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Rengaraj Venkatesh

Bio: Rengaraj Venkatesh is an academic researcher from Aravind Eye Hospital. The author has contributed to research in topics: Medicine & Cataract surgery. The author has an hindex of 19, co-authored 101 publications receiving 1445 citations. Previous affiliations of Rengaraj Venkatesh include Johns Hopkins University School of Medicine & Johns Hopkins University.


Papers
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Journal ArticleDOI
TL;DR: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes, and Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon.
Abstract: Aim: To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. Methods: In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. Results: Best corrected visual acuity of ⩾6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16–18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon. Conclusion: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.

144 citations

Journal ArticleDOI
Chiea Chuen Khor1, Chiea Chuen Khor2, Tan Do, Hongyan Jia3  +248 moreInstitutions (70)
TL;DR: It is confirmed that significant association at three previously described loci (P < 5 × 10−8 for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1–ST18), providing new insights into the biology of PACG, is confirmed.
Abstract: Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG.

135 citations

Journal ArticleDOI
TL;DR: Results show that ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.
Abstract: Purpose To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting. Setting Two tertiary care centers of the Aravind Eye Care System in southern India. Design Observational case series. Methods Manual waste audits, purchasing data, and interviews with Aravind staff were used in a hybrid environmental lifecycle assessment framework to quantify the environmental emissions associated with cataract surgery. Kilograms of solid waste generated and midpoint emissions in a variety of impact categories (eg, kilograms of carbon dioxide equivalents). Results Aravind generates 250 grams of waste per phacoemulsification and nearly 6 kilograms of carbon dioxide-equivalents in greenhouse gases. This is approximately 5% of the United Kingdom's phaco carbon footprint with comparable outcomes. A majority of Aravind's lifecycle environmental emissions occur in the sterilization process of reusable instruments because their surgical system uses largely reusable instruments and materials. Electricity use in the operating room and the Central Sterile Services Department (CSSD) accounts for 10% to 25% of most environmental emissions. Conclusions Surgical systems in most developed countries and, in particular their use of materials, are unsustainable. Results show that ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.

129 citations

Journal ArticleDOI
TL;DR: The modified sterilization and asepsis protocol adopted to facilitate high‐volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis.
Abstract: Purpose To report the incidence of postoperative endophthalmitis at a high-volume eye hospital in southern India using a modified cost-effective sterilization protocol. Setting Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. Methods In this retrospective observational series at a single eye hospital, records of patients who had cataract surgery using a modified sterilization protocol from January 2007 through August 2008 and developed postoperative endophthalmitis within the first 3 postoperative months were drawn from a computerized database. The patient's socioeconomic status, the surgeon's experience, and the type of cataract procedure performed were analyzed as possible risk factors using the chi-square test/Fischer exact test. Results During the study period, 42 426 cataract surgeries were performed. From these, 38 cases of presumed postoperative endophthalmitis were identified (incidence 0.09%). Thirty-five of the 38 cases were in the manual large- and small-incision extracapsular cataract extraction (ECCE) group, which had a statistically higher rate than the phacoemulsification group (P = .016). There was no statistical difference in the endophthalmitis rates between private patients and charity patients for either surgical method (manual ECCE or phacoemulsification). Conclusions The modified sterilization and asepsis protocol adopted to facilitate high-volume cataract surgery in a clinical setting appeared to be safe and effective in preventing postsurgical endophthalmitis. Despite a 3:1 ratio of manual ECCE to phacoemulsification and the elimination of certain traditional sterilization practices, the rate of endophthalmitis in this generally underserved patient population with multiple risk factors for infection was comparable to that reported in other modern settings.

115 citations

Journal ArticleDOI
TL;DR: The results suggest that MSICS may have a lower societal cost than other options and government and NGO hospitals providing cataract surgeries should invest in regular cost analyses, reviews of the literature on effectiveness, and formal cost-effectiveness analyses in order to plan economically efficient interventions.
Abstract: purpose To estimate the direct and indirect costs of three cataract surgery procedures: extracapsular cataract extraction with intra-ocular lens implantation (ECCE-IOL), phacoemulsification (PHACO)...

112 citations


Cited by
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Journal ArticleDOI
Matthew J. Burton1, Matthew J. Burton2, Jacqueline Ramke2, Jacqueline Ramke3, Ana Patrícia Marques2, Rupert R A Bourne4, Rupert R A Bourne5, Nathan Congdon6, Nathan Congdon7, Iain Jones, Brandon A M Ah Tong8, Simon Arunga2, Simon Arunga9, Damodar Bachani10, Covadonga Bascaran2, Andrew Bastawrous2, Karl Blanchet11, Tasanee Braithwaite12, Tasanee Braithwaite2, John Buchan13, John Buchan2, John Cairns2, Anasaini Cama14, Margarida Chagunda, Chimgee Chuluunkhuu15, Andrew Cooper, Jessica Crofts-Lawrence16, William H. Dean2, William H. Dean17, Alastair K Denniston1, Alastair K Denniston18, Joshua R. Ehrlich19, Paul M. Emerson20, Jennifer R Evans2, Kevin D. Frick21, David S. Friedman22, João M. Furtado23, Gichangi M, Stephen Gichuhi24, Suzanne Gilbert25, Reeta Gurung26, Esmael Habtamu2, Peter Holland16, Jost B. Jonas27, Pearse A. Keane1, Lisa Keay28, Lisa Keay29, Rohit C Khanna28, Rohit C Khanna30, Peng T. Khaw1, Hannah Kuper2, Fatima Kyari31, Fatima Kyari2, Van C. Lansingh, Islay Mactaggart2, Milka Madaha Mafwiri32, Wanjiku Mathenge33, Ian McCormick2, Priya Morjaria2, L Mowatt34, Debbie Muirhead35, Debbie Muirhead8, Gudlavalleti V S Murthy2, Nyawira Mwangi2, Nyawira Mwangi36, Daksha B Patel2, Tunde Peto6, Babar Qureshi, Solange Rios Salomão37, Virginia Sarah8, Bernadetha R Shilio, Anthony W. Solomon, Bonnielin K. Swenor21, Hugh R. Taylor35, Ningli Wang38, Aubrey Webson, Sheila K. West21, Tien Yin Wong39, Tien Yin Wong40, Richard Wormald1, Richard Wormald2, Sumrana Yasmin, Mayinuer Yusufu38, Juan Carlos Silva41, Serge Resnikoff28, Serge Resnikoff42, Thulasiraj Ravilla, Clare Gilbert2, Allen Foster2, Hannah Faal43 
TL;DR: In this paper, the authors defined eye health as maximised vision, ocular health, and functional ability, thereby contributing to overall health and wellbeing, social inclusion, and quality of life.

