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To analyse clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) ... more To analyse clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) after failed therapeutic keratoplasty (TPK). Retrospective consecutive, comparative, interventional case series METHODS: Setting: LV Prasad Eye Institute, Hyderabad, India STUDY POPULATION: Patients aged >18 years who underwent a repeat PK or EK following a failed TPK with a follow up of atleast one year were included. Patients with culture negative ulcers, viral aetiology, co existent ocular surface disease and multiple grafts were excluded from the study. PK or EK for failed TPK MAIN OUTCOME MEASURE: Corrected distance visual acuity at one year follow up. Secondary outcome measure: graft clarity. One-hundred twelve eyes (67-PK, 45-EK) were included in the study. The PK group had a significantly higher number of cases with high risk features prior to re-graft. Improvement in visual acuity in each of the types of grafts was statistically significant (p<0.01) but there was no differ...
Ophthalmic plastic and reconstructive surgery, Jan 8, 2015
The aim of this study is to report the histopathological, Immunohistochemical, and ultrastructura... more The aim of this study is to report the histopathological, Immunohistochemical, and ultrastructural features of a dacryocystorhinostomy ostium cicatrix. A prospective histopathological study was performed in a tertiary eye care setting. Scarred nasal mucosal tissues obtained during endoscopic revisions of 10 previously failed dacryocystorhinostomies secondary to complete cicatricial closure of the ostia were studied. The tissue specimens were analyzed using hematoxylin and eosin, periodic acid-Schiff staining. Special stains used include Masson's trichrome and Alizarin red. Immunohistochemistry was performed using vimentin, smooth muscle actin, CD3, CD5, and CD20. Specimens were processed for ultrastructural analysis as per standard protocols for transmission electron microscopy. The respiratory epithelial regeneration was noted to be complete. Irregular laying of deeply eosinophilic and hyalinized collagen with intervening fibroblasts was noted. Focal areas of new bone formation...
The British journal of ophthalmology, Jan 10, 2015
To determine the effect of mitomycin-C (MMC) on the contraction and migration of human nasal muco... more To determine the effect of mitomycin-C (MMC) on the contraction and migration of human nasal mucosal fibroblasts (HNMFs) in vitro in order to identify the least concentration of MMC required to prevent cicatrix development following dacryocystorhinostomy (DCR). Primary cultures of HNMFs were established from nasal mucosal tissues of patients undergoing DCR. Myofibroblast transformation of HNMFs was induced using transforming growth factor-β (TGF-β1) and confirmed by immunostaining for α-smooth muscle actin (α-SMA). Collagen gel contraction assay was employed to study contraction in the presence or absence of TGF-β1 (5 and 10 ng/mL) and MMC (0.2 and 0.4 mg/mL). Scratch wound assay was employed to determine the influence of MMC treatment on cell migration. Quantification of gel contraction and wound closure was done using Image J software. α-SMA expression increased with TGF-β1 treatment in a time- and dose-dependent manner indicating myofibroblast transformation of HNMFs. MMC inhibit...
Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previousl... more Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previously. This study aims to classify the DCR-related granulomas based on their ostial locations and to assess the outcomes of their management. A retrospective consecutive case series of 47 ostial granulomas evaluated over a period of 2 years were included in this study. All patients underwent detailed endoscopic examination to assess the granuloma locations and their response to initial topical steroids treatment. Persistent granulomas either underwent further management with excision or intralesional steroids based on their location. Patients were followed up for a minimum of 6 months. The primary outcome measure was resolution of granuloma. The mean age at presentation was 45 years with a female preponderance (68%). 70% (33/47) of granulomas were following external DCR and 30% (14/47) occurred in the setting of endonasal DCR. The most common location was an edge granuloma in 46.8% (22/47) f...
Ophthalmic plastic and reconstructive surgery, Jan 27, 2015
The aim of this study was to illustrate the usefulness of stereotactic or image-guided navigation... more The aim of this study was to illustrate the usefulness of stereotactic or image-guided navigation in the management of traumatic secondary acquired lacrimal drainage obstructions. Image-guided dacryolocalization was performed on 3 patients. All the patients were posttraumatic nasolacrimal duct obstruction as a consequence of gross naso--orbito-ethmoid fractures. All the procedures were performed through an endoscopic endonasal approach using the intraoperative electromagnetic image-guided Fusion ENT navigation system. Intraoperative anatomical guidance in localizing the lacrimal drainage system, usefulness at crucial phases of surgery, ease of surgery, and complications were noted. All patients underwent a powered endoscopic dacryocystorhinostomy using standard protocols but with an additional intraoperative navigation use at each of the major steps during the surgery. The dacryolocalization provided useful anatomical clues while operating in the vicinity of orbit and skull base. Th...
Ophthalmic plastic and reconstructive surgery, Jan 27, 2015
The aim of this study was to examine the ultrastructural features of the external and internal su... more The aim of this study was to examine the ultrastructural features of the external and internal surfaces of healthy lacrimal drainage systems. A prospective interventional study was performed on the healthy adult lacrimal drainage systems obtained from fresh exenterated specimens. Exenteration was performed for malignancies unrelated to lacrimal system where preoperative lacrimal evaluation was normal. A careful and thorough dissection was carried out to isolate the entire lacrimal drainage system from the punctum to the nasolacrimal duct. The analysis was performed using the standard protocols of scanning electron microscopy. Inner punctal surfaces showed a definite and slightly elevated junction between the luminal surfaces of punctum and beginning of the vertical canaliculus. Similar junction could be identified between the lacrimal sac and nasolacrimal duct. The valves of the canaliculi showed broad rugae-like mucosal surfaces, whereas the external surfaces of the canaliculi demo...
Endoscopic dacryocystorhinostomy (DCR) is rapidly gaining recognition as a primary modality of ma... more Endoscopic dacryocystorhinostomy (DCR) is rapidly gaining recognition as a primary modality of management in acute dacryocystitis and lacrimal abscess. The purpose of the present study is to report long-term outcomes of powered endoscopic DCR in cases of acute dacryocystitis. Prospective interventional case series. Twenty-one powered endoscopic DCRs were performed in 21 patients presenting with acute dacryocystitis. All cases were operated by a single surgeon (m.j.a.) using earlier published techniques. All lacrimal systems were intubated for 6 weeks. A minimum follow-up of 1 year after stent removal was considered for final analysis. Main outcome measures were the anatomical and functional success of the surgical procedure. The mean age of patients at presentation was 31.8 years. A total of 14.3% (3/21) were pediatric patients with known history of persistent congenital nasolacrimal duct obstruction (CNLDO), and 9.5% (2/21) had a history of external DCR in the past. All patients received postoperative antibiotics. Additional procedures included distal canalicular trephination, septoplasty, and middle turbinoplasty in one patient each. All cases showed resolution of pain and swelling at 1 week follow-up. At the mean follow-up of 15.4 months, anatomical success was achieved in 85.7% of the patients (18/21), and functional success was achieved in 80.9% (17/21). Powered endoscopic DCR is a useful modality in the management acute dacryocystitis, with good outcomes that are maintained over a long duration of time. 4. Laryngoscope, 2015.
Ophthalmic plastic and reconstructive surgery, Jan 22, 2015
The aim of this study was to examine the presence of biofilms and physical deposits within the lu... more The aim of this study was to examine the presence of biofilms and physical deposits within the lumen of silastic nasolacrimal duct stents inserted during dacryocystorhinostomy. A prospective interventional study was performed on consecutive patients undergoing endoscopic dacryocystorhinostomy with Crawford stent insertion. All the patient samples were retrieved 4 weeks after the surgery. None of the patients had any clinical evidence of postoperative infection. The intraluminal portions studied include the distal cut ends and the entire intraluminal surface. The analysis was performed using the standard protocols of scanning electron microscopy. The luminal surfaces were compared against sterile stents that acted as controls. A total of 7 stents were studied. Five were consecutive patient samples and 2 were sterile stents. The cut ends and intraluminal surfaces of all the patient stents demonstrated evidence of biofilm formation and physical deposits. The luminal cut ends demonstrat...
To assess the frequency of concomitant adjunctive nasal procedures performed in powered endoscopi... more To assess the frequency of concomitant adjunctive nasal procedures performed in powered endoscopic dacryocystorhinostomy (DCR). Retrospective review of 269 consecutive powered endoscopic DCR's performed in 202 patients over a period of 10 years from 2003 to 2013. Patient records were reviewed for demographic data, clinical profiles and surgical notes. Concomitant adjunctive procedures were studied with relation to number of patients, indications, types of procedures (septoplasty, middle turbinoplasty and functional endoscopic sinus surgery or FESS) and complications. 269 powered endoscopic DCR's were performed on 202 patients. The mean age at surgery was 58.4 years (range 20-91 years). Adjunctive nasal procedures were performed in 53.4% (108/202) of the patients. 47% (95/202) required a septoplasty. Among the 95 septoplasty patients, 85 required solo septoplasty and 10 had additional sinus procedure. Middle turbinoplasty was performed in 5.9% (12/202) and septal papilloma ex...
Ophthalmic plastic and reconstructive surgery, Jan 8, 2015
To review and summarize the symptomatology, microbiology, special clinical entities, management, ... more To review and summarize the symptomatology, microbiology, special clinical entities, management, complications, and outcomes of pediatric acute dacryocystitis. The author performed a PubMed search of all articles published in English on acute dacryocystitis. Pediatric subpopulations of these articles were reviewed along with the scant literature of direct references to neonatal and pediatric acute dacryocystitis. Data reviewed included demographics, presentations, microbiological work up, management, complications, and outcomes. Acute dacryocystitis is not very common in the pediatric age groups and occurs mostly as a complication of congenital nasolacrimal duct obstruction. The age of onset is usually in the neonatal period with a female preponderance. The clinical spectrum ranges from classic pediatric acute dacryocystitis to meningitis. Staphylococcus aureus is the commonest isolate. Occasionally acquired etiologies and rare organisms like Pantoea sp., Epstein-Barr Virus, and Spo...
World journal of gastroenterology : WJG, Jan 28, 2007
To study the loss of heterozygosity (LOH) at 8p21-23 locus in diffuse gastric cancer. To evaluate... more To study the loss of heterozygosity (LOH) at 8p21-23 locus in diffuse gastric cancer. To evaluate the involvement of this region in gastric cancer, we used eight microsatellite markers covering two Mb of mentioned region, to perform a high-resolution analysis of allele loss in 42 cases of late diffuse gastric adenocarcinoma. Six of these STS makers: D8S1149, D8S1645, D8S1643, D8S1508, D8S1591, and D8S1145 showed 36%, 28%, 37%, 41%, 44% and 53% LOH, respectively. A critical region of loss, close to the NAT2 locus and relatively far from FEZ1 gene currently postulated as tumor suppressor gene in this region.
International forum of allergy & rhinology, Jan 24, 2015
The purpose of this study is to report the time taken for superior osteotomy and complications du... more The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr. This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, soft tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests. A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanic...
