Study-of-phacoemulsification-vs-phacotrabeculectomy-in-management-of-primary-angle-closure-glaucoma

Introduction: The study was conducted to evaluate IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. Vision impairment is a major public health problem and the burden is increasing with increase in aged population. This study wasAims And Objectives: undertaken for study the IOP management by surgical modalities such as combined trabeculectomy and phacoemulsification and phacoemulsification surgery alone. A pre-designed prospective study was conducted at the OPD of upgraded Department of Ophthalmology at LLRM Medical College, Meerut. A total of 60 patients were divided in to two equal groups randomly and studied. Majority of the patients in both the groups wereObservation And Result: aged between 61 – 70 years. Females outnumbered males in this study which was statistically significant between the two groups. The mean pre- operative intra ocular pressure was 23.3 mm Hg in combined surgery group and 23.9 mm Hg in cataract surgery alone group. Mean Intra ocular pressure decreased regularly in each follow up more in combined group than the cataract surgery alone group. The mean intra ocular pressure after 1 years follow up in combined surgery group was 10.8 mm Hg and 13.4 mm Hg in the cataract surgery alone groups which was statistically significant. Mean BCVA before the operation was 3.2 in combined surgery group and 3.8 in cataract surgery before surgery. Mean BCVA declined after 1 year of follow up in combined surgery group was 1.9 and 2.7 in cataract surgery alone group which was statistically significant. The surgery success was complete in 80.0% of the combined surgery group and 60% of the cataract alone group. Criteria For Failure Of Surgeries Ÿ The IOP >23 MMHG at the end of 1 year or Ÿ The IOP not reduced by 20 % from base line at the end of 1 year Conclusion: This study was mainly undertaken to study the efficacy of combined trabeculectomy with cataract extraction and cataract only on primary angle closure glaucoma. This study had found that, the reduction of intra ocular pressure in both the groups but more prominent in combined surgery group than cataract alone surgery group.

Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery

Purpose: Functional recovery after cataract surgery depends on the anatomical recovery of the eye. This study compared the improvement in visual function parameters after uniocular manual small-incision cataract surgery (MSICS) and phacoemulsification cataract surgery. Methods: This study included 310 patients divided randomly into two groups: 155 who received MSICS (MSICS group) and 155 who underwent phacoemulsification (phaco group) for cataract treatment. Outcome measures assessed included vertical and horizontal keratometry reading. The mean corneal astigmatism tear function measured using Schirmer 1 test results were recorded preoperatively, and on postoperative day 1, day 7, and day 30. Optical coherence tomography (OCT) was done to record the average central macular thickness (?m) on day 7 and day 30. Results: The mean corneal astigmatism and anterior chamber inflammation were more in the MSICS group than in the phaco group immediately postoperatively. However, no statistically significant difference was found between the groups with respect to corneal sensation, mean corneal astigmatism, tear film function, and visual outcomes on postoperative day 30. Uncorrected visual acuity was better in the phacoemulsification group than in the manual SICS group on postoperative day 1, day 7, and day 30 (P < 0.001). Conclusion: Both phacoemulsification cataract surgery and manual small-incision sutureless cataract surgery (MSICS) are safe and effective for visual rehabilitation. Phacoemulsification is the preferred technique where resources are available with the advantages of less mean corneal astigmatism, less anterior chamber inflammation, and better uncorrected visual acuity (UCVA) in the immediate postoperative period

Re-inventing the straight incision with a single central suture in manual small-incision cataract surgery to minimize surgically induced astigmatism

Purpose: To calculate the surgically induced astigmatism (SIA) in MSICS through a superiorly placed straight scleral incision closed with a single, central, perpendicular 10?0 polyamide suture and to document any suture?related complaints and complications. Methods: A retrospective, hospital?based study was carried out in 50 cases of uncomplicated senile cataract (>50 year) with nuclear sclerosis ? grade 4, 搘ith the rule� astigmatism who underwent MSICS through a superior, straight incision with a single, central, perpendicular 10?0 nylon suture. Patients with 揳gainst the rule� astigmatism, keratoconus, pre?existing corneal opacity, astigmatism >2D, distorted or oblique mires, and previous ocular surgeries and unwilling to participate were excluded. Results: The mean age of the patients was 64.81 + 2.824 years, with a male: female ratio of 1.38:1. The mean SIA at day 7, week 6, and 12 weeks was 0.539 + 0.118, 0.529 + 0.134, and 0.524 + 0.129, respectively. Only 6 patients (12%) complained of foreign body sensation. No patient developed any suture?related complications. Conclusion: SIA is significantly reduced in straight incision by applying a single, central, and perpendicular 10?0 polyamide suture, as compared to a straight incision without a suture.

Clinical observation on removing or reserving the epithelial flap in high myopia correction by LASEK / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the clinical effects of removing or reserving the epithelial flap in high myopia correction by laser subepithelial keratomileusis(LASEK). <p>METHODS: Retrospective analysis of 58 patients(115 eyes)with high myopia received LASEK were selected and divided into reserving the epithelial flap group(30 patients, 59 eyes)and removing epithelial flap group(28 patients, 56 eyes)according to the order of the alternating vists. The changes of corneal irritation, epithelial healing time,uncorrected visual acuity and the occurrence of haze after surgery were observed.<p>RESULTS:Postoperative 1d, 2d, 3d, respectively, the pain score of the two groups were 1.64±0.64, 1.57±0.57; 0.83±0.49, 0.84±0.56; 0.36±0.48, 0.34±0.47, respectively, the differences were not significant(<i>P</i>>0.05). Postoperative 1wk, 1mo, 3mo, respectively, the uncorrected visual acuity of two group was 0.15±0.06, 0.12±0.05; 0.032±0.004, 0.041±0.003; 0.018±0.004, 0.022±0.005, and the differences were not significant(<i>P</i>>0.05). After 1mo, 3mo of surgery, the differences of the haze less than grade one of the two group, respectively, and were not significant(<i>P</i>>0.05), the differences of the haze of grade two of the two groups, respectively, and the differences were significant(<i>P</i><0.05). The epithelial healing time of the two groups were 4.22±0.30d, 3.89±0.32d(<i>P</i><0.05). The number of epithelial delayed healing of two groups was 0 eye and 10 eyes(<i>P</i><0.05).<p>CONCLUSION:It was similar both the changes of corneal irritation and uncorrected visual acuity of two groups,the rate of level two haze was higher in removing epithelial flap group. The time of healing of epithelium was quick than reserving the epithelial flap group,but the rate of delayed healing and poor healing of epithelium was higher than reserving the epithelial flap group. Therefore, for high myopia, it is worthy of clinical application of reserving the epithelial flap by LASEK.

Orthokeratology lens and conventional frame glasses for ocular parameters of myopia adolescent / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of overnight orthokeratology lens and conventional frame glasses on the myopic diopter, uncorrected visual acuity and ocular parameters of myopia adolescent. <p>METHODS: Totally 102 cases of(204 eyes)of adolescent myopia patients were randomly divided into observation group and control group with 51 cases(102 eyes)in each group during April 2014 to April 2017. Control group was only given conventional frame glasses, and observation group was given overnight orthokeratology lens. The myopic diopter and uncorrected visual acuity(UCVA)before wearing glasses and at 1wk, 1, 3, 6mo and 1a of wearing glasses, and the ocular parameters before wearing glasses and at 1a after wearing glasses were observed in the two groups, and the occurrence of complications was compared between the two groups. <p>RESULTS: After 1wk to 1a of wearing glasses, the myopic diopter in observation group was gradually decreased(<i>P</i><0.05), and there was no significant difference in control group(<i>P</i>>0.05), but there was statistically significant difference between-groups at different time points(<i>P</i><0.05). After 1wk to 1a of wearing glasses, the UCVA in observation group showed a increasing tendency(<i>P</i><0.05), and the UCVA in observation group after 6mo to 1a of wearing glasses was significantly higher than that in control group(<i>P</i><0.05). At 1a after wearing glasses, the axial length, corneal endothelial cell density, central anterior chamber depth, and intraocular pressure in observation group were not significantly different from those before wearing glasses(<i>P</i>>0.05), and the axial length in control group was significantly longer than that before wearing glasses and that in observation group(<i>P</i><0.05). The total incidence rates of complications in observation group and control group were 10.8% and 6.9% respectively(<i>P</i>>0.05).<p>CONCLUSION: Overnight orthokeratology lens for adolescent myopia can effectively correct the myopic diopter, and improve the uncorrected visual acuity. It is less harmful to the eyes and less complications, and it is safe and reliable in clinical application.

Effect of cataract surgical incision on original astigmatism and tear film stability of corrected cornea / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the effect of the size of cataract surgical incision on original astigmatism and tear film stability of corrected cornea.METHODS: Totally 92 cataract patients (92 eyes) who were admitted to our hospital from July 2014 to July 2016 were randomly divided into the control group and the observation group,46 cases (46 eyes) in each group.Both groups were treated by clear corneal tunnel incision phacoemulsification combined with intraocular lens implantation.The incision of the control group was 3.0mm while of the observation group was 1.8mm.The uncorrected visual acuity,corneal astigmatism,Schirmer I test (SⅠt) and break-up time (BUT) were detected before surgery and at 1d,1wk,1mo and 3mo after surgery.The surgery induced astigmatism (SIA) was recorded at 1d,1wk,1 and 3mo after surgery.RESULTS: There were significant differences in the uncorrected visual acuity between the two groups at 1 and 3mo before surgery (P0.05).At 1wk,1 and 3mo after surgery,SIA of two groups decreased continuously,and the SIA of the observation group was significantly lower than that of the control group at 1d,1wk and 1mo after surgery (P0.05).SⅠt and BUT in the observation group were less or shorter than those in the control group at 1wk after surgery (P0.05).CONCLUSION: Compared with 3.0mm standard incision,1.8mm clear corneal incision can reduce SIA and shorten the time for corneal stability recovery.

Correlation between Uncorrected Visual Acuity and Macular Distortion in Idiopathic Epiretinal Membrane Patients

PURPOSE: To evaluate the association between degree of retinal abnormalities and uncorrected visual acuity (UCVA) in idiopathic epiretinal membrane (ERM) patients with a small amount of refractive error. METHODS: We retrospectively reviewed 49 eyes (37 patients) of idiopathic ERM patients. We investigated the association between visual acuity and macular status (central macular thickness [CMT], outer retinal integrity score, and inner retinal irregularity index) that was assessed by optical coherence tomography using multiple linear regression analysis. We defined visual acuity difference (VAD) as the difference between UCVA and best-corrected visual acuity (BCVA). We divided patients into two groups according to VAD size and compared clinical characteristics between the two groups. We also investigated factors associated with VAD using multiple linear regression analysis. RESULTS: BCVA showed significant association with CMT and outer retinal integrity score, while UCVA showed significant association with CMT and inner retinal irregularity index. Patients with a large VAD showed a similar level of BCVA compared to the small VAD group (logarithm of the minimum angle of resolution [logMAR], large VAD group 0.11 ± 0.11 vs. small VAD group 0.13 ± 0.12, p = 0.585). However, UCVA was worse (logMAR, large VAD group 0.44 ± 0.14 vs. small VAD group 0.18 ± 0.14, p < 0.001) and inner retinal irregularity was higher (large VAD group 1.06 ± 0.04 vs. small VAD group 1.04 ± 0.03, p < 0.001) in patients with a large VAD. On multiple linear regression analysis, the absolute value of spherical equivalent (standardized coefficient β 0.521, p < 0.001) and inner retinal irregularity index (standardized coefficient β 0.448, p < 0.001) were significantly associated with VAD. CONCLUSIONS: UCVA was associated with inner retinal irregularity in idiopathic ERM patients with a mild degree of refractive error. Inner retinal irregularity was also associated with degree of VAD, suggesting that the effect of refractive error correction is greater in patients with more distorted retina.

Observation on phacoemulsification and intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy of phacoemulsification and intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis. ●METHODS:Retrospective study. A total of 57 cases (57 eyes ) with complicated cataract with uveitis were involved in the study from Jan. 2015 to Dec. 2015. All cases underwent phacoemulsification and intraocular lens implantation surgery successfully. The postoperative reaction, effect, complications and so on were retrospectively analyzed after phacoemulsification and intraocular lens implantation surgery. The date of visual outcome was analyzed using Non - parametric Wilcoxon test. ●RESULTS: lris were bleed in 21 eyes ( 37%) , 4 eyes ( 7%) with posterior capsule rapture and posterior chamber intraocular lens was not implanted in 4 eyes ( 7%) . The uncorrected visual acuity ( UCVA ) was significantly increased after surgery. The UCVA of 8 eyes (14%) were 0. 1 or better before surgery, and the UCVA of 42 eyes (74%) were 0. 1 or better 3mo after surgery, the difference was statistically significant ( Z=23. 42, P ● CONCLUSION: The phacoemulsification combined intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis has good effect and fewer complications.

Outcome of laser surgery for mild myopia and myopic astigmatism / Шинэ санаа Шинэ нээлт

LASIK is the most popular treatment method for correction of the refractive errors of ophthalmology its development in 1990 and number of patients has continued to increase.The safety and efficacy of LASIK surgery have been reported several times by numerous researchers and doctors, but all studies have made abroad. This time we have summarized postoperative outcomes of LASIK surgery, which have performed in our country. Consequently 103 patients (206 eyes) who underwent LASIK surgery in “Bolor-Melmii” eye clinic between 2007 and 2011 were enrolled. The retrospective method of study was used to evaluate postoperative outcomes. Preoperative UCVA of 0.04-0.4 improved to 0.5-1.2(decimal) at 1 day after surgery and during 1 year after surgery revealed minimal but wasstable. Preoperative mean sphere equivalent of 2.2+/-0.72D improved at the 1 year by +/-0.5D in 161 eyes (78.15%), by +/-1.0D in 39 eyes (18.9%) and by +/-2.0D in 6 eyes (2.9%)after surgery. Mean sphere equivalent and astigmatism improved to -0.46 +/-0.4D and -0.43+/-0.34D respectively at 1 year after surgery. Improvement of the sphere equivalent and its stability during a year period of study proves that LASIK surgery is an effective with stable improvements and safe procedure for correcting myopia/myopic astigmatism. No severe complications occurred during and after surgery.

lmpact of incision position of phacoemulsification cataract exaction on corneal astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

To compare the impact of different incision positions of phacoemulsification cataract exaction on corneal astigmatism. ●METHODS: Totally 412 patients ( 456 eyes) who had undergone the phacoemulsification and lOL implantation from June 2006 to June 2013 were randomly divided into two groups (each 228 eyes): observation group (incision above the middle of the limbus for the rule astigmatism, at the temporal for against the rule astigmatism, at the top of the temporal regulation on the maximum curvature of the meridian of the cornea for oblique astigmatism, at the top of the temporal for patients without astigmatism);control group ( incision at top and middle of limbus), using a 3mm cornea scleral tunnel incision without suture, 2mm from the limbus. Corneal refractive status of preoperative and postoperative at different times were detected by corneal refractive, comparing the impact of different surgical incision on postoperative corneal astigmatism. ●RESULTS:The visual acuity of 1, 3mo postoperative of observation group was significantly better than the control group ( P ●CONCLUSlON:lncision at the corneal curvature of the largest radial could correct preoperative astigmatism and improve visual acuity to a certain extent.

