ABSTRACT
@#Mass of the vulva include both benign and malignant lesions. Benign mass lesions of the vulva include tumors, hamartomas, cysts, infectious disorders, and non-neoplastic epithelial disorders. Some are rare mass lesions. Here, we presented three rare mass lesions of the vulva. The first case presented with the complaint of vulvar lesion since childhood, while the two cases presented in reproductive age and perimenopausal age. All three cases presented as mass lesions in the vulva with pain or uneasiness during work. In all these cases, excision was done. On histopathological examination, the lesions have different diagnoses which are common in other parts of the body, but rarely present at the vulva. A definitive diagnosis of a vulvar mass lesion is difficult to make, especially in the case of rare mass lesion. Histopathology is the principal tool of diagnosis.
Subject(s)
Lymphangioma , FibroadenomaABSTRACT
Background: In LASIK (laser in situ keratomileusis), a hinged corneal flap is made, which enables the flap to be lifted and the excimer laser to be applied to the stromal bed. If the hinge of the corneal flap detaches from the cornea, the flap is called a free cap. A free cap is a rare intra-operative complication of LASIK most commonly associated with the use of a microkeratome on corneas with flat keratometry, which predisposes to a small flap diameter. Free caps are preventable and treatable. Rarely does the complication lead to a severe or permanent decrease in visual acuity. Purpose: As free caps are avoidable, prevention is critical. Our video gives some tips and tricks on how to avoid a free flap and also focuses on how to manage a cut through a free flap. Synopsis: If a free cap is created, the surgeon must decide whether to continue with excimer laser ablation or to abort the procedure. When to abort: If the stromal bed is irregular, the flap is replaced without applying laser ablation. Without ablation, generally, there is no change in refractive error or significant loss of visual acuity. When to continue: If the stromal bed is regular and the cap is of normal thickness, the surgeon may proceed with ablation. To prevent desiccation, the free cap should be handled with caution and should be placed on a drop of balanced salt solution. The free cap should be placed epithelial facing up, along with a bandage contact lens. The endothelial cell pump mechanism typically allows the cap to re-adhere tightly. Highlights: Risk factors for a free cap are generally anatomic or mechanical. Especially in flat corneas, an appropriate ring and stop size should be chosen looking at the nomogram on the basis of the keratometry values. Deep orbits and deep-seated eyes should be looked for as PRK is a better option in such cases. Inadequate suction should be dealt with a lot of care, and once this is done, the vacuum should be stopped. Re-docking of the microkeratome with suction can be done again. Prior testing of the microkeratome and a good verbal anesthesia are a few more such important points to be pondered upon. This video gives us such tips and is a comprehensive video for a novice surgeon performing microkeratome LASIK
ABSTRACT
Purpose: The purpose of the study was to evaluate the knowledge and perception of health-care professionals (HCPs), such as doctors/surgeons, pharmacists, nurses, optometrists, and lab technicians, on clinical trials (CTs) in India. Methods: The study was a pan-Indian cross-sectional survey initiated by the Indian Ophthalmology Clinical Trial Network (IOCTN) by using a previously validated questionnaire for three months of data collection. An online survey was used to record information regarding demographics, CT knowledge, and CT perception among HCPs. Results: A total of 630 responses were recorded from HCPs: 207 doctors and surgeons, 159 pharmacists, and 264 laboratory technicians, nurses, and optometrists across India. Over 90% of HCPs had a clear knowledge on the purpose of CTs, the informed consent (IC) process, ethical approval by the Drugs Controller General of India (DCGI). About 80% and 90% were aware of confidentiality of patients, voluntariness of participation, and good clinical practice. Surprisingly, less than 50% had lesser knowledge regarding monetary incentives of CT participants (CTPs). A slightly positive perception was observed regarding the potential benefits of CTPs, compensation related to injury, and importance of obtaining IC. Less than 50% had a negative perception that monetary compensation to CTPs led to bias and deprivation of standard treatments. However, no significant difference was observed between other aspects of demographics and perception regarding CTs. Conclusion: We observed doctors and surgeons to be having the highest regarding CTs, followed by pharmacists. The survey highlighted the necessity of scheduling awareness programs among the HCPs, which would improve their misconceptions and perception of CTs while interacting with patients for CT enrollment.
ABSTRACT
Non-Hodgkin’s lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T-cells, B-cells, or both. Sometimes, tuberculosis and lymphoma presentation can share common symptoms and features. In this case report, we present the case of a 28-year-old female patient who came with a chief complaint of swelling on the right side of the face for the past 6 months. Initially, it was not associated with pain but gradually developed severe pain over the region and reduced salivary flow. The patient was planned for surgery with a differential diagnosis of salivary gland pathology. Post-operatively, the histopathological report showed atypical cells which were diffusely positive for cluster of differentiation (CD)20. Focally positive for CD45 and CD3 which was positive in reactive T lymphocytes. Immunohistochemistry pattern favors the diagnosis of B-cell type NHL. Through this case report, we want to share our experience in treating an aggressive tumor that mimics salivary gland pathology.
ABSTRACT
Background: Photic sneeze reflex (PSR) also known as autosomal dominant compelling helioophthalmic outburst is a rare condition characterized by uncontrolled sneezing in response to bright light. The exact mechanism causing this is poorly understood. However, various hypotheses have been proposed. Ophthalmic examination involves exposing the patient to bright light like slit lamp, indirect ophthalmoscopy and surgical microscope, which can trigger sneezing in PSR patients. Purpose: The purpose of this video is to draw light to this rare phenomenon and its implication in ophthalmic surgery. Synopsis: A 74?year?old male patient presented with diminution of vision in left eye. On routine slit lamp and IDO examination, patient had repeated sneezing. We diagnosed him to have photic sneeze reflex. He had pseudophakic bullous keratopathy in the right eye and senile immature cataract in the left eye. Taking into consideration his one eyed status and PSR, measures were taken accordingly and cataract surgery was performed uneventfully. We describe in this video the challenges encountered with this phenomenon and approach in such cases. Highlights: In this video, we tried to give an idea about photic sneeze reflex and its theories. Also, we tried to bring out the impact of PSR on ophthalmologic practice.
ABSTRACT
INTRODUCTION: The WHO, broadcasted COVID 19 as a public health emergency onJANUARY 30th ,2020 and subsequently declared a pandemic on MARCH 11th2020.Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19that occurs in 20-41% of patients with severe disease.The pathophysiology of ARDS andCOVID-19 lung injury share many of the same aspects of reduced lung parenchymalcompliance, vasculopathy, alveolar flooding, and gas exchange impairment arising fromdirect infectious causes and noninfectious injuries.In patients with pneumonia,HFNOallows improved mobilisation of secretions,minimises oxygen dilution,meets inspiratorydemands and improve end-expiratory lung volumes.According to the present theories,prone positioning, by reducing ventral alveolar expansion and dorsal alveolar collapse,results in ventilation that is more homogeneous.OBJECTIVE: The goal of our study is to evaluate the reduction in consumption of oxygenby using proning as an adjunct to HFNO in patients of COVID 19 admitted in ICU.METHOD: This is an observational cross sectional type of study, which includes patientswho were hemodynamically stable and required HFNO to maintain oxygenation. Allpatients were counselled for the benefits of proning. Proning was done with the help ofnursing staff. All vitals were noted before proning and all throughout proning. We keptpatients in a prone position till patients were comfortable and duration of proning wasnoted. We titrated oxygen requirement (FIO2 and flow) to target spo2 level of 93-95%.RESULT: We studied in 26 patients on HFNO with proning, we found that proning helpsin 11-50% reduction in oxygen requirement to achieve target Spo2 level.The mean value ofoxygen consumption was 20833.27 L/HR with only use of HFNO which was more than15996.92 L/HR when patients were encouraged to be prone along with the use ofHFNO.The collected data was analysed and unpaired t test was applied after which p valueof 0.0154 was obtained, which is statistically significant.CONCLUSION: Based on this study it is concluded that there is significant reduction inconsumption of oxygen by using the prone position as an adjunct to HFNO in patients ofCOVID 19.
