Management of cataract--a revolutionary change that occurred during last two decades.

In the field of ophthalmology, perhaps no other surgery has undergone such rapid changes in the past few decades, as the surgery for cataract. Over these years there has been an emergence of small incision cataract surgery, especially by phaco-emulsification. It offers a number of attractive benefits to both the surgeon and the patient. Phaco has now captured the centre stage in the surgical management of cataract. With the advent of phaco it became imperative to design incision in a valvular manner to provide water tight anterior chamber, to design phacoprofile intra-ocular lenses specifically foldable intra-ocular lenses, instruments for precision and better control, better visco-elastic material and irrigating fluids. These advancements in this field have revolutionised the management of cataract surgery and have facilitated achieving new peaks in quality of surgery and recovery of visual acuity to precataract stage and correction of pre-existing astigmatism.

Why go endocapsular?

A prospective randomized clinical trial was carried out to compare the intercapsular or the endocapsular technique of IOL insertion and conventional posterior chamber IOL insertion after can opener capsulotomy. Age and sex matched groups of 76 patients each underwent surgery by the two techniques. The corneal and the uveal reaction was evaluated on the first day after the surgery and specular counts were done at six weeks. Though the difference between the two groups was not statistically significant, a trend in favour of intercapsular technique emerged strongly.

Destructive ocular myiasis in a noncompromised host.

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.

Pitfalls in aphakic contact lens fitting.

We examined 23 consecutive cases of unilateral aphakia reporting to the contact lens office for endothelial count and morphology, corneal thickness and toricity. The fellow eye served as a control in all the cases. It was found that there is a significant drop in the central endothelial cell density, and change in the size and shape of the cells. These observations indicate a thermodynamically unstable state. The aphakic corneas were thicker than the controls but not to a significant extent. The cell count and pachymetry had no statistical correlation. Toricity of the aphakic corneas make successful fitting of a lens difficult. Since prolonged use of extended wear gas permeable as well as hydrogel lenses have a deleterious effect on the endothelium it is suggested that a careful case selection be made and strict monitoting carried out at follow up. These corneas are liable for decompensation with only mild noxious stimuli. This article is intended to acquaint the ophthalmologist with the pitfalls in aphakic contact lens fitting so that a cautious follow up may be planned.

Specular microscopy of unilateral hard contact lens wearers.

The effects of long term wear of PMMA contact lenses on the corneal endothelium used on a daily wear basis were determined by examining 8 patients who had been prescribed lenses in one eye only. The patients excluded unilateral aphakes. It was found that a significant reduction in the cell density and a change in the cell size and shape was induced by PMMA lenses. These changes reflect an endothelial metabolic stress and emphasize the need to find newer lens materials that are more oxygen permeable and produce little interference with the corneal metabolism.