategy for managing these patients.

QJM: An International Journal of Medicine, Jan 23, 2019

Kayser-Fleischer ring in Wilson's disease A 20-year male patient admitted in neurology department... more Kayser-Fleischer ring in Wilson's disease A 20-year male patient admitted in neurology department for gait difficulty, dystonic posture and psychiatric issues was suspected of Wilson's disease and referred for ophthalmic evaluation. Ophthalmic examination revealed a characteristic thick band of golden-brown pigment deposition in peripheral cornea involving the deeper layers of cornea suggestive of Kayser-Fleischer ring (Figure 1). Wilson's disease is a disorder of copper metabolism with accumulation of copper deposits in various organs including liver, brain, kidney or eyes. 1 The disease can manifest as jaundice, ascites, neurological disturbances in form of dystonia, rigidity, gait abnormalities or psychiatric disturbances including depression, schizophrenia etc. The presence of KF ring suggests copper overload in the body which deposits in the descemet's membrane of the cornea. It can diminish or even disappear following treatment of the disease and thus can help in monitoring the treatment course. 2 KF ring can be seen in about 95% of the cases in presence of neurological/psychiatric symptoms, and about 50-65% of the cases with liver involvement. 3

Clinical and experimental vision and eye research, 2018

Aim: This study aims to study the presentation pattern of primary congenital glaucoma (PCG) in No... more Aim: This study aims to study the presentation pattern of primary congenital glaucoma (PCG) in Northern India and analyze the relationship to its outcome if any. Methods: A total of 90 patients (157 eyes) with PCG presenting between January 2003 and December 2011, with at least 1-year follow-up after surgery were included in the study. Inclusion criteria were increased corneal diameter (>12.0 mm), intraocular pressure (IOP) >18 mmHg, and/or presence of Haab's striae with or without optic disc changes. Demographic data, whether the patient was self-reported or doctor referred, presenting IOP, corneal diameter, corneal clarity, and optic nerve damage where visualized, were recorded. Outcome of treatment was determined depending on IOP control and requirement of drugs. Differences in presenting feature between selfreported and doctor-referred patients, and association between presenting features and outcome was analyzed. Results: Majority (67%) were self-reported. 102 eyes had hazy corneas; 45 eyes (28.7%) presented with corneal opacity. Doctor-referred patients presented earlier (P ≤ 0.001), had significantly lower IOP (P = 0.009), and smaller corneal diameters (P = 0.049) than self-reported. Good outcome was correlated with lower IOP (P = 0.005) and smaller cornea (P < 0.001) at presentation. Corneal opacity at presentation was strongly correlated to poor outcome (P < 0.001). Optic disc cupping at presentation had no bearing on the final outcome. Conclusions: Corneal involvement appears to occur early in this cohort of PCG. Corneal examination under torchlight by paramedical personnel, general physicians, and pediatricians might lead to an early referral before vision-threatening complications develop. However, early corneal involvement may indicate more severe disease and is likely to have a poor prognosis regardless of the time of referral.

Eye, Jul 9, 2018

Background To study the role of selective laser trabeculoplasty (SLT) in intraocular pressure (IO... more Background To study the role of selective laser trabeculoplasty (SLT) in intraocular pressure (IOP) reduction in post-laser iridotomy primary angle-closure disease patients with inadequately controlled IOP. Methods In this prospective cross-sectional study, 34 patients with primary angle-closure disease with post-laser iridotomy open angles up to at least 180°were recruited. Following SLT, patients were examined at 1 day, 1 week, 1 and 3 months, 6 months and 1 year post SLT. Results Data of 34 patients (34 eyes; 8 males and 26 females), with a mean age of 57.80 ± 6.44 years, were analysed. The reduction in IOP at each follow-up visit was significant (p < 0.001). The maximum reduction in IOP was noticed on postlaser day 1 and the least reduction was noticed 1 week post laser. Post-SLT range of IOP reduction varied from 9 to 46% at 1 year, which indicates the variability of a response to SLT. Mean IOP in both primary angle closure (PAC) and primary angle closure glaucoma (PACG) groups was comparable at all visits except at post-SLT week 1 when IOP in the PACG group was significantly higher than that in the PAC group (p = 0.035). None of the patients complained of pain and/or discomfort or had any clinically significant anterior segment inflammation on any of the follow-up visits. None of the patients underwent repeat SLT or surgery. The mean pre-SLT and post-SLT visual field index at 1-year follow-up was 95.47 ± 3.58 and 95.90 ± 4.13, respectively, which was not significant (p = 0.84). Conclusions High baseline IOP significantly correlated with reduction in IOP. Our results suggest that SLT is a safe, costeffective modality for reducing IOP in primary angle-closure disease with patent laser iridotomy with a visible trabecular meshwork.

Scientific Reports

We aimed to evaluate the efficacy and safety of low-dose atropine compared to placebo in the Indi... more We aimed to evaluate the efficacy and safety of low-dose atropine compared to placebo in the Indian population and also to study the impact of various modifiable and non-modifiable factors on myopia progression (MP) and drug efficacy (DE). It was a single-centre prospective placebo-controlled interventional study. 43 participants aged 6–16 years with progressive myopia received 0.01% atropine in the right eyes (treatment) and placebo in the left eyes (control) for 1-year. The main outcome measures were annual MP and axial length elongation (ALE) in treatment and control eyes and their percentage difference between two eyes (drug efficacy). Secondary outcome measures were the occurrence of any adverse events and the correlation of MP, ALE, and DE with various factors. 40 participants (80 eyes) completed the follow-up. After 1-year, MP was 0.25 D (IQR 0.13–0.44) and 0.69 D (IQR 0.50–1.0) (p < 0.001) in treatment and control respectively (63.89% reduction) with respective ALE of 0.1...

British Journal of Ophthalmology, 2019

PurposeTo compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glauc... more PurposeTo compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glaucoma valve (AGV).MethodRetrospective analysis of patients with refractory glaucoma who underwent AGV (AGV-FP7) and AADI (AADI Model 350) implantation. The outcome measures were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs) and re-surgery for IOP control. The postoperative complications were classified as early (≤3 months), intermediate (>3 months to ≤1 year) or late (>1 year).Results173 patients (189 eyes) underwent AGV implantation (AGV Group) while 201 patients (206 eyes) underwent AADI implantation (AADI group). The IOP in AADI group was significantly lower than AGV group at all time points till 2 years and comparable at 3 years. AADI group had significantly higher number of AGM in preoperative period and significantly lower number in postoperative period till 3 years compared with AGV group. AADI group had more hypotony-related complications but stat...

QJM: An International Journal of Medicine, 2019

A 12-year boy presented with decreased vision in the right eye. The uncorrected visual acuity was... more A 12-year boy presented with decreased vision in the right eye. The uncorrected visual acuity was 6/12, which improved to 6/6 after myopic refractive correction. Examination revealed portwine stain on the right side of the face and dilated episcleral blood vessels in the right eye suggestive of episcleral hemangioma (Figure 1A and B). Intraocular pressure was 26.0 and 14.0 mm Hg in the right and left eye respectively. There was a diffuse choroidal hemangioma, and the optic nerve head was cupped (cup-disc ratio 0.8), suggestive of glaucoma. The patient did not have any history of seizures, and MRI brain did not reveal any abnormality. He has diagnosed as Sturge Weber syndrome (SWS) type II with facial angioma and ocular involvement in the form of episcleral as well as diffuse choroidal hemangioma and glaucoma. SWS, also known as encephalotrigeminal angiomatosis is characterized by leptomeningeal hemangioma, facial angiomatosis, and ocular pathological changes. 1 It has three types:

Ophthalmology Research: An International Journal, 2016

Background: Prospective Interventional Pilot study of selective laser trabeculoplasty as adjuncti... more Background: Prospective Interventional Pilot study of selective laser trabeculoplasty as adjunctive treatment in patients affected by open angle glaucoma for control of intraocular pressure in Indian eyes. Methods: This prospective Interventional pilot study included 29 eyes of 29 patients affected by open angle glaucoma, were treated with Selective laser trabeculoplasty (360 degree trabecular meshwork treated with 100 spots) for IOP control between January 2011 to December 2011. Of these 29 patients, 24 were males, 5 were females. Mean age was 58.96±18.19 years. Primary open Angle Glaucoma was diagnosed in 22 patients, Secondary Open Angle Glaucoma in 6, and Juvenile Open Angle Glaucoma in 1 patient. All patients underwent complete ophthalmic evaluation before SLT and at each follow up. This evaluation included visual acuity, IOP (GAT), slit lamp examination with 90D. The gonioscopy and visual field analysis was done at 6 &12 months. The IOP was measured on day 1, day 7, 1 month, 3 month, 6 month and at 1 year post SLT On GAT.

ATLAS Optical Coherence Tomography of Macular Diseases and Glaucoma, 2006

Journal of Clinical & Experimental Ophthalmology

To study the quality of life and burden of care in glaucoma patients and their families and to co... more To study the quality of life and burden of care in glaucoma patients and their families and to compare it with cataract patients. Methods: This was an observational, prospective, cross-sectional study in which 100 glaucoma patients and 50 patients with age-related cataract as controls, 40 years of age or older were enrolled. Patients were interviewed to obtain information on visual disability and vision-specific quality of life using NEI VFQ-25 and on general quality of life using WHOQoL-BREF. Burden of care of glaucoma was assessed using Family Burden Interview Schedule. Scores of these three questionnaires were taken as main outcome measures. Results: Scores for patients with glaucoma were significantly lower than those with cataract in visual function, social function, mental health, role difficulties and dependency sub-scales in NEI VFQ-25 questionnaire (P<0.05). General quality of life scores were significantly poor in glaucoma as compared to cataract patients in all domains of WHOQoL-BREF questionnaire including general well-being, physical health, psychological, social relationship and environment (P<0.05). There was more burden of care in glaucoma patients and their families as compared to cataract patients in Family Burden Interview Schedule questionnaire for all sub-scales including financial burden, disruption of routine family activities, family leisure, family interaction, physical health and mental health (P<0.05). Conclusions: The general quality of life was poor, and influence of limitation in visual functioning on health related quality of life, and burden of care was significantly higher in glaucoma patients as compared to cataract patients.

