ABSTRACT
Purpose: To determine the safety and efficacy of manual small?incision cataract surgery (MSICS) for brunescent and black cataracts in patients with other ocular comorbidities. Methods: Medical records of patients with hard cataracts (grade 4 nuclear opalescence and above) with other ocular comorbidities such as spheroidal degeneration of the cornea (SDC), pseudoexfoliation (PXF), non?dilating pupil, and high myopia who underwent MSICS were retrieved retrospectively. Intraoperative and postoperative complications were noted. Preoperative and postoperative visual outcome comparisons were performed using paired t?tests. Statistical significance was set at P < 0.05. Results: A total of 124 cataract patients with brunescent or black cataracts and other ocular comorbidities underwent surgery during the study period. They ranged in age from 56 to 89 years (mean: 68.9 + 11.9 years), with 55.66% (n = 69) of the patients being female and 44.35% (n = 55) male. Of the 124 cases, 45.16% (n = 56) had SDC, 31.45% (n = 39) had PXF, 14.51% (n = 18) had non?dilating pupils, and 8.87% (n = 11) had high myopia. Preoperatively all patients had visual acuity <6/60. At 1 month postoperatively 77.4% of patients achieved good vision >6/18, 16.9% had a borderline vision (6/18�60), and 5.6% had a poor vision (<6/60). No serious complications were observed. One patient had posterior capsular rent in a case of high myopia, and two cases had zonular dialysis for pseudoexfoliation. Conclusion: MSICS with intraocular lens implantation is safe and effective in eyes with brunescent/black cataracts if associated with SDC, PXF, high myopia, and non?dilating pupils and provides good visual outcomes with minimal complications.
ABSTRACT
Purpose: To evaluate the gonioscopic changes in patients receiving Descemet’s stripping endothelial keratoplasty (DSEK) without pre?existing ocular hypertension (OHT) and to report its correlation with post?surgery OHT, graft survival, and visual outcomes. Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow?up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post?DSEK OHT details were documented. Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra?ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid?induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre?operative best corrected visual acuity was 1.62 logMAR (range 1.17–1.77), which gradually improved to 0.79 logMAR (range 0.3–1.77) after 2 years (p < 0.00001). Conclusion: PAS was found to be an important factor associated with post?DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.
ABSTRACT
Purpose: To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma. Methods: Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg. Results: Seventy?one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow?up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure. Conclusion: TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.
ABSTRACT
Purpose: This study was performed to compare the rate of progression of myopia before and during the COVID?19 pandemic and to assess the risk factors of hastened progression. Methods: All children with myopia of spherical equivalence ? ?0.5 D with at least two prior documented refractions 6 months and 1 year before were included. The annual progression rate before COVID?19 and during COVID?19 was calculated. Annual myopia progression was categorized as no progression (0), slow progression (<1 D), and fast progression (?1 D). Results: A total of 133 children (266 eyes) aged 6–18 years were included in the study. Mean annual myopia progression was found to be statistically significant during COVID?19 as compared with pre?COVID?19 (0.90 vs 0.25 D, P < 0.00001). A total of 45.9% of children showed an annual progression of ?1 D during the pandemic as compared with 10.5% before the COVID?19 (p < 0.00001). In multivariate analysis, history of rapid progression in pre?COVID?19 era (P = 0.002) and sun exposure <1 h/ day (P < 0.00001) were found to be independent risk factors for rapid myopia progression. Conclusion: Parents should consider risk of rapid myopia progression in children during current pandemic and children should be provided with socially distant outdoor activities to increase their sun exposure and diminish the rate of myopia progression
ABSTRACT
To simulate the effects of acute psychological stress, the effects of stressful computer game in young adult subjects were assessed by various physiological, psychological and biochemical parameters. The results showed a significant increase in the physiological and psychological markers of stress. It is concluded from these results that computer game can be used as an acute laboratory psychological stressor for future studies on physiological effects of stress.