Keratorefractive surgery practice in a tertiary eye care center in central India / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the patient characteristics and keratorefractive surgery(KRS)practice in central India.METHOD: The retrospective study was conducted on 410 patients who underwent KRS from June 2017 to April 2022 at a tertiary eye care center in central India. Demographic data of the patients presenting for the spectacle free vision like age, sex, residence in the form of urban or rural area, refractive error, cause for spectacle-free vision, best-corrected visual acuity, types of procedure, postoperative follow-up and complications were recorded.RESULTS: Among the 410 patients who presented for spectacle-free vision, 324 patients were considered for KRS(79.0%), and 200 patients(61.7%)underwent the laser-assisted in situ keratomileusis(LASIK)procedure, whereas 124 patients(38.3%)underwent the photorefractive keratectomy(PRK)procedure. The final study group comprised 179 female and 145 male. The mean age of the patients was(25±3.5)years. A majority of patients were from urban areas(n=250, 77.2%). The mean preoperative manifest refraction in the right and left eyes was -4.5±2.1 and -4.9±2.0, respectively. The mean surgical time in the LASIK patient was(15±2)min and(17±3)min for both eyes in PRK. None of the patients exhibited epithelial ingrowth, flap healing complications, or infection, and none of them required enhancement. Suboptimal corneal thickness(n=28, 32.6%)was the most common reason for rejection. At the end of the 1-year follow up, 3 patients who underwent the LASIK procedure exhibited regression(-0.5 D±1 D), with a refractive error correction of -6.75 D, -8.5 D, and -7.0 D, respectively.CONCLUSION: LASIK is the predominant procedure for the correction of refractive error in the central Indian population. Although the number of PRK procedures was small, both LASIK and PRK exhibited excellent visual outcome. Myopic regression should be considered when choosing LASIK for high myopia.

Proparacaine hydrochloride topical drop and intracameral 0.5% lignocaine for phacotrabeculectomy in patients with primary open angle glaucoma

To compare the efficacy and safety of 0.5% intracameral lignocaine to 1% intracameral lignocaine prior to phacotrabeculectomy. Prospective, comparative, observational, and interventional study. Tertiary eye care center in central India. This study was comprised of 79 patients [79 eyes] with primary open angle glaucoma scheduled for phacotrabeculectomy. Patients were assigned to 1 of 2 Groups receiving proparacaine 0.5% eye drops and 1% intracameral lignocaine just prior to phacotrabeculectomy [Group 1, n = 39] and 0.5% intracameral lignocaine after completion of phacoemulsification just prior to trabeculectomy [Group 2, n = 40]. The visual analogue scale was used to record intraoperative and postoperative pain. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. An anesthetist also noted the vital parameters and the requirement for intravenous medications. There was no significant difference in the intraoperative pain score [P = 0.0733] or supplemental anesthesia [P = 0.372] between Groups. Postoperative pain score was statistically significant in Group 2 [P < 0.0001]. The overall operating conditions in both Groups were comparable [P = 0.7389]. A greater number of patients in Group 2 [88.57%] preferred the same anesthetic technique for combined surgery in the fellow eye. There was no difference in inadvertent eye movements and lid squeezing between Groups and they did not interfere with surgery. Topical anesthetic drops supplemented with 0.5% intracameral lignocaine before performing trabeculectomy is as effective as 1% intracameral lignocaine given at the beginning of phacotrabeculectomy for primary open angle glaucoma

Diffractive multifocal intraocular lens compared to pseudo-accommodative intraocular lens implant for unilateral cataracts in pre-presbyopic patients

To evaluate the efficacy of diffractive multifocal and pseudo-accommodative IOLs in pre-presbyopes with cataract. A prospective randomized control study was performed on patients with cataract in the pre-presbyopic age group. Patients were randomly allocated to 2 groups: Group 1 comprised 12 patients who underwent implantation of a diffractive multifocal IOL and Group 2 comprised 13 patients who underwent implantation of a pseudo-accommodative IOL after standard phacoemulsification. Efficacy was measured by postoperative distance and near uncorrected visual acuity, contrast sensitivity, spectacle independence, and glare and halo. Between-group comparison was performed with the unpaired t test. Fisher's exact test was used for categorical variables. All the tests were two-sided with confidence interval set at 95%.The study patients were aged 22-35 years and included 14 females and 11 males. All examinations were performed 6 months postoperatively by a second observer unaware of the study objectives. Mean uncorrected distance visual acuity was 0.125 +/- 0.1 Log MAR in Group 1 and 0.1385 +/- 0.1 in Group 2 [P = 0.7993]. Near visual acuity was 0.0917 +/- 0.1 in Group 1 and 0.386 +/- 0.2 in Group 2 [P < 0.0001]. Contrast sensitivity was good in both groups based on the Pelli-Robson chart [P = 0.3919]. Night-time glare was present in 3 [25%] patients in Group 1 and in 2 [15.4%] patients in Group 2. No patients in either group had difficulty driving during the day or night. Ten patients in Group 1 [83.3%] and 7 patients in Group 2 [53.85%] had spectacle independence [P = 0.1249]. Greater proportions of patients who underwent diffractive multifocal implantation achieved functional distance and near vision as compared to those in the pseudo-accommodative IOL group. There was greater variability in near vision in patients who received the pseudo-accommodative IOL as compared to those in the multifocal IOLs. Contrast sensitivity remained adequate in both the groups. There were more glare and halos in the multifocal group as compared to those in the pseudo-accommodative group. More patients achieved spectacle independence with multifocal IOLs

single drop of 0.5% proparacaine hydrochloride for uncomplicated clear corneal phacoemulsification

The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification. Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery [proparacaine group] and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine [xylocaine group]. A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant. No statistically significant difference was seen in the intraoperative [P = 0.24] and post-operative [P = 0.164] pain scores between groups. There was no pain [0 score] in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time [P = 0.279] and surgeon discomfort [P = 0.07] were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery [89.11% for the proparacaine group and 90.18% for the xylocaine group]. No patients in either group had changes in vital parameters or required intravenous sedation. A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon