ABSTRACT
Hands-on resident surgical training for various ocular procedures is essential to impart good surgical skills to the budding ophthalmologists. Here in this report, we demonstrate a simple and inexpensive technique of performing extraocular muscle surgery on goats' eye. These animal eyes possess soft tissue resemblance to that of human eyes to a greater extent in terms of scleral rigidity, muscle elasticity, its width, thickness, and its insertion onto the sclera. Therefore, rectus muscle recession, resection, and plication surgeries can be performed repeatedly to improve an individual's orientation and practical experience before performing the procedure on human eyes.
ABSTRACT
Purpose: To evaluate the clinical factors associated with repeat Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK. Methods: Retrospective observational study of cases with failed DSAEK admitted to our center for a repeat keratoplasty over 5 years (January 2013–Decemeber 2017) was undertaken. Demographic and perioperative details of all cases and type of repeat keratoplasty were recorded. Logistic regression analysis was performed to analyze the factors affecting the type of repeat keratoplasty. Results: total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% of cases. Significantly increased odds for requiring PKP were observed in association with stromal scarring [odds ratio (OR) = 2.9, P = 0.018)], trainee surgeons (OR = 4.05, P = 0.008), intraoperative complications (OR = 4.58, P = 0.003), scleral fixated intraocular lens or anterior chamber intraocular lens in situ (OR = 33.8, P < 0.001), secondary glaucoma (OR = 3.02, P = 0.015), peripheral anterior synechiae (OR = 8.6, P < 0.001), preoperative corneal thickness (OR = 1.01, P < 0001), time to primary surgery (OR = 1.03, P = 0.03), post-DSAEK host thickness (OR = 1.01, P < 0.001), and time interval from graft failure to regraft (OR = 1.18, P < 0.001). All eyes with congenital hereditary endothelial dystrophy, bee-sting-induced corneal decompensation, Axenfeld-Rieger syndrome, and multiple failed grafts underwent secondary PKP. All cases (nine eyes) that required surgical intervention for secondary glaucoma underwent secondary PKP (P < 0.001). Conclusion: Repeat DSAEK is feasible in up to two-third of cases of failed DSAEK. A PKP is required in one-third of cases, and various preoperative, intraoperative and postoperative factors are associated with unsuitability for repeat DSAEK.
ABSTRACT
Purpose: To review the nature of firecracker-related ocular injuries at a tertiary eye hospital in northern India following the firecracker ban and also to review the level of awareness among the victims. Methods: A cross-sectional observational study involving the patients presenting with firecracker-related ocular injuries from October 18 to 27, 2017 were assessed for demographic distribution, detailed ocular evaluation, and a questionnaire related to the awareness about the injuries. Results: A total of 68 patients were observed. Fifty patients (74.5%) were males. This year, a majority of patients were from outside Delhi. Uttar Pradesh constituted the most 38.23% of the patients followed by Haryana 30.88%, Delhi 23.5%, and Bihar 7.35%. Visual acuity varied from 6/6 to no perception of light. Open globe injury was observed in 56 patients (82.35%) who commonly had zone I injury. A significant number of patients (88.23%) were aware of firecracker-related injuries, and a large number of such injuries (58.8%) occurred in those who were not actively involved in the ignition of firecrackers but were in the vicinity. Conclusion: This year, following a ban, the number of firecracker-related ocular injuries reported from areas outside Delhi outnumbered as compared to within Delhi. However, firecracker-related ocular injuries are still a major cause of significant visual loss, especially involving the bystanders. Thus, firecracker-related celebrations should be monitored with a stringent protocol.