A pilot randomized clinical trial comparing muscle transplant versus hang back recession in extra-large angle exotropia.

PURPOSE: For extra-large angle exotropia (>60 prism diopters, PD), single-setting surgical alternatives are scarce; frequently, more than two muscle or two eye procedures are indicated. To evaluate the viability of single eye surgery, a current randomized comparative trial is undertaken. METHODS: Twenty adult patients with extra-large angle exotropia underwent a thorough orthoptic evaluation before being divided into two groups at random. Ten patients in group 1 underwent medial rectus resection (5.5-7.5 mm), followed by transplant-aided lateral rectus recession (effective length: 4-5.5 mm) (9 mm). In group two, ten different patients underwent medial rectus resection (5.5-7 mm), but this time, the lateral rectus recession (9 mm) was aided with a hang-back suture (5-7 mm). The two procedures were compared at baseline and six months post-operatively. RESULTS: There was no significant difference in the groups' median ages (P = .95). In groups one and two, the median corrections achieved were 81.00 (79.50-85.50) PD and 81.00 (79.75-86.50) PD, respectively. The differences in corrections were statistically insignificant (p = .99). In all patients, abduction limitation was frequently noted in the immediate post-operative period, which improved over time. In each group, there were two patients (>90 prisms) with residual deviation of at least 30 PD, for which the contralateral eyes were operated. CONCLUSIONS: The hang-back recession was as successful as muscle transplant procedure in correcting 80-90 PD of exotropia with notable clinical benefits and ease.

Intra-operative aberrometry versus conventional biometry for intraocular lens power calculation: A prospective observational study from a tertiary referral center.

Purpose: To evaluate the per operative intra-ocular lens (IOL) power calculation using intra-operative aberrometry (ORA) and its comparison with conventional methods. Methods: Patients with cataract planned for phacoemulsification by a single surgeon under topical anesthesia were enrolled in this prospective observational study in this prospective observational study. All patients underwent pre-operative biometry (Manual SRK-II and IOLMaster® 500) to determine the intra-ocular lens (IOL) power. Intra-operative aberrometry using ORA was also performed; however, IOL was inserted according to IOLMaster® (SRK/T). Spherical equivalent (SE) was recorded on post-operative days 1, 7, and 30. Patients were divided into three groups based on axial lengths for analysis. Comparative analysis was performed for the calculated IOL powers and prediction errors of ORA with conventional methods. Adjusted IOL power to calculate the emmetropic IOL using the LiHue formula was also determined and was compared with existing methods. A P-value less than 0.05 was considered statistically significant. Results: A total of 115 eyes from 113 patients were included, with a median age of 54.90 ± 14.3 years. The mean axial length was found to be 23.94 ± 2.3 mm. There was good agreement (87%) between ORA and IOLMaster® for calculated IOL powers with a mean difference of 0.047 ± 0.5D between the two (P = 0.33). A positive correlation was found between IOL power calculated using ORA, IOLMaster®, SRK-II, and adjusted IOL. Conclusion: The use of intra-operative aberrometry (ORA) to calculate IOL power in patients undergoing uncomplicated phacoemulsification is non-inferior relative to standard pre-operative measurement and planning.

Clinical outcomes of clear lens extraction in eyes with primary angle closure.

PURPOSE: To evaluate the effect of clear lens extraction (CLE) on intraocular pressure (IOP) and the anterior chamber angle in primary angle closure after laser peripheral iridotomy (LPI). SETTING: Tertiary eyecare center at a university hospital, New Delhi, India. DESIGN: Prospective case series. METHODS: The study included eyes with primary angle closure and an IOP over 25.0 mm Hg more than 8 weeks after LPI. All eyes had CLE by phacoemulsification. Absolute success was defined as an IOP less than 18.0 mm Hg without medications at 12 months. RESULTS: In 44 eyes (24 women, 20 men; mean age 57.2 years ± 4.2 [SD]), the mean preoperative IOP of 27.1 ± 1.55 mm Hg decreased to 13.2 ± 1.12 mm Hg at 12 months (P < .0001). The angle opening distance at 500 µm increased from baseline values at 0 degrees (from 0.104 ± 0.015 mm to 0.31 ± 0.013 mm) and 180 degrees (from 0.202 ± 0.008 mm to 0.412 ± 0.012 mm). The trabecular iris angle also increased at 0 degrees (from 9.3 ± 3.2 degrees to 32.7 ± 5.6 degrees) and 180 degrees (from 9.12 ± 3.2 degrees to 31.7 ± 5.6 degrees) (all P < .0001). In multivariate analysis, the preoperative IOP was the strongest determinant of IOP change (R(2) = 0.69, P < .0001). Absolute success was achieved in 38 eyes (86.3%). CONCLUSION: Clear lens extraction led to a significant reduction in IOP, a widening of the anterior chamber angle, and a reduced need for ocular hypotensive medications in eyes with primary angle closure and persistently raised IOP after LPI. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Intraoperative fracture of phacoemulsification tip.

Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery.

Levodopa-carbidopa with occlusion in older children with amblyopia.

PURPOSE: To study the role of levodopa-carbidopa in supplementing occlusion therapy in older children with strabismic or anisometropic amblyopia. METHODS: A clinical study was performed on 40 amblyopic children (19 strabismic and 21 anisometropