Comparison of acrylic and polymethyl methacrylate lenses in a pediatric population.

PURPOSE: To compare the intra-patient incidence of posterior capsular opacification (PCO) and their post operative course, in children with bilateral cataract, following implantation of acrylic (Group 1) and polymethyl methacrylate (PMMA) (Group 2) intraocular lenses (IOLs). MATERIALS AND METHODS: This was a prospective, interventional intra-patient case series. Twenty-five children with bilateral cataract, 5 years and older, underwent cataract surgery and implantation of an acrylic (AcrySof MA30BA, Alcon, Fortworth, TX) in one eye and PMMA (Indo Am IAB 203, Ocular Vision, Inc.) IOL in the other eye of each patient. They were followed up for an average of 11.1 +/- 9.5 months to assess the incidence of clinically significant PCO and occurrence of postoperative complications. RESULTS: Twenty-three children (46 eyes), were included in this study. Post-operatively, 22(95.6%) patients with acrylic IOLs and 20 (86.9%) patients with PMMA IOLs, either maintained or improved their vision. In the acrylic and PMMA IOL groups respectively, the incidence of clinically significant PCO was 21% (4) and 75% (12) ( P =0.002), with a median onset at 2.9 months and 0.7 months. Other complications included pupillary capture in 2 (8.7%) eyes and uveal prolapse in 1 (4.3%) eye in the acrylic group and increased uveal inflammation in 6 (26.1%) eyes and presumed noninfectious endophthalmitis in 2 (8.7%) eyes in the PMMA group. CONCLUSION: Incidence of PCO and post operative uveal inflammation is significantly less with acrylic lenses and were safe to use in pediatric eyes.

Ophthalmic complications and management of Stevens-Johnson syndrome at a tertiary eye care centre in south India.

PURPOSE: To review the possible aetiological factors, ocular complications and their management in patients of Stevens-Johnson syndrome with ocular involvement, seen at a tertiary eye care centre. METHODS: We retrospectively reviewed the medical records of patients with Stevens-Johnson syndrome seen between 1987-1998 at L V Prasad Eye Institute. The demographic and possible aetiological factors data causing Stevens-Johnson syndrome were collected. The details of the ocular examination and treatment were collected and examined to determine the pattern of presentation, complications, treatment response and outcome. RESULTS: A total of 95 patients, 40 males (42.10%) and 55 females (57.89%), were identified during the 11-year period. A majority of the patients (n = 53; 55.78%) were between 20 and 40 years of age. All patients had bilateral involvement and most (n = 93; 97.89%) had bilateral symmetrical presentation. The duration from the onset of symptoms to the time of presentation at the institute varied from 6 days to 18 years with most patients presenting after one year (n = 39; 41.05%). The most commonly identified possible causative factor was drugs (n = 55; 51.89%). No definitive cause was identified in 37 (38.94%) patients, and 3 (3.15%) patients had a history of viral fever preceding the onset of Stevens-Johnson syndrome. The best corrected visual acuity at initial presentation was 6/12 or better in 32 (33.68%) patients. Lid abnormalities were observed in 87 (91.51%) patients, conjunctival abnormalities in 92 (96.84%) and corneal complications in 93 (97.89%). All patients were managed medically and 26 (27.36%) patients underwent surgery. CONCLUSION: Stevens-Johnson syndrome remains an important cause of severe visual loss and ocular morbidity, both of which significantly affect the quality of life. Not many medical or surgical options are available even in tertiary eye-care centres. Future advances in immune modulation techniques may prevent many of the sequelae that continue to occur despite the best possible medical care.

Complications of laser-in-situ-keratomileusis.

Laser-in-situ-keratomileusis (LASIK) has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased postoperative haze. Compared to photorefractive keratectomy (PRK), LASIK involves an additional procedure of creating a corneal flap. This may result in complications related to the flap, interface and underlying stromal bed. The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include undercorrection, regression, irregular astigmatism, decentration and visual aberrations. Honest and unbiased reporting is important to understand the aetiology and redefine the management.