Browsing by Author "Bibhuti Prassan Sinha"

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A Systematic Review and Meta-Analysis on the Efficacy and Safety of Topical Pilocarpine 1.25% in Presbyopia Treatment
(Wolters Kluwer Medknow Publications, 2024) Mamta Singh; Bibhuti Prassan Sinha; Siddhartha Dutta; Kunal Khanderao Deokar; Deepak Mishra; Khyati Goswami
Purpose: To do a qualitative and quantitative assessment of the existing literature on the effectiveness and safety of pilocarpine 1.25% eye drops in presbyopia management. Methods: Relevant articles were extracted from the online database using keywords - 'pilocarpine and presbyopia', 'AGN-190584 and presbyopia', and 'Vuity and presbyopia'. The primary outcome measure considered was an improvement in distance-corrected near visual acuity (DCNVA) and secondary outcome measures were improvement in distance-corrected intermediate visual acuity (DCIVA) and adverse events (AEs). Risk of bias (ROB) assessment was done using the ROB2 tool and R software was used for quantitative analysis. Results: The 3 included randomized control trials (RCTs) had a total of 980 participants between 40-55 years of age. They were randomized into 2 groups - 489 in the pilocarpine group and 491 in the vehicle group. In the pilocarpine group, 1.25% of pilocarpine was used either once (in the Gemini 1 and 2 trials) or twice daily (Virgo trial). A significantly higher proportion of patients reported improvement of DCIVA and gain of ≥ 3 lines in binocular DCNVA in the pilocarpine group than the vehicle group (P < 0.01). Headache was the most commonly reported AE (13.49% of participants). Three case reports published on pilocarpine use for presbyopia management have reported vitreomacular traction in 1 and retinal detachment in 5 eyes. Conclusions: The available evidence documents significant improvement in near and intermediate vision in presbyopia participants with pilocarpine 1.25% drop. However, more RCTs, involving a wider age group, larger refractive error, longer follow-up, and clinical testing in a real-world scenario are required to conclusively prove its role in presbyopia management. © 2025 Journal of Current Ophthalmology | Published by Wolters Kluwer - Medknow
Role of corneal collagen cross-linking in bullous keratopathy: A systematic review
(Wolters Kluwer Medknow Publications, 2023) Mamta Singh; Bibhuti Prassan Sinha; Deepak Mishra; Kunal Deokar; Gayatri Bhatia; Garima Upreti
Corneal cross-linking (CXL), a corneal strengthening procedure, is known to alter anterior stroma swelling behavior and is one of the treatment modalities of bullous keratopathy (BK). There are multiple studies published on the role of CXL in the treatment of BK. These articles had heterogeneous study population, different protocols used, and variable conclusions. This systematic review aimed to determine the role of CXL in the treatment of BK. The primary outcomes considered were changes in central corneal thickness (CCT) after 1, 3, and 6 months of CXL. The secondary outcome measures were changes in visual acuity, corneal clarity, subjective symptoms, and complications after CXL. We included randomized control trials (RCTs), observational and interventional studies, and case series with reports of more than 10 cases in this review. In RCTs, the mean pre-CXL CCT (794.0 ± 178.5 μm) in the intervention group (n = 37), decreased at 1 month (750.9 ± 154.3 μm) followed by a subsequent increase, but this difference was not significant during the 6-month follow-up (P- value 0.28, 0.82, and 0.82 at 1, 3, and 6 months, respectively). In noncomparative clinical studies (n = 188), the mean pre-CXL CCT (794.0 ± 178.5 μm) decreased at 1 month (710.9 ± 127.2 μm, P < 0.0001). Seven of the 11 articles included in the review reported no significant improvement in vision with CXL. The initial improvement in corneal clarity and clinical symptoms was not sustained. Current evidence suggests that CXL has short-term efficacy in the treatment of BK. More RCTs with high-quality evidence are needed. © 2023 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow.