Sujata Subbiah

Joseph Eye Hospital

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Philip A. Thomas

Joseph Eye Hospital

CA Nelson Jesudasan

Joseph Eye Hospital

Susan J. Wilson

AstraZeneca (United States)

J L Best

Royal Victoria Hospital

S Sankarnarayanan

Topiwala National Medical College & BYL Nair Charitable Hospital

Christadoss Arul Nelson Jesudasan

Joseph Eye Hospital

Sophia Louis

Joseph Eye Hospital

C E McAvoy

Albert B. Chandler Hospital

R Best

University of Ulster

AntonyArokiadass Baskaran

Joseph Eye Hospital

Cooperative Institutions

Joseph Eye Hospital

Royal Victoria Hospital

University of Ulster

University College London

Institute of Ophthalmology

AstraZeneca (United States)

University of Southampton

University College Dublin

New Jersey Institute of Technology

Texas A&M University

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An unusual presentation of Terson's syndrome

Eye (2007)

Sujata Subbiah Susan J. Wilson R Best

Presentation (obstetrics)

10.1038/sj.eye.6702714

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Citations (4)

A case of spontaneously resolved primary congenital glaucoma

Indian Journal of Ophthalmology (2016)

Sujata Subbiah Sophia Louis AntonyArokiadass Baskaran Philip A. Thomas

Sir, We read with interest the article by Sanghi et al. "A case of spontaneously resolved primary congenital glaucoma" and congratulate them for presenting this rare case.[1] We feel the authors should provide additional details of clinical examination findings to support the diagnosis of regressed primary congenital glaucoma (PCG). The authors state that the corneal diameter was 13.5 mm in the right eye with Haab's striae in the nasal half, with normal posterior segment and gonioscopy findings, and a normal fundus examination. In infants and young children, elevated intraocular pressure (IOP) may cause enlargement of the globe (buphthalmos), limbal tissue (limbal ectasia with the deep anterior chamber) and cornea, leading to circumferential, and horizontal ruptures of the Descemet's membrane (Haab's striae).[2] In PCG, enlargement is mainly at the corneoscleral junction. Single or multiple breaks in Descemet's membrane (Haab's striae) may result in irregular astigmatism.[3] The anterior segment photograph of the right eye reveals an enlarged cornea with Haab's striae but does not show limbal ectasia or a deep anterior chamber. The sclera also expands gradually when exposed to an elevated IOP, with increasing axial length and resultant myopia and astigmatism.[4] Enlargement of the globe with elevated IOP during the first 3 years of life creates a myopic shift and may lead to amblyopia and significant astigmatism.[5] Myopic astigmatism and anisometropia occur in children with PCG (the latter is almost always present in unilateral cases).[4] The patient, in this case, the study had simple hypermetropic astigmatism of +1.00 D only. The axial length of both eyes needs to be mentioned. Measurement of the axial length has been recommended by some investigators for routine use in diagnosis and follow-up of congenital glaucoma, contending that the axial length is a sensitive and reversible measure of the disease.[3] The disc photographs and corresponding optical coherence tomography–retinal nerve fiber layer (RNFL) scans shown in Fig. 6. Furthermore, do not show any significant thinning of the RNFL. The visual field of the right eye [Fig. 5] does not reveal any scotoma and appears to be normal. The authors state that gonioscopic examination revealed prominent iris processes in the right eye. There is no evidence to suggest any prior angle anomaly in the right eye. PCG patients have angle anomalies, that is, a more anterior iris insertion, with the altered translucency of the angle face rendering the ciliary body band, trabecular meshwork, and scleral spur indistinct.[5] Nagao et al., in their study reporting spontaneous resolution of PCG, stated that all the 14 eyes studied showed a deep anterior chamber, with a clear lens, but abnormal angles with a typical appearance of PCG.[1] In conclusion, we wish to differ with the diagnosis of unilateral spontaneously-regressed PCG in the patient reported by Sanghi et al. since the patient has no prior records or photographs providing evidence of PCG. Moreover, we are of the opinion that the reported observation by the patient of whitish discoloration of the right eye during childhood, which spontaneously cleared in due course of time, is not convincing enough to accept that this is a case of spontaneously-regressed PCG. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Primary (astronomy)

10.4103/0301-4738.179732

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Citations (1)

Scleral- fixated intraocular lens implantation in microspherophakia

Indian Journal of Ophthalmology (2014)

Sujata Subbiah Philip A. Thomas CA Nelson Jesudasan

Background: In microspherophakia, abnormal laxity of the lenticular zonules leads to development of a spherical lens and possible subluxation. We evaluated long-term results of lens removal with scleral-fixated intraocular lens (SFIOL) implantation in microspherophakia. Materials and Methods: Case series. SF IOLs were implanted in four consecutive patients with bilateral microspherophakia (eight eyes [three with pupillary block and secondary glaucoma who underwent immediate surgery and five with only subluxation who underwent elective surgery]). Post-operative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and lens position were evaluated periodically from day 1 to 18 months. Results: All patients were females (mean age 28 ± 7.03 years). In group 1 eyes (three eyes that presented with pupillary block), the mean BCVA improved from 0.008 decimals (preoperative) to 0.50 decimals (final post-operative visit); in group 2 eyes (the other five eyes), the mean BCVA improved from 0.12 ± 0.21 decimals to 0.73 ± 0.14 decimals. The preoperative mean IOP (54.53 ± 7.33 mmHg) in group 1 eyes was significantly (P = 0.03) higher than that (16 ± 4.30 mm Hg) in group 2 eyes. At final post-operative visit, the mean IOP (11.67 ± 2.88 mmHg) in group 1 eyes was not significantly different from that in group 2 eyes (13.0 ± 3.08 mmHg). All SFIOLs were well- centred at the final visit. None of the patients encountered any peroperative or postoperative complications. Conclusions: SFIOLs may be an option for surgical management of microspherophakia.

10.4103/0301-4738.129787

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Citations (16)

Comparison of ultrasound biomicroscopy and ultrasonographic parameters in eyes with phacomorphic glaucoma and eyes with mature cataract

International Ophthalmology (2016)

Sujata Subbiah Philip A. Thomas Christadoss Arul Nelson Jesudasan

Ultrasound biomicroscopy

Mean value

IRIS (biosensor)

10.1007/s10792-016-0343-z

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Citations (12)

Retinal vasculitis as an early sign of bacterial post-operative endophthalmitis

Eye (2010)

Sujata Subbiah C E McAvoy J L Best

Retinal vasculitis

10.1038/eye.2010.18

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Citations (21)

Comparative evaluation of optical coherence tomography in glaucomatous, ocular hypertensive and normal eyes

Indian Journal of Ophthalmology (2007)

Sujata Subbiah S Sankarnarayanan Philip A. Thomas CA Nelson Jesudasan

Background: To correlate the findings of optical coherence tomography (OCT) evaluation of retinal nerve fiber layer (RNFL) thickness with visual field changes in glaucomatous, ocular hypertensive and normal eyes. Materials and Methods: Thirty consecutive normal, 30 consecutive ocular hypertensive and 30 consecutive glaucomatous eyes underwent a complete ophthalmic examination, including applanation tonometry, disc evaluation, (30-2) Humphrey field analyzer white on white (W/W) perimetry and short- wavelength automated perimetry. Thickness of the RNFL around the optic disc was determined with 3.4 mm diameter-wide OCT scans. Average and segmental RNFL thickness values were compared among all groups. A correlation was sought between global indices of perimetry and RNFL thickness. Results: Of the 90 eyes enrolled (mean age of patients 52.32±10.11 years), the mean RNFL thickness was significantly less in ocular hypertensive (82.87±17.21 mm; P =0.008 and glaucomatous eyes (52.95±31.10 mm; P < 0.001), than in normals (94.26±12.36 mm). The RNFL was significantly thinner inferiorly in glaucomatous eyes (64.41±43.68 mm; P < 0.001) than in normals (120.15±14.32 mm) and ocular hypertensives (107.87±25.79 mm; P < 0.001). Ocular hypertensives had thinner RNFL in the nasal, inferior and temporal quadrants (P < 0.001) when compared to normals. Global indices in ocular hypertensives on SWAP showed Mean Deviation (MD) of 5.32±4.49, Pattern Standard Deviation (PSD) 3.83±1.59 and Corrected Pattern Standard Deviation (CPSD) 2.84±1.85. The RNFL thickness could not be significantly correlated with global indices of visual fields in ocular hypertensives. Conclusion: Optical coherence tomography is capable of detecting changes at the level of RNFL in ocular hypertensive eyes with normal appearance of discs and W/W perimetry fields.

Absolute deviation

Optic disc

10.4103/0301-4738.33041

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Citations (27)

Comment on: Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract

Indian Journal of Ophthalmology (2017)

Sujata Subbiah Philip A. Thomas

Sir, We congratulate Mathur and Pai for their interesting article entitled, "Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract,"[1] in which they noted significantly higher mean serum sodium levels in individuals above 50 years of age with cataract than in age-matched individuals without cataract; however, mean serum potassium levels were not significantly different. The authors concluded that a high level of serum sodium contributes to cataract formation and that diets with high sodium content could be a risk factor for senile cataract formation.[1] We wish to offer a few comments: The mean serum values of sodium and potassium in the cases (cataractous eyes) versus controls (noncataractous eyes) are given without standard deviations (SDs)/standard errors of the mean (SEM); the means in the two groups are stated to be within the normal range, and "P values" are given to validate the findings. The SD/SEM values should have been provided to allow readers to independently perform relevant statistical tests and draw their own conclusions Although the authors state that nonparametric tests – Kruskal–Wallis/Mann–Whitney U-test – were performed for statistical analysis, details are not discussed The authors also state that "alteration in cation concentration of aqueous humor, which is attributed to alterations in serum cation concentration, can be known as a risk factor for cataract formation;" however, this sequence of events has not been proven to occur in the article cited by the authors (Clayton et al. 1980). Moreover, Mathur and Pai made no attempt to document aqueous humor levels of sodium and potassium The authors conclude (both in the abstract and text) that "diets with high sodium contents are a risk factor for senile cataract formation and dietary modifications can possibly reduce the rate of progression; a high level of serum sodium in turn contributes to cataract formation." The first conclusion is highly speculative and unsubstantiated since they presumably did not compare the sodium content of diets consumed by their cases (patients with cataract) versus diets of their controls (individuals without cataract). The statement "a high level of serum sodium in turn contributes to cataract formation" contradicts their own findings "the means in the two groups (cataract cases vs. controls) were within the normal range" (emphasis ours). The electrolyte composition of the lens resembles that of other human cells, with a high potassium and low sodium and chloride concentrations.[2] The aqueous bathing the lens closely reflects the ionic composition of the plasma, with high concentrations of sodium and chloride but low levels of potassium.[2] Potassium loss from the lens, which occurs during cataract formation, probably results from interruption of the ion pump within the cell membrane; potassium complexes thus break down and diffuse outward.[2] Interestingly, Consul et al. reported that although mean aqueous humor levels of sodium, potassium, and chloride were slightly lower in eyes with senile cataract than those in normal eyes, the differences were not statistically significant, leading them to suggest that this was "just another manifestation of senility."[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Senile cataract

10.4103/0301-4738.202863

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Citations (0)