Short-term outcomes of Tanito microhook ab interno trabeculotomy combined with phacoemulsification in primary open-angle glaucoma - A pilot study.

PURPOSE: The aim of the study was to assess the early postoperative efficacy and safety of Tanito microhook (TMH) ab interno trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). METHODS: This prospective interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate POAG. All patients underwent a temporal clear corneal phacoemulsification combined with TMH ab interno trabeculotomy. Postoperative evaluation was done on day 1, 1 month, and 3 months. The outcome measures included intraocular pressure (IOP) at different follow-ups and postoperative complications. RESULTS: In total, 30 eyes of 30 patients were included in the study. There were 16 (53.3%) females and 14 (46.7%) males with a mean age of 62.63 ± 6.7 years. The mean IOP reduced from 23.57 ± 1.65 to 17.33 ± 2.84 at 3 months (P < 0.001). All eyes had a corrected distance visual acuity ≥6/9 at 1 month postoperatively. Postoperative complications included corneal stromal edema in eight (26.7%) eyes, hyphema in four (13.3%) eyes, and IOP spike in one (3.3%) eye. CONCLUSION: TMH ab interno trabeculotomy combined with phacoemulsification in patients with mild-moderate POAG is an effective and safe procedure with fewer complications.

Toric intraocular lens: A literature review.

Toric intraocular lenses (IOLs) are universally recommended in cataract cases with preoperative corneal astigmatism ≥1.5 D. An optimal surgical outcome depends on careful patient selection, complete preoperative evaluation, accurate IOL power calculation, precise marking of the axis, meticulous intraoperative approach, and methodical postoperative care. Understanding the importance of posterior corneal astigmatism, surgically induced astigmatism, and effective lens position in IOL power calculation and newer techniques to measure them directly have resulted in better postoperative refractive outcomes. We present a brief overview of toric IOLs along with the preoperative evaluation, IOL power calculation, different marking methods, intraoperative approach, and postoperative outcomes. Functional and anatomical outcomes, including uncorrected visual acuity, residual refractive astigmatism, and postoperative IOL misalignment, which have been reported for both toric IOLs and multifocal toric IOLs, are reviewed.

Comparison between opposite clear corneal incision versus toric intraocular lens in correcting astigmatism.

PURPOSE: To compare the visual outcomes and efficacy of opposite clear corneal incision (OCCI) and toric intraocular lens (IOL) implantation in correcting preexisting astigmatism (PEA) in patients undergoing phacoemulsification. METHODS: This prospective interventional comparative study was conducted between June 2022 and January 2023 in patients having cataract with PEA undergoing phacoemulsification. Patients were divided into two groups - group A underwent phacoemulsification with OCCI and group B underwent phacoemulsification with toric IOL implantation. Uncorrected distance visual acuity (UDVA), manifest refractive cylinder, and corneal astigmatism using corneal tomography were measured preoperatively and at 6 weeks postoperatively. The eyes were categorized into three groups with PEA ranging from 1 to 1.5 D, 1.6 to 2 D, and 2.1 to 3 D. Depending upon the white-to-white corneal diameter, the eyes were also categorized into four groups with corneal diameter ranging from 10.5 to 10.9 mm, 11 to 11.4 mm, 11.5 to 11.9 mm, and 12 to 12.4 mm. RESULTS: Sixty eyes of 60 patients were studied. At postoperative 6 weeks, 83.3% (25 eyes) in the OCCI group and 96.7% (29 eyes) in the toric IOL group achieved UDVA of 6/9 or better. No statistically significant difference was noted between the groups (P = 0.37). The reduction in mean corneal astigmatism was 0.63 ± 0.37 D in the OCCI group and 0.15 ± 0.12 D in the toric IOL group (P < 0.001). The residual mean refractive cylinder was 0.60 ± 0.38 D in the OCCI group and 0.05 ± 0.15 D in the toric IOL group at 6 weeks (P = 0.007). CONCLUSION: Both OCCI and toric IOL are effective in correcting PEA. However, in a resource-limited setting, OCCI is a better alternative surgical option for correcting astigmatism of 1-1.5 D during phacoemulsification without requiring additional skills or instruments.

