ABSTRACT
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
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: 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
Background: The normative data set in authomated perimetry is predominantly of non?Indian origin and hence may not be an accurate basis for visual field analysis in Indian population.This video describes an attempt to create a native normative dataset for automated perimetry, which can then be fed in our machines and be used as the normative database. Purpose: To formulate normative data and to increase domain knowledge of normative values for automated perimetry in Indian population of different age groups. Synopsis: Cross?sectional study conducted on patients receiving outpatient care in a span of 3 years, which included 6586 healthy normal patients (13172 eyes) with vision 6/6 unaided or after refractive correction. The patients were tested with 30?2 SITA FAST threshold algorithm on Humphrey Field Analyzer Model no: 745i. Normative data was calculated on basis of age group ranging from 19?75 years categorized to every decade. Normal values were formulated on basis of perimetry performed on normal patients. Highlights: Our work on creating a native normative dataset may add value as well as increase the accuracy of perimetry analysis in Indian eyes
ABSTRACT
It is frequently difficult to identify and localize intraorbital foreign bodies despite modern-day high-resolution imaging studies. Although there can be grave complications associated with retention of organic intraorbital foreign bodies, many believe that removal of such bodies in most cases is unwarranted. A high clinical suspicion, proper choice of imaging studies, and removal by a skilled orbital surgeon probably make the risk of surgical exploration and foreign body removal less than the risk of foreign body retention. We present a case of extraconal foreign bodies (11 glass particles), which required exploration for retrieval. An initial bedside exploration led to locating two foreign bodies (glass particles of 2 × 2 cm and 1 × 1 cm size respectively). A second exploration in the ophthalmology operating theater yielded 11 foreign bodies (glass particles of various sizes) in the superior area of extraconal space.
ABSTRACT
Background: Drug utilization provides prescribing behaviors of prescriber. Rational prescribing of antimicrobial drugs plays a crucial role in reducing the antibiotic resistance. The study aim was to analyze the patterns of antimicrobial prescribed ophthalmology outpatient department (OPD) patients. Methods: The study was an observational study completed over a period of 6 months, from July 2014 to December 2014. The study was conducted in Department of Ophthalmology, MGM Medical College, and Hospital Navi Mumbai. A questionnaire was specifi cally designed factoring patients’ demographical profi le, diagnosis of disease, drug regimen. Results: A total 125 prescriptions of patients were analyzed who visited ophthalmology OPD department. Maximum patients belonged to the age group of 41-50 years (27.2%), followed by age group of 31-40 years (25.6%). The proportion of male (59%) patients was more as compared to female patients (41%). Total drug prescribed was 296. Average drug per prescription was 2.36. Among 296 drugs, 144 were antibiotic prescribed. Average antibiotic per prescription was 1.15. Most commonly antibiotic prescribed was moxifloxacin. Most common fixed dose combination (FDC) of antibiotic prescribed was tobramycin plus loteprednol. Among total 125 patients, maximum patients were diagnosed with cataract (25%), followed by meibomitis (12%), conjunctivitis (24%), blephritis (9%), foreign body in eye (12%), psedophakia (10%) and other disease (8%). 96% of antimicrobial were prescribed from essential drug list. The FDC of antimicrobial (40%), fl uroquinolone (19%), aminoglycoside (13%), broad spectrum (12%), macrolide (9%), anti-viral (7%) was prescribed. Maximum number of drugs was found in the form eye drops (72%). Conclusion: The present study found that FDC of antibiotic was prescribed maximum. Most common dosage form of prescribed drug was eye drop. Prescription of drugs by brand name was a matter of concern