Toxoplasma Retinochoroiditis Following Intravitreal Dexamethasone Implant Injection for Diabetic Macular Edema: A Rare Complication.

PURPOSE: To report a case of ocular toxoplasmosis as a rare complication of intravitreal dexamethasone implant in a case of diabetic macular edema. METHODS: A 56 years old male, a known case of Proliferative Diabetic Retinopathy, received intravitreal dexamethasone implant for diabetic macular edema in left eye. He developed toxoplasma retinochoroiditis involving the macula with further diminution of vision in his left eye 3 weeks after the injection. His serum titres were positive for Toxoplasma IgG (161 IU/ml). He was treated with oral Sulfamethoxazole 800 mg + Trimethoprim 160 mg 12 hourly for 4 weeks. RESULTS: The visual acuity in left eye improved with resolution of retinochoroiditis after the course of antibiotic therapy. CONCLUSION: It is imperative to follow-up closely after intravitreal steroid implantation, to look for the possible rare complication of infectious retinitis/retinochoroiditis, as timely antimicrobial treatment can lead to a good visual outcome.

Ray tracing biometry in post radial keratotomy eye.

OBJECTIVE: To report a case of post radial keratotomy (RK) cataract in a 55-year-old lady wherein biometry was done by ray-tracing method incorporated in scheimpflug topographer (Sirius + Scheimpflug Analyzer, CSO, Italy). METHOD: In our case, we performed intraocular lens (IOL) power calculation using a recent concept of ray tracing with scheimpflug topographer and compared with traditional methods available at American Society of Cataract and Refractive Surgery(ASCRS) website (www.ascrs.org) for eyes with prior RK. Phacoemulsification was performed and a monofocal + 24.5D IOL implanted in the capsular bag. RESULT: Manifest refraction at six weeks postoperative period was + 1.0DS/-2.0DC × 75° with spherical equivalence of 0. On comparison of all the methods used to calculate IOL power, the absolute errors of ray tracing and Barrett true K were found to be the least, 0.14 and 0.18 respectively. CONCLUSION: Ray tracing biometry with scheimpflug topographer seems to provide accurate IOL power in post RK eyes.

Outcomes of Descemet stripping endothelial keratoplasty in cases of corneal endothelial dysfunction.

BACKGROUND: Automated microkeratome is commonly used to get donor lenticules for Descemet stripping endothelial keratoplasty (DSEK); however, manual dissection of donor lenticules is also being done with good outcomes. AIM: The aim of this study was to describe the results of manual DSEK performed in cases of corneal endothelial dysfunction caused due to pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, and postpenetrating keratoplasty graft failure. MATERIALS AND METHODS: This was a retrospective observational study. The medical records of all patients with corneal decompensation who underwent DSEK at a tertiary care center performed by the same surgeon were reviewed. A standard DSEK with manually dissected donor lenticules was performed in all cases with the exception of the Descemet membrane not being removed in two cases. A comprehensive ophthalmic examination was performed preoperatively and at each postoperative visit in all patients. RESULTS: Eight eyes of seven patients (four males and three females) were included. The mean age was 64.8 years (range, 49-74 years). The average follow-up was 10.9 months (range, 5-22 months). There was one case of primary graft failure which was managed by repeat DSEK. In the rest, corneas remained clear at the last follow-up. No rebubbling was done as none of the cases showed graft detachment. The preoperative best-corrected visual acuity (BCVA) was 20/2000 or less, and postoperatively, BCVA attained was 20/30 in four eyes and one eye achieved 20/80. CONCLUSIONS: Manual DSEK performed in eyes with corneal decompensation allowed rapid restoration of corneal clarity while minimizing intraoperative and postoperative complications.

Assessment of posture-induced cyclotorsion during cataract surgery using the Verion image-guided system.

BACKGROUND: The purpose of this prospective observational study is to analyse posture-induced cyclotorsion in eyes undergoing conventional phacoemulsification with toric intraocular lens (IOL) implantation and femtolaser-assisted cataract surgery (FLACS) using the Verion image-guided system. METHODS: Cyclotorsion was assessed in patients who underwent conventional phacoemulsification with toric IOL implantation and FLACS between June 2017 and November 2017 with registration of iris architecture, limbal and bulbar conjunctival blood vessels acquired preoperatively using the Verion Reference Unit (the patient in sitting position) and intraoperatively under the microscope using the digital marker of the Verion image-guided system with the patient in supine position. RESULTS: Forty-four eyes of 30 patients (21 men and 9 women) were included with the mean age of 56.5 ± 17.1 (range, 19-89; median, 62) years. The mean cyclotorsion induced by change in posture from sitting to supine position was 5.84 ± 3.25° (range, 1-17; median, 5). Overall, clockwise (CW) rotation (59.1%) was noted to be more common than counter clockwise (CCW) rotation (40.9%). Furthermore, CW rotation was more common in men than in women, and CCW rotation was significantly more common in women. Patients who underwent bilateral sequential cataract surgery show similar cyclorotation (CW or CCW) in both eyes more often than mixed rotation (85.7% vs 14.3%). CONCLUSION: Significant cyclotorsion can occur in supine position during cataract surgery. Accurate assessment of the amount and direction of cyclotorsion aids in appropriate alignment of the toric IOL for optimal visual outcomes.

Long-term Functional and Anatomic Outcomes of Repeat Graft After Optically Failed Therapeutic Keratoplasty.

PURPOSE: To evaluate the functional and anatomic outcomes of repeat penetrating keratoplasty (PK) in optically failed therapeutic grafts. DESIGN: Prospective interventional case series. METHODS: All cases admitted at the apex tertiary care center for repeat keratoplasty following optically failed therapeutic PK were enrolled over a period of 1 year. Repeat optical PK was performed in all eyes. Primary outcome measures were postoperative graft clarity and visual acuity. Secondary outcome measures were complications including graft rejection, infections, failure, and secondary glaucoma. Follow-up examinations were undertaken on day 1; on day 7; at 1, 3, 6, and 12 months; and yearly thereafter. RESULTS: Thirty-two eyes underwent repeat PK with mean follow-up of 18.4 ± 8.9 months. Clear grafts were observed in 63.14% of cases 1 year after regraft, and graft survival further decreased to 50% at last follow-up. Visual acuity ≥ 20/200 was achieved in 43.8% of cases, and no case had a visual acuity of ≥ 20/40. Multivariate Cox regression analysis analyzed risk factors for regraft survival, and observed a hazard ratio of 3.56 with size of initial therapeutic graft ≥ 8.75 mm, and 10.99 with deep vascularization in 1 or more quadrants. Graft survival (P = .004), visual acuity (P = .039), and rejection rates (P = .036) were significantly better in cases with initial therapeutic graft size < 8.75 mm. Secondary glaucoma was present in 59.4% (19/32) after regrafts. CONCLUSION: Regraft after therapeutic PK is associated with suboptimal visual outcomes and long-term graft survival. Large size of initial therapeutic graft and deep vascularization adversely affect graft survival.