Trends in teleconsultations for uveitis during the COVID-19 lockdown

Purpose: To study the use of teleophthalmology as a tool to manage patients with uveitis and to describe the experience of teleconsultation for uveitis at a tertiary eye care hospital in India during the two waves of the COVID?19 pandemic. Methods: A prospective observational case series of uveitis patients seeking teleconsultations during the first (March 25–May 2020) and second lockdown (April 27 to June 21, 2021) in a tertiary eye care center were analyzed. Results: There were 79 teleconsultations in the first and 89 teleconsultations in the second lockdown. A majority of the patients presented in the age group of 41– 60 years in both the lockdowns. There were both new or primary consultations and follow?up patients (6% vs. 94%) in the first lockdown, and similarly in the second lockdown (8% new vs. 92% follow?up). The majority of patients resided in Bengaluru city (78% in the first and 76% in the second lockdown). After evaluation through video consultation, only 15% required a hospital referral in the first lockdown, whereas in the second lockdown, 21.3% were referred to the hospital. During the second lockdown, 20% presented with COVID?19 infection?related ailments. Conclusion: Based on our preliminary experience using a customized smartphone?based application for teleconsultation, we found it to be an alternative option to provide continuation of ophthalmic care to uveitis patients. Given the current COVID?19 situation, it can help avoid physical visits of uveitis patients to the hospital

Effect of fluidics on corneal endothelial cell density, central corneal thickness, and central macular thickness after phacoemulsification with torsional ultrasound.

Aim: To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound. Settings and Design: Prospective, randomized clinical trial based on a tertiary eye hospital. Subjects and Methods: The study included 65 patients in each group. Patients were randomized to either the high or the low flow group using a computerized random number table. The study was patient and examiner masked. All patients underwent phacoemulsification with torsional ultrasound. Visual acuity, ECD, CCT, and CMT were measured for all patients preoperatively at 2 weeks and 6 weeks postoperatively. Statistical Analysis Used: The Shapiro–Wilks test was used to assess the normality of the data. Mann–Whitney U‑test with the P value set at 0.05 was used to compare the two groups. Results: Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks. Conclusions: No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon’s preference, as both high and low flow parameters were found to have comparable postoperative outcomes.

Repeatability and Agreement of Four Biometers for Measuring Various Anterior Segment Parameters.

Purpose: To assess the repeatability and agreement of a new swept source optical coherence tomography (SS-OCT) biometer (IOL Master® 700, Carl Zeiss Meditec), an optical low coherence reflectometer (Lenstar LS 900®, Haag-Streit AG, Koeniz, Switzerland), a dual scheimpflug ray tracing biometer (Galilei G6®, Ziemer, Switzerland) and a partial coherence interferometer, AL scan® (Nidek Co. Ltd., Japan) to measure the keratometry (K), astigmatism (AST), axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW) in cataractous eyes in a Cross-sectional study. Methods: 50 eyes of 50 consecutive patients scheduled for cataract surgery were included. Three consecutive scans were performed using the 4 biometers by a single operator. Within-subject standard deviation (Sw), test-retest repeatability and coefficient of variation for assessing repeatability were assessed. Bland-Altman plots for the agreement between the mean measurements of each machine were examined. Results: The mean age of patients was 60.2 ± 10.6 years. Dropouts for AL measurement were significantly higher in AL scan® and Galilei G6® compared to IOL Master® 700. There was good agreement between IOL Master® 700 and Lenstar LS 900® for AL and keratometry (P < 0.5). High variability was seen between the 4 machines for AST and WTW. Conclusion: The new SS-OCT biometer showed valid measurements, good repeatability and good agreement with the optical low coherence reflectometry biometer. The new long range SS-OCT biometer was better than the other three devices in acquiring AL measurements in denser cataracts due to better penetration.

Systematic Transition to Phaco-Chop.

Phaco surgeons initially train in a four quadrant divide and conquer technique. Subsequently, several surgeons transition to chopping techniques due to the perceived advantages of phaco-chop that include lower ultrasound energy and lesser zonular stress. Stop and chop has conventionally been the technique of choice for making this transition. However, the surgeon has to execute a full-fledged chop after the creation of two hemi-segments by the classical trenching and cracking skills already acquired in divide and conquer techniques. Here we describe a set of intermediate steps during four quadrant divide and conquer that breaks down the skills required for chopping and enables the surgeon to sequentially imbibe the required skill sets to make the transition to chop safer and smoother.

Toric implantable collamer lens for keratoconus.

Keratoconus is a progressive non-inflammatory thinning of the cornea that induces myopia and irregular astigmatism and decreases the quality of vision due to monocular diplopia, halos, or ghost images. Keratoconus patients unfit for corneal procedures and intolerant to refractive correction by spectacles or contact lenses have been implanted toric posterior chamber phakic intraocular lenses (PC pIOLs) alone or combined with other surgical procedures to correct the refractive errors associated with keratoconus as an off label procedure with special informed consent from the patients. Several reports attest to the safety and efficacy of the procedure, though the associated corneal higher order aberrations would have an impact on the final visual quality.

Endothelial cell study in a case of Werner's syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy.

Werner's syndrome (WS) is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG) capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS.

Safety and efficacy of Intacs in Indian eyes with keratoconus: an initial report.

CONTEXT: In contact lens-intolerant keratoconus patients, intrastromal placement of Intacs is becoming a promising new modality of treatment. AIMS: To study the safety and efficacy of implantation of microthin corneal inserts (Intacs) in Asian-Indian keratoconus patients. SETTINGS AND DESIGN: Retrospective interventional case series, in the cornea and refractive surgery service, at a tertiary care eye hospital in South India, between May 2006 and July 2007. MATERIALS AND METHODS: Intacs (Addition Technology, USA) were successfully implanted by mechanically creating tunnels, in 12 eyes of 12 keratoconus patients, who were contact lens-intolerant. The patients (mean age 25.58 years, nine male and three female) had a minimum follow-up of six months. Five patients had severe keratoconus (mean K > 53 D) and nine had central cones. RESULTS: All patients improved or retained visual acuity. The uncorrected visual acuity (UCVA) improved from a mean value of 0.06, (SD +/- 0.08) to 0.19 postoperatively (SD+/- 0.15) ( P = 0.01). The change in mean best corrected visual acuity (BCVA) was from 0.51, (SD +/- 0.24), to 0.69, (SD +/-0.00) ( P = 0.01) postoperatively. The average central keratometry reading was 52.55 D. The change in mean K from 52.84 to 49.16 and 49.15 at one and six months respectively, was statistically significant. We did not have any major intra- or early postoperative complications. Eight of 12 eyes became contact lens-tolerant post-surgery. CONCLUSION: The procedure of Intacs implantation appears to be safe and effective in a small group of Indian population at an intermediate follow-up.