Two-mm chord manual small-incision cataract surgery with phacofracture: A brief exposition of the surgical technique.

We describe a surgical technique for manual small-incision cataract extraction with 2-mm chord incision with phacofracture. The authors describe a curvilinear 2-mm chord incision 1.5 mm behind the limbus and antiparallel to the limbus with back cuts of variable length; 1.5 mm for foldable lenses and 2.5-3 mm for the rigid nonfoldable lenses. Continuous curvilinear capsulorhexis with a 26-G bent needle cystitome (or Utrata forceps) is followed by cortical cleaving hydrodissection and cartwheeling of the nucleus into the anterior chamber. A specially designed Sahu modified vectis (SMV) and a flattened visco cannula are used for the phacofracture. The heminuclei are removed along their longitudinal axis and direct implantation of the pseudophakos. Surgically induced astigmatism was found to be a mean change in astigmatism of 0.14 DCyl when the axis was ignored. Corneal endothelial counts were not vastly different from the routine manual small-incision and phacoemulsification at 3 months of follow-up. The technique used here by the surgeon for cataracts of any C (1-5) or any P (1-5) to grade NC4 NO4 as graded by the LOCS III. Case selection is of paramount importance. Two-millimeter chord MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery.

Early postoperative astigmatism in 2-mm manual small incision cataract surgery with phacofracture.

Purpose: India's cataract surgery rate has been hovering around a creditable 6000 per million population but the coverage is variable across the geography and demography with sharp urban rural divide. Smaller incisions in manual small incision cataract surgery (MSICS) with phacofracture have been credited with lower astigmatism and faster recovery, which is especially useful for patients traveling for surgeries. Methods: In this retrospective chart analysis based observational study of 66 eyes, we describe the early postoperative results with 2 mm MSICS with phacofracture. Results: The mean spherical equivalent of the autorefractor measured astigmatic error changed marginally to -0.51 diopters (SD = 0.58) from -0.44 diopters (SD = 0.42) (t = -8.410, P = 0.0) translating to mean change in astigmatism of 0.14 DCyl when the axis was ignored. The keratometric difference between steepest and flattest axis of the anterior surface of the central 3 mm zone of the cornea changed from a mean of 0.89 diopters (SD = 0.55) to 1.39 diopters (SD = 1.03). The visual acuity improved to mean logarithm of the minimum angle of resolution (logMAR) score of 0.27 (SD = 0.33) at 1 week and 0.007 (SD = 0.04) which corresponds to 6/6P on Snellen's acuity at 1 month or more. Conclusion: A 2 mm MSICS with phacofracture can deliver low astigmatism and good visual recovery in cataract surgery. The study underlines the need for considering the refraction at anterior and posterior corneal interfaces when the triplanar incision with separate interfaces is used.

Echographic study of extraocular muscle thickness in normal Indian population.

PURPOSE: To establish normative data of extraocular muscle (EOM) dimensions, both vertically and horizontally, using a reproducible echographic method in various age groups. METHODS: Two hundred eyes of 100 healthy subjects (50 males and rest females) were included in this prospective observational study. All subjects were divided into 5 groups with an interval of 10 years from 10 to 60 years. Each group contained 10 male and 10 female healthy subjects. A single operator took measurements at 4 mm distance from the globe plane after drawing a perpendicular line on the globe to the muscle belly. RESULTS: The average age of subjects was 37.28 ± 17.14 years. Intraobserver reproducibility was very high (intersession concordance correlation co-efficient = 0.995). Mean horizontal and vertical diameters of recti were 3.0775 and 8.26 mm, respectively. Mean muscle thickness of superior rectus/levator palpebral superioris (LPS) muscle complex and LPS was 4.56 and 1.45 mm, respectively. Extraocular muscle diameter increases up to the middle age, then it starts decreasing. There was no statistically significant correlation between diameter of each EOM, both eye and gender (p â©¾ 0.05). There was a non-significant change in extraocular muscle thickness with age. CONCLUSION: The study provides normative data for extraocular muscle thickness in both genders of various age groups in Indian population. Muscle dimensions do not change significantly with age, between the eyes and gender.

Report on ocular biometry of microphthalmos, retinal dystrophy, flash electroretinography, ocular coherence tomography, genetic analysis and the surgical challenge of entropion correction in a rare case of Hallermann-Streiff-Francois syndrome.