ABSTRACT
Though technological advancements have transcended beyond expectation, phacoemulsification remains a challenge in uncooperative patients, where the procedure may be contemplated under general anesthesia, with simultaneous bilateral cataract surgery (SBCS) being the surgery of choice. In this manuscript, we have reported a novel two-surgeon technique of SBCS on a 50-year-old mentally subnormal patient. Under general anesthesia, two surgeons performed phacoemulsification simultaneously, using two separate microscopes, irrigation lines, phaco machines, instruments, and assistants. Intraocular lens (IOL) implantation was performed in both eyes (OU). The patient had a visual recovery from 5/60, N36 in OU preoperatively to 6/12, N10 in OU on post-operative day 3 and 1 month, with no complications. This technique can potentially reduce the risk of endophthalmitis, repeated and prolonged anesthesia, and the number of hospital visits. To the best of our knowledge, this two-surgeon technique of SBCS has never been reported in the literature.
ABSTRACT
Background: The lack of specialized geriatric healthcare in India, coupled with an aging population, has resulted in longer wait times, communication barriers, and a potential increase in unmet needs in a demographic that is already financially and socially vulnerable. This raises the need for exploring the perspectives and needs of the geriatric patient population to improve the quality and accessibility of the healthcare they receive. Objectives: This study was conducted to assess the perceptions and perceived needs of geriatric patients regarding current healthcare and their attitudes toward specialized geriatric healthcare. Materials and methods: Following the Institutional Ethics Committee (IEC), a cross-sectional study was carried out among 262 geriatric patients (age >60) from seven outpatient departments (OPD). A structured 10-item questionnaire was administered to assess the perceptions and perceived needs of the study population. Results: A total of 165 (63%) patients were not satisfied with the healthcare being provided to them. Around 96.1% of patients felt the need for a separate geriatric OPD/department. A total of 98% of patients had optimistic attitudes toward the possibility of specialized geriatric healthcare. A total of >80% of the patients were willing to spend more time for checkups and follow-ups regularly if that would improve their quality of life. Conclusion: This study showed a low satisfaction rate of geriatric patients with the current healthcare and a high felt need for specialized geriatric facilities. There was an overall positive attitude of patients toward the implementation of various facilities of specialized geriatric healthcare.
ABSTRACT
Background: Toric Intraocular lenses (IOLs) are supposed to be aligned at a particular axis for spectacle?free vision for distance. The evolution of topographers and optical biometers has made it quite achievable for us to aim the target. However, the result sometimes remains unpredictable. A big aspect of this depends on the preop axis marking for toric IOL alignment. Errors in axis marking have been reduced recently with the array of different toric markers in the market, but still we see postoperative refractive surprises due to faulty marking. Purpose: In this video, we present a novel slit lamp–based toric marker innovation, STORM, which gives us a hands?free approach to a reliable and accurate axis marking on the cornea. The axis marker is a simple modification to our age?old marker, with the advantage of no touch and slit?lamp assistance, which will make it error free and easy to use. Synopsis: The present innovation answers the problem statement of stable, economical, and accurate marking solution. Many a times, hand?holding devices create inaccurate and stressed condition while marking the cornea before corneal surgery. Highlights: The invention can be used for marking of accurate and easy astigmatic axis of a toric IOL preoperatively, that is, before the surgery. If the appropriate device is used to mark the cornea, it would impact the outcome of surgery. This device also makes the patient and the surgeon comfortable to mark the cornea with accuracy and without hesitation
ABSTRACT
Background: Lamaze breathing is a breathing technique based on the idea that controlled breathing can enhance relaxation and decrease the perception of pain. Some of the important techniques for controlled breathing include slow, deep breathing. Pregnancy and childbirth are one of the greatest events in the life of a woman which she aspires and longs for with great expectation. Methods: The data were collected by using the structured close-ended knowledge questionnaire. From using the disproportional stratified random technique of 50 staff nurses. Attending HSK and Daddenavara hospital, Bagalkot in a pre-experimental survey. The data was analyzed by using descriptive and inferential statistics in terms of mean, frequency distribution, percentage, paired t-test and chi-square test. Results: In post-test reveals that out of 50 staff nurses, the highest post-test (40%) of staff nurses had good knowledge, (30%) had excellent knowledge followed percentage (30%) of staff nurses with average knowledge. The overall findings reveal that the posttest knowledge score (30.54�66), which was (72.88%) of the total score was more when compared to the pre-test knowledge score (13�61), which was (36.05%) total score. The effectiveness of VATP in this area was a mean knowledge score of 17 with SD�04, which was (36.83%) of the total score. The calculated 't' value (17.77) was much higher than the table valve (1.96) for the degree of freedom 49 and 0.05% level of significance. Conclusion: The study provides that a video-assisted teaching programme on knowledge regarding the use of Lamaze breathing exercises among staff nurses was a scientific, logical, and cost-effective strategy.
ABSTRACT
Purpose: Prolonged postoperative topical corticosteroids are commonly given after pediatric cataract surgery to control inflammation. This study was undertaken to compare the efficacy, safety, and compliance of postoperative topical steroids and adjunctive intracameral (I/C) triamcinolone acetonide (tricort) and posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery. Methods: Forty?eight eyes of children with pediatric cataract between the ages of 5 and 10 years were randomized into three equal groups (T, I, S) before surgery. Group T received postoperative topical 1% prednisolone tapered over 4 weeks; Group I received adjunctive intraoperative I/C 1.2 mg/0.03 ml tricort and topical 1% prednisolone for 2 weeks postoperatively, and Group S received a single 0.5 ml (40 mg/ ml) PST tricort without topical steroids. Signs of inflammation, intraocular pressure (IOP), and central corneal thickness were assessed at day 1, week 1, week 3, week 6, and week 12 postoperatively with optical coherence tomography (OCT) macula to rule out cystoid macular edema at the sixth and 12th weeks postoperatively. Results: Posterior synechiae were present in two eyes out of 16 in groups T and I, which resolved. Severe anterior chamber cells were present in four eyes out of 16 in group T, in two eyes in group I, and in one eye in group S, which resolved. All groups had comparable pre? and postoperative IOP. Conclusion: In pediatric cataracts, outcomes were better with PST tricort and the adjunctive I/C tricort compared to postoperative topical prednisolone, for modulating postoperative inflammation
ABSTRACT
Purpose: To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery?specific questionnaires. Methods: This cross?sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ?25), Glaucoma Quality of Life (GQL?15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared. Results: The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ?25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL?15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ?25 showed a better QoL in the GDD group compared to the medical group, whereas GQL?15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups. Conclusion: NEIVFQ?25 questionnaire scores provided a holistic measure of QoL. GQL?15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision?specific and disease?specific questionnaires should always be used in conjunction
ABSTRACT
Background & objectives: The overall adult prevalence of HIV in India was estimated to be 0.22 per cent in 2019. The HIV prevalence among men who have sex with men (MSM), a high-risk group for HIV, was estimated to be 4.3 per cent, which is 16 times higher than the national average. In Delhi, the estimated prevalence among MSM was 1.8 per cent. Despite free HIV testing services being made available by the National AIDS Control Programme for more than two decades, many MSM were not aware about their HIV status. Therefore, newer testing strategies are needed. Oral HIV self-testing (HIVST) has proved to be one such promising innovation. At present, there are no programme guidelines on HIVST and oral HIVST kit is not available in India. The aim of this study was to understand the perceived advantages and disadvantages of introduction of oral HIVST strategy among MSM. Methods: MSM who were registered with the selected non-governmental organizations working as targeted intervention sites in Delhi, India, were recruited for focus group discussions (FGDs) between January and May 2021. For the purpose of this study, MSM were defined as males who had anal/oral sex with male/hijra partner in the past one month. A total of six FGDs were conducted using a prepared FGD guide. The FGD guide included questions on problems faced during conventional HIV testing, participants’ awareness, acceptability and perceptions of oral HIVST. The data were manually coded and entered in NVivo release 1.5 and themes were identified. Results: A total of 67 respondents participated in the FGDs. A total of 28.4 per cent MSM were beggars at traffic lights, 12 per cent were sex workers and 11.9 per cent were bar/event dancers. Nearly half (50.7%) of the participants had undergone HIV testing less than twice in the preceding one year. None of the MSM were aware about oral HIVST. Perceived advantages of oral HIVST were ease of use, confidentiality and the non-invasive pain-free procedure. Perceived concerns included lack of post-test counselling, linkage to care, poor mental health outcomes and forced testing. Interpretation & conclusions: Most MSM had positive perceptions about oral HIVST. Therefore, it is likely that the introduction of oral HIVST may result in higher uptake of HIV testing among MSM
ABSTRACT
Background: Meconium Aspiration Syndrome (MAS) is a complex respiratory disease of the term and near-term neonate. Inhalation of meconium causes airway obstruction, atelectasis, epithelial injury, surfactant inhibition and pulmonary hypertension, the chief clinical manifestations of which are hypoxemia and poor lung compliance. Supplemental oxygen is the mainstay of therapy of MAS, with around one-third of infants requiring mechanical ventilation. For those ventilated, high ventilator pressures, as well as relatively long inspiratory time and slow ventilatory rate, may be necessary to achieve adequate oxygenation. High frequency ventilation may offer a benefit in infants with refractory hypoxemia and/or gas trapping. High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic “inflate–deflate” cycle imposed by CV. Few studies have shown that, HFOV can effectively improve lung ventilation and oxygenation function, shorten ventilator treatment time and reduce the incidence of air leakage for neonatal MAS, making it a safe and effective treatment method. Objective:To study the Outcome of Neonates with Meconium Aspiration Syndrome on High Frequency Oscillatory Ventilation (HFVO).Material & Methods:It is a Prospective Observational Study of 10 neonates >34 weeks of gestation and birth weight >1500gm with meconium-stained liquor with respiratory distress requiring mechanical ventilation. Study was conducted over a period of 10months from August 2021 to May 2022. These neonates requiring mechanical ventilation were electively first hand put on SensorMedics 3100A High Frequency Oscillatory Ventilator after taking informed written consent from parents and given appropriate Intensive care. Data was analyzed at the end of the study duration and looked for outcome in the form of successful weaning from mechanical ventilation and discharge from NICU, and Death.Results:8 out of 10 (80%) neonates with MAS that were ventilated via HFOV were successfully weaned from mechanical ventilation and discharged, while death was reported in 2 out of 10 (20%) of the neonates included in the study.Conclusion:80% of neonates with MAS that were provided mechanical ventilation in the form of HFOV were effectively weaned off from mechanical ventilation, whereas 20% neonates died. This shows clinical effectiveness of HFOV in MAS making it a safe and effective treatment modality in neonates with MAS.
