Comparative analysis of outcomes following topography-guided laser in situ keratomileusis using manifest refraction versus a new topographic analysis algorithm.

Purpose: To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods: A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results: Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and - 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion: Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction.

Visual outcomes of early enhancement following small incision lenticule extraction versus laser in situ keratomileusis.

Purpose: To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Methods: Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. Results: In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). Conclusion: PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.

Salivary Menopausal Markers and Oral Health Status - A Hidden Hook Up.

Aim and Objectives: The aim of our study was to evaluate salivary estradiol and salivary calcium in postmenopausal women with varying degrees of oral dryness. The primary objective was to establish the interrelationship between salivary parameters and oral health status among menopausal women and compare the same with premenopausal women and normal controls. Materials and Methods: The study included 60 women Group I consisted of healthy menstruating women between 25 and 34 years of age. In Group II premenopausal women between 35 and 45 years of age were present and Group III consisted of menopausal women between 45 and 60 years of age. Unstimulated saliva was collected from the participants and estradiol analysis was done using ELISA method and calcium analysis was done using Arsenazo III reaction using colorimetric method. The oral health status in these patients was determined by using xerostomia score, Russell's periodontal score, and oral hygiene index. The values obtained were subjected to statistical analysis and the results were derived. Results: On oral examination, most of them had poor oral hygiene, periodontal disease, and moderate to severe levels of xerostomia. Salivary estradiol levels were low and salivary calcium levels were high among postmenopausal women and as salivary estradiol levels decreased there was an increase in xerostomia scores and salivary calcium. And also as salivary calcium levels increased the periodontal disease scores increased. All parameters were within normal limits among healthy menstruating women. Conclusion: Saliva can be a preferred medium and an emerging alternative for serum to estimate estradiol and calcium levels. As a dentist, we have to educate them about the oral changes they will experience during menopause and emphasize its strong association between low estradiol levels. Oral hygiene instructions should be given for the maintenance of healthy periodontium. Menopausal women who experience severe postmenopausal symptoms can be identified and the dentist and gynecologist can work hand in hand to treat the symptoms of these women.

Comparison of horizontal versus vertical split conjunctival autograft in the management of double head pterygium: A retrospective analysis.

Purpose: To compare horizontal and vertical split conjunctival autograft technique in the management of double head pterygium. Methods: Retrospective analysis of 96 and 99 eyes with double head pterygia that underwent horizontal (Group 1) and vertical (Group 2) split conjunctival autografting, respectively. Comparison of recurrence rates and other complications was done. Results: Recurrence was seen in 5.2% and 4% of the eyes in Groups 1 and 2, respectively (P > 0.05). Other complications like subconjunctival hemorrhage, graft edema, graft retraction, granuloma, and graft loss were also comparable among the two groups. Conclusion: Both the techniques provide good results with comparable efficacy in terms of rates of recurrence and complication profiles.

Topography-guided treatment in regular and irregular corneas.

Over the last decade, refractive surgery has been revolutionized by advancements in ablation profiles, available for the treatment of both regular and irregular corneas. Advances in corneal imaging have helped highlight the presence of higher-order aberrations, the correction of which could result in a better quality of vision. Topographic measurements being static are more repeatable and pupil independent and therefore provide the ideal platform for correction of both lower and higher-order aberrations and could result in improved visual quality even in patients with seemingly regular corneas. The combination of topography-guided treatment with collagen cross-linking has further increased the scope of treating irregular corneas like keratoconus, post-laser in-situ keratomileusis ectasia, and pellucid marginal degeneration. This review delves into the current literature and guidelines available for the topographic treatment of regular and irregular corneas.

Comparison of inferior conjunctival autografting and conjunctival tissue grafting from pterygium itself in the cases of filtering blebs and glaucoma suspects-A retrospective analysis.

PURPOSE: This study aims at comparing the effectiveness of inferior conjunctival autografting (CAG) and conjunctival tissue grafting from pterygium itself (CTG) in the cases of filtering blebs/glaucoma suspects. METHODS: One hundered and five eyes of 97 patients who underwent pterygium excision with conjunctival autografting (CAG) in the period from 2010 to 2016 were included. Fifty one eyes had filtering blebs and 54 were glaucoma suspects. Fifty two eyes of 49 patients (Group 1) had undergone pterygium excision with inferior conjunctival autograft (CAG) and 53 eyes of 48 patients (Group 2) had undergone pterygium excision with conjunctival tissue graft (CTG) from the pterygium itself. The minimum follow up period was 6 months. RESULTS: Both groups had 2 eyes with recurrence, which was not statistically significant. Among other complications, graft retraction was seen with a higher incidence in Group 2, which was statistically significant. CONCLUSION: In situations where sparing of the superior conjunctiva is mandatory, both the techniques of inferior conjunctival autografting and conjunctival tissue graft from the pterygium itself are excellent alternate options with comparable outcomes and no additional risk of significant complications.

