Macular Degeneration: Singh R

Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. · Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. · Indian J Ophthalmol. · Pubmed #18417817 links to  free full text

Abstract: Diabetes mellitus is a major cause of avoidable blindness in both the developing and the developed countries. Significant technological advances have taken place to improve the diagnostic accuracy of diabetic retinopathy. In the last three decades, the treatment strategies have been revised to include, besides laser photocoagulation, early surgical interventions and pharmacotherapies.

Hirsch JD, Morello C, Singh R, Robbins SL. · Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla California 92093-0714, USA. · Surv Ophthalmol. · Pubmed #18029270 No free full text.

Abstract: There is increasing pressure for medical care reimbursement to be linked to outcomes. New medications approved for glaucoma, age-related macular degeneration (AMD), and dry eye disease may offer improved outcomes, but they have higher acquisition costs. This article reviews published pharmacoeconomic studies assessing the incremental change in outcomes achieved vs. the increased medication costs incurred. The different types of pharmacoeconomic evaluations are described. Identified pharmacoeconimic evaluations range from simple cost-consequence statements to more complex cost-utility analyses conducted across many healthcare systems. Notably missing in all analyses are the effects of improved treatment on patient productivity. Although the diversity and small number of studies limit conclusions, there is some evidence that the newer glaucoma medications, as a group, produce economic offsets such as reduced glaucoma surgeries and fewer physician visits. Photodynamic therapy for AMD may be cost-effective when used early in patients with better visual acuity allowing cost-offsets over longer periods of time to be considered. The single pharmacoeconomic analysis of topical cyclosporine for dry eye disease was only hypothesis-generating. Comprehensive studies that investigate clinical, economic, and humanistic outcomes for the patient and society are needed to adequately assess the comparative value of current and future ophthalmic medications.

Singh R, Kaiser PK. · Cole Eye Institute - Retina Service, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. · Int Ophthalmol Clin. · Pubmed #17237674 No free full text.

This publication has no abstract.

Sachdev N, Gupta V, Abhiramamurthy V, Singh R, Gupta A. · Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. · Eye. · Pubmed #17417620 No free full text.

Abstract: AIM: To correlate the microaneurysmal closure rate measured on fundus fluorescein angiography (FFA) with reduction in macular thickness observed on optical coherence tomography (OCT) following laser photocoagulation of diabetic macular edema. MATERIALS AND METHODS: A prospective observational case series. Fifty patients (50 eyes) of type II diabetes mellitus with clinically significant macular oedema (CSME) underwent focal/grid laser photocoagulation. OCT and FFA were performed at baseline and at 2 and 12 weeks following laser photocoagulation to measure the change in macular thickness and the number of leaking microaneurysms respectively. Statistical analysis was performed using paired-ttest and Pearson's correlation test. RESULTS: A significant reduction in macular thickness was seen at both 2 (P=0.02) and 12 weeks (P<0.0001), most remarkably in the central 1 mm quadrant. However, microaneurysm closure was only 0.67% at 2 weeks, which increased to 89.6% by 12 weeks. The change in retinal thickness correlated significantly with the decrease in the number of leaking microaneurysms at 12 weeks (r=0.597, P<0.0001), but not at 2 weeks (r=-0.228, P=0.112). On OCT, the final reduction in retinal thickness achieved at 12 weeks from baseline correlated significantly with the initial decrease in retinal thickness at 2 weeks (r=0.66, P<0.0001). However, on FFA, the final closure rate of leaking microaneurysms at 12 weeks from baseline did not correlate with the initial closure rate at 2 weeks (r=-0.039, P=0.413). Conclusion: Following laser photocoagulation for CSME, an OCT at 2 weeks is more informative and better correlates with the final outcome than an FFA at 2 weeks.

Kaushik S, Gupta V, Gupta A, Dogra MR, Singh R. · Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. · Am J Ophthalmol. · Pubmed #15059722 No free full text.

Abstract: PURPOSE: To document secondary glaucoma observed after intravitreal injection of triamcinolone for cystoid macular edema in central retinal vein occlusion. DESIGN: An interventional case series. METHODS: Retrospective study. The setting was a tertiary care referral institute. Nine patients with central retinal vein occlusion and cystoid macular edema received 4.0 mg/0.1 ml of intravitreal triamcinolone acetate injected through the inferior pars plana under topical anesthesia. Baseline intraocular pressures were normal in all, and no patients had glaucoma. RESULTS: Seven of the nine patients had a post-injection rise in intraocular pressures, of which one had intractable secondary glaucoma requiring removal of the depot corticosteroid by pars plana vitrectomy combined with trabeculectomy. Two patients were controlled only by maximal medical therapy. CONCLUSIONS: The occurrence of intractable glaucoma after intravitreal triamcinolone in central retinal vein occlusion is a serious concern and warrants caution in the use of this modality for these patients.

Singh P, Singh R, Kishore KS, Vig VK, Singh R, Singh B. · Dr Sohan Singh Eye Hospital, Amritsar, India. · Indian J Ophthalmol. · Pubmed #10892486 links to  free full text

Abstract: Submacular haemorrhage is a major cause of sudden visual loss in age-related macular degeneration (AMD). If left untreated it often results in permanent central visual loss. We present our experience in the use of intravitreal tissue plasminogen activator (tPA) in a 65-year-old male with submacular haemorrhage.

Singh P, Singh R, Kishore KS, Vig VK, Singh R, Singh B. · Dr Sohan Singh Eye Hospital, Amritsar, India. · Indian J Ophthalmol. · Pubmed #10892486 links to  free full text

Abstract: Submacular haemorrhage is a major cause of sudden visual loss in age-related macular degeneration (AMD). If left untreated it often results in permanent central visual loss. We present our experience in the use of intravitreal tissue plasminogen activator (tPA) in a 65-year-old male with submacular haemorrhage.

Singh R, Gupta V, Gupta A, Sachdev N, Dogra MR, Bhansali A. · No affiliation provided · Diabetes Care. · Pubmed #17130221 links to  free full text

This publication has no abstract.

Singh R, Abhiramamurthy V, Gupta V, Gupta A, Bhansali A. · No affiliation provided · Diabetes Care. · Pubmed #16443911 links to  free full text

This publication has no abstract.