ABSTRACT
Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD), has been recognized as the most common co-morbidity of prematurity. Prematurity and RDS largely contribute to early neonatal morbidity and mortality. With adequate antenatal steroid and early continuous positive airway pressure, early surfactant therapy improve survival outcome.Material & Methods:Prospective interventional study included newborns with prematurity 28-36 weeks(GA) with clinical Respiratory distress syndrome and birth weight(BW)>650 gm. All subjects were preferably provided early surfactant therapy (within 2hours after birth). Surfactant (survanta) was delivered by INSURE technique (Intubate- Surfactant administration- Extubate) and only those who required further respiratory support were ventilated. Records on birth weight, gestational age, timing of therapy (early/late), sepsis, complications, and survival/death outcome were collected and data was analyzed using SSPS version 20 software.Results:Out of 76 neonates (42 male, 34 female), 46 received early surfactant therapy and 30 obtained it late; Although mortality was observed with both early(36.66%) and late therapy(63.33%), there was significantly higher survival with early therapy. higher mortality occurred in lower Birth weight(LBW) /Gestational age (GA) subgroups. Culture positive sepsis was found in 52.6% with higher association with late therapy . Hypotension was most common complication with late intervention , whereas there was no difference for pulmonary haemorrhage or apnea.Conclusion:Early surfactant administration improved survival with minimal complications in RDS except for extremely premature/LBW babies.
ABSTRACT
Coronavirus disease 2019 (COVID-19) vaccinations have been associated with a higher risk of thromboembolic events. There have been no reports of central retinal artery occlusion (CRAO) after vaccination with the indigenously developed Covaxin, and worldwide, there has been only one such isolated case after administration of the AstraZeneca vaccine. We report a case of a 44-year-old healthy man who presented with sudden painless vision loss in his left eye 10 days after receiving Covaxin. His best-corrected visual acuity was minimal perception of light, with a relative afferent pupillary defect. Fundus examination revealed arterial attenuation and macular cherry red spot, suggesting an acute CRAO. Optical coherence tomography showed macular swelling and disorganization of the inner layers due to ischemic sequelae. Blood work was normal and cardiovascular examination was unremarkable. The patient was kept on follow-up. To our knowledge, this is the first case of an isolated CRAO after Covaxin administration, but further studies are needed to evaluate this potential association.
ABSTRACT
Background: With about 87% of patients with cataracts having astigmatism, management of astigmatism in cataract surgery not only yields an improved unaided visual acuity and image quality but also higher patient satisfaction. The video will give a step?wise guide to cataract surgeons to manage astigmatism with cataracts. Purpose: To hit the bull’s eye as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting?edgetechnology and formulae and apply them to the cataract surgery practice. The purpose of the video is to make sure that we have no surprises in our Toric intraocular lens (IOL) planning. Synopsis: After a brief introduction to available modalities for the treatment of astigmatism, a step?wise approach to diagnostics is discussed, which will include the role of corneal topography and aberrometers and their application to planning Toric IOLs. Appropriate planning, implementation, and execution in form of preoperative and intraoperative pearls of using Toric IOLs are shown in the video. This will be followed by troubleshooting and case?based discussions and future perspectives including the possible role of corneal biomechanics. Highlights: What this video adds new is the importance of topography, interpretation of Belin?Ambrosio display map and the equivalent keratometry reading (EKR) map, aberrometry, and higher order aberration (HOA) analysis and role of biomechanics in Toric IOL planning. Video also highlights the importance of posterior corneal astigmatism and accurate axis marking. With a case?based approach and relevant examples, we are trying to decipher the enigma of astigmatism by giving a step?wise approach for the same
ABSTRACT
