Intra-operative aberrometry versus conventional biometry for intraocular lens power calculation: A prospective observational study from a tertiary referral center.

Purpose: To evaluate the per operative intra-ocular lens (IOL) power calculation using intra-operative aberrometry (ORA) and its comparison with conventional methods. Methods: Patients with cataract planned for phacoemulsification by a single surgeon under topical anesthesia were enrolled in this prospective observational study in this prospective observational study. All patients underwent pre-operative biometry (Manual SRK-II and IOLMaster® 500) to determine the intra-ocular lens (IOL) power. Intra-operative aberrometry using ORA was also performed; however, IOL was inserted according to IOLMaster® (SRK/T). Spherical equivalent (SE) was recorded on post-operative days 1, 7, and 30. Patients were divided into three groups based on axial lengths for analysis. Comparative analysis was performed for the calculated IOL powers and prediction errors of ORA with conventional methods. Adjusted IOL power to calculate the emmetropic IOL using the LiHue formula was also determined and was compared with existing methods. A P-value less than 0.05 was considered statistically significant. Results: A total of 115 eyes from 113 patients were included, with a median age of 54.90 ± 14.3 years. The mean axial length was found to be 23.94 ± 2.3 mm. There was good agreement (87%) between ORA and IOLMaster® for calculated IOL powers with a mean difference of 0.047 ± 0.5D between the two (P = 0.33). A positive correlation was found between IOL power calculated using ORA, IOLMaster®, SRK-II, and adjusted IOL. Conclusion: The use of intra-operative aberrometry (ORA) to calculate IOL power in patients undergoing uncomplicated phacoemulsification is non-inferior relative to standard pre-operative measurement and planning.

Cataract in retinopathy of prematurity - A review.

Preterm babies with retinopathy of prematurity (ROP) can become blind if they do not receive appropriate timely intervention. The presence of cataract in these individuals in addition to visual deprivation amblyopia, also delays proper screening, adequate treatment, and makes follow-up assessment difficult. Anatomical differences in these infants and amblyopia management, especially in unilateral cataract, are other important concerns, and hence, management of these cases with cataract and ROP is challenging. In this review, studies where ROP cases were associated with cataract, were evaluated with a focus on preterm individuals less than 6 months age. Preterm babies are at increased risk of developing cataract because of systemic factors. In addition, those with ROP may have cataract associated with retinal detachment or treatment received. The type of cataract, risk factors, and pathophysiology associated with each cause varies. This review highlights these different aspects of cataract in ROP including causes, pathophysiology, types of cataracts, and management. The management of these cases is critical in terms of the timing of cataract surgery and the challenges associated with surgery and posterior segment management for ROP. Anatomical differences, preoperative retina status, pupillary dilatation, neovascularization of iris in aggressive posterior ROP, fundus examination, amblyopia, and follow-up are various important aspects in the management of the same. The preoperative workup, intraoperative challenges, postoperative care, and rehabilitation in these individuals are discussed.

Sinskey hook and viscoelastic assisted posterior capsular plaque extraction.

Posterior capsule plaques (PCPs) are a rare cause of suboptimal vision after eventless cataract surgery. While these can be managed with posterior capsulotomy, violation of the posterior capsular integrity and associated vitreous disturbances may lead to sight-threatening complications. Viscoseparation and peeling of PCPs with the aid of retinal end-grasping forceps and irrigation and aspiration have also been described in adults for getting rid of PCPs with minimal disturbance of PC and vitreous. While Sinskey hook (SH) has been used to peel PCPs in children, the combined use of SH with viscoseparation for removal of PCP, particularly for adults, remains vaguely described in the literature. Presently, we describe a method of SH and viscoelastic assisted PCP extraction (SVAPE) in adult eyes with centrally located PCPs.

Persistent Fetal Vasculature With Subluxated Lens, Posterior Segment Pathology, and Bifid Fibrous Membrane: An Atypical Presentation.

The authors report a rare case of persistent fetal vasculature (PFV) associated with lens subluxation, axial myopia, and a thick bifid vascular stalk connecting the lens to an anomalous disc, along with medullated nerve fibers temporal to the disc. A thick fibrous membrane encasing the subluxated lens with multiple branch-like fibrovascular channels extending to the zonules was noted. This membrane with its extensions had similar histology as that of the PFV stalk. This case report adds to the understanding of PFV spectrum. [J Pediatr Ophthalmol Strabismus. 2020;57:e38-e40.].

Intraoperative aberrometry in cataract surgery with topical versus peribulbar anesthesia.

Purpose: To study the effect of choice of anesthesia on the refractive outcomes of intraoperative aberrometry (IA) for intraocular lens power calculation in cataract surgeries. Methods: This prospective, interventional nonrandomized cohort study was conducted at a tertiary care hospital between March and August 2018. A total of 178 patients with age-related cataract were allocated into two groups. Group 1 received peribulbar anesthesia using a mixture of xylocaine 2% + adrenaline 0.125 mg/ml + hyaluronidase 15 IU/ml with a 23G, 32 mm needle, while Group 2 received topical anesthesia with proparacaine hydrochloride 0.05% drops. Intraoperative aphakic measurements and IOL power calculations were obtained in all patients with the optiwave refractive analysis (ORA) system. Analysis was performed to compare the baseline parameters and postoperative manifest refraction at month 1. Results: A total of 89 patients were included in group 1 and 89 in group 2. At baseline, the axial lengths (P = 0.66) and mean keratometry (P = 0.91) were comparable. The quality measure of captured wavefront data was comparable (0.25) between the groups. Also, the postoperative mean refractive spherical equivalents were comparable between the two groups (P = 0.98) at one month. Conclusion: IA can be utilized well for cataract surgeries performed under local anesthesia with good quality of captured wavefront, provided the eye can be aligned in centre with the fixation light of ORA.

Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study.

Purpose: To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip. Methods: Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively. Results: Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05). Conclusion: Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.

Bilateral Total Cataract After Intravitreal Bevacizumab Injection in Aggressive Posterior Retinopathy of Prematurity.

The authors report a rare occurrence of bilateral cataract in eyes with aggressive posterior retinopathy of prematurity after bilateral administration of intravitreal bevacizumab in a neonate, with no evidence of lens touch. Although the exact mechanism of cataractogenesis is unclear, the possibility of local drug toxicity needs to be investigated. [J Pediatr Ophthalmol Strabismus. 2019;56:e28-e30.].

Cortical riders of zonular cataracts as "reverse cuneiform" cataracts: A hypothesis.

Zonular cataracts are childhood cataracts involving one or more zone(s) of lens. They often show 'riders' which are wedge-shaped opacifications of inner cortex of the lens seen to radiate towards the lens equator, though little is known about the exact mechanism behind their development. Cortical riders may be described as 'reverse cuneiform' cataracts on the basis of their evolution pattern being exact opposite to that of senile cuneiform cortical cataracts.

Posterior lenticonus with persistent fetal vasculature.

A 10 year old girl present with both eyes central cataract with posterior lenticonus. Intraoperative, she was noted to have both eyes persistent fetal vasculature (PFV). To the best of our knowledge, association of bilateral posterior lenticonus and PFV has not been reported before. This supports the hypothesis that PFV has a role in pathogenesis of posterior lenticonus.

Outcomes of microscope-integrated intraoperative optical coherence tomography-guided center-sparing internal limiting membrane peeling for myopic traction maculopathy: a novel technique.

PURPOSE: To evaluate the outcomes of pars plana vitrectomy (PPV) with microscope-integrated intraoperative optical coherence tomography (I-OCT)-guided traction removal and center-sparing internal limiting membrane (cs-ILM) peeling. METHODS: Nine eyes with myopic traction maculopathy as diagnosed on SD-OCT underwent PPV with I-OCT-guided cs-ILM peeling and were evaluated prospectively for resolution of central macular thickness (CMT) and improvement in best-corrected visual acuity (BCVA), and complications, if any, were noted. All patients were followed up for more than 9 months. RESULTS: Resolution of the macular retinoschisis was seen in all nine eyes on SD-OCT. At 36 weeks, there was a significant improvement in mean BCVA from the preoperative BCVA (P = 0.0089) along with a reduction in the CMT from 569.77 ± 263.19 to 166.0 ± 43.91 um (P = 0.0039). None of the eyes showed worsening of BCVA or development of full-thickness macular hole in the intraoperative or follow-up period. CONCLUSION: PPV with I-OCT-guided cs-ILM peeling helps in complete removal of traction, resolution of retinoschisis and good functional recovery with low intraoperative and postoperative complications.

Pediatric cataract.

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.