Cut-and-place technique of pterygium excision with autograft without using sutures or glue: Our experience.

BACKGROUND: Conjunctival sutures used in pterygium surgery are not only time-consuming process but also may lead to local complications such as discomfort, scarring, granuloma, or infection. Plasma-derived products such as fibrin glue may produce possible hypersensitivity reactions whereas the risk of viral transmission remains theoretically possible. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. MATERIALS AND METHODS: After pterygium excision and fashioning of the autologous conjunctival graft, the recipient bed is encouraged to achieve natural hemostasis and relative desiccation before graft placement. Excessive hemorrhage in the graft bed is tamponed. Graft adherence and positioning is examined 12-15 min after surgery. RESULTS: A total of 205 cases of pterygium underwent excision with conjunctival autograft without using sutures or glue. Mean follow-up time was 14.6 months. Cosmesis achieved was excellent in all cases. There were no intraoperative complications seen. Recurrence was seen in 6.8% of cases (14 cases). Nasal gaping was seen in 36% of cases (74 cases), which healed spontaneously without any surgical intervention. CONCLUSION: This simple technique for pterygium surgery is not only cost effective and quick but also may prevent potential adverse reactions encountered with the use of foreign materials and in this large series provided safe and comparable results to current methods.

Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery.

PURPOSE: To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX) in noncomplicated cataract surgery. METHODS: In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories) was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts. RESULTS: The study included 120 cases of age-related cataract whose mean age (standard deviation [SD]) was 59.68 years (9.47). There was a highly statistically significant endothelial cell loss (P < 0.001). The endothelial cell loss ranged 11-1149 cells/mm(2) with a median (interquartile range) of 386 cells/mm(2) (184.5-686 cells/mm(2)). The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range) of 15.4% (7.2% to 26.8%). A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman's rank-order correlation coefficient values, rho, (ρ) were as follows: CDE (ρ = 0.425), aspiration time (ρ = 0.176), and volume (ρ = 0.278). Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall's tau τ = 0.42). CONCLUSION: Microcoaxial phacoemulsification was efficient in removing noncomplicated cataracts; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness. This endothelial cell loss was mostly related to the increased cumulative dissipated energy (CDE), aspiration time, and volume of balanced salt solution used.

Effect of tropicamide and homatropine eye drops on a-scan parameters of the phakic normal eyes.

OBJECTIVES: A prospective study to evaluate the changes in A-Scan axial parameters of phakic normal eyes before and after instillation of 1% topical Tropicamide and 2% Homatropine eye drops. METHODS: Anterior chamber depth, lens thickness, vitreous chamber length, and ocular axial length were measured in 76 eyes before and after cycloplegia induced by 1% topical Tropicamide, and in 28 eyes with 2% Homatropine eye drops. RESULTS: Anterior chamber depth demonstrated increase from baseline readings with Tropicamide and Homatropine eye drops, while lens thickness showed decrease from the baseline readings with both eye drops. Effect of both the eye drops on over all axial length and vitreous chamber length is statistically seen, but is clinically negligible and not significant. CONCLUSION: Cycloplegia induced by 1% Tropicamide eye drops and 2% Homatropine eye drops has a significant measurable influence on anterior chamber depth and lens thickness, while vitreous chamber length and overall axial length demonstrated negligible statistical difference on A-Scan parameters of the normal phakic eyes.

Treatment of primary pterygium: role of limbal stem cells and conjunctival autograft transplantation.

PURPOSE: The limbus and its stem cells are important in the pathogenesis of pterygium. In this study, the usefulness of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium is assessed. METHODS: In this prospective noncomparative cohort study, 42 eyes of 42 patients with grade I-III primary pterygium underwent pterygium excision followed by superotemporal limbal stem cells and conjunctival autograft transplantation. Pterygium recurrences and complications within a mean follow-up period of 18.26 months (range, 10-28 months) were assessed. RESULTS: There were no recurrences of pterygium growth except in 2 cases (4.75%). In addition, no significant complications were noted. No further surgical interventions were needed in any case except for reoperation in the 2 recurrent cases. CONCLUSIONS: Although limbal stem cells and conjunctival autograft transplantation is a time-consuming procedure, it is a safe and effective technique for the treatment of different grades of pterygium. It is useful in prevention of pterygium recurrence, which is a major problem in pterygium surgery.