Investigative Ophthalmology & Visual Science, 2018

Ophthalmology Glaucoma, 2021

Journal of Glaucoma, 2020

Supplemental Digital Content is available in the text. Precis: This study evaluated 2 doses of in... more Supplemental Digital Content is available in the text. Precis: This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose of 3.5 µg/kg was more efficacious and obviated the need for repeated general anesthesia. Purpose: This study was carried out to determine the safety and effective dose of IND as a procedural sedative for postoperative follow-up examinations after glaucoma surgery in children in place of repeated examination under anesthesia. Materials and Methods: In this prospective randomized double-blinded interventional study, consecutive children aged 6 months to 6 years were randomized to receive 3.0 and 3.5 µg/kg IND using a mucosal atomizer device in the preoperative area of the operating room, under continuous monitoring of vital signs. Intranasal midazolam 0.25 mg/kg was used as a rescue agent in case of inadequate sedation, and general anesthesia was administered in case of persistent failure. All infants underwent a complete anterior and posterior segment evaluation including intraocular pressure and corneal diameter measurements. Results: A total of 30 and 31 children aged 23.9±15.0 and 19.2±10.1 months, respectively, received 3.0 and 3.5 µg/kg IND. Adequate sedation was possible in 18 of 30 (60%) children receiving 3.0 µg/kg and 24 of 31 (77.4%) receiving 3.5 µg/kg IND alone (P=0.17). In combination with midazolam, successful sedations were 86.6% versus 100%, respectively (P=0.052). One patient in the 3.5 µg/kg group had ventricular arrhythmia, reversed with dextrose-saline infusion and injection glycopyrrolate. Conclusions: IND appears to be a safe and effective procedural sedative for postoperative follow-up examinations of pediatric glaucoma patients at doses of 3 and 3.5 µg/kg. The dose of 3.5 µg/kg was successful in more children.

Ophthalmology Glaucoma, 2018

Journal of Ayurveda and Integrative Medicine, 2020

Background: Repeated failure to rescue the damaged retinal ganglion cells (RGCs) by various drugs... more Background: Repeated failure to rescue the damaged retinal ganglion cells (RGCs) by various drugs has warranted the need to screen common herbal compounds available in the form of various eye formulations for their efficacy. Objective: We aimed to investigate the neuroprotective effect of pretreatment with aqueous extract of A. cepa in Ischemia/Reperfusion (I/R) induced retinal injury. Methods: Ischemia was induced for 2 h by pterygopalatine artery (PPA) ligation in C57BL/6J mice, followed by reperfusion. The neuroprotective role of oral pretreatment with aqueous extract of A. cepa (300 mg/kg) was analyzed with respect to control and injury only group at 7, 14, and 28 day after the surgery for expression of different genes in the retina by Real-Time PCR. Results: Molecular analysis at different time points showed increased expression of BCl-2, GDNF, GFAP, and Brn3b in the retina at 14 and 28 day after A. cepa treatment in comparison to the injury alone group. However, at shorter time point (7th day), the expression of these genes was pronounced in the injury only group in comparison to the injury and pretreated group. Conclusion: Pretreatment with aqueous extract of A. cepa may protect from the neuronal damage in I/Rinduced retinal injury in mice by altering the expression of neurotrophic factor.

Clinical and Experimental Vision and Eye Research, 2019

Presentation of bilateral simultaneous angle closure in a patient must alert one to look beyond t... more Presentation of bilateral simultaneous angle closure in a patient must alert one to look beyond the common "knee-jerk" diagnosis of acute primary angle closure (APAC). We describe a case with bilateral simultaneous acute angle closure with signs of anterior chamber inflammation with intraocular pressure of 60 mmHg. Based on the clinical details and ultrasonic findings of peripapillary choroidal thickening and supraciliary fluid, a diagnosis of Vogt-Koyanagi-Harada (VKH) disease was made. Our case highlights that every angle closure is not a primary angle closure requiring laser peripheral iridotomy. Detailed clinical examination with appropriate investigations could prevent misdiagnosis of APAC in VKH.

Clinical and Experimental Vision and Eye Research, 2018

Aim: This study aims to study the effectiveness of laser peripheral iridotomy and other treatment... more Aim: This study aims to study the effectiveness of laser peripheral iridotomy and other treatment modalities in reducing intraocular pressure (IOP) in patients of pigment dispersion syndrome (PDS), pigmentary ocular hypertension (POH), and pigmentary glaucoma (PG). Materials and Methods: Retrospective analysis of the records of patients diagnosed with PDS, POH, and PG was done in glaucoma clinic of tertiary eye care center. Patients of PG who underwent laser iridotomy (LI) were separately analyzed. Minimum follow-