Ectasia after keratorefractive surgery: Analysis of risk factors and treatment outcomes in the Indian population.

Purpose: To analyze the risk factors in eyes developing ectasia following keratorefractive procedures. In addition, the study assessed visual outcomes following various treatment modalities for ectasia. Methods: In this retrospective study, data of patients who underwent keratorefractive procedures, presenting to the refractive services of a tertiary eye care hospital in South India between January 2016 and May 2019 was analyzed. Of these, the eyes that developed ectasia were noted and the possible risk factors were determined. Visual outcomes following treatment with corneal collagen crosslinking (CXL) with or without intracorneal ring segment implantation (ICRS) or topography-guided corneal ablation (T-PRK) were analyzed. Results: Forty eyes of 26 patients developed ectasia following keratorefractive procedures, with a mean interval of 73.1± 45.4 months between primary procedure and ectasia development. Of these, 14 patients had bilateral presentation. Identifiable risk factors included ablation depth > 75 µm (59.25%), percentage of tissue altered (PTA) > 40% (48.14%), residual stromal bed < 300 µm (22.22%), mean refractive spherical equivalent > 8 D (25.92%), inferior-superior (I-S) asymmetry > 1.4D (7.40%), central corneal thickness (CCT) < 500 µm (7.40%), Belin Ambrosio Display (BAD) > 2.5 (7.40%), posterior float elevation maximum ≥18 µm (3.70%), and pellucid marginal degeneration (PMD; 3.70%). Conclusion: Our study shows that only 70% of the eyes demonstrated an identifiable risk factor for the development of ectasia. Ablation depth of > 75 µm and the PTA > 40% were the most common risk factors. Treatment following CXL with ICRS or T-PRK demonstrated significantly better visual outcomes in comparison with CXL alone.

Impact of anterior capsular polishing on capsule opacification rate in eyes undergoing femtosecond laser-assisted cataract surgery.

Purpose: To evaluate the impact of anterior capsular polishing on capsule opacification and contraction in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS). Methods: This prospective interventional comparative analysis included patients undergoing FLACS between August 2016 and May 2017. The eyes were subdivided into three groups based on the extent of intraoperative anterior capsular polishing performed: complete 360-degree polishing; inferior 180-degree polishing; and no polishing. Visual acuity, posterior capsular opacification (PCO) score, anterior capsular opacification (ACO) grade, and capsulorhexis diameter were evaluated at 1-week, 6-months, and 1-year postoperative visits. Results: The study included 99 eyes of 90 patients. No significant differences were observed between the three groups in ACO grade and capsulorhexis contraction at all follow-up visits. There was a statistically significant difference in PCO grade among the groups at 6-month and 1-year follow-up but it was found to be clinically insignificant. One eye in the no polishing group underwent neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy at the 1-year follow-up visit. Conclusion: A lower incidence of PCO was demonstrated in the 360-degree polishing group, although it was visually insignificant. No significant difference in postoperative capsular contraction was demonstrated between the cohorts up to one-year follow-up.

Comparison of vertical split conjunctival autograft with and without limbus to limbus orientation in cases of double-head pterygium-A retrospective analysis.

Purpose: The aim of this study is to compare the outcome and complications in patients who underwent double-head pterygium excision with split conjunctival autograft with and without limbus to limbus orientation. Methods: In this retrospective, comparative study, 99 eyes with double-head pterygium which underwent split conjunctival autograft with limbus to limbus orientation (Group 1) and 93 eyes which underwent without limbus to limbus orientation (Group 2) during the period of 2011-2016 were included in this study. The primary outcome compared was the recurrence rate. Other complications were included as secondary outcomes. Results: Mean age in group 1 and group 2 were 46.84 +/- 10.78 years and 54.38 +/- 11.44 years respectively. M:F was 36:63 in group 1 and 45:48 in group 2 with a mean follow up of 18.30 +/- 7.48 months in group 1 and 17.04 +/- 9.98 months in group 2. Recurrence was seen in 4 cases in each of the 2 groups with the mean time of recurrence being 7 +/- 2.34 months in group 1 and 6 +/- 2.01 months in group 2. Other complications included graft edema, SCH, graft retraction, granuloma, dellen and graft loss with only graft loss being statistically significant between 2 groups. Conclusion: This study provides data that recurrence rates are not different among patients who undergo split conjunctival graft with and without limbal orientation. The strict adherence to maintaining limbus to limbus orientation while managing double-headed pterygia may not be necessary in all cases, especially in those with large defects following excision.