Sideways sculpting - A novel technique in eyes with posterior polar cataracts.

Posterior polar cataracts (PPCs) have long been a concern for cataract surgeons due to their natural proclivity for posterior capsule rupture. Although problems can be avoided, there is no surgical procedure that can completely eliminate the possibility of posterior capsular rupture. Research reports a higher percentage of capsule rupture and related complications post surgical intervention. The sideways sculpting technique is a novel method to alleviate unnecessary tension on the posterior capsule. To disseminate this novel technique to practicing ophthalmologists to reduce the risk of complications related to polar cataracts. This video presents the creation of sculpting or trench at the center of the nucleus, sideways movement of the phacotip trench, rotation of the nucleus, and phacoemulsification steps while operating a dense PPC. Step-by-step demonstration of sideways sculpting and an overview of its significance. Video Link: https://drive.google.com/file/d/17ukCjdr9DlEgguCgfh0DPAPYxCCEzirq/view?usp=sharing .

Use of cryopreserved donor corneal tissues first time in India for therapeutic penetrating keratoplasty during COVID-19 pandemic - A case series.

Coronavirus disease (COVID-19) pandemic caused restricted eye retrieval leading to acute scarcity of donor corneas. Nine patients with perforated corneas needed urgent donor tissues where we used 10 cryopreserved corneal tissues for therapeutic penetrating keratoplasty (TPK). Repeat TPK was done in one eye for recurrence of infection. The anatomical integrity of the eyeball was maintained in seven eyes, while two eyes were lost to phthisis. Thus, cryopreserved corneas can be taken into consideration for TPK when other donor tissues are not available.

The safety and efficacy of passive removal of silicone oil with 23-gauge transconjunctival sutureless system.

PURPOSE: To evaluate the safety and efficacy of passive removal of silicone oil with 23-gauge (G) transconjunctival sutureless system. METHODS: This is a single-center, prospective, interventional, randomized control study. Forty eyes of 40 patients were enrolled in this study and randomized into 2 groups. Group 1 (n = 20) patients underwent passive removal of silicone oil with 23-G transconjunctival sutureless system. Group 2 (n = 20) underwent 20-G active silicone oil removal using all three 20-G ports. In both groups, air-fluid exchange was performed and the globe was left air filled at the end of surgery. All eyes in both groups received 360 degrees endolaser. We recorded surgical time, time for silicone oil removal, number of sutured 23-G sclerotomy sites, presence of preoperative scarring at sclerotomy site, postoperative hypotony, endophthalmitis, and inflammation at sclerotomy site. RESULTS: Opening and closing times were significantly shorter in Group 1 than in Group 2. Only 3 cases (15%) in Group 1 required 1 additional suture each in the superior sclerotomy site. Both groups were similar in safety in terms of chance of endophthalmitis, redetachment rate, and postoperative hypotony. Only 1 patient of Group 1 (5%) and 5 patients of Group 2 (25%) showed significant conjunctival inflammation at the end of 2 weeks. CONCLUSION: Passive removal of silicone oil with 23-G transconjunctival sutureless system may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. It is a safe and effective procedure when compared with 20-G active silicone oil removal for 1000 centistoke oil.

Profile of asymmetrical retinopathy of prematurity in twins.

BACKGROUND: In twin births, both babies have the same gestational age and pre-natal conditions. However, twins may develop a varied retinopathy of prematurity (ROP) course depending on birth weight and other systemic factors. OBJECTIVE: To study the profile of asymmetric ROP in twins DESIGN: Retrospective study. SETTING: Tertiary ROP referral eye hospital. MATERIALS AND METHODS: The profile of 56 pairs of twins with ROP were studied and analyzed for differences in zone or need for treatment, while studying possible causes for the varied outcome. RESULTS: In 45 pairs of twins (80%) the disease progressed identically in both eyes, while in 11 pairs (20%) the ROP showed differences in zone or need for treatment. Four of these pairs were discordant. In 3 of these 4 pairs, the heavier birth weight twin had a more severe ROP course. CONCLUSIONS: Twins can present with asymmetric ROP course, and it is therefore essential to examine both twins as per screening protocols.

Importance of the 'third criterion' for retinopathy of prematurity screening in developing countries.

PURPOSE: Developing countries often need a modification of the American screening guidelines for retinopathy of prematurity. METHODS: A total of 1,302 eyes in 651 infants with retinopathy of prematurity were analyzed by the parameters of gestational age and birth weight suggested by the American guidelines. RESULTS: With the use of current gestational age and birth weight guidelines, 86 of 1,302 eyes (6.6%) were missed, and 38 of these eyes (2.9%) had potentially treatable or more severe retinopathy of prematurity and were in need of treatment. CONCLUSION: Use of the "third criterion" (ie, neonatologist referral of sick infants who were believed to be at high risk for retinopathy of prematurity), enabled larger infants who were otherwise missed by the American guidelines to be included for screening. Even when the parameters were increased, a relatively small number of infants was still missed. Therefore, in view of the limited resources and manpower in developing countries, the American screening guidelines are appropriate.

Intraoperative retinoscopy for intraocular lens power estimation in cases of combined phacoemulsification and silicone oil removal.

PURPOSE: To study the application of intraoperative retinoscopy for intraocular lens (IOL) power calculation in combined cataract extraction and silicone oil removal. SETTINGS: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This study comprised patients with silicone oil-filled eyes and visually significant cataract who had combined cataract extraction by phacoemulsification and silicone oil removal by a standard method through the pars plana route. Retinoscopy was performed with a streak retinoscope, standard vertex distance of 13.0 mm, and distance of 50.0 cm. All eyes had in-the-bag implantation of a foldable IOL with an A-constant of 118.4. The IOL power was calculated using the Ianchulev formula as follows: R x 2.01449. Postoperative refraction was performed at 3 months, and the spherical equivalent was calculated. RESULTS: Twelve eyes of 12 patients were evaluated. The mean emmetropic power calculated by intraoperative retinoscopy was 20.46 diopters (D) +/- 3.4 (SD) (range 13.09 to 25.18 D) and the mean refractive error, -0.45 +/- 0.63 D (range -1.00 to +1.00 D). The postoperative refractive error was within +/-0.50 D in 4 eyes (33.3%) and within +/-1.00 D in all eyes. Ten eyes (83.33%) had a postoperative refractive error in the range of 0.00 to -1.00 D using IOL power based on intraoperative retinoscopy. CONCLUSION: Intraoperative retinoscopy for IOL power calculation in combined cataract extraction and silicone oil removal gave satisfactory refractive outcomes, although further studies with more patients are required to confirm its usefulness and determine whether there are disadvantages.

Preferred clinical practice in convergence insufficiency in India: a survey.

PURPOSE: Convergence insufficiency (CI) is a common binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for CI. The aim of the study was to investigate the treatment for CI by surveying the ophthalmologists regarding the most common treatment modalities used in India. MATERIALS AND METHODS: Four hundred questionnaires were distributed amongst ophthalmologists attending different sessions of the Delhi Ophthalmological Society annual conference held in April 2007. Two hundred and three ophthalmologists responded (response rate 50.75%). The responders included 109 private practitioners, 57 consultants attached to teaching institutes and 37 residents. RESULTS: The majority of ophthalmologists (66.7%) claimed encountering > 5% outpatient department patients with CI. Pencil push-ups therapy (PPT) was the most common first line of treatment offered by ophthalmologists (79%) followed by synoptophore exercises (18%). Only 3% referred the patients to optometrists. Thirty per cent ophthalmologists claimed good results with PPT, which was significantly higher in private practitioners (35%). Only 26% ophthalmologists explained physiological diplopia to patients on a regular basis and reported significantly higher percentage of patients (46.3%) with good results. Only 12.3% ophthalmologists needed to refer > 30% patients for synoptophore exercises. For failure of PPT 86.7% considered lack of compliance as the major reason as perceived by ophthalmologists. CONCLUSIONS: This survey suggested that most ophthalmic practitioners prescribed PPT as the initial treatment for CI and had satisfactory results with PPT. The majority of the practitioners did not explain to the patient about physiological diplopia. Explaining physiological diplopia may improve outcome, as perceived from the survey.