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Background: Corneal melt with iris prolapse is a rare complication of autoimmune diseases, especially rheumatoid arthritis. Purpose: To highlight a challenging case of a peripheral ulcerative keratitis (PUK) with corneal melt and iris prolapse in a patient’s only eye. Synopsis: A 56?year?old Asian Indian male presented with blurring of vision in the right eye and was diagnosed with cataract. He was a known type 2 diabetes mellitus and a rheumatoid arthritis patient and was not on treatment. He had been previously diagnosed with PUK in the left eye and was lost to follow?up due to coronavirus disease 2019 (COVID?19) after therapeutic penetrating keratoplasty and lost his vision in that eye. Cataract surgery in the right eye was done under cover of immunosuppression. Subsequently, he developed PUK and was treated with a glue and bandage contact lens. Again, he was lost to follow?up and then presented a few months later with corneal melt with iris prolapse in the right eye. We describe in the video the surgical and medical challenges and successful salvage of both the eyeball and the vision. Highlights: Highlights include the following: 1. A rare case of corneal melt with iris prolapse. 2. Demonstration of surgical technique of patch graft. 3. Anterior segment optical coherence tomography before and after the procedure.
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Mastering manual small-incision cataract surgery (MSICS) for beginner surgeons is difficult. In the initial days of residency or training, surgeons struggle to make a proper scleral tunnel and keratome entry. It commonly results in premature entry and iris prolapse. Most of the literature has shed light on premature entry during tunnel construction by a crescent blade, whereas a significant majority of iris prolapse happens due to improper keratome entry. This novel trypan blue dye-assisted tunnel staining (TBTS) technique helps in proper tunnel demarcation which can reduce the incidence of premature entry with a keratome.
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Background: Dilemma of cost effectiveness of manual small incision cataract surgeries (MSICS) in the terms of training and equipment has been widely pondered upon in developing areas. Objective of the study is to compare the manual small incision cataract surgery and extra capsular cataract extraction. Methods: A prospective study was conducted among the IPD patients of the Ophthalmology Department of Khaja Bandanawaz Teaching and General Hospital, Kalaburagi, from June to December 2017. Statistical Analysis was performed using Microsoft Excel 2013, SPSS 23.0 and Chi-square test was performed. Results: Out of the 160 individuals who underwent extra capsular cataract extraction (ECCE), 06 (3.75%), 91 (56.88%) and 63 (39.37%) of the study subjects had poor (5/50), moderate (6/60-6/24) and good (6/18-6/6) visual acuity respectively. Highest incidence was that of lens prolapse (25%) and corneal complications (25%) in ECCE. Among the subjects who underwent MSICS, highest incidence of intra operative complication noticed was that of lens prolapse, iris prolapse and anterior chamber collapse, each at 20%. Conclusions: It was concluded that the restoration of visual acuity was fairly good and uniform in both the procedures. Certain intra operative complications such as lens prolapse, iris prolapse and anterior chamber collapse were noticed in MSICS and capsular flaps and vitreous loss were noticed only in ECCE.
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PURPOSE: To report a case of bilateral corneal wound dehiscence with iris prolapse after coronary artery bypass surgery. CASE SUMMARY: A 65-year-old woman complained of sudden bilateral vision loss. Slit lamp microscope examination showed bilateral corneal wound dehiscence, collapse of the anterior chamber and iris prolapse. The patient had a history of bilateral cataract surgery one-month earlier and a coronary artery bypass surgery one-day previously. The authors resutured the corneal wound and performed an emergency iris repositioning. Postoperative 1 day, the best corrected visual acuity (BCVA) was 0.3 in the right eye and hand motion in the left eye. Total hyphema was observed in the left eye. At postoperative 2 months, the right eye had a BCVA of 0.63 with a sutured state of the corneal wound, and the left eye had a BCVA of light perception with a clotted hemorrhage in the anterior chamber. CONCLUSIONS: When a patient with a history of a previous sutureless cataract surgery has a coronary bypass surgery under general anesthesia, corneal wound dehiscence and iris prolapse may occur. For those patients, the authors recommend suturing the corneal wound instead of sutureless cataract surgery.