Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia

Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. Methods: This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA?assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal ? and Hill?RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Results: Sixty?five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal ? (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill?RBF > Haigis > SRK/T > Barrett Universal ?). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill?RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal ? (53.84%). Conclusion: IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal ? although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift

Urachal fistula in a 22 year male: a case report

A patent urachus is one of the spectrums of congenital urachal anomalies. It has been termed as "urachal fistula" when the lumen of intra-embryonic portion of allantois persist abnormally.  Persisting urachal fistula is a rare condition mostly diagnosed during childhood or in autopsies. Here we report a very rare case of urachal fistula of a young male. We present a case of 22 years male with intermittent periumbilical pain and sero-purulent discharge from umbilicus since birth. On examination sero-purulent discharging umbilical sinus with granuloma was present. Surgical excision of whole of the urachal fistulous tract was done with repair of bladder. Patient did well during post-operative period. Persisting urachal fistula in adult is rare entity and difficult to diagnose because of low incidence and non-specific symptoms. So a high index of suspicion is required in order to make the early diagnosis of urachal anomalies.

Inferior meso-caval shunt for portal hypertension with bleeding esophageal varices.

We report a 12-year-old boy with cavernomatous malformation of the portal vein who presented with repeated hematemesis. Inferior meso-caval shunt was performed to decompress the portal hypertension. There was minimal dissection and disturbance of periportal collateral channels in comparison to using the superior mesenteric vein. One year later, esophagoscopy showed no varices, and he has had no further episode of bleed.