Chandelier-assisted scleral buckling using wide angle viewing contact lens for pseudophakic retinal detachment repair.

AIM: To evaluate a modified technique for scleral buckling (SB) in pseudophakic retinal detachment (RD). METHODS: A retrospective non-comparative study included 21 consecutive eyes with uncomplicated pseudophakic RD that was repaired by chandelier assisted SB using wide angle viewing (WAV) contact lens. Segmental tire alone was used in 5 eyes (23.81%), and combined with encircling band in 7 eyes (33.33%). Radial sponge alone was used in 3 eyes (14.29%) and combined with encircling band in 6 eyes (28.57%). RESULTS: Primary success rate was (90.48%). External drainage of subretinal fluid was performed in 8 eyes (38.1%). Intraoperative complications included vitreous prolapse at chandelier sclerotomy site in 4 eyes (19.05%) and localized subretinal hemorrhage at drainage site in one eye (4.76%). No case of intraocular lens (IOL) displacement, retinal incarceration or iatrogenic retinal tear was detected. Postoperative complications included choroidal detachment in one eye (4.76%), elevated intraocular pressure in 2 eyes (9.52%), epiretinal membrane formation in one eye (4.76%) and proliferative vitreoretinopathy in 3 eyes (14.29%). Mean postoperative corrected distance visual acuity was 0.7±0.3 logMAR units. CONCLUSION: Chandelier-assisted SB using WAV contact lens is a reliable technique for repairing selected cases of simple pseudophakic RD.

V4B implantable collamer lens versus Intacs corneal rings to manage anisometropic myopic amblyopia in children.

OBJECTIVE: To compare the safety and efficacy of phakic intraocular lens (PIOL) versus intrastromal corneal ring segments (Intacs), for correcting high myopic anisometropia in amblyopic children. DESIGN: Nonrandomized prospective multi-center study. PARTICIPANTS: Thirty children, aged between 4 and 12 years, with unilateral high myopic anisometropic amblyopia were included in this study. METHODS: Patients who were prospectively subdivided into group A, with mean preoperative manifest refraction spherical equivalent (MRSE) of -12.96 ± 4.17 D, underwent unilateral phakic posterior chamber intraocular lens implantation. Patients with mean preoperative MRSE of -8.60 ± 1.16 D in group B were treated by Intacs corneal rings. Pre- and postoperative visual acuity, ocular examination, stereoacuity, axial biometry measurements, cycloplegic refraction, and endothelial cell counts were performed in all patients. RESULTS: Group A revealed prevention of amblyopia with improvement in spectacle-corrected distance visual acuity, where 4-6 lines were achieved in 77% of children, 2-3 lines in 4%, and just 0-1 lines restricted to 19% of children. Improvement in stereoacuity was noted in 93.33% of group A cases, whereas group B showed fewer cases of successfully improved vision, with 4-6 lines in 70% of children, 2-3 lines in 3%, and just 0-1 lines restricted to 27% of children. Improvement in stereoacuity was noted in 86.66% of cases. Two cases of cataract and 1 case of glaucoma with 1 case of uveitis were noted in the implantable contact lens (ICL) group. CONCLUSIONS: Posterior chamber PIOLs or Intacs may provide a safe alternative in treating anisometropic myopic patients. Intacs implantation is safer with fewer complications than ICL. However, ICL implantation is advantageous over the corneal ring segment procedure owing to the wide range of errors to correct.

Subthreshold diode-laser micropulse photocoagulation as a primary and secondary line of treatment in management of diabetic macular edema.

BACKGROUND: The purpose of this study was to evaluate subthreshold diode-laser micropulse (SDM) photocoagulation as a primary and secondary line of treatment for clinically significant diabetic macular edema (CSDME). METHODS: In this prospective nonrandomized case series, 220 cases of nonischemic CSDME were managed primarily and secondarily by SDM photocoagulation on a 15% duty cycle with a mean power of 828 mW and a spot size of 75-125 µm. SDM treatment was repeated at 3-4-month intervals if residual leakage was observed. Additional intravitreal pharmacologic therapy was used according to the response. Follow-up varied from 12 to 19 (mean 14±2.8) months. Novel software designed by the authors was used to record the subvisible threshold laser applications and their parameters on the fundus image of the eye. Evaluation of the results of treatment was done using fluorescein angiography and optical coherence tomography (OCT). Primary outcome measures included changes in visual acuity and foveal thickness at OCT. Secondary outcome measures included visual loss of one or more Snellen lines and laser scars detectable on fundus biomicroscopy or fluorescein angiography. RESULTS: In the primary treatment group, there was significant improvement or stabilization of visual acuity after the first 3-4 months, which was stable thereafter. Visual acuity was stable in the secondary treatment group. A corresponding reduction of macular thickness on OCT was noted during the follow-up period in both groups. Additional therapy included repeat SDM photocoagulation, intravitreal injection of triamcinolone, and pars plana vitrectomy. Laser marks seen as changes in retinal pigment epithelium on fundus biomicroscopy and fluorescein angiography were noted in 3.3% and 5.7% of cases. Our novel software could accurately record the location of all SDM-invisible applications. CONCLUSION: Micropulse laser is an effective minimal intensity therapy that offers the clear advantage of minimizing or avoiding laser-induced visible retinal burn/scarring while reducing the foveal thickness in the management of selected cases of CSDME. Future prospective studies should include the use of SDM photocoagulation as a combined minimally invasive therapy to consolidate the prompt but temporary effects of anti-vascular endothelial growth factor or anti-inflammatory agents. Virtual localization of SDM-invisible applications using our proprietary software could be used to guide further retreatments.