Effect of decentration on the quality of vision in two aspheric posterior chamber intraocular lenses: A contralateral eye study.

PURPOSE: To perform an intraindividual comparison of the quality of vision and the effect of decentration between two aspheric intraocular lenses: aspheric balanced curve (ABC) design Vivinex iSert XY1 (Hoya Surgical Optics, Singapore) and anterior aspheric design Tecnis ZCB00 (Abbott Medical Optics, CA). SETTING: Tertiary Eye Care Centre. DESIGN: Prospective, randomized comparative study using a random number table. METHODS: Thirty patients were randomized to the implantation of Vivinex iSert XY1 in one eye and Tecnis ZCB00 in the contralateral eye. Then, 12 weeks postoperatively, a laser ray-tracing aberrometer was used to evaluate the visual Strehl ratio, higher-order aberrations (HOA), decentration of IOL from the visual axis and geometric axis, angle alpha, and angle kappa. Contrast sensitivity was measured using the functional visual analyzer. RESULTS: The visual internal Strehl ratio was higher ( P < 0.05) at all pupil sizes and the spherical aberrations values were lower ( P < 0.05) at larger pupil sizes (5 mm and 6 mm) in the Vivinex group. The mean decentration from the visual axis in the Vivinex group was significantly more than that in the Tecnis group ( P < 0.01). With an increase in angle alpha, there was a greater decline in the visual Strehl ratio for Tecnis; however, there was a statistically significant decline at 3 mm pupil size for Tecnis ZCB00 ( P = 0.028). The contrast sensitivity was similar for both IOLs. CONCLUSION: In comparison to an anterior aspheric design IOL, the ABC design IOL yielded better quality of vision, neutralized spherical aberrations to a larger extent, and provided a relatively superior quality of vision with decentration.

Waldenström Macroglobulinemia of the orbit: A diagnostic challenge.

PURPOSE: Ocular adnexal lymphomas (OAL) constitute 55% of all orbital tumors. Waldenström Macroglobulinemia (WM) presenting as an orbital mass with diffuse extraocular muscle (EOM) involvement is rare. We report an elderly patient who presented to the ophthalmologist for an orbital mass which on evaluation, turned out to an ocular adnexal WM. OBSERVATIONS: A 75 years old man presented with a palpable mass in the left anterior superior orbit and bilateral restricted ocular motility in all gazes. Computed tomography scan revealed a hyperdense mass with diffuse thickening of extraocular muscles and enlarged lacrimal gland on the left side. Incisional biopsy of the mass revealed a lymphoproliferative neoplasm with plasmacytic morphology. Immunohistochemistry (IHC) of the orbital mass as well as the bone marrow was sought, lymphoplasmacytic lymphoma (CD20+, CD38+, MUM1+, BCL 2+, CD3-, CD5-, CD10-, CD23-, cyclin D1). Bone marrow flow cytometry showed CD5-, CD10- kappa restricted B cell neoplasm. Serum analysis significantly elevated IgM levels. This indicated a diagnosis of ocular adnexal Waldenström Macroglobulinemia. CONCLUSION AND IMPORTANCE: This case highlights the importance of clinical evaluation, histopathology, and immunohistochemistry for phenotyping of ocular adnexal lymphomas.

Outcome of phacoemulsification without anti-vascular endothelial growth factor in patients with treatment naïve diabetic retinopathy.

INTRODUCTION: This retrospective, non-randomized, observational study was conducted at ASG Eye Hospital, Kathmandu to evaluate the outcome of phacoemulsification without anti-Vascular Endothelial Growth Factor (VEGF) in patients with treatment naïve diabetic retinopathy. MATERIALS AND METHODS: Records of all patients who underwent phacoemulsification without Bevacizumab in treatment of naïve patients with any grade of non-proliferative Diabetic Retinopathy (NPDR) were seen. Pre-operative and post-operative visual acuity along with central macular thickness (CMT) was compared. RESULTS: The study comprised 32 eyes of 20 patients with treatment naïve non-proliferative Diabetic Retinopathy who underwent phacoemulsification. Twelve were men and eight were women with an average age of 69.2 years (range 55 years to 83 years). The average preoperative central macular thickness as measured on optical coherence tomography was 254.63± 20.25 microns and 1-month postoperative central macular thickness was 254.72± 19.96 microns; the study did not find any significant difference (p-value 0.918). The average difference in the central macular thickness between the 1-month postoperative and preoperative values was 0.09 microns. CONCLUSION: Uneventful phacoemulsification in eyes with treatment naïve diabetic retinopathy does not cause an increase in central macular thickness after surgery and thus anti-Vascular Endothelial Growth Factor as an adjunct is not mandatory.

Mitigation of traumatic blepharoptosis with "central levator tuck": A novel approach in upper eyelid repair.

PURPOSE: Complex upper eyelid lacerations can present to the emergency department after a myriad of trauma. The goal of the surgical repair is anatomical and functional recovery along with symmetrical cosmesis. Despite meticulous surgery, post traumatic blepharoptosis may develop. We describe an additional step during upper eyelid laceration repair to help mitigate the development of traumatic blepharoptosis. METHODS: Patients with traumatic eyelid laceration without head injury, globe injury or associated orbital fractures, who were planned for a primary upper eyelid repair were included. Intraoperatively, wound margins and tissues were identified to establish anatomical continuity. After the LPS muscle was reinserted onto the tarsus, a single, central suture LPS plication - the "central levator tuck" was performed. This helped in improving the muscle action as well as strengthening its reattachment onto tarsus. RESULTS: Four cases underwent laceration repair with this modified technique. The nature of eyelid injury, surgical technique, and the outcome at 6 months is described. Three patients had a successful outcome, whereas one patient developed early scarring which reduced with scar therapy over time. CONCLUSION: We describe a simple and effective "central levator tuck" technique for traumatic eyelid laceration repair with optimal functional and cosmetic outcome while reducing the development of blepharoptosis in four patients.