To analyse clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) ... more To analyse clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) after failed therapeutic keratoplasty (TPK). Retrospective consecutive, comparative, interventional case series METHODS: Setting: LV Prasad Eye Institute, Hyderabad, India STUDY POPULATION: Patients aged >18 years who underwent a repeat PK or EK following a failed TPK with a follow up of atleast one year were included. Patients with culture negative ulcers, viral aetiology, co existent ocular surface disease and multiple grafts were excluded from the study. PK or EK for failed TPK MAIN OUTCOME MEASURE: Corrected distance visual acuity at one year follow up. Secondary outcome measure: graft clarity. One-hundred twelve eyes (67-PK, 45-EK) were included in the study. The PK group had a significantly higher number of cases with high risk features prior to re-graft. Improvement in visual acuity in each of the types of grafts was statistically significant (p<0.01) but there was no differ...
Ophthalmic plastic and reconstructive surgery, Jan 8, 2015
The aim of this study is to report the histopathological, Immunohistochemical, and ultrastructura... more The aim of this study is to report the histopathological, Immunohistochemical, and ultrastructural features of a dacryocystorhinostomy ostium cicatrix. A prospective histopathological study was performed in a tertiary eye care setting. Scarred nasal mucosal tissues obtained during endoscopic revisions of 10 previously failed dacryocystorhinostomies secondary to complete cicatricial closure of the ostia were studied. The tissue specimens were analyzed using hematoxylin and eosin, periodic acid-Schiff staining. Special stains used include Masson's trichrome and Alizarin red. Immunohistochemistry was performed using vimentin, smooth muscle actin, CD3, CD5, and CD20. Specimens were processed for ultrastructural analysis as per standard protocols for transmission electron microscopy. The respiratory epithelial regeneration was noted to be complete. Irregular laying of deeply eosinophilic and hyalinized collagen with intervening fibroblasts was noted. Focal areas of new bone formation...
The British journal of ophthalmology, Jan 10, 2015
To determine the effect of mitomycin-C (MMC) on the contraction and migration of human nasal muco... more To determine the effect of mitomycin-C (MMC) on the contraction and migration of human nasal mucosal fibroblasts (HNMFs) in vitro in order to identify the least concentration of MMC required to prevent cicatrix development following dacryocystorhinostomy (DCR). Primary cultures of HNMFs were established from nasal mucosal tissues of patients undergoing DCR. Myofibroblast transformation of HNMFs was induced using transforming growth factor-β (TGF-β1) and confirmed by immunostaining for α-smooth muscle actin (α-SMA). Collagen gel contraction assay was employed to study contraction in the presence or absence of TGF-β1 (5 and 10 ng/mL) and MMC (0.2 and 0.4 mg/mL). Scratch wound assay was employed to determine the influence of MMC treatment on cell migration. Quantification of gel contraction and wound closure was done using Image J software. α-SMA expression increased with TGF-β1 treatment in a time- and dose-dependent manner indicating myofibroblast transformation of HNMFs. MMC inhibit...
Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previousl... more Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previously. This study aims to classify the DCR-related granulomas based on their ostial locations and to assess the outcomes of their management. A retrospective consecutive case series of 47 ostial granulomas evaluated over a period of 2 years were included in this study. All patients underwent detailed endoscopic examination to assess the granuloma locations and their response to initial topical steroids treatment. Persistent granulomas either underwent further management with excision or intralesional steroids based on their location. Patients were followed up for a minimum of 6 months. The primary outcome measure was resolution of granuloma. The mean age at presentation was 45 years with a female preponderance (68%). 70% (33/47) of granulomas were following external DCR and 30% (14/47) occurred in the setting of endonasal DCR. The most common location was an edge granuloma in 46.8% (22/47) f...
Ophthalmic plastic and reconstructive surgery, Jan 27, 2015
The aim of this study was to illustrate the usefulness of stereotactic or image-guided navigation... more The aim of this study was to illustrate the usefulness of stereotactic or image-guided navigation in the management of traumatic secondary acquired lacrimal drainage obstructions. Image-guided dacryolocalization was performed on 3 patients. All the patients were posttraumatic nasolacrimal duct obstruction as a consequence of gross naso--orbito-ethmoid fractures. All the procedures were performed through an endoscopic endonasal approach using the intraoperative electromagnetic image-guided Fusion ENT navigation system. Intraoperative anatomical guidance in localizing the lacrimal drainage system, usefulness at crucial phases of surgery, ease of surgery, and complications were noted. All patients underwent a powered endoscopic dacryocystorhinostomy using standard protocols but with an additional intraoperative navigation use at each of the major steps during the surgery. The dacryolocalization provided useful anatomical clues while operating in the vicinity of orbit and skull base. Th...