Electroretinogram as a Screening Tool to Assess Vigabatrin-Induced Retinal Toxicity in Children With Infantile Spasms.

PURPOSE: To assess the utility of electroretinogram (ERG) as a screening tool for vigabatrin-induced retinal toxicity in children with infantile spasms. METHODS: This was an observational cohort study including children with infantile spasms receiving treatment with vigabatrin. A 30-Hz flicker potential ERG, using the RETeval system (LKC Technologies), was done at baseline before starting vigabatrin at 6 months and 1 year. The amplitudes were recorded. RESULTS: Eleven children were included in the study. The most common etiologic factor for infantile spasms was tuberous sclerosis (36.4%) followed by West syndrome (27.3%). The mean age of the children was 7.14 ± 2.9 months, with a range of 3 to 16 months. The mean difference in amplitude was 3.21 ± 2.45 and 5.72 ± 4.18 µV at 6 and 12 months follow-up, respectively (P < .001). Eight of the 11 children (72.7%) showed vigabatrin-induced retinal toxicity, and all 8 children were receiving vigabatrin for more than 6 months. CONCLUSIONS: ERG can be used for vigabatrin-induced retinal toxicity monitoring in children with infantile spasms. Vigabatrin-induced retinal toxicity is related to the duration of treatment rather than cumulative dosage. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.

Comparison of visual outcomes in patients implanted with Tecnis Eyhance ICB00 and 1-Piece ZCB00 monofocal intraocular lenses.

PURPOSE: To compare the visual outcomes and monocular defocus curve of a new monofocal Tecnis Eyhance IOL (Tecnis ICB00) with Tecnis 1 single piece (ZCB00). METHODS: Eighty patients diagnosed with cataract were divided into two groups: Tecnis ICB00 (n = 40) and ZCB00 (n = 40). The visual outcome was evaluated using the following parameters: uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA), corrected near visual acuity (CNVA), uncorrected visual acuity contrast sensitivity (UVACS), best-corrected visual acuity contrast sensitivity (BCVACS), manifest refraction, and defocus curve and was compared at the 6th week and 3 months after surgery. RESULTS: The UIVA and UNVA were significantly (P < 0.05) better in ICB00 as compared with ZCB00 at 6 weeks and 3 months postoperative. The DCIVA was significantly better in ICB00 as compared with ZCB00 at 3 months postoperative (-0.015 ± 0.04 vs. 0.01 ± 0.020; P = 0.01). Regarding contrast sensitivity, UVACS and BCVACS were significantly better in ICB00 as compared with ZCB00 at 6 weeks and 3 months postoperative (P < 0.05). The defocus curves showed that the mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between - 0.5 D and - 2.50 D of defocus. CONCLUSION: In patients undergoing cataract surgery, Eyhance ICB00 provided better intermediate vision as compared with ZCB00.

Flow capsulorhexis: A novel technique in white and hypermature cataracts.

We described a novel "flow capsulorhexis" technique in white and hypermature cataracts and compared it with the standard "needle decompression capsulorhexis" technique. Six hundred and eight eyes of 420 patients with intumescent or non-intumescent mature white cataracts who had undergone phacoemulsification or manual small incision cataract surgery with "flow capsulorhexis" (Group 1) or "needle decompression capsulorhexis" (Group 2) were assessed. The mean continuous curvilinear capsulorhexis (CCC) completion time was 6.6 ± 3.4 seconds in Group 1 and 10.4 ± 4.2 seconds in Group 2 (P < 0.001). The mean number of times for an ophthalmic viscosurgical device (OVD) supplement was 0.4 ± 0.2 and 1.8 ± 0.8 in Group 1 and Group 2, respectively (P < 0.001). CCC success rate was 95.8% in Group 1 and 87.2% in Group 2 (P = 0.001). The new technique was observed to have better outcomes in terms of surgical time, OVD supplement times, and success rate than the standard needle decompression technique.

Long-term outcomes of tailored stromal expansion with refractive lenticule for crosslinking thin corneas.

PURPOSE: To assess the long-term safety and stability of visual outcomes following the modified technique of collagen crosslinking (CXL) using refractive lenticule in eyes with thin corneas (<400 µm) and progressive keratoconus. SETTING: A tertiary eye care hospital in India. DESIGN: Prospective, interventional case series. METHODS: Eyes with progressive keratoconus and thin corneas (<400 µm) underwent CXL with intraoperative stromal augmentation using a refractive lenticule obtained from small-incision lenticule extraction (SMILE). Preoperative and postoperative evaluation (3 months, and then yearly thereafter) included corneal tomography (Oculus Pentacam), uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), manifest refraction, and endothelial cell count (specular microscopy), and adverse events, if any, were noted. The patients were followed up for a period of 5 years. RESULTS: Seven eyes were included in the analysis. Mean corneal flattening of -4.29 D was noted from preoperative maximum keratometry (P = 0.018). An improvement in UDVA and CDVA of 0.38 logarithm of minimum angle of resolution (logMAR) and 0.36 logMAR, respectively, was noted at 5 years postoperative visit. Four eyes demonstrated a gain of two lines in CDVA. Mean spherical equivalent improved from -6.85 D preoperatively to -6.05 D at 5 years postoperatively. Clear demarcation line was noted between 230 to 270 µm on anterior segment optical coherence topography. No significant endothelial cell loss was noted postoperatively. CONCLUSION: Long-term outcomes demonstrated safety and disease stability following lenticule-assisted CXL.

Conjunctiva in strabismus surgery - to stitch or to stick? - A randomized clinical trial.

PURPOSE: To evaluate the clinical outcomes with fibrin glue in comparison with vicryl sutures for limbal conjunctival wound closure in strabismus surgery. METHODS: In this prospective interventional study, patients undergoing horizontal muscle strabismus surgery were randomized into two groups: the vicryl suture group and the fibrin glue group. The limbal conjunctival incisions were closed with 8-0 vicryl in the suture group and with fibrin glue in the other group. The outcomes measured were post-operative conjunctival inflammation and wound apposition, patient comfort with the help of a questionnaire, and conjunctival thickness using anterior segment optical coherence tomography (AS-OCT) for both groups at 6 weeks. RESULTS: The study included 64 eyes of 64 patients (32 eyes in each group). The fibrin glue group performed better than the vicryl suture group for most of the symptoms like redness, irritation, watering, and foreign body sensation till 2 weeks post-operatively ( P < 0.001), after which both the groups performed similarly. As for clinical signs, no significant difference was noted between the two groups, except for conjunctival hyperemia, which was significantly lesser in the fibrin glue group at 2 weeks post-operatively ( P < 0.001). The conjunctival thickness measured at 6 weeks using AS-OCT revealed that the thickness increased significantly in the suture group compared to that in the glue group ( P < 0.001 medial site, P = 0.004 lateral site). CONCLUSION: Because of greater patient comfort and reduced inflammation associated with fibrin glue, it may be considered as a procedure of choice for conjunctival wound closure in strabismus surgery in the absence of the cost constraints.

Comparison of peripapillary capillary plexus using optical coherence tomography angiography and retinal nerve fibre layer analysis using spectral domain optical coherence tomography in glaucoma patients, glaucoma suspects, and healthy subjects.

Purpose: To assess the association between radial peripapillary capillary (RPC) plexus using optical coherence tomography angiography (OCTA) and retinal nerve fibre layer (RNFL) thickness using spectral domain OCT (SD-OCT) in primary open-angle glaucoma (POAG) patients, glaucoma suspects, and healthy subjects. Methods: In this single-centre cross-sectional observational study, POAG, glaucoma suspects, and healthy patients underwent OCT-RNFL and optic nerve head angiography scans. The RNFL thickness and the vascular parameters obtained from RPC plexus, including perfusion density (PD), flux index (FI), and vessel density (VD), were analysed. Results: In all, 120 eyes of 120 patients, including 40 POAG patients, 40 glaucoma suspects, and 40 healthy subjects, were included. The pairwise comparison of mean RNFL thickness, FI, and VD showed significant difference (P < 0.001) in all sectors between POAG, glaucoma suspects, and healthy eyes. However, PD showed no significant difference between glaucoma suspects and healthy eyes. The average RNFL thickness was found to have a better diagnostic ability than VD to distinguish POAG eyes from healthy eyes and glaucoma suspects based on receiver operating characteristics curve and area under the curve. VD had better diagnostic accuracy than RNFL when glaucoma suspects and healthy were compared. Conclusion: OCT-RNFL has better diagnostic capability in differentiating glaucoma from healthy eyes compared to OCTA. However, OCTA was found to be better in screening out glaucoma suspects from healthy eyes. The VD is a better OCTA parameter than FI and PD to differentiate POAG and glaucoma suspects from healthy eyes.

A New Mechanism of Silicone Oil-Induced Glaucoma and Its Management.

Purpose: To describe a case of secondary acute angle closure glaucoma due to silicone oil migration into the posterior chamber causing entrapment of aqueous and its successful management. Case Presentation. A 69-year-old female presented with decreased vision and pain in the left eye (LE) for one month. She had a history of complicated phacoemulsification with nucleus drop and retinal detachment in LE, for which vitreoretinal surgery with silicone oil endotamponade was done. She was also a known case of primary open angle glaucoma on medications. The corrected distance visual acuity was 20/20 and 20/125 in the right eye (RE) and LE, respectively. The intraocular pressure (IOP) was 18 mmHg in RE and 45 mmHg in LE. Anterior segment examination of LE revealed 270° of iridocorneal apposition in the periphery of the anterior chamber. Fundus examination of LE showed silicone oil filled vitreous cavity with attached retina. Given the recent history of silicone oil injection and elevated IOP despite maximum antiglaucoma medications, we decided to perform laser peripheral iridotomy (LPI) in the area of iridocorneal apposition. Following LPI, the IOP in LE came down to 17 mmHg and remained stable within the normal range for one month, after which the patient was taken up for silicone oil removal. Conclusion: This case report highlights a new mechanism of silicone oil-induced glaucoma and the technique of performing LPI in the area of iridocorneal apposition, for the first time in the literature. Silicone oil migration into the posterior chamber from the vitreous cavity in the presence of zonular dehiscence can push the iris forward and lead to iridocorneal apposition, resulting in an acute rise in IOP. Performing LPI within the area of iridocorneal apposition can help the aqueous seep into the anterior chamber and release the silicone oil globule trapped behind the iris to enter the anterior chamber, thus relieving the iridocorneal adhesions and lowering the IOP.

Acute Unilateral Hypopyon Uveitis and Secondary Glaucoma in an Adult With Relapsing Acute Lymphoblastic Leukemia.

Anterior segment infiltration in acute lymphoblastic leukemia (ALL) presenting as hypopyon uveitis in an adult is rare. We report this case as an uncommon presentation in a patient in remission after chemotherapy for ALL. In addition to the hypopyon, the patient presented with congested eye caused by secondary raised intraocular pressure. There is a need to maintain a high index of clinical suspicion in uveitis cases, as early diagnosis of ocular malignancy can save vision. Atypical unilateral hypopyon, even in adults, can be an indication of relapsing ALL.

Comparison of the clinical outcomes of Eyecryl™ and Tecnis® toric intraocular lenses: A real-world study.