Background: Recently, the number of litigations on cataract surgeons has increased. Because of the increasing ambitions of surgeons and demands for a spectacle?free life, the incidence of unhappy patients is at an all?time high. To an ophthalmologist, the fruits of a good surgery are dependent largely on their skills. However, more importantly, the roots of good results of a surgery are laid by a perfect IOL (intraocular lens) power calculation. Inaccurate biometry is one of the major reasons for unhappy patients, especially in some challenging scenarios. Purpose: To hit the bull’s eye, as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting?edge technology and formulae and apply them to the cataract surgery practice. The aim of the video is to familiarize modern?day ophthalmologists to these situations to achieve a perfect IOL power calculation. Synopsis: Using a step?by?step approach, we decoded biometry in special scenarios like poor cornea, ocular surface disorders, dry eyes, toric IOL calculation, cases with posterior corneal astigmatism, irregular corneas like keratoconus, pellucid marginal degeneration, post Lasik ectasia and penetrating keratoplasty. In this video we tried to address the solution to these special conditions and how to attain target refraction in such cases. A few more issues are addressed like biometry post retina surgery, very dense cataract where it is difficult to obtain axial length, and cases with extreme axial lengths. Highlights: In this case?based approach, with relevant example, we tried to provide solutions for biometry in tricky scenarios like poor cornea, biometry post refractive surgery, dense cataracts, and cataract post retinal surgery. On following these commandments, not only will the litigations stop but our patients will be happier as well
ABSTRACT
Background: Research and awareness on refractive solutions for presbyopia, commonly known as the “Curse of the 40’s,” is essential as a large population in the world suffer from vision impairments. Population-based surveys have shown that one billion people in the world are in presbyopic age. Purpose: Many structural and physiological changes occur in the eye with the onset of presbyopia, including the decrease in amplitude of accommodation. At present, various static and dynamic techniques have been attempted to give presbyopes good vision at near-, intermediate-, and far-viewing distances. The aim of the video is to familiarize the modern-day ophthalmologists to these modalities. Synopsis: In this video, we tried to summarize the indications and contraindications of presbyopic laser. Preoperative investigations like dominance testing and micro monovision testing are described. The role of neuroadaptation and patient counselling is emphasized. Static techniques described in the video include spectacles, contact lenses, surgical options like corneal inlays and onlays, corneal laser ablation, conductive keratoplasty, corneal implant lenses, INTRACOR and IOLs. Dynamic presbyopia correction (accommodative) is always surgical. This is split into lenticular (accommodating IOLs, piggyback, lens refilling, lentotomy) and scleral treatment (laser-assisted presbyopia reversal and scleral expansion bands). Highlights: The types of corneal laser ablation, which is otherwise very confusing, is elaborated in a step-wise manner here. The difference in approach of PresbyLasik (Nidek), Presbyond (Zeiss) - Laser Blended Vision, PresbyMax (Schwind), INTRACOR (Technolas) are explained with examples. Each approach has its pros and cons. Our challenge as a surgeon is to identify the best combination for the patient. This video illustrates the treatment options which can help break the curse of presbyopia
ABSTRACT
Purpose: To determine exophthalmometry values (EV) in the north Indian population and to find its correlation with the age, gender, height, weight, body mass index (BMI), locality, and base value of the population. Methods: A total of 1000 eligible participants with 504 females and 496 males with age >5 years were included in this observational cross-sectional study. Age, gender, and locality of the subjects were noted. Hertel’s exophthalmometry was performed on all subjects. The exophthalmometry values and base values were recorded. Height and weight were measured for all participants. BMI was calculated using the parameters. Results: The overall mean exophthalmometry value (mm) was 14.94 ± 2.43 mm with a range between 8 and 22 mm. There was no significant difference in EV between the two eyes. Males recorded a significantly higher mean EV of 15.4 ± 2.51 mm as compared to females with a value of 14.49 ± 2.27 mm. Base value of Hertel’s exophthalmometer had a mean value 100.78 ± 5.63 mm and a range of 84–120 mm. Age, height, weight, BMI, and locality of the subjects were found to have a significant effect on the exophthalmometry as well as the base value of the population. A significant correlation was also seen between exophthalmometry values and base values of the population. Conclusion: Our study provided the normal exophthalmometric range for the north Indian population and also demonstrated the relationship of age, gender, height, weight, BMI, locality, and base value with the exophthalmometric values