Ophthalmic plastic and reconstructive surgery, Jan 27, 2015
The aim of this study was to examine the ultrastructural features of the external and internal su... more The aim of this study was to examine the ultrastructural features of the external and internal surfaces of healthy lacrimal drainage systems. A prospective interventional study was performed on the healthy adult lacrimal drainage systems obtained from fresh exenterated specimens. Exenteration was performed for malignancies unrelated to lacrimal system where preoperative lacrimal evaluation was normal. A careful and thorough dissection was carried out to isolate the entire lacrimal drainage system from the punctum to the nasolacrimal duct. The analysis was performed using the standard protocols of scanning electron microscopy. Inner punctal surfaces showed a definite and slightly elevated junction between the luminal surfaces of punctum and beginning of the vertical canaliculus. Similar junction could be identified between the lacrimal sac and nasolacrimal duct. The valves of the canaliculi showed broad rugae-like mucosal surfaces, whereas the external surfaces of the canaliculi demo...
Endoscopic dacryocystorhinostomy (DCR) is rapidly gaining recognition as a primary modality of ma... more Endoscopic dacryocystorhinostomy (DCR) is rapidly gaining recognition as a primary modality of management in acute dacryocystitis and lacrimal abscess. The purpose of the present study is to report long-term outcomes of powered endoscopic DCR in cases of acute dacryocystitis. Prospective interventional case series. Twenty-one powered endoscopic DCRs were performed in 21 patients presenting with acute dacryocystitis. All cases were operated by a single surgeon (m.j.a.) using earlier published techniques. All lacrimal systems were intubated for 6 weeks. A minimum follow-up of 1 year after stent removal was considered for final analysis. Main outcome measures were the anatomical and functional success of the surgical procedure. The mean age of patients at presentation was 31.8 years. A total of 14.3% (3/21) were pediatric patients with known history of persistent congenital nasolacrimal duct obstruction (CNLDO), and 9.5% (2/21) had a history of external DCR in the past. All patients received postoperative antibiotics. Additional procedures included distal canalicular trephination, septoplasty, and middle turbinoplasty in one patient each. All cases showed resolution of pain and swelling at 1 week follow-up. At the mean follow-up of 15.4 months, anatomical success was achieved in 85.7% of the patients (18/21), and functional success was achieved in 80.9% (17/21). Powered endoscopic DCR is a useful modality in the management acute dacryocystitis, with good outcomes that are maintained over a long duration of time. 4. Laryngoscope, 2015.
Ophthalmic plastic and reconstructive surgery, Jan 22, 2015
The aim of this study was to examine the presence of biofilms and physical deposits within the lu... more The aim of this study was to examine the presence of biofilms and physical deposits within the lumen of silastic nasolacrimal duct stents inserted during dacryocystorhinostomy. A prospective interventional study was performed on consecutive patients undergoing endoscopic dacryocystorhinostomy with Crawford stent insertion. All the patient samples were retrieved 4 weeks after the surgery. None of the patients had any clinical evidence of postoperative infection. The intraluminal portions studied include the distal cut ends and the entire intraluminal surface. The analysis was performed using the standard protocols of scanning electron microscopy. The luminal surfaces were compared against sterile stents that acted as controls. A total of 7 stents were studied. Five were consecutive patient samples and 2 were sterile stents. The cut ends and intraluminal surfaces of all the patient stents demonstrated evidence of biofilm formation and physical deposits. The luminal cut ends demonstrat...
To assess the frequency of concomitant adjunctive nasal procedures performed in powered endoscopi... more To assess the frequency of concomitant adjunctive nasal procedures performed in powered endoscopic dacryocystorhinostomy (DCR). Retrospective review of 269 consecutive powered endoscopic DCR's performed in 202 patients over a period of 10 years from 2003 to 2013. Patient records were reviewed for demographic data, clinical profiles and surgical notes. Concomitant adjunctive procedures were studied with relation to number of patients, indications, types of procedures (septoplasty, middle turbinoplasty and functional endoscopic sinus surgery or FESS) and complications. 269 powered endoscopic DCR's were performed on 202 patients. The mean age at surgery was 58.4 years (range 20-91 years). Adjunctive nasal procedures were performed in 53.4% (108/202) of the patients. 47% (95/202) required a septoplasty. Among the 95 septoplasty patients, 85 required solo septoplasty and 10 had additional sinus procedure. Middle turbinoplasty was performed in 5.9% (12/202) and septal papilloma ex...
Ophthalmic plastic and reconstructive surgery, Jan 8, 2015
To review and summarize the symptomatology, microbiology, special clinical entities, management, ... more To review and summarize the symptomatology, microbiology, special clinical entities, management, complications, and outcomes of pediatric acute dacryocystitis. The author performed a PubMed search of all articles published in English on acute dacryocystitis. Pediatric subpopulations of these articles were reviewed along with the scant literature of direct references to neonatal and pediatric acute dacryocystitis. Data reviewed included demographics, presentations, microbiological work up, management, complications, and outcomes. Acute dacryocystitis is not very common in the pediatric age groups and occurs mostly as a complication of congenital nasolacrimal duct obstruction. The age of onset is usually in the neonatal period with a female preponderance. The clinical spectrum ranges from classic pediatric acute dacryocystitis to meningitis. Staphylococcus aureus is the commonest isolate. Occasionally acquired etiologies and rare organisms like Pantoea sp., Epstein-Barr Virus, and Spo...
World journal of gastroenterology : WJG, Jan 28, 2007
To study the loss of heterozygosity (LOH) at 8p21-23 locus in diffuse gastric cancer. To evaluate... more To study the loss of heterozygosity (LOH) at 8p21-23 locus in diffuse gastric cancer. To evaluate the involvement of this region in gastric cancer, we used eight microsatellite markers covering two Mb of mentioned region, to perform a high-resolution analysis of allele loss in 42 cases of late diffuse gastric adenocarcinoma. Six of these STS makers: D8S1149, D8S1645, D8S1643, D8S1508, D8S1591, and D8S1145 showed 36%, 28%, 37%, 41%, 44% and 53% LOH, respectively. A critical region of loss, close to the NAT2 locus and relatively far from FEZ1 gene currently postulated as tumor suppressor gene in this region.
International forum of allergy & rhinology, Jan 24, 2015
The purpose of this study is to report the time taken for superior osteotomy and complications du... more The purpose of this study is to report the time taken for superior osteotomy and complications during this step in primary powered endoscopic dacryocystorhinostomy (PEnDCR) using the piezoelectric system and mechanical burr. This prospective interventional comparative series was performed on all consecutive patients who underwent a primary PEnDCR over a 4-month period. The surgery was performed as per standard protocols and all patients were operated on by a single surgeon (M.J.A.). Parameters documented were demographic data, type of powered instrument used, time taken for superior osteotomy, exposure of the agger nasi, exposure of entire sac, and complications such as excess bleeding, soft tissue injury, or mucosal burns. Statistical analyses were performed using the linear mixed-effect model and 2-sample t tests. A total of 55 PEnDCRs were studied, 29 in the mechanical burr group and 26 in the piezoelectric or ultrasonic group. The mean time for superior osteotomy in the mechanic...
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Drafts by Mohammad Ali
Papers by Mohammad Ali