PURPOSE: To compare the postoperative uncorrected distance visual acuity (UDVA) and refractive outcomes of cataract patients with astigmatism following implantation of Eyecryl™ and Tecnis® toric intraocular lenses (IOLs). METHODS: We conducted a single-center, retrospective study including patients who had undergone phacoemulsification and implantation with either Eyecryl™ toric (Group 1) or Tecnis® toric (Group 2) IOL. The primary outcome measures included postoperative UDVA and residual astigmatism at 3 months. The secondary outcome measure was IOL misalignment >10° throughout the follow-up period. RESULTS: One hundred and eight eyes of 76 patients (44 males and 32 females) were analyzed. Twenty-nine patients (38 eyes) received Eyecryl™ toric IOL (Group 1), and 47 patients (70 eyes) received Tecnis® toric IOL (Group 2). Groups 1 and 2 showed a mean postoperative logMAR UDVA of 0.09 ± 0.11 and 0.06 ± 0.09, respectively, at 3 months (P = 0.114). In both groups, all the eyes achieved a postoperative UDVA of ≤0.3 logMAR. The postoperative residual astigmatism of group 1 and group 2 was -0.29 ± 0.34 D and -0.16 ± 0.27 D, respectively (P = 0.038). Postoperative astigmatism was within ± 1.00 D in all the eyes. No eyes had an IOL misalignment >10° throughout the follow-up period. CONCLUSION: Both Eyecryl™ and Tecnis® toric IOLs provided significant improvement in uncorrected visual acuity and astigmatism correction postoperatively. The Tecnis® toric IOL provided statistically significant lower residual astigmatism than Eyecryl™toric IOL. However, the difference in postoperative astigmatism between the two IOLs was clinically insignificant.

Spontaneous posterior dislocation of the cataractous lens in a patient with Parkinson-plus syndrome.

PURPOSE: To report a case of unilateral posterior dislocation of the cataractous lens and subluxation of the lens in the fellow eye of a patient with Parkinson-plus syndrome. OBSERVATIONS: A 67-year-old-man who was a known case of Parkinson-plus syndrome on long-term dopamine agonists and anti-psychotic medications demonstrated apraxia of lid opening associated with moderate-to-severe blepharospasm. He had unilateral posterior dislocation of the cataractous lens and subluxation of the lens in the fellow eye with no prior history of trauma or other known ocular risk factors. CONCLUSION AND IMPORTANCE: This case may represent an unusual example of spontaneous lens dislocation secondary to apraxia of lid opening and concurrent blepharospasm, which is associated with Parkinson-plus syndrome.

Microincision phacoemulsification combined with sutureless transpupillary passive silicone oil removal.

PURPOSE: To evaluate the outcomes of combined microincision phacoemulsification with sutureless transpupillary silicone oil (SO) removal using an irrigation probe of bimanual irrigation/aspiration. METHODS: We conducted a single-center retrospective study, including patients who had undergone phacoemulsification with transpupillary removal of SO, which had been used for intraocular tamponade after a previous pars plana vitrectomy. Outcome measures were corrected distance visual acuity (CDVA), refractive error, intraocular pressure (IOP), and endothelial cell count (ECC) evaluated preoperatively and postoperatively at 3-month follow-up. Any intraoperative or postoperative complications, duration of surgery, and final retinal status at 3 months were also noted. RESULTS: Seventy-four eyes (74 patients) were analyzed. The mean interval between SO placement and cataract surgery was 4.73 months (standard deviation [SD]: 1.02). CDVA improved in 66 (89.2%) eyes and remained the same in 8 (10.8%) eyes (P < 0.001). The mean postoperative spherical equivalent was -0.96D (SD: 0.75) at 3 months (P < 0.001). There was a significant drop in IOP from 15.08 mmHg (SD: 2.67) preoperatively to 11.64 mmHg (SD: 2.02) postoperatively (P < 0.001). The average ECC loss was only 5.7% at 3 months postoperatively. The mean surgical duration was 17.20 min (SD: 7.02). One patient had retinal redetachment and required resurgery. At 3 months, the retina was attached in all patients. CONCLUSION: Combined microincision phacoemulsification with transpupillary passive SO removal using irrigation probe of bimanual irrigation/aspiration is a safe, effective, and less invasive technique that offers the main advantage of reduced surgical trauma, and should be reserved for patients with a stable retina, not requiring additional surgical intervention.