Visual Function and Patient Satisfaction in Pseudophakic Monovision

PURPOSE: To evaluate visual performance as well as patient satisfaction and to explore factors associated with clinical outcomes in pseudophakic monovision acquired after bilateral phacoemulsification and sequential monofocal intraocular lens (IOL) implantation. METHODS: The present retrospective study examined patients with pseudophakic monovision. Preoperative and postoperative binocular uncorrected distant visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), refractive errors and postoperative near stereopsis were measured. Postoperative measurements were obtained at least 6 months after the fellow eye surgery. Patient satisfaction and independence from glasses were evaluated using a questionnaire. RESULTS: Preoperative and postoperative binocular UCDVA, UCNVA, and differences in spherical equivalent refractive error were statistically significant. Postoperative near stereopsis was 107.1 arcsec. Questionnaire responses showed that 71.4% of patients were less dependent on glasses and 85.7% were satisfied with the postoperative visual performance. Various designs of monovision, such as crossed monovision or customized minimonovision with moderate myopic defocus showed the same level of patient satisfaction. Patients who were older than 60 years or had poorer preoperative binocular UCDVA showed higher satisfaction. CONCLUSIONS: Pseudophakic monovision is an effective approach for managing loss of accommodation after cataract surgery, especially in patients older than 60 years.

Relationship between Uncorrected Visual Acuity and Refractive Error in Visual Acuity Test of Children

PURPOSE: To evaluate the relationship of uncorrected visual acuity and refractive error in children. METHODS: Visual acuity testing was performed, using LogMAR chart without optical aids, in children between 4 and 11 years old. Cycloplegic refraction was carried out to check the refractive error. Correlation indices between uncorrected visual acuity (UCVA) and refractive error were obtained by regression analysis with SPSS according to the sex, age, and refractive error type, myopia, or hyperopia. RESULTS: One hundred and one children were enrolled in this study. Spherical refractive error range was -13.00D~+6.25D and cylinder range was -4.50D~0D. In the older age group, correlation indices of UCVA and refractive error increased. In addition, female patient and myopia were other components that increased the correlation indices. The formulae for the UCVA regression line and refractive error were; y=0.491e0.1492x (x=refractive error, y=UCVA), R2=0.4319. Based on the regression line, a prediction table to calculate the refractive error from the UCVA and UCVA prediction table of refractive error was made. CONCLUSIONS: For the children who are not cooperative, the prediction table of this study will be helpful to reduce the test error in visual acuity and refractive error tests.

Changes of Astigmatism after Sutureless Cataract Surgery Through 3.2mm and 5.1mm Incisions

To evaluate the changes of surgically induced astigmatism in sutureless small incision cataract surgeries, we divided our cases into two groups. In group 1 (38 eyes), we performed phacoemulsification and implanted foldable silicone intraocular lenses (IOLs) through 3.2mm clear corneal incisions. In group 2 (30 eyes), we did phacoemulsification and implanted PMMA IOLs through 5.1mm scleral tunnel incisions. We analyzed the early postoperative astigmatism in two groups. The average surgically induced astigmatism in group 1 was 0.1D at one day, 0.36D at six months. In group 2, it was 0.6D at one day, and 0.36D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the superior incision cases, the average surgically induced astigmatism in group 1 was 0.47D against the rule(-0.47D) at one day, -0.07D at six months. In group 2, it was 0.42D at one day, 0.44D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the temporal incision cases, the mean surgically induced astigmatism in group 1 was 0.31D at one day, 0.59D at six months. In group 2, it was 0.83D at one day, 0.24D six months postoperatively. Also, there was no statistically significant difference between the two groups(p>0.05). Percentages of uncorrected visual acuity above 0.5 reached over 90% in group 1 at one month postoperatively, and in group 2 at two months postoperatively. In conclusion, both the 3.2mm clear corneal incision group and the 5.1mm scleral tunnel incision group revealed good visual rehabilitation in early postoperative period and their mean surgically induced astigmatism was not statistically significant.

One Year Surgically Induced Astigmatism and Uncorrected Visual Acuity in 5.5 mm Unsutured Scleral Tunnel Incision

We evaluated postoperative changes of astigmatism and uncorrected visual acuity in 5.5 mm unsutured scleral tunnel incision, phacoemulsification and oval shape intraocular lens(IOL) implantation. Average surgically induced astigmatic changes were 0.09D against the rule(-0.09D) at one week, -0.25D at one month, -0.28D at two months in 55 patients as well as -0.21D at six months(n=25) and -0.38D over one year(n=25). The average uncorrected visual acuities improved from 0.07 preoperatively to 0.67 at one week, 0.75 at one month, 0.75 at two months in 48 patients as well as 0.72 at six months(n=25) and 0.64 over one year(n=25) postoperatively. There were no statistic~lly significant changes from one week over one year in both variables(p>0.05). Our results suggest that change of surgically induced astigmatism is little and stable as a well as rehabilitation of postoperative visual acuity is rapid in cataract operation using the 5.5 mm unsutured scleral tunnel technique.

Radial keratotomy for the purpose of reducing glasses power in high myopia

Anterior radial keratotomy for high myopia (over-6.25 diopter) to reduce refractive error was not able to dispense with glasses or contact lenses due to the high myopia itself. However patients could see objects well and were free of dizziness while wearing glasses of relatively reduced power. We performed anterior radial keratotomies on 83 high myopic and/or astigmatic eyes of 47 patients at Kangnam St. Mary's Hospital between May 1990 and Mar. 1991. Eight radial incisions with a diamond blade were performed and the Ruiz technique was added for astigmatism of over 2.0 diopters. The depth of incision was 90 to 95% of corneal thickness and the optical zone was 3mm in diameter. Patients were followed up on postoperative 7 days. 1 month, 3 months, 6 months, 1 year and thereafter. Uncorrected visual acuity of 20/40 or better after radial keratotomy could be obtained in 19.6% of high myopic eyes. A mean reduction of the spherical equivalent cycloplegic refraction of 5.13 diopters and a keratometric reading of 3.89 diopters after radial keratotomy were observed. About 90% of patients were satisfied with their visual outcome with reduced refractive power glasses. We recommend radial keratotomy for high myopic patients to reduce the refractive power and to help them enjoy a more comfortable life.

Clinical Results of Radial Keratotomy in High Myopia

Anterior radial keratotomy for high myopia (over -6.25 diopter) to reduce the refractive error was not able to dispense with glasses or contact lenses due to high myopia itself. However they could see the objects well and be free of a dizziness with wearing a relatively reduced power of glasses. Authors had performed on anterior radial keratotomy for 239 high myopic and/or astigmatic eyes of 143 patients at Kangnam St. Mary's Hospital between Nov. 1984 and Dec. 1990. Eight radial lines cut with diamond blade was performed and Ruiz technique was added for the astigmatism over 2.0 diopters. The depth of incision was 90 to 95% of corneal thickness and the optical zone was 3mm in diameter. Most of patients were followed up on postoperative 7 days, 1 month, 3 months, 6 months, 1 year and thereafter. Uncorrected visual acuity of 20/40 or better after radial keratotomy could be obtained in 19.2% of high myopic eyes. In addition, mean reduction of spherical equivalent of cycloplegic refraction and keratometric reading after radial keratotomy were 5.1 diopters and 3.85 diopters, respectively. About 90% of patients were satisfied with their visual outcome with reduced refractive power of glasses. We recommend radial keratotomy on high myopic patients to reduce the refractive power and to enjoy a comfortable life.