167 results on '"Tibrewal S"'
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2. Posterior dislocation of the Oxford knee meniscal bearing: a treatment option
- Author
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Tibrewal, S., Pandit, H., McLardy-Smith, P., Tibrewal, S. B., and Murray, D. W.
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- 2014
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- View/download PDF
3. Single-stage revision for the infected total knee replacement: RESULTS FROM A SINGLE CENTRE
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Tibrewal, S., Malagelada, F., Jeyaseelan, L., Posch, F., and Scott, G.
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- 2014
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4. The anatomy knowledge of surgical trainees: the trainerʼs view
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Tibrewal, S
- Published
- 2007
5. THE ANATOMY KNOWLEDGE OF SURGICAL TRAINEES: THE TRAINERʼS VIEW
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Tibrewal, S
- Published
- 2006
6. The image intensifier as an operating table: a dangerous practice
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TIBREWAL, S B
- Published
- 2000
7. 33BEST PRACTICE TARIFF FOR FRAGILITY HIP FRACTURES - A COMPLETED AUDIT CYCLE IN A DISTRICT GENERAL HOSPITAL
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Walters, S, primary, Cuthbert, R, additional, Karaj, J, additional, Zincraft, C, additional, Kalyaniwalla, T, additional, and Tibrewal, S, additional
- Published
- 2019
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8. Extra-Articular Synovial Chondromatosis of the Ankle
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Tibrewal, S. B. and Iossifidis, A.
- Published
- 1995
9. Best practice tariff for fragility hip fractures – A completed audit cycle in a district general hospital
- Author
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Walters, S., primary, Cuthbert, R., additional, Karaj, J., additional, Zincraft, C., additional, Kalyaniwalla, T., additional, and Tibrewal, S., additional
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- 2018
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10. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial
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O'Brien, J, Duncan, H, Kirsh, G, Allen, V, King, P, Hargraves, R, Mendes, L, Perera, T, Catto, P, Schofield, S, Ploschke, H, Hefner, T, Churchland, M, Woolnough, S, Wuttke, R, Manning, M, Jeffries, T, Hensley, L, Bath, P, Bainbridge, D, Guinane, F, McMahon, L, Zavattaro, D, Wilson, D, Blake, K, Morton, J, Sharman, D, Locke, R, Ghabrial, J, McNeil, S, Rehfisch, P, van der Merwe, S, Einoder, B, Douglas, D, Ashwell, J, Morrissey, A, Brown, A, Simm, R, Fisch, G, Crawford, W, Everding, T, Tanham, D, Hooper, J, Aldana, C, Goldwasser, M, Mibus, M, Rowden, N, Mills, J, Johnson, P, Stilwell, J, Williams, R, Stevenson, T, Zwar, J, Bauze, R, Nyunt, B, Russell, R, Day, G, Cameron, M, Clements, P, Beck, T, Ellis, A, Phipps, S, Quaill, W, Skirving, A, McGuiness, M, Gray, P, Rankin, J, Wood, D, Senior, J, Courtenay, B, Green, M, Harris, I, Rush, J, Kilgour, M, Davies, J, Newcombe, J, Lewis, C, Leitl, S, Chilcott, R, Pianta, R, Aguila, A, Hawe, C, Nade, S, Smith, M, Robertson, P, Rothwell, A, May, S, Williams, S, Shamy, S, Martin, G, Steele, V, Jeffery, K, Kelman, I, McKillan, J, Dayaram, P, Culling, J, Lawson, D, Winfield, P, Kuzel, R, Milburn, C, Palmer, N, Pitts, A, Lamb, G, Prodan, L, Gray, H, Walker, K, Smith, K, Newton, C, Atkinson, D, Fail, B, Panting, A, Menzies, J, Watkiss, A, Outhred, J, Clay, D, Lander, R, Fou, R, Clarke, DS, Murrell, T, Rolleston, B, Keyworth, S, Medlicott, P, Woods, T, Dawe, C, Waldron, R, Taine, W, Le Roy, L, Smith, A, Cowley, G, Campbell, C, Maxwell, R, Elvy, M, Thurston, A, Newth, S, Cousins, L, Sanderson, M, MacMillan, C, Golele, R, Walters, J, Kruger, S, Ramsden, T, Joseph, H, Gantz, D, Steyn, S, Hadjichristofis, S, Nojoko, L, Snowdowne, R, Botha, M, Knebel, R, Sernbo, I, Ferris, B, Tello, E, Nevelos, A, Dunn, C, Warwick, D, Sudhakar, J, Tuite, JD, Francis, J, Wallace, ME, Jordan, A, Baird, P, Fowler, W, Ainscow, DAP, Harrison, A, Butler-Manuel, A, Broome, G, Swailes, P, Stahl, TJ, Randall, AM, Forester, AJ, Hucker, J, Redden, J, Logan, L, Howard, PW, Brownlee, D, Angus, P, Boyce, A, Porter, BB, Arbid, M, Youll, J, Ogden, AS, MacDowell, C, Beverly, M, Ramdeholl, P, Nelson, I, Howlett, I, Weeber, A, Peacock, A, Hubbard, MJS, Flanagan, M, Crawshaw, C, Kinninmonth, A, Campbell, T, Tibrewal, S, Lennox, CME, Clifford, I, Gillham, N, Hunt, M, Bulstrode, C, Handley, R, Iyer, V, Lawton, J, Robbins, J, Harper, WM, Davison, J, Hope, P, Smallbones, K, Jones, W, Ratnam, KR, Upton, J, Hirst, P, Knox, S, Sadique, T, Khan, M, Umar, M, Anderson, J, Frank, J, Briggs, P, Sanderson, P, McBride, D, Leese, K, Bayliss, NC, El-Deen, M, Banan, H, Parker, MJ, Minhas, H, Best, A, Blakeway, C, Salter, T, Foy, MA, Pollitt, A, Blayney, JDM, Davis, S, Parnell, E, Ko, C, Grover, ML, Howells, S, Williams, D, Saunders, C, Brenkel, I, Mani, G, Grizzle, M, Henderson, A, Board, T, Chadwick, CJ, Overton, M, Hodkinson, S, Macdonald, DA, Lewis, V, McDonald, RJM, Adamson, J, Bradley, J, Hodgson, E, Plewes, JL, Clarke, D, Hullin, M, Smith, J, Lemon, GJ, Greatrex, K, Miles, C, Bannister, G, Dare, J, Carden, DG, Aughton, J, Stirrat, A, Fishburn, J, Ebizie, AO, Mason, M, Irvine, G, Facey, T, Spratt, C, Kanagavel, N, Gerrard, T, Reissis, N, Tzanetos, P, Stefanotti, M, Greiss, M, Wright, V, Rahmaty, A, Archer, J, Bedford, A, Taylor, D, Griffith, M, Evans, J, Heron, K, Livingstone, B, O'Dwyer, K, Wheatley, D, Campbell, P, Dixon, P, McSweeney, L, Shanahan, MDG, Griffith, I, MacMahon, S, Rodgers, A, Collins, R, Prentice, C, Norton, R, Ockleford, P, Rutland, M, Dickinson, J, Gregg, P, Macdonald, D, Mollan, RAB, Douglas, J, Beaumont, D, Broad, J, Clark, T, Henderson, M, McCulloch, A, Neal, B, Prasad, R, Walker, N, Wood, M, Beighton, A, Bell, P, Farrell, B, Murch, K, Sharpe, N, Gordon, G, Doughty, R, Ratnasabapathy, Y, Danesh, J, Sleight, P, Peto, R, Simes, J, Keech, A, and Tri, PEP
- Subjects
medicine.medical_specialty ,Hip fracture ,Aspirin ,business.industry ,Deep vein ,medicine.medical_treatment ,Hazard ratio ,General Medicine ,Placebo ,medicine.disease ,Thrombosis ,Arthroplasty ,Surgery ,Pulmonary embolism ,medicine.anatomical_structure ,Anesthesia ,medicine ,business ,medicine.drug - Abstract
Summary Background Previous trials of antiplatelet therapy for the prevention of venous thromboembolism have individually been inconclusive, but a meta-analysis of their results indicated reductions in the risks of deep-vein thrombosis and of pulmonary embolism in various high-risk groups. The aim of this large randomised placebo-controlled trial was to confirm or refute these apparent benefits. Methods During 1992–1998, 148 hospitals in Australia, New Zealand, South Africa, Sweden and the UK randomised 13 356 patients undergoing surgery for hip fracture, and 22 hospitals in New Zealand randomised a further 4088 patients undergoing elective arthroplasty. Study treatment was 160 mg daily aspirin or placebo, started preoperatively and continued for 35 days. Patients received any other thromboprophylaxis thought necessary. Follow-up was of mortality and of in-hospital morbidity up to day 35. Findings Among the patients with hip fracture, allocation to aspirin produced proportional reductions in pulmonary embolism of 43% (95% CI 18–60; p=0·002) and in symptomatic deep-vein thrombosis of 29% (3–48; p=0·03). Pulmonary embolism or deep-vein thrombosis was confirmed in 105 (1·6%) of 6679 patients assigned aspirin compared with 165 (2·5%) of 6677 assigned placebo, which represents an absolute reduction of 9 (SE 2) per 1000 and a proportional reduction of 36% (19–50; p=0·0003). Similar proportional effects were seen in all major subgroups, including patients receiving subcutaneous heparin. Aspirin prevented 4 (1) fatal pulmonary emboli per 1000 patients (18 aspirin-group vs 43 placebo-group deaths), representing a proportional reduction of 58% (27–76; p=0·002), with no apparent effect on deaths from any other vascular cause (hazard ratio 1·04 [95% CI 0·86–1·26]) or non-vascular cause (1·01 [0·84–1·23]). Deaths due to bleeding were few (13 aspirin vs 15 placebo), but there was an excess of 6 (3) postoperative transfused bleeding episodes per 1000 patients assigned aspirin (p=0·04). Among electivearthroplasty patients, rates of venous thromboembolism were lower, but the proportional effects of aspirin were compatible with those among patients with hip fracture.
- Published
- 2000
11. Posterior intertransverse fusion assessed clinically and with biplanar radiography
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Suzuki, T., Pearcy, M. J., Tibrewal, S. B., Wilson, D., and Duthie, R. B.
- Published
- 1985
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12. Hyperosmolar Stress Induces Neutrophil Extracellular Trap Formation: Implications for Dry Eye Disease
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Tibrewal, S., primary, Ivanir, Y., additional, Sarkar, J., additional, Nayeb-Hashemi, N., additional, Bouchard, C. S., additional, Kim, E., additional, and Jain, S., additional
- Published
- 2014
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13. Posterior dislocation of the Oxford knee meniscal bearing: a treatment option
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Tibrewal, S., primary, Pandit, H., additional, McLardy-Smith, P., additional, Tibrewal, S. B., additional, and Murray, D. W., additional
- Published
- 2013
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14. Facet joint injection in lower back pain--is its continued use justified?
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Tibrewal, S., primary, Khan, O. H, additional, and Tibrewal, S. B, additional
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- 2007
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15. Management Outcome and the Role of Manipulation in Slipped Capital Femoral Epiphysis
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Al-Nammari, SS, primary, Tibrewal, S, additional, Britton, EM, additional, and Farrar, NG, additional
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- 2008
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16. A Case of Penile and Scrotal Strangulation by a Metal Ring
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Lim, Cs, primary, Tibrewal, S, additional, and Mok, Wlj, additional
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- 2008
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17. Squamous cell cancers contain a side population of stem-like cells that are made chemosensitive by ABC transporter blockade
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Loebinger, M R, primary, Giangreco, A, additional, Groot, K R, additional, Prichard, L, additional, Allen, K, additional, Simpson, C, additional, Bazley, L, additional, Navani, N, additional, Tibrewal, S, additional, Davies, D, additional, and Janes, S M, additional
- Published
- 2008
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18. Patello-femoral joint pain due to unusual location of localised pigmented villonodular synovitis—a case report
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Edwards, M.R, primary and Tibrewal, S, additional
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- 2004
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19. Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.
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Tibrewal S, Jayakumar P, Vaidya S, Ang SC, Tibrewal, Saket, Jayakumar, Prakash, Vaidya, Sujit, and Ang, Swee Chai
- Abstract
Purpose: The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings.Methods: A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management.Results: Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%).Conclusions: MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures. [ABSTRACT FROM AUTHOR]- Published
- 2012
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20. Septic Arthritis of the Hip Due to Bacteriodes-Melanogenicus
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Tibrewal, S B, primary and Kenwright, J, additional
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- 1990
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21. A prospective study of lumbar spinal movements before and after discectomy using biplanar radiography. Correlation of clinical and radiographic findings.
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Tibrewal, S B, Pearcy, M J, Portek, I, and Spivey, J
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- 1985
22. Axial Rotation and Lateral Bending in the Normal Lumbar Spine Measured by Three-Dimensional Radiography.
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Pearcy, M. J. and Tibrewal, S. B.
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- 1984
23. Treatment of giant cell tumour of the femoral head and neck.
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Tibrewal, S B
- Abstract
Giant cell tumours of the femoral head and neck treated at the Nuffield Orthopaedic Centre between 1970 and 1982 were reviewed to evaluate the effectiveness of primary treatment by curettage and bone grafting. All 4 cases recurred within two years, necessitating the likelihood of recurrence following curettage and bone grafting, particularly at this anatomical site, is stressed, and the possibility that hip replacement arthroplasty be considered the primary treatment of choice is discussed. [ABSTRACT FROM AUTHOR]
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- 1986
24. Bilateral Oxford Meniscal Knee arthroplasty.
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Sherman, K P, Goodfellow, J, Tibrewal, S, and O'Connor, J
- Abstract
Thirty-two patients who underwent bilateral bicompartmental Oxford Meniscal Knee arthroplasty have been followed up prospectively for a mean period of 51 months from the time of their first operation. Pain relief was obtained in all but one knee; walking ability was improved in more than two-thirds. Overall patient satisfaction with the results was good. Two knees failed. The results demonstrate that bilateral knee arthroplasty can be expected to give good functional results. [ABSTRACT FROM AUTHOR]
- Published
- 1985
25. Sclerosing mesenteritis presenting with small bowel obstruction and subsequent retroperitoneal fibrosis.
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Lim CS, Ranger GS, Tibrewal S, Jani B, Jeddy TA, and Lafferty K
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- 2006
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26. Lumbar intervertebral disc heights in normal subjects and patients with disc herniation.
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Tibrewal, S B and Pearcy, M J
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- 1985
27. Lumbar Intervertebral Disc and Ligament Deformations Measured In Vivo
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PEARCY, M. J., primary and TIBREWAL, S. B., additional
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- 1984
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28. Peroneal Nerve Palsy at the Level of the Lower Third of Leg
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Tibrewal, S B, primary and Goodfellow, J W, additional
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- 1984
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29. Challenges in management of congenital enophthalmos due to anomalous accessory orbital extraocular muscle bands.
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Goyal P, Tibrewal S, Lefebvre DR, Ganesh S, and Hunter DG
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- Humans, Male, Female, Ophthalmologic Surgical Procedures methods, Orbit abnormalities, Orbit diagnostic imaging, Orbit surgery, Imaging, Three-Dimensional, Infant, Oculomotor Muscles surgery, Oculomotor Muscles abnormalities, Oculomotor Muscles diagnostic imaging, Enophthalmos surgery, Enophthalmos etiology, Enophthalmos diagnosis, Magnetic Resonance Imaging
- Abstract
Introduction: Congenital enophthalmos is a rare condition characterized by posterior displacement of the globe, often associated with bony orbital anomalies or whole globe development defects. The purpose of this report is to present two unrelated cases of congenital enophthalmos secondary to anomalous accessory orbital bands and to describe characteristics of orbital imaging that differentiate this condition from the other causes., Methods: The case records of two patients who presented with congenital enophthalmos and were discovered to have anomalous accessory orbital extraocular muscle bands were reviewed. The clinical features, initial diagnosis, high resolution magnetic resonance imaging (MRI) findings, and surgical outcomes were noted. A 3-dimensional reconstruction model was used to understand the approach and surgical management in one of the cases., Results: Both patients presented with unilateral severe enophthalmos, globe retraction, and restricted ocular motility in all directions since birth. High-resolution MRI of the orbits revealed a short anomalous band, isointense to the muscle, arising from a rectus muscle belly and attaching to the posteroinferior part of the globe adjacent to the optic nerve. The caliber of the extraocular muscles and ocular motor nerves was normal. In one patient, surgery was not pursued due to the extreme posterior location of the band with proximity to the optic nerve. In the other patient, the deviation did not improve, despite successfully severing the accessory band, due to extensive scarring., Conclusion: Anomalous accessory orbital extraocular muscle bands are a rare and often overlooked cause of congenital enophthalmos when associated with limited ocular motility. Imaging the orbit can aid in diagnosis and help differentiate it from other causes. Safe surgical approaches to address the problem are limited, and available approaches may not be effective. These two cases highlight that the management of accessory extraocular muscle bands causing enophthalmos can be extremely challenging and difficult to improve even with intensive surgical intervention.
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- 2024
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30. Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia.
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Sharma P, Tibrewal S, Singh PK, and Ganesh S
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- Humans, Child, Preschool, Male, Female, Child, Retrospective Studies, Oculomotor Muscles physiopathology, Exercise Therapy methods, Treatment Outcome, Esotropia physiopathology, Esotropia therapy, Vision, Binocular physiology, Visual Acuity physiology
- Abstract
Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision., Methods: A retrospective review of patients aged 3-8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test., Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3-8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post-operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3-8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03-93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %). Near stereopsis improved to 200 s of arc or more in 60% of the patients. The mean esotropia reduced from 5.7 ± 4.0 PD for distance and 6.2 ± 4.66 PD for near to 2.7 ± 2.4 PD and 3.38 ± 4.7 PD respectively, at the last follow-up (p-value 0.004 and 0.006). Failure of therapy was noticed after six months of follow-up in the child with infantile esotropia., Conclusion: Anti-suppression exercises may be beneficial to improve binocular vision functions in children with small-angle esotropias of variable etiologies. Recurrence of suppression after cessation of therapy is possible, warranting regular follow up., Competing Interests: Declaration of Competing Interest None of the authors have any conflict of interest., (Copyright © 2023 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2024
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31. Persistent foetal vasculature masquerading as Peters anomaly.
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Franco E, Tibrewal S, and Nischal KK
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- 2024
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32. Accuracy of Intraocular lens power calculation in pediatric traumatic cataract.
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Goyal P, Tibrewal S, Ganesh S, Rath S, and Majumdar A
- Abstract
Purpose: To evaluate the prediction error (PE) in pediatric traumatic cataract surgery involving primary or secondary intraocular lens implantation (IOL) and the factors affecting it., Methods: Retrospective data of unilateral traumatic cataract eyes of children aged ≤16 years were collected between February 2019 and March 2022 at a tertiary eye care hospital. Absolute PE was calculated by deducting the target refraction from the observed refraction at 6 weeks postsurgery following suture removal. Simulated PE was calculated in eyes with corneal scar replacing the affected eye keratometry (K) with the K of the fellow eye and standard K (44D) and was then compared with absolute PE., Results: Fifty children with a mean age of 9.5 years (2-16 years) were included. Mean absolute PE was 1.63 ± 1.8D (0 to 9D). Absolute PE was not affected by the age at surgery, method of biometry, duration of injury, type of cataract surgery, position of IOL, and preoperative keratometry. The absolute PE was affected by axial length (AXL) being <1.5D in AXL of 22.73 ± 0.84 mm, <1.5-2D in AXL of 22.07 ± 0.61 mm, and >2D in AXL of 22.01 ± 0.74 mm (P = 0.039) in univariate analysis. In multivariate analysis, none of the factors affected the absolute PE. In 34 eyes with corneal scar, higher variability in PE was observed. The standard K resulted in greater simulated PE as compared to the affected eye average K in eyes with scar involving the visual axis., Conclusion: Absolute PE following pediatric traumatic cataract was studied. It was higher in shorter AXLs. In corneal scar involving the visual axis, using the fellow eye K yielded lesser simulated PE as compared to standard K., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)
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- 2024
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33. Low-dose atropine 0.01% for the treatment of childhood myopia: a pan-India multicentric retrospective study.
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Saxena R, Gupta V, Dhiman R, Joseph E, Agarkar S, Neena R, Magdalene D, Jethani J, Ganesh SC, Patil M, Gogri P, Gadaginamath S, Sen P, Sukhija J, Mishra D, Matalia JH, Sahu A, Kapoor S, Nishanth S, Chaurasia S, Pawar N, Deori N, Sivaraman V, Bordoloi A, Tibrewal S, Singh D, Prasad P, Phuljhele S, and Sharma N
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- Child, Humans, Retrospective Studies, Disease Progression, Ophthalmic Solutions therapeutic use, Refraction, Ocular, Mydriatics therapeutic use, Atropine therapeutic use, Myopia diagnosis, Myopia drug therapy
- Abstract
Objective: The objective of this study was to assess the efficacy of low-dose atropine 0.01% in controlling myopia progression among Indian children over a 2-year period., Methods: This retrospective study, conducted across 20 centres in India, monitored the progression of myopia over 2 years after initiating treatment with 0.01% atropine eye drops. This included children between 6 and 14 years with baseline myopia ranging from -0.5 D to -6 D, astigmatism≤-1.5 D, anisometropia ≤ -1 D and documented myopia progression of ≥0.5 D in the year prior to starting atropine. Subjects with any other ocular pathologies were excluded., Results: A total of 732 children were included in the data analysis. The mean age of the subjects was 9.3±2.7 years. The mean myopia progression at baseline (1 year before starting atropine) was -0.75±0.31 D. The rate of myopia progression was higher in younger subjects and those with higher baseline myopic error. After initiating atropine, myopia progression significantly decreased to -0.27±0.14 D at the end of the first year and -0.24±0.15 D at the end of the second year (p < 0.001). Younger children (p<0.001) and higher baseline myopia (p<0.001) was associated with greater myopia progression and poor treatment response (p<0.001 for both)., Conclusion: Low-dose atropine (0.01%) effectively reduces myopia progression over 2 years in Indian children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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34. Amblyopia treatment outcomes in patients with neurodevelopmental disorders.
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Nazir A, Rath S, Tibrewal S, and Ganesh S
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- Humans, Treatment Outcome, Visual Acuity, Amblyopia therapy, Neurodevelopmental Disorders therapy
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- 2024
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35. New horizons in aniridia management: Clinical insights and therapeutic advances.
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Gour A, Tibrewal S, Garg A, Vohra M, Ratna R, and Sangwan VS
- Abstract
Congenital aniridia is a rare genetic eye disorder characterized by the complete or partial absence of the iris from birth. Various theories and animal models have been proposed to understand and explain the pathogenesis of aniridia. In the majority of cases, aniridia is caused by a mutation in the PAX6 gene, which affects multiple structures within the eye. Treating these ocular complications is challenging and carries a high risk of side effects. However, emerging approaches for the treatment of aniridia-associated keratopathy, iris abnormalities, cataract abnormalities, and foveal hypoplasia show promise for improved outcomes. Genetic counseling plays a very important role to make informed choices. We also provide an overview of the newer diagnostic and therapeutic approaches such as next generation sequencing, gene therapy, in vivo silencing, and miRNA modulation., Competing Interests: The authors declare that there are no conflicts of interests of this paper, (Copyright: © 2023 Taiwan J Ophthalmol.)
- Published
- 2023
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36. Acquired comitant esotropias - comparison of surgical outcomes of accommodative vs non-accommodative types.
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Sharma R, Tibrewal S, Majumdar A, Rath S, and Ganesh S
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- Humans, Child, Preschool, Child, Adolescent, Treatment Outcome, Retrospective Studies, Oculomotor Muscles surgery, Accommodation, Ocular, Ophthalmologic Surgical Procedures, Vision, Binocular physiology, Follow-Up Studies, Esotropia surgery
- Abstract
Purpose : To compare the motor and sensory outcomes of strabismus surgery and the factors affecting surgical success in acquired acute non-accomodative esotropia (ANAET) and partially accommodative refractive esotropia (pARET). Methods : A retrospective chart review of patients with ANAET and pARET who underwent unilateral or bilateral horizontal rectus muscle surgery between January 2020 and December 2021 was conducted. Patients with postoperative follow-up of at least six weeks were included. Patients with pattern deviation, lateral incomitance, and near-distance disparity were excluded. Motor success was defined as a postoperative deviation within eight prism diopters of orthophoria. Sensory success was defined as presence of binocular single vision (BSV) for both distance and near (Worth four dot test). The effect of factors like age at onset, age at surgery, amblyopia before surgery, duration of squint before treatment, presence or absence and magnitude of vertical deviation, preoperative angle of deviation, and spherical equivalent on the motor and sensory success in each group were analyzed and compared. Results : 38 patients with ANAET and 33 patients with pARET were included. The mean age of onset of esotropia was 8.55 ± 4.65 years and 4.39 ± 2.27 years ( p < .001) and the mean age at surgery was 10.62 ± 4.99 years and 7.89 ± 2.84 years ( p = .006) in the ANAET and the pARET group respectively. The mean duration of the final follow-up was 38.51 weeks in the ANAET and 48.68 weeks in the pARET group ( p = .089). Patients were successfully aligned for both distance and near in 81.5% of patients in the ANAET and 78.9% of patients in the pARET group at the final follow-up (p. 0.775). A BSV for both distance and near at the final follow-up was seen in 81.2% vs 66.6% of patients in the ANAET and the pARET group respectively ( p = .25). A good near stereoacuity (<120 arcsecs) was seen in 60.6% and 41.9% of the ANAET and the pARET groups respectively ( p = .175). The percentage of patients in the ANAET group who had orthophoria, any esodeviation, and any exodeviation for distance at the final follow-up was 63.1%, 34.2% and, 2.6%. The percentage of patients in the pARET group in similar categories was 36.3%, 42.4% and, 21.2%. None of the demographic and preoperative factors were found to affect the surgical outcomes in the two groups. Conclusions : The motor and sensory outcomes were similar in the two groups. A higher proportion of ANAET patients remained orthophoric during the follow-up. The patients in the pARET group showed a tendency toward exodrift.
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- 2023
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37. Measures and variability with age of low contrast acuity and near stereoacuity in children.
- Author
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Baldev V, Tibrewal S, Ganesh S, Majumdar A, and Chandna A
- Subjects
- Male, Female, Child, Humans, Child, Preschool, Adolescent, Depth Perception, Visual Acuity, Physical Examination, Vision Tests, Vision, Binocular, Refractive Errors diagnosis
- Abstract
Clinical Relevance: Low contrast acuity (LCA) and near stereoacuity (NS) testing are integral to the comprehensive assessment of sensory visual function in children. However, routine ophthalmological evaluations seldom take these measures into consideration. Additionally, there is limited literature regarding the normative values of these parameters in children., Background: This study investigated LCA and NS measures and their variability in children with normal visual acuity. The aim was to provide a benchmark for distinguishing normal measures from abnormal ones., Methods: A prospective observational study was conducted in primary and secondary schools across North India. The participants numbered 240 children, aged between 3 and 15 years. They were split into 12 smaller groups of 20 participants in each age group. Only participants with normal monocular uncorrected visual acuity, no refractive error, normal birth history, and no systemic ailments, were recruited. All the participants underwent a complete ophthalmic examination and non-cycloplegic retinoscopy. LCA was measured, using the low contrast Lea number chart at three metres. NS was measured using the Randot® stereo test at 40 cm., Results: The percentages of males and females, were found to be 55%, and 45%, respectively (p = 0.093). The mean NS was found to be 38.7 ± 11.5 arcsecs in the 3-9-year age group, and 26.7 ± 5.6 arcsecs in the 9-15-year age group ( p -value <0.001). The mean NS showed an increasing trend up to 9 years of age. The mean LCA was 64.4 ± 20.1 in the age group of 3-8 years, and 76.38 ± 11.39 in the age group of 8-15 years ( p -value <0.001). Considerable variability was noted in the LCA in the younger age group ( p -value = 0.000)., Conclusions: LCA and NS mature gradually during childhood. LCA stabilises after the age of 8, while NS stabilises after the age of 9.
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- 2023
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38. Sutureless Cataract Surgery in the Pediatric Age Group: Is It Advisable?
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Tibrewal S, Sharma P, Rath S, and Ganesh S
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- Humans, Child, Postoperative Complications, Suture Techniques, Cataract Extraction, Cataract complications, Lens, Crystalline
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- 2023
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39. Evaluation of dry eyes in children with vernal kerato-conjunctivitis using clinical tests and ocular surface analysis.
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Gupta S, Rahman M, Tibrewal S, Gaur A, Ganesh S, and Sangwan VS
- Subjects
- Child, Humans, Fluorescein, Tears, Conjunctivitis, Allergic diagnosis, Dry Eye Syndromes diagnosis, Keratoconus
- Abstract
Purpose: To evaluate dry eyes in children with vernal kerato-conjunctivitis (VKC) and correlate it with symptoms, clinical findings, and ocular surface analysis (OSA) parameters., Methods: Children with clinically diagnosed VKC underwent complete ophthalmological examination, Schirmer's testing, modified ocular surface disease index (OSDI) scoring, Bonini grading, fluorescein tear-film break-up time (TBUT), VKC - Collaborative Longitudinal Evaluation of Keratoconus (CLEK) scoring, and OSA. Children with a TBUT of < 10 s were defined to have dry eyes. The above-mentioned parameters were compared between dry eye and non-dry eye VKC children., Results: The mean age of the 87 children included in the study was 9.1 ± 2.9 years. Dry eyes were seen in 60.9% [95% confidence interval (CI); 51% to 71%]. The mean TBUT was 13.4 ± 3.8 and 5.9 ± 1.9 s in non-dry and dry eye groups, respectively (P < 0.001). The mean value of Schirmer's test was 25.9 ± 9.8 and 20.8 ± 8.6 mm in the non-dry and dry eye groups, respectively (P = 0.01). The two groups did not differ in their OSDI scores, Bonini grading, and CLEK scores. The OSA parameter of non-invasive break-up time (NIBUT) was 8.3 ± 3.2 s in non-dry eye group and 6.4 ± 2.9 s in dry eye group, P = 0.008. The lower lid Meibomian gland (MG) loss was 7.4% in non-dry eye group and 12.2% in dry eye group, P = 0.028. Other OSA parameters did not differ significantly among the two groups., Conclusion: Dry eyes are seen in two-thirds of pediatric VKC. Evaluation of dry eyes should be incorporated in their clinical evaluation. Among OSA parameters, NIBUT and lower lid MG loss are associated with dry eyes in pediatric VKC patients., Competing Interests: None
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- 2023
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40. Molecular diagnosis of autosomal dominant congenital cataract in two families from North India reveals a novel and a known variant in GJA8 and GJA3 .
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Vanita V, Goyal S, Tibrewal S, and Ganesh S
- Abstract
Aims: The study aims to detect the underlying genetic defect in two autosomal dominant congenital cataract (ADCC) families., Methods: A detailed family history was collected, pedigrees were drawn, and slit-lamp examination and lens photography were performed. Mutation screening was carried out in the genes for crystallins and connexins by PCR and Sanger sequencing. Ethnically matched controls were tested for the identified variants. Different bioinformatics tools were used to assess the pathogenicity of the observed variants., Results: In an ADCC family with total cataract, a novel change (c.166A > G) (p.Thr56Ala) in GJA8 was identified. In another ADCC family with nuclear cataract, c.134G > C (p.Trp45Ser) in GJA3 has been detected. These variants co-segregated completely in patients in their respective families and were neither observed in unaffected family members nor in ethnically matched 100 controls, excluding them as polymorphisms., Conclusions: The present study identifies a novel variant c.166A > G (p.Thr56Ala) in GJA8 in an ADCC family having total cataract and a previously known mutation c.134G > C (p.Trp45Ser) in GJA3 in another ADCC family. Thr56 in GJA8 seems to be a mutation hotspot, as previously an ADCC Mauritanian family harbored a different substitution (p.Thr56Pro) at the same codon, although for a different phenotype (nuclear cataract). Similarly, Trp45 in GJA3 appears as a mutation hotspot, as p.Trp45Ser has previously been reported for nuclear cataract in a Chinese ADCC family. p.Thr56 (GJA8) and p.Trp45 (GJA3 ) are in the extracellular loop 1 (EL1) in their respective connexin proteins, which, along with EL2, are essential for gap junction formation, hemichannel docking, and regulating the voltage gating of the channels. Hence, residues in these regions seem crucial for maintaining eye lens transparency., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Vanita, Goyal, Tibrewal and Ganesh.)
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- 2022
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41. Correction of horizontal and torsional compensatory head posture in infantile nystagmus syndrome using horizontal rectus muscle recession and resection with vertical transposition.
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Baldev V, Tibrewal S, Rath S, and Ganesh S
- Abstract
Infantile nystagmus syndrome (INS) is often characterized by an identifiable null zone. When the null zone is not in the straight-ahead gaze, a compensatory head posture (CHP) is adopted by the patient to achieve best possible vision. Various surgical procedures have been recommended to correct a CHP which is clinically predominant in one dimension of yaw (lateral rotation), pitch (anterior or posterior flexion/extension) or roll (lateral flexion). However, the presence of a complex CHP which is clinically evident in more than one dimension, warrants either a combination of multiple techniques or a stepwise approach. We report the case of a 26-year-old male with INS with an eccentric null and a multi-dimensional complex CHP of 30º left face turn, 20º right head tilt and 10º chin depression. The patient was managed by all four horizontal rectus muscle recession and resection with full tendon vertical transposition to address the face turn and head tilt. He underwent lateral rectus muscle (LR) recession with upward transposition and medial rectus muscle (MR) resection with downward transposition in the right eye. MR recession with upward transposition and LR resection with downward transposition were performed in the left eye. Postoperatively. the head posture improved significantly for both distance and near viewing. The chin depression also reduced after the procedure. He developed transient diplopia due to a small vertical deviation after the surgery, which was managed by prisms and fusional exercises. Thus, horizontal rectus muscle recession and resection combined with vertical transposition may be helpful to simultaneously improve the head tilt associated with the face turn, obviating the need for vertical rectus muscle or oblique muscle surgery.
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- 2022
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42. A rare case of congenital aniridia with an unusual run-on mutation in PAX6 gene.
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Ratna R, Tibrewal S, Gour A, Gupta R, Mathur U, and Vanita V
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- Humans, Mutation, PAX6 Transcription Factor genetics, Aniridia diagnosis, Aniridia genetics
- Abstract
Competing Interests: None
- Published
- 2022
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43. Clinical and molecular aspects of congenital aniridia - A review of current concepts.
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Tibrewal S, Ratna R, Gour A, Agarkar S, Dubey S, Ganesh S, Kekunnaya R, Sangwan V, Liu Y, and Vanita V
- Subjects
- Humans, Intracellular Signaling Peptides and Proteins genetics, PAX6 Transcription Factor genetics, Phenotype, Tripartite Motif Proteins genetics, Aniridia diagnosis, Aniridia genetics, Eye Abnormalities, Glaucoma
- Abstract
Congenital aniridia is a pan ocular disorder characterized by partial or total loss of iris tissue as the defining feature. Classic aniridia, however, has a spectrum of ocular findings, including foveal hypoplasia, optic nerve hypoplasia, nystagmus, late-onset cataract, glaucoma, and keratopathy. The latter three are reasons for further visual compromise in such patients. This entity is often due to mutations in the PAX6 (Paired box protein Pax-6) gene. Recently, aniridia-like phenotypes have been reported due to non-PAX6 mutations as in PITX2, FOXC1, FOXD3, TRIM44, and CYP1B1 as well wherein there is an overlap of aniridia, such as iris defects with congenital glaucoma or anterior segment dysgenesis. In this review, we describe the various clinical features of classic aniridia, the comorbidities and their management, the mutation spectrum of the genes involved, genotype-phenotype correlation of PAX6 and non-PAX6 mutations, and the genetic testing plan. The various systemic associations and their implications in screening and genetic testing have been discussed. Finally, the future course of aniridia treatment in the form of drugs (such as ataluren) and targeted gene therapy has been discussed., Competing Interests: None
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- 2022
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44. Anomalous insertion of the superior oblique tendon onto the superior rectus muscle causing congenital superior oblique palsy.
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Tibrewal S, Rath S, and Ganesh S
- Subjects
- Child, Humans, Oculomotor Muscles abnormalities, Oculomotor Muscles surgery, Paralysis, Tendons surgery, Exotropia surgery, Strabismus etiology, Strabismus surgery, Trochlear Nerve Diseases surgery
- Abstract
Congenital superior oblique (SO) palsy is often associated with anomalies of its tendon, increased tendon laxity being the most common. Rarely, the tendon lies in an abnormal location nasal to the superior rectus (SR) muscle, either attaching to the sclera or to Tenon's capsule. We describe a case of a child who presented with abnormal head posture and exotropia. The orthoptic evaluation revealed a left hypertropia and V-pattern exotropia. The motility pattern and the Parks three-step test were suggestive of left-sided SO palsy. Intraoperatively, the left SO tendon was very lax and was absent from its usual insertion. Further exploration revealed it to be inserted entirely to the nasal border of the SR muscle, with no scleral attachment. This tendon was advanced to its normal attachment to the sclera, and 11 mm inferior oblique recession was also performed. Postoperative alignment was satisfactory., (Copyright © 2022 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)
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- 2022
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45. Extraocular Muscle Transplantation for Primary Treatment of Large-Angle Exotropia.
- Author
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Tibrewal S, Kapoor R, Rath SS, Sachdeva V, and Kekunnaya R
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Male, Oculomotor Muscles surgery, Ophthalmologic Surgical Procedures, Retrospective Studies, Treatment Outcome, Exotropia surgery
- Abstract
Aim: To report the feasibility and outcomes of muscle transplantation combined with a unilateral recession-resection procedure for primary large-angle [≥60 Prism Diopters (PD)] exotropia., Methods: We retrospectively reviewed medical records of patients from three tertiary eye-care institutes who underwent unilateral recess-resect with muscle transplantation for primary treatment of large angle exotropia between August 2017 and July 2020. Motor and restorative success were defined as alignment ≤10PD of orthotropia and ≤12PD of manifest deviation, respectively, at the final follow-up. Patients with at least 3 months of follow-up were included., Results: Ten patients; six males and four females (median age 26 years) met the study criteria. The median follow-up was 12.89 months. The median preoperative exotropia reduced from 65PD (60 to 90PD) to 10PD (0 to 25PD) at final follow-up ( p = .0019). The median correction obtained for the entire procedure (recession + resection + muscle transplantation) was 3.05 (1.8 to 4.3) PD/mm. Motor and restorative success was achieved in 60% and 70% of the patients, respectively. The median abduction limitation was -1 (0 to -1) at the final follow-up and there were no palpebral fissure changes beyond 6 weeks postoperatively., Conclusions: Unilateral muscle transplantation combined with the recession-resection procedure could be a useful alternative for the management of large-angle exotropia.
- Published
- 2021
46. Clinical spectrum of non-syndromic microphthalmos, anophthalmos and coloboma in the paediatric population: a multicentric study from North India.
- Author
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Tibrewal S, Subhedar K, Sen P, Mohan A, Singh S, Shah C, Nischal KK, and Ganesh S
- Subjects
- Adolescent, Anophthalmos diagnosis, Anophthalmos physiopathology, Blindness diagnosis, Blindness epidemiology, Blindness physiopathology, Cataract diagnosis, Cataract epidemiology, Cataract physiopathology, Child, Child, Preschool, Coloboma diagnosis, Coloboma physiopathology, Cross-Sectional Studies, Female, Humans, India epidemiology, Infant, Infant, Newborn, Male, Microphthalmos diagnosis, Microphthalmos physiopathology, Nystagmus, Pathologic diagnosis, Nystagmus, Pathologic epidemiology, Nystagmus, Pathologic physiopathology, Retinal Detachment diagnosis, Retinal Detachment epidemiology, Retinal Detachment physiopathology, Retrospective Studies, Strabismus diagnosis, Strabismus epidemiology, Strabismus physiopathology, Syndrome, Visual Acuity physiology, Anophthalmos epidemiology, Coloboma epidemiology, Cornea abnormalities, Microphthalmos epidemiology
- Abstract
Aims: To describe the clinical features, visual acuity and causes of ocular morbidity in children (0-18 years) with microphthalmos, anophthalmos, and coloboma (MAC) from North India., Methods: A retrospective study conducted between October 2017 and September 2018 in three tertiary eye institutes, part of the Bodhya Eye Consortium with consensus led common pro formas. Children with complete clinical data and without syndromic/systemic involvement were included. The clinical phenotype was divided into isolated ocular coloboma (CB), coloboma with microcornea (CBMC), colobomatous microphthalmos (CBMO), non-colobomatous microphthalmos (MO) and anophthalmos (AO)., Results: A total of 532 children with MAC were examined. Seventeen records were excluded due to incomplete data (0.2%). 515 children (845 eyes) were included: 54.4% males and 45.6% females. MAC was unilateral in 36% and bilateral in 64%. CB, CBMC, CBMO, MO and AO were seen in 26.4%, 31%, 22%, 8% and 12.5% of eyes, respectively. Nystagmus was found in 40%, strabismus in 23%, cataract in 18.7% and retinal detachment in 15%. Best-corrected visual acuity (BCVA) of <3/60 was seen in 62.4% eyes. Blindness (BCVA <3/60 in better eye) was seen in 42.8% of bilateral patients. Those with microcornea or microphthalmos with coloboma had worse BCVA (p<0.001). There were regional differences in the type of MAC phenotype presenting to the three institutes., Conclusion: The MAC group of disorders cause significant ocular morbidity. The presence of microcornea or microphthalmos with coloboma predicts worse BCVA. The variation of the MAC phenotype with the district of origin of the patient raises questions of aetiology and is subject to further studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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47. Good Long-term Motor and Sensory Outcomes of Infantile Esotropia: A Strabismus Surgeon's Goal.
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Goyal P, Tibrewal S, Rath S, and Ganesh S
- Subjects
- Goals, Humans, Infant, Oculomotor Muscles surgery, Esotropia surgery, Strabismus, Surgeons
- Published
- 2021
- Full Text
- View/download PDF
48. Horizontal rectus muscle transplantation for recurrent and residual strabismus.
- Author
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Kannam M, Sutraye J, Kapoor R, Tibrewal S, Kekunnaya R, and Sachdeva V
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Male, Oculomotor Muscles surgery, Ophthalmologic Surgical Procedures, Prospective Studies, Retrospective Studies, Treatment Outcome, Vision, Binocular, Young Adult, Esotropia surgery, Exotropia surgery, Strabismus surgery
- Abstract
Purpose : To report outcomes of muscle transplantation for recurrent/residual strabismus. Retrospective, multicentric, observational study. Methods : We retrospectively reviewed records of all patients operated at three institutes who underwent transplantation of the resected muscle for re-operations for residual/recurrent strabismus from January 1, 2018, to December 31, 2019. Data were collected regarding age, gender, visual acuity, type of strabismus, fixation preference, associated amblyopia, the surgical procedure performed, preoperative and postoperative primary position deviation, limitation of ductions, associated intra-operative and post-operative complications. Surgical success was defined as heterotropia less than or equal to 8 PD, and cosmetic success was defined as manifest deviation ≤12 PD (at 6 weeks follow up). Results : During this period, we identified records of seven patients (5 men: 2 women, median age: 24 years) who underwent muscle transplantation for residual/recurrent strabismus. Six patients underwent extraocular muscle surgery for residual/recurrent exotropia (XT) and one for residual esotropia (ET). In all the patients, median pre-operative primary position deviation reduced from 40 prism diopters (PD) (range: 30 to 55 PD) to 8 PD (range: 6 PD ET to 10 PD XT) at six-weeks follow-up. Four patients had residual exotropia (10-16PD), two had orthotropia and one patient had small-angle esotropia (6PD) at the last follow-up. Excluding two patients who underwent supramaximal re-recession of lateral rectus (≥11 mm from insertion) and re-resection of medial rectus, 3/5 (60%) patients achieved surgical success, and all (100%) achieved cosmetic success at six-weeks-follow-up. There was mild (up to -1) limitation of duction in all patients except one patient (-2 limitation of abduction) who underwent re-recession of lateral rectus to 11 mm from insertion along with medial rectus re-resection and muscle transplant procedure. No intra-operative or post-operative complications were encountered. No patient reported postoperative diplopia. Conclusions : This study describes the feasibility and successful use of muscle transplantation procedure to correct residual/recurrent strabismus, with or without re-recession, especially in patients planned for surgery in one eye. However, larger prospective studies with longer follow-ups will be needed to establish long-term outcomes and correction achieved from this procedure, and comparison with other approaches for reoperations.
- Published
- 2021
- Full Text
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49. Surgical Outcomes of Exotropic Duane Retraction Syndrome From a Tertiary Eye Care Center.
- Author
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Sheth J, Ezisi CN, Tibrewal S, Sachdeva V, and Kekunnaya R
- Subjects
- Adolescent, Adult, Child, Female, Humans, Male, Oculomotor Muscles surgery, Ophthalmologic Surgical Procedures, Retrospective Studies, Treatment Outcome, Young Adult, Duane Retraction Syndrome surgery
- Abstract
Purpose: To report surgical outcomes of patients with exotropic Duane retraction syndrome., Methods: A retrospective review of the medical records from patients with exotropic Duane retraction syndrome who underwent strabismus surgery and had at least 2 months of postoperative follow-up was conducted. Surgical success was defined as a postoperative horizontal deviation within 8 prism diopters (PD), abnormal head posture (AHP) less than 5 degrees, and a two-step decrease in overshoots., Results: Seventy-three patients with exotropic Duane retraction syndrome (38, 52% male, mean age 14 ± 7.9 years) met the study criteria. Unilateral type 3 Duane retraction syndrome was seen in 56 (77%) patients and type 1 in 14 (19%) patients. The mean follow-up period was 22 weeks (range: 8 to 209 weeks). Unilateral and bilateral lateral rectus recession were performed in 48 (65%) and 25 (34%) patients, respectively. In addition to recession, a lateral rectus Y-splitting was performed in 42 (56%) patients. Five patients underwent differential medial rectus and (larger) lateral rectus recession to alleviate severe globe retraction. The mean primary position reduced from 23 PD (CI: 19.6 to 26 PD) preoperatively to 9 PD (CI: 7.02 to 11.02 PD) postoperatively (P < .0001). Postoperatively 50% of patients were orthotropic in the primary position. Surgical success for primary position deviation, AHP, and overshoots were achieved in 74%, 81%, and 71% of patients, respectively., Conclusions: In the current study, type 3 Duane retraction syndrome was the most common subtype necessitating surgery for exotropic Duane retraction syndrome. Good surgical outcomes were obtained for various indications. Unilateral or bilateral lateral rectus recession was successful in improving motor alignment and AHP. The addition of lateral rectus Y-splitting corrected overshoots greater than grade 2 in most patients with exotropic Duane retraction syndrome. [J Pediatr Ophthalmol Strabismus. 2021;58(1):9-16.]., (Copyright 2021, SLACK Incorporated.)
- Published
- 2021
- Full Text
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50. Lateral Rectus Muscle Injury During Double-Headed Pterygium Surgery: A Rare Complication.
- Author
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Tibrewal S, Rath S, Ganesh S, and Sangwan VS
- Subjects
- Adult, Eye Injuries complications, Eye Injuries physiopathology, Humans, Male, Rare Diseases, Strabismus diagnosis, Strabismus physiopathology, Vision, Binocular, Eye Injuries diagnosis, Eye Movements physiology, Intraoperative Complications, Oculomotor Muscles injuries, Ophthalmologic Surgical Procedures adverse effects, Pterygium surgery, Strabismus etiology
- Abstract
A 43-year-old man developed double vision, esotropia, and abduction limitation after excision of a doubleheaded pterygium. Exploration during strabismus surgery 4 months later revealed a partially severed lateral rectus muscle and extensive conjunctival scarring. Direct injury to the lateral rectus muscle during pterygium surgery is extremely rare. Prevention and management strategies are discussed. [J Pediatr Ophthalmol Strabismus. 2020;57:e96-e99.]., (Copyright 2020, SLACK Incorporated.)
- Published
- 2020
- Full Text
- View/download PDF
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