ABSTRACT
Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification technique for dealing with soft cataracts using high vacuum and zero energy. Following capsulorhexis and hydrodissection, we introduced the phacoemulsification probe, keeping the torsional and longitudinal power at zero. A central groove was created in sculpting mode. We held the nucleus with adequate vacuum in chop mode and divided the nucleus. Then, we rotated and chopped the nucleus similarly into small pieces without using any power. For emulsification, we increased the vacuum to 600 mmHg and then shredded and stuffed the pieces into the phaco probe by the chopper. A newer generation phaco machine with active fluidic system and monitored pressurized infusion helps the surgeon control the intraocular pressure (IOP) and hold the nucleus with vacuum alone, allowing chopping and emulsifying of the pieces without any energy.
ABSTRACT
Purpose: To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma. Methods: This prospective, comparative study was conducted on patients with glaucoma. The participants’ anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or ‘State’ anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]. Results: A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five. Conclusion: Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients
ABSTRACT
Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription?polymerase chain reaction (RT?PCR) to screen COVID?19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital?based study. Point?of?care (PoC) RAT was performed using nasopharyngeal swab, while RT?PCR for SARS?CoV?2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS?CoV?2 by using both RAT and RT?PCR. Only one patient had tested positive for SARS?CoV?2 with both RAT and RT?PCR, while two patients had tested positive with RT?PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT?PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT?PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT?PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID?19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.
ABSTRACT
Purpose: The International Council of Ophthalmology?Small Incision Cataract Surgery (ICO?SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents’ surgical skills by using the ICO?SICS rubric and the perceptions of residents and faculties about its use. Methods: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February?2020 included 14 residents and five faculties. Faculties scored residents’ SICS by ICO?SICS?rubric (four sessions/resident) and helped them identify three steps as “area of focus” to work upon. Feedback was taken using a semi?structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. Results: Step?wise rubric score showed improvement for initial SICS steps and wound closure (P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO?SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. Conclusion: ICO?SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency
ABSTRACT
Neuroophthalmic manifestations are very rare in corona virus disease?19 (COVID?19) infection. Only few reports have been published till date describing COVID?19?associated neuroophthalmic manifestations. We, hereby, present a series of three cases who developed optic neuritis during the recovery period from COVID?19 infection. Among the three patients, demyelinating lesions were identified in two cases, while another case was associated with serum antibodies against myelin oligodendrocyte glycoprotein. All three patients received intravenous methylprednisolone followed by oral steroids according to the Optic Neuritis Treatment Trail ptotocol. Vision recovery was noted in all three patients, which was maintained at 2 months of the last follow up visit
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Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram?negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day?care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia. Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow?up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection