Continuous intraoperative OCT guided management of post-deep anterior lamellar keratoplasty descemet's membrane detachment

Continuous intraoperative optical coherence tomography [iOCT] integrated into the operating microscope is a new modification in the current operating microscope to aid in the surgical procedures involving both the anterior and the posterior segment. This helps in intraoperative planning, modification of the surgical steps if required and confirmation of the surgical endpoint in the operating room itself. iOCT was used for the successful management of descemet's membrane detachment [DMD] following deep anterior lamellar keratoplasty [DALK] with intracameral injection of 20% Sulphur hexafluoride. The gas was injected under direct visualization through the microscope with continuous real time monitoring of the change in height of the detached Descemet's membrane [DM]. Additionally stab incisions were given through the anterior cornea due to the presence of residual fluid above the DM which was visible on continuous iOCT images. This led to the successful apposition of the DM which otherwise would have remained detached due to the residual fluid. This highlights the importance of continuous iOCT monitoring of the ophthalmic surgical procedures in order to produce a successful anatomical outcome of the surgery without disruption of the surgical procedure

Rose-K versus Soper contact lens in keratoconus: a randomized comparative trial

To perform a comparative evaluation of the efficacy and acceptability of Rose-K and Soper contact lenses in Keratoconus. Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. A randomized comparative clinical trial was performed in keratoconic eyes fitted with Rose-K [Rose-K group] and Soper [Soper group] contact lenses. Patients data were evaluated for best spectacle corrected visual acuity, best contact lens corrected visual acuity [BCLCVA], corneal topography, glare acuity, contrast sensitivity, tear function tests and specular microscopy. Patients were also asked to complete a self-reported comfort questionnaire at each visit. Sixty eyes were randomized to the Rose-K and Soper groups. The two groups were comparable in all the baseline parameters. There was a statistically significant improvement in BCLCVA in both groups at 3 months [P < 0.01, both groups]. The difference between in BCLCVA in both groups was not statistically significant. In both groups, there was a significant improvement in the comfort score at 3 months compared to baseline [P< 0.05, both group]. The Rose-K group had statistically significantly better scores at 1 and 3 months compared with the Soper group [P- 0.006 and P< 0.001 respectively]. Both groups were associated with a significant [P< 0.0l], but comparable improvement in glare acuity at 3 months. There was a significant improvement in contrast sensitivity at 3 months in both groups [P< 0.0l]? the Rose-K group was significantly better than the Soper group at 1 and 3 months [P= 0.001 and 0.002 respectively]. The mean number of trial lenses required for fitting Rose-K lens [2.00 +/- 0.59] was significantly lower than the Soper lens [3.43 +/- 0.82; P< 0.00l]. Both the contact lens designs provide an equal improvement in visual acuity in patients with Keratoconus. However, Rose-K contact lens provides greater comfort, better quality of vision and requires less chair time compared with the Soper lens and hence may possibly have a greater acceptability

Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous

To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous [PHPV]. In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade [plasma knife] and removed with a vitrector. A foldable posterior chamber intraocular lens [IOL] was implanted in eight eyes and the outcomes were evaluated. The mean age of patients was 16.8 +/- 6.37 months [range: 5 to 28 months]. The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation [aphakic]. None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of >/= 20/200 with 50% [4/8] of these eyes with >/= 20/60 vision. Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV

Spontaneous, uncomplicated dissolution of a large cotton fiber in the laser in situ keratomileusis interface

In this article, we report the spontaneous dissolution of a long cotton thread in the laser in situ keratomileusis [LASIK] flap interface. In this observational case report, sequential follow-up of a post-LASIK eye with a long cotton fiber noticed in the LASIK interface was performed. The postoperative course was uneventful, with no evidence of infection, uveitis, or any other complications. The cotton thread underwent spontaneous dissolution. Conservative management of a cotton fiber, not causing any symptoms and noticed after the immediate postoperative follow-up period is over, seems to be a possible alternative to flap relift and intervention

Management of intraoperative miosis during pediatric cataract surgery using healon 5

We describe a technique for achieving pupillary dilatation in order to manage and counteract intraoperative miosis during pediatric cataract surgery using viscoadaptive viscoelastic [sodium hyaluronate 2.3%]. The technique of viscomydriasis was used in six eyes with pediatric cataracts with intraoperative pupillary miosis. Pupillary dilatation was achieved and maintained in all eyes throughout cataract surgery. All the surgical steps including anterior and posterior capsulorrhexis and aspiration were performed successfully. Viscomydriasis is a simple and effective technique for the management of intraoperative pupillary miosis during cataract surgery in pediatric eyes

Scrofuloderma and bilateral anterior staphyloma of eye: an unusual association

We report a patient with bilaterally symmetrical perforated corneal ulcers with formation of anterior staphyloma associated with scrofuloderma. A 22-year-old female in her third month postpartum presented with multiple perforated corneal ulcers bilaterally. There was a presence of a skin lesion that was consistent with scrofuloderma. Fine needle aspiration cytology of preauricular lymph nodes showed evidence of granulomatous inflammation consistent with tuberculosis. Corneal scraping revealed the presence of coagulase-negative Staphylococcus. She was treated with topical fortified combination antibiotics [cefazolin and tobramycin]. The corneal ulcer resolved with formation of anterior staphyloma in both eyes. The patient underwent anterior staphylectomy and tectonic keratoplasty in both eyes. Eight weeks postoperatively, her visual acuity improved to 20/200 in both eyes with clear grafts. Scrofuloderma may be associated with recurrent phlyctenulosis. Multiple corneal ulcerations coupled with use of topical steroids may result in corneal perforation and formation of anterior staphyloma