ABSTRACT
Purpose: To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified 揻rown� incision with triangular scleral flap technique. Methods: This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified 揻rown� incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann朩hitney U test for averages and Chi-square test for categorical values. Results: Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative � postoperative) for group A was 20.8 � 8.3 mm Hg and that for group B was 17.2 � 13.5 mm Hg. Conclusion: Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified 揻rown� incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.
ABSTRACT
The risk of endophthalmitis is always a concern when an intraocular procedure is performed. Intravitreal injection is a frequently used method for therapeutic management of many diseases, affecting the posterior segment of the eye. Hence, it is important to assess the risk of complications, especially endophthalmitis. Most studies conducted concentrate on risk assessment from single use from single drug vial. The present article reports the occurrence of cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single vial. Intravitreal injection of bevacizumab was administered to eight eyes of eight patients. Administered dose was prepared from single 4-ml vial of bevacizumab and was injected in the eye, after patient preparation and under aseptic conditions. The procedure was repeated for the remaining patients, thereby imparting multiple pricks in the same vial. Four of the eight patients reported to the hospital on the 3rd day after injection with complaints of pain, watering, and diminution of vision. Two patients reported the following day with similar complaints. Two patients who did not report by the 4th day were contacted and recalled for an examination. All the patients were thoroughly examined using slit lamp biomicroscopy and indirect ophthalmoscopy. Six out of eight were clinically diagnosed to have endophthalmitis and were administered intravitreal antibiotics. The present report highlights possibility of microbial contamination of the drug vial or during compounding process. However, from the present incident, we are encouraged to stay vigilant and wary of contamination.
ABSTRACT
Introduction: Modern day cataract surgery is aimed at giving optimal catarefractive outcome . This study was inspired by a chance finding of high astigmatic reading on performing retinoscopy three weeks after surgery in a female who underwent manual small incision cataract surgery. Aim of study: To study effect of scleral tunnel incision at different locations on pre-existing astigmatism ,and to calculate surgically induced astigmatism there from . Design: The scleral tunnel incision is known to undergo changes upto six weeks after cataract surgery .If pre operative value and post operative values at the end of six weeks are known ,SIA can be calculated. All patients operated free of cost for cataract are implanted an all PMMA non foldable 6.0mm intraocular lens hence we chose a six mm frown incision. From our study we aim to give cut off values of native astigmatism to chose incision site in order to provide least residual astigmatism, since this group of patients being non affording cannot undergo any additional surgical procedure to get astigmatism corrected . The higher order post cataract surgery residual error degrades quality of image ,hence accentuation of native error by SICS is non justifiable . Rather,our aim should be to regress existing error by 50% -75%. Method: In 150 eyes undergoing cataract surgery in the department of Ophthalmology, Aurobindo Institute Of Medical Sciences under eye camp, the preoperative keratometric values in vertical and horizontal axis were noted .At the end of six weeks after cataract surgery performed by 6mm incision at superior, superotemporal and absolute temporal locations , keratometry readings were noted again along the principle meridia .SIA was calculated from these two readings. At the end of six weeks keratometry and retinoscopy weres done. Result: From the study it was concluded that location of incision in the eye has a bearing on existing astigmatic error . A regression (or accentuation) in the existing error is dependent on the incision site and the magnitude of pre-existant error. With superior and absolute temporal scleral tunnel incision , SIA average was 0.77 Dioptres while with BENT( between nine and twelve) clock hours it was lesser (0.68 Dioptres) Except in thirteen eyes who accepted cylindrical lens in oblique meridia, all others accepted glasses in primary meridia. Conclusion: For upto 1 D astigmatism, ATR or WTR, placement of incision on steeper axis should be the choice. For WTR, of any degree, a superior location should be the choice. For ATR amounting to 1.25D, a superotemporal incision offers best results. For higher ATR absolute temporal location should be the choice if regression in astigmatism is desired.
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Aim of study: To evaluate efficacy of surgical intervention in patients having aphakia by secondary IOL implant and to study their complications.Design: A time bound study for management of aphakia in the department of ophthalmology , SAIMS Indore from Feb. 2004 to Feb. 2012. Method: After clinical evaluation on individual basis, we carried out a secondary procedure on thirty two eyes of thirty one patients from age group twenty-six months to seventy four years. Placement of implant in posterior compartment was given first priority in cases of aphakia reporting on out patient basis. In cases where cataract surgery was eventful or could not be completed we preferred doing in the bag placement.If this was not feasible then placement of haptic in ciliary sulcus was the next preferred choice.In the event of pre-existing PAS or insuffecient iris ,we chose to do scleral fixation. In absence of these with inadequate capsular support, anterior chamber placement of lens was done . Power of intraocular lens was calculated by SRK formula. In all cases, except one ab externo, a scleral tunnel was made or previous tunnel used for implantation, depending on duration elapsed between cataract surgery and secondary implantation. Best corrected visual acuity for distance and near was determined at the end of six weeks. In traumatic cases A-Scan biometry was done after six weeks using aphakic mode. Undercorrection of implant power in paediatric patients was done according to age. Result: On the basis of visual acuity recorded patients were categorized into three groups. Twenty four (80%) patients achieved BCVA of 6 /18 or better, four(13.3%) patients gained vision between 6/24 to 6 /60 while two (6.6%) had visual acuity between 3/60 to 5/60. Mean spherical refractive correction was - 0.616 , mean value of cylinder was -0.742 ,which is considerred the most optimal and desired outcome after IOL implantation. Conclusion: Though secondary intervention was done in eyes where ocular tissues had undergone prior surgical handling , inclusive of patients with poor visual prognosis, still 80% could achieve BCVA 6/18 or better. This shows that secondary implantation is an effective means of rehabilitating aphakic patients. Traumatic cases should better be dealt with by a sequential approach.
ABSTRACT
Glomus tumours are usually benign neoplasms of glomus bodies. Here we report a rare case of malignant glomus tumour of soft tissue. The tumour was 8 cm in size, infiltrating deep tissue, with nuclear atypia, high mitotic activity (6/HPF), atypical mitosis and showed recurrence, thus fulfilling all the criteria of malignancy.