Browsing by Author "Kumawat, Devesh"

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    Asymmetric Presentation of Retinopathy of Prematurity
    (Indian Academy of Pediatrics, 2018-06) Kumawat, Devesh; Chandra, Parijat; Tewari, Ruchir
    Retinopathy of prematurity (ROP) usually has symmetricpresentation and progression between fellow eyes. In thisretrospective review of records, asymmetric presentation wasnoted in 16 (3.9%) out of 410 babies over a period of one year.Management and final outcome differed in 10 and 11 infantsrespectively. ROP need not always be symmetric and may requirevariable management.
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    Automated and ImageJ thresholding algorithm-based analysis of macular vessel density in diabetic patients
    (All India Ophthalmological Society, 2022-06) Kumawat, Devesh; Chawla, Rohan; Shah, Pooja; Sharma, Anu; Sachan, Anusha; Pandey, Veena
    Purpose: To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT?A) using proprietary software (automated) and image processing software (manual) in diabetic patients. Methods: In a retrospective study, OCT?A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP?VD, automated and manual), deep capillary plexus VD (DCP?VD, manual), and correlation between automated and manual SCP?VD. Results: OCT?A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP?VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP?VD (Huang and Otsu methods) did not differ between the groups. Manual DCP?VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP?VD correlated moderately with manual SCP?VD using Huang method (r = 0.51, P < 0.001) with a mean difference of ?0.01% (agreement limits from ?6.60% to +6.57%). Conclusion: DCP?VD differs consistently between NoDR and NPDR with image processing, while SCP?VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm
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    Exploring the use of millipore filters to prevent post-injection endophthalmitis: A proof-of-concept in-vitro study
    (Wolters Kluwer – Medknow, 2025-06) Kumawat, Devesh; Ahmed, Nishat H; Venkatesh, Pradeep
    Purpose: Millipore filters are routinely used in vitreous surgeries for loading intraocular gas. This study purports to establish feasibility of in?line Millipore filter as a filtration barrier and rationalize their use during intravitreal antivascular endothelial growth factor (antiVEGF) injection to reduce the risk of endophthalmitis. Design: Proof?of?concept in?vitro study. Methods: At the Ocular Microbiology section of a tertiary care eye center in North India, bacterial broths of various microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Corynebacterium species, Streptococcus species, and a mixture of Staphylococcus aureus and Pseudomonas aeruginosa) of different concentrations (McFarland 0.5 and McFarland 1) were inoculated onto blood, chocolate, and/or MacConkey agar with (Group 1) or without (Group 2) in?line sterile Millipore filter of 0.22?micron pore size (Set GS Mini filter, ARCEOLE, France). The filter was attached to a one?ml syringe with bacterial broth solution at one end and a 30?gauge needle at the other. Culture plates were incubated and observed daily for colony formation with photographic documentation for up to 5days. Results: Bacterial broths could be injected across the filter with little resistance. None of the culture media showed growth when filters were used, compared with growth in all culture plates when inoculation of broth was done without the filter. The fluid loss in the filter (dead space volume) ranged from 0.12 to 0.17ml. Conclusions: Millipore filter act as an effective filtration barrier and could enhance the safety of intravitreal antiVEGF injection by reducing the risk of endophthalmitis. Further microbiological and toxicology studies are essential before their integration into clinical practice.
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    Intraoperative aberrometry-assisted refractive optimization of SFIOL
    (Wolters Kluwer – Medknow, 2025-01) Verma, Saurabh; Venkatesh, Pradeep; Azad, Shorya Vardhan; Kumawat, Devesh; Khokhar, Sudarshan
    Scleral?fixated intraocular lens (SFIOL) is a widely used technique for IOL implantation in patients where capsular support is insufficient. Most surgeons have shifted away from sutured to sutureless SFIOL techniques where haptics of a multifocal IOL are inserted in scleral tunnels/flaps. Large?scale publications have shown wide variation in the refractive status of eyes post?SFIOL even in the best of the hands. This is because even slight variations in the site of scleral flap/tunnel formation and tension on haptics due to the variable length of haptics placed in scleral flaps/tunnels can alter the effective lens position and induce significant residual refractive error, especially cylindrical astigmatism due to IOL tilt. Our technique aims to reduce residual refractive error after SFIOL implantation. This is achieved by using intraoperative aberrometry and adjusting haptics accordingly to achieve minimal refractive error intraoperatively.
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    Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India
    (All India Ophthalmological Society, 2022-05) Pandurangan, Sneha; Samanta, Ramanuj; Kumawat, Devesh; Sood, Gitanjli; Devi, Thounaojam S; Agrawal, Ajai
    Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.