Effect of 10% phenylephrine eye drops on systemic blood pressure in normotensive & hypertensive patient.

OBJECTIVES: A prospective study to evaluate the effect of 10% Phenylephrine eye drops on systemic blood pressure in normotensive and hypertensive patients. METHODS: The sample comprised of 55 normotensive patients and 34 hypertensive patients were subjected to 10% Phenylephrine eye drops during routine eye examination. RESULTS: No statistically and clinically significant increase in blood pressure after the instillation of 10% Phenylephrine eye drops was seen in 87% of normotensive patients and 76% of hypertensive patients. Mild rise of blood pressure was seen in 11% of normotensive patients and in 15% of the hypertensive patients. Only one patient (3%) had severe rise of blood pressure in the hypertensive group. CONCLUSION: This study shows that pupillary dilatation with 10% Phenylephrine eye drops did not significantly increase systemic blood pressure in normotensive and hypertensive patients. Although precautions should be taken when used in hypertensive patients.

Treatment of primary pterygium: Role of limbal stem cells and conjunctival autograft transplantation.

PURPOSE: The limbus and its stem cells are very important in the pathogenesis of pterygium. In this study, the efficacy of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium will be assessed. DESIGN: Prospective noncomparative cohort study. MATERIALS AND METHODS: Forty-two eyes of 42 patients with grade I-III primary pterygium were included in the study. Pterygium excision was performed followed by superotemporal limbal stem cells and conjunctival autograft transplantation in all cases. Recurrence of pterygium and complications within a mean follow-up period of 18.26 months (10-28 months) was studied. RESULTS: Recurrence of pterygium occurred in two eyes (2/42; 4.75%). No significant complications were noted. Apart from re-operation in the two recurrent cases, no further surgical interventions were needed in any case. CONCLUSIONS: Limbal stem cells and conjunctival autograft transplantation is a safe and effective technique for the treatment of different grades of pterygium. It is very useful in preventing pterygium recurrence, which is a major problem in pterygium surgery.

Use of supero-temporal free conjunctivo-limbal autograft in the surgical management of pterygium: our technique and results.

BACKGROUND: A pterygium is a fibro-vascular, wing shaped encroachment of the conjunctiva on to the cornea. The prevalence rates ranges from 0.7 to 31% among different populations and also influenced by age, race, and exposure to solar radiations. Ultraviolet light-induced damage to the limbal stem cell barrier with subsequent conjunctivalisation of the cornea is the currently accepted aetiology of this condition. Indication of surgery include visual impairment, cosmetic disfigurement, motility restriction, recurrent inflammation and interference with contact lens wear. This Study was conducted to know the safety, efficacy and success with supero-temporal free conjunctivo-limbal auto graft transplantation in the surgical management of pterygium. METHODS: Prospective case series where supero temporal free conjunctivo-limbal auto grafting was performed on 72 eyes of 72 patients with vascular progressive pterygia. Pterygium recurrence was considered a surgical failure. Recurrence was defined as fibro vascular tissue crossing the corneo-scleral limbus on to the clear cornea in the area of previous pterygium excision before 6 months. RESULTS: Recurrence of pterygium was noted in three out of 72 eyes (4.16%), after a minimum follow up of 12 months to maximum of 25 months (Mean 14.6 months). No major intra-operative or postoperative complications were encountered. CONCLUSION: Supero temporal free conjunctivo-limbal auto graft appears to be a safe and effective technique in the surgical management of pterygium. The inclusion of limbal tissue in the conjunctival auto graft following pterygium excision appears to be essential to ensure low recurrence rate.

Outcome of trabeculectomy surgery in primary open angle glaucoma.

OBJECTIVES: Retrospective study to evaluate the short term outcome and contributing prognostic factors of trabeculectomy in terms of intraocular pressure in Omani patients of South Batinah region with primary open-angle glaucoma. METHODS: This study involved retrospective evaluation of 18 patients (22 eyes) with primary open angle glaucoma who underwent primary trabeculectomy between February 2005 and February 2008. All patients were aged over 40 years and were Omani. Follow-up for all subjects lasted at least 6 months or more [Average follow up 388 days with standard deviation of 182]. Successful control of Intraocular pressure (IOP) was defined as achieving IOP of 21 mmHg or less without medication (complete success). RESULTS: The results are presented with particular emphasis being placed only on intraocular pressure (IOP) control. The tonometric success rate of trabeculectomy in controlling the IOP at 21mmHg or less without any medication was 46% [complete successes], 18% had qualified success [Post operative IOP 21 mm Hg or less with one topical medication], while 36% trabeculectomies failed to show desired results. CONCLUSION: The results of this retrospective study underline that the procedure of trabeculectomy has moderate success in controlling the intra ocular pressure in the study population. The procedure failed to show the desired result in almost one third of the patients (36%) and topical medical treatment was reinstated in these patients with either two or three drugs. However these results lead to the following question: Should trabeculectomy be the therapy of first choice in the early stage of glaucoma?

Uncommon presentation of congenital lacrimal duct obstruction a case report of congenital amniontocele.

BACKGROUND: Congenital amniontocele also known as congenital dacryocystocele is an uncommon variant of a very common condition (Naso-Lacrimal Duct Obstruction, NLDO) that affects newborn babies. The congenital amniontocele causes obstruction of the lacrimal drainage system creating a cystic swelling of the lacrimal sac. It usually presents at birth or soon after birth, as a bluish swelling, below and nasal to the medial canthus. If the congenital amniontocele is associated with intranasal cystic swelling of the NLD and if it is large and bilateral it can cause severe respiratory distress particularly during milk feeding. METHOD: We report a case of 24 days old female newborn baby who were presented to us from pediatric clinic of Rustaq Hospital with bluish cystic swelling below the left medial canthus soon after the birth. CONCLUSION: Congenital amniontocele is relatively rare and the literature describes a variable natural course of these lesions with resultant controversy in their management. Usually congenital amniontocele resolves spontaneously with conservative management, and if not, dacryocystitis might develop. Treatment of congenital amniontocele comprises digital sac massaging and early probing the lacrimal system,(8) or some times, intranasal surgery in the form of marsupialization of the intranasal cyst, this is usually performed endoscopically.(7) We report successful conservative management in our case and recommend this with oral and topical antibiotics with lacrimal sac massage for 7 to 10 days and, if there is no response, to consider surgical intervention in the form of lacrimal probing.

Health care of female outpatients in south-central India: comparing public and private sector provision.

The object of this study was to compare components of quality of care provided to female outpatients by practitioners working in the private and public sectors in Karnataka State, India. Consultations conducted by 18 private practitioners and 25 public-sector practitioners were observed for 5 days using a structured protocol. Private practitioners were selected from members of the Indian Medical Association in a predominantly rural sub-district of Kolar District. Government doctors were selected from a random sample of hospitals and health centres in three sub-districts of Mysore District. A total of 451 private-sector and 650 public-sector consultations were observed; in each sector about half involved a female practitioner. The mean length of consultation was 2.81 minutes in the public sector and 6.68 minutes in the private sector. Compared with public-sector practitioners, private practitioners were significantly more likely to undertake a physical examination and to explain their diagnosis and prognosis to the patient. Privacy was much better in the private sector. One-third of public-sector patients received an injection compared with two-thirds of private patients. The mean cost of drugs dispensed or prescribed were Rupees 37 and 74 in public and private sectors, respectively. Both in terms of thoroughness of diagnosis and doctor-patient communication, the quality of care appears to be much higher in the private than in the public sector. However, over-prescription of drugs by private practitioners may be occurring.