435 citations

01 Jan 2011
TL;DR: This independent study is designed to provide primary care practitioners with an introduction to the pathologies that lead to sight loss, their functional implications, appropriate method of referrals, training programs, and special considerations for interactions with visually impaired individuals.
Abstract: Acting Under Secretary of Health requested that a working group be established to develop the Veterans Health Initiative (VHI). He envisioned this as a comprehensive program to recognize the connection between certain health effects and military service, to allow military history to be better documented, to prepare health care providers to better serve their veteran patients, and to establish a data base for further study. This was first discussed by the Acting Under Secretary in relation to the health of former prisoners of war. Development was really begun by the former Chief Academic Affairs Officer, Dr. David Stevens, with the Military Service History project. This involves a pocket card for medical residents detailing the important components of a military service history targeting the health risks associated with various periods of service and more generic issues of concern and a website containing references relevant to the issues. Educational modules in the Veterans Health Initiative VHA will assist health care providers in recognizing the connection between certain health effects and military service, prepare health care providers to better serve veteran patients, and will provide a data base for further study. This independent study is designed to provide primary care practitioners with an introduction to the pathologies that lead to sight loss, their functional implications, appropriate method of referrals, training programs, and special considerations for interactions with visually impaired individuals. After completing this independent study, participants would be able to: • Define legal blindness; • Describe the causes of sight loss; • Delineate the functional implications of vision loss • Delineate the psycho/social impact of vision loss on the veteran; • Outline the role of the Visual Impairment Services Team (VIST) in the treatment of legally blind veterans and the referral process; • Describe the special personal and environmental considerations needed for visually impaired patients; • Describe the special medical considerations needed for visually impaired patients; • Describe the primary care practitioner's role in assisting veterans in establishing well-grounded claims for disability related to the loss of vision; and • Describe compensation and pension benefits provided for veterans with eye disabilities. After completing this independent study, you should 1. be able to: state the definition of legal blindness; 2. be able to: associate eye diseases with their visual implications; 3. be able to: demonstrate insight into the functional and Psycho/Social implications of sight-loss; 4. know when referrals to VIST are indicated; 5. understand …

395 citations

28 Aug 2014
TL;DR: Loss-of-function mutations in humans provide strong evidence that SLC30A8 haploinsufficiency protects against type 2 diabetes, suggesting ZnT8 inhibition as a therapeutic strategy in T2D prevention.
Abstract: Loss-of-function mutations protective against human disease provide in vivo validation of therapeutic targets, but none have yet been described for type 2 diabetes (T2D). Through sequencing or genotyping of ∼150,000 individuals across 5 ancestry groups, we identified 12 rare protein-truncating variants in SLC30A8, which encodes an islet zinc transporter (ZnT8) and harbors a common variant (p.Trp325Arg) associated with T2D risk and glucose and proinsulin levels. Collectively, carriers of protein-truncating variants had 65% reduced T2D risk (P = 1.7 × 10−6), and non-diabetic Icelandic carriers of a frameshift variant (p.Lys34Serfs*50) demonstrated reduced glucose levels (−0.17 s.d., P = 4.6 × 10−4). The two most common protein-truncating variants (p.Arg138* and p.Lys34Serfs*50) individually associate with T2D protection and encode unstable ZnT8 proteins. Previous functional study of SLC30A8 suggested that reduced zinc transport increases T2D risk, and phenotypic heterogeneity was observed in mouse Slc30a8 knockouts. In contrast, loss-of-function mutations in humans provide strong evidence that SLC30A8 haploinsufficiency protects against T2D, suggesting ZnT8 inhibition as a therapeutic strategy in T2D prevention.

370 citations

01 Jan 2011
TL;DR: This paper reported a genome-wide association study for open-angle glaucoma (OAG) blindness using a discovery cohort of 590 individuals with severe visual field loss (cases) and 3,956 controls.
Abstract: We report a genome-wide association study for open-angle glaucoma (OAG) blindness using a discovery cohort of 590 individuals with severe visual field loss (cases) and 3,956 controls. We identified associated loci at TMCO1 (rs4656461[G] odds ratio (OR) = 1.68, P = 6.1 × 10-10) and CDKN2B-AS1 (rs4977756[A] OR = 1.50, P = 4.7 × 10-9). We replicated these associations in an independent cohort of cases with advanced OAG (rs4656461 P = 0.010; rs4977756 P = 0.042) and two additional cohorts of less severe OAG (rs4656461 combined discovery and replication P = 6.00 × 10-14, OR = 1.51, 95% CI 1.35-1.68; rs4977756 combined P = 1.35 × 10-14, OR = 1.39, 95% CI 1.28-1.51). We show retinal expression of genes at both loci in human ocular tissues. We also show that CDKN2A and CDKN2B are upregulated in the retina of a rat model of glaucoma. © 2011 Nature America, Inc. All rights reserved.

347 citations

Journal ArticleDOI
TL;DR: SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification, and may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.

265 citations