PURPOSE: To report new aspects of the phenotype including Retinal dystrophy and surgical challenges in Hallermann-Streiff Francois syndrome (HSFS). METHODS: Detailed phenotype of a female with HSFS was evaluated including skeletal changes, comprehensive eye examination, detailed ocular biometry, electroretinography and macular Ocular coherence tomography. Surgical notes of lid surgery for entropion were reviewed. Genetic screening was also done. RESULTS: Unique Ocular biometry with electroretinography changes, macular folds and fundus changes suggestive of an unreported Retinal dystrophy in a typical patient with HSFS were noted. Surgery was challenging both due to difficulty in endotracheal intubation anaesthesia because of the dento-facial abnormalities and the skin fragility. CONCLUSION: This report provides additional information especially pigmentary retinal dystrophy, macular folds and electroretinography in HSFS. The microphthalmos had overlapping posterior segment findings usually reported with Nanophthalmos and Posterior microphthalmos. The surgical difficulties and outcomes of the rarely encountered adnexal abnormalities emphasize the need for a multi disciplinary approach for appropriate management.

Review of endogenous endophthalmitis during pregnancy including case series.

Endogenous endophthalmitis during pregnancy is a rare condition with few reports of such infections in the peri- and post-partum period. We reviewed the literature on endogenous endophthalmitis in pregnancy and also report a series of four patients who presented to our institution from January 2011 to September 2011. We retrospectively reviewed four patients who developed endogenous endophthalmitis either during pregnancy (two patients) or in the post-partum period (two patients--one after abortion and one after normal term delivery). Presenting visual acuity ranged from finger counting at 3 m to no perception of light. Positive cultures included Bacillus mycoides (vitreous) and Klebsiella pneumoniae (urine). Vitrectomy was performed in three patients. In one patient, the vision improved to 20/20. On reviewing the literature and our experience we concluded that endogenous endophthalmitis related to pregnancy is a rare entity with visual prognosis generally being poor. Fluoroquinolones are best avoided. Cephalosporins and amphotericin B are generally the preferred drugs.

Foveal atrophy and macular hole formation following intravitreal ranibizumab with/without photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration.

BACKGROUND: To report the occurrence of foveal atrophy and macular hole formation following intravitreal ranibizumab with or without photodynamic therapy for choroidal neovascularization caused by age-related macular degeneration. METHODS: This was a retrospective, interventional case series, in which 78 eyes of 76 patients were treated for wet age-related macular degeneration between February 2007 and August 2007. Of these, three eyes developed foveal atrophy following treatment. Two eyes underwent combination photodynamic therapy and intravitreal ranibizumab, and one eye underwent intravitreal ranibizumab alone. One of the two eyes that underwent combination therapy progressed to develop a macular hole. RESULTS: On the first follow-up visit, all three eyes showed thinning of the fovea on optical coherence tomography. Subsequently, treatment was continued with repeat intravitreal ranibizumab injections. At the last follow-up, although choroidal neovascularization regressed in all eyes, extensive foveal atrophy developed in two eyes with macular hole formation in one eye. CONCLUSION: The possibility of foveal atrophy and macular hole formation must be borne in mind before initiating ranibizumab in combination with or without photodynamic therapy. However, larger studies with longer follow-up are required to understand such adverse effects better.

Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN--DREAMS III): study design and research methodology.

BACKGROUND: To describe the methodology of the Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study III, an ongoing epidemiological study to estimate the prevalence of diabetes and diabetic retinopathy in rural population of Kanchipuram and Thiravallur districts of Tamil Nadu, India and to elucidate the clinical, anthropometric, biochemical and genetic risk factors associated with diabetic retinopathy in this rural population. METHODS: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study III will be a mobile van based epidemiological study; 11,760 participants aged ≥ 40 years will be recruited from the study areas. Eligible subjects will undergo blood sugar estimation to diagnose diabetes.Oral glucose tolerance test will be done to conform diabetes. All subjects with diabetes will undergo complete information of knowledge, aptitude and practice of diabetes and diabetic retinopathy, Diet questionnaire, demographic data, socioeconomic status, physical activity, anthropometric measurements, and risk of sleep apnoea. A detailed medical and ocular history, a comprehensive eye examination including refraction, slit lamp biomicroscopy examination, indirect ophthalmoscopy, slit lamp biomicroscopy, digital stereo fundus photography and ultrasound of eye will be done in the mobile van. Blood will be collected for biochemical investigations including blood hemoglobin, glycosylated hemoglobin, lipid profile, urea and creatinine, genetic study. Urine will be collected for microalbuminuria. All fundus photographs will be graded at base hospital. Participants who need treatment will be sent to the base hospital. A computerized database is created for the records. CONCLUSION: The study is expected to provide an estimate of the prevalence of diabetes and diabetic retinopathy and also a better understanding of the genetic, anthropometric and socio-economic risk factors associated with diabetic retinopathy in a rural South Indian population.