Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation

Purpose: To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes. Methods: Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL. Results: Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL. Conclusion: Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.

Development of integrated care tool � BRIEF for screening the unmet psychosociomedical needs of older Indians

Background: With demographic shifts, there is an unprecedented increase in noncommunicable diseases, multimorbidity, and geriatric syndromes among older adults, especially in economically weaker sectors. However, there is no socioculturally appropriate tool to screen older adults for age-related health needs, multimorbidity, and geriatric syndromes at their doorstep. Objective: Our objective was to create a self-assessment tool, 搃ntegrated care tool� (ICT), and to assess its psychometric properties by applying it on older adults from multiple settings such as hospital, community, and old-age home (assisted living services). Methods: new questionnaire was developed using standardized procedure including item development, pilot testing, and psychometric validation. After obtaining the institutional ethics committee clearance, data were collected from consenting respondents attending the Outpatient Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, community settings through health camps, and long-term care center, between May 2016 and February 2017. Data were computerized and analyzed by principal component analysis as extraction method and orthogonal varimax as rotation method. Results: The final 30-item questionnaire was arranged into various domains as per rotated component matrix analysis. Overall internal consistency of the final questionnaire, as calculated by Cronbach's alpha, was 0.79, and the measure of sampling adequacy was 0.79. Conclusion: ICT-BRIEF is a simple, self-assessment/caregiver-assisted tool to screen the health needs of older adults. This tool can be validated for developing risk score and scaled up to generate a large database to create elderly centered care plans.

Epiretinal membrane profile on spectral domain optical coherence tomography in patients with uveitis

Purpose: To study the epiretinal membrane (ERM) profile on the spectral-domain optical coherence tomography (SDOCT) in eyes with uveitis. Methods: In this prospective observational study, macula of uveitic eyes were evaluated by SDOCT (Cirrus, model 5000) for ERM. ERM was quantified (in microns) and were followed up along with the best-corrected visual acuity (BCVA) and treatment profile for 1 year. ERM morphology (focal, global, or mixed) and characteristics (thickness at fovea, maximum thickness, and location of maximum thickness in relation to fovea) were documented. Changes in altered foveal contour, cystoid macular edema (CME), and central foveal thickness were also noted. BCVA was noted when the inflammation subsided and it was correlated to specific ERM characteristics. SDOCT characteristics were compared in three treatment groups (no oral steroids, oral steroids with, and without immunomodulators). Results: Thirty-four eyes of 25 patients were evaluated. Mean logMAR BCVA decreased from 0.25 to 0.35 (P = 0.005). Foveal involvement with ERM (P = 0.011), lost foveal contour (P = 0.043), and ellipsoid layer disruption (P = 0.017) were associated significantly with reduced BCVA. Focal attachment of ERM was more commonly associated with CME (P = 0.03). Median ERM thickness showed significant increase (P < 0.001). Significant ERM progression from parafoveal to foveal (P = 0.02), significant progression of the thickest area of ERM closer to fovea (P = 0.0006) indicated a strong tendency of foveal involvement and this was correlated with worse BCVA (P = 0.009, r = ?0.44) Oral steroids/immunomodulators showed no significant benefit on ERM progression. Conclusion: ERM progression in uveitis has a tendency to involve the fovea and is associated with significant vision loss, particularly in foveal ERM, focal attachment, and IS-OS disruption. Oral steroids and immunomodulators have no role in halting progression.

Iris and knot configuration after Single Pass Four Throw (SFT) pupilloplasty as imaged by the spectral-domain optical coherence tomography

Purpose: To analyze the morphological changes in the iris-knot complex configuration using spectral-domain optical coherence tomography (SD-OCT) following the single pass four throw (SFT) pupilloplasty. Methods: In this retrospective case series, eyes with SFT pupilloplasty were examined by SD-OCT (Optovue). Iris morphology compared to the normal iris, presence of specific patterns (single hump, double humps, peaks and valleys, tethering), prolene suture, knot complex (length and orientation), and intraocular lens (IOL) vault were evaluated. Results: Overall, 41 knots of 26 patients with a mean time duration of 3.1 � 2 months from surgery were analyzed. Iris configurations seen were single hump (n = 28, 63.8%), double humps (n = 7, 17%), loop (n = 2, 4.8%), flat (n = 3, 7.3%), and mulberry (n = 1, 2.4%). The mean length and the height of the knot complex was 784.1 � 433.7 ?m and 317.7 � 110.4 ?m, respectively. Knot positions were at 3 clock hours in 9 eyes (21.9%), 9 in 8 eyes (19.5%), and others in 24 eyes (58.5%). Cut end of the prolene suture was detectable in 26 eyes (63.4%) as hyper-reflective line, and the mean cut length was 465.8 � 321.1 ?m. The suture was predominantly vertically oriented (80.6%) to the iris with a mean distance of 3.6 � 0.3 mm (2.6�mm) away from corneal endothelium. The mean distance from the knot complex and the IOL was 289.2 � 146 ?m and the mean anterior chamber depth was 4.1 � 0.1 mm. Conclusion: A significant change in iris configuration was noted after SFT pupilloplasty, and vertically oriented retained prolene suture was predominant with good endothelial vault.

Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture

We present a case of posterior capsular defect with traumatic cataract after blunt trauma in which an extended focal length intraocular lens (IOL) was implanted in the bag after conventional phacoemulsification and anterior vitrectomy. Anterior segment optical coherence tomography performed preoperatively aided in the confirmation and documentation of the capsular integrity. Intraoperative trocar anterior chamber (AC) maintainer allowed AC maintenance without further complications. IOL was well centered postoperatively at 6 months, and the unaided visual acuity was 20/20 for distance and N8 for near. The report showed that an extended depth of focus IOL can be placed in eyes with ruptured posterior capsule for good visual outcome in posttraumatic young eyes and it may not be considered as a relative contraindication for it.

Single-pass four-throw pupilloplasty for angle-closure glaucoma

Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be associated with a pupillary block. Surgical pupilloplasty with single-pass four-throw technique helps to alleviate the appositional closure along with the breakage of peripheral anterior synechia, thereby increasing the aqueous outflow and decreasing intraocular pressure.