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    Reducing Preoperative Waiting-time in a Pediatric Eye Operation Theater by Optimizing Process Flow: A Pilot Quality Improvement Project
    (Indian Academy of Pediatrics, 2018-09) Chandra, Parijat; Tewari, Ruchir; Dolma, Yangchen; Das, Deepsekhar; Kumawat, Devesh
    Objective: To decrease the preoperative area waiting-time forchildren posted for eye surgery.Methods: A pilot quality improvement project was conducted in asingle paediatric eye operation theatre in our tertiary-carehospital. Operation theatre process flow was analyzed, baselinedata was collected, and two Plan-Do-Study-Act cycles wereperformed on consecutive days. Average and maximal waiting-time were recorded across six operation theatre days.Results: The average and maximal waiting time at baseline were221 and 390 minutes, respectively. After two rapid Plan-Do-Study-Act cycles, these were reduced to 29 (87% reduction) and 52minutes (87% reduction) from baseline, respectively, and couldsubsequently be sustained.Conclusion: Preoperative waiting time in ophthalmic operationtheatre was significantly reduced by simple process flowoptimization, thereby improving quality of care.
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    Reducing Waiting-time of Preterm Babies at a Retinopathy of Prematurity Clinic: A Quality Improvement Project
    (Indian Academy of Pediatrics, 2018-09) Chandra, Parijat; Kumawat, Devesh; Tewari, Ruchir; Panyala, Rakesh Reddy; Sreeshankar, SS
    Objective: To decrease the waiting time for preterm babiesvisiting the Retinopathy of prematurity clinic in a tertiary eyehospital.Design: Interventional study.Setting: Tertiary eye care hospital.Patients: All preterm babies reporting for screening and follow upat Retinopathy of prematurity clinic.Intervention/Procedure: A quality improvement teamcomprising of a faculty (team leader), two senior residents, twojunior residents, one nursing officer, and a registration staff wasconstituted.Fish bone analysis was done to understand variousreasons for the high waiting time for preterm babies. Baseline datawas collected followed by multiple Plan-Do-Study- Act (PDSA)cycles.Main outcome measures: Average waiting-time, maximumwaiting-time, and last baby entry-time were measured.Results: The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min(90 to 118 min), respectively. At the end of 3rd PDSA cycle, thesereduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110to 135 min), and 60 min (range 45 to 80 min), respectively andwere sustained; the decrease from baseline being 14.3%, 31.2%,and 46%, respectively.Conclusion: The time spent in the waiting area at theRetinopathy of Prematurity clinic was significantly reduced bysimple changes in the process flow.
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    Surgeon’s perceptions and preferences in the management of idiopathic macular hole
    (Wolters Kluwer – Medknow, 2025-01) Kumawat, Devesh; Dave, Vivek Pravin; Venkatesh, Pradeep; Shanmugam, Mahesh P; Nagpal, Manish; Gupta, Vishali; Bhende, Pramod S; Babu, Naresh; Narayanan, Raja; Shroff, Daraius
    Purpose: The management of idiopathic macular holes (iMH) has evolved over time with various modifications in surgical approach. The study aimed to survey the surgeons’ preferences in the management of iMH in current times. Design: Cross?sectional descriptive survey. Methods: A 12?item questionnaire addressing the key aspects of iMH management was sent, between October 2022 to November 2022, by personal correspondence to 104 vitreoretinal specialists, actively practicing and performing iMH surgeries at various institutes in India. The responses were gathered till January 2023 and analyzed as per appropriate statistical methods. Results: Ninety?one retina specialists responded to the survey (response rate of 87.5%) with a median annual surgical load of 30 cases (range: 5–150). Most respondents had similar views on patient selection, combined phaco?vitrectomy, internal limiting membrane (ILM) staining, ILM peel initiation and propagation, tamponade, postoperative positioning, and prognostic factors. The preferred approach for peel initiation was “pinch and peel,” but “scrape and peel” was equally recommended for beginners. Most respondents considered iMH >600 microns in size as large and used additional surgical maneuvers for large and failed cases such as ILM flap, large flap, macular detachment, platelet?rich plasma application, and amniotic membrane graft. The three most important visual prognostic factors were duration, preoperative vision, and MH size. Conclusions: The practice of surveyed surgeons performing iMH surgery was uniform in several aspects. There is a need to create consensus on the preferred ILM peel technique among trainee surgeons, revisit the iMH size classification, and standardize the surgical approach as per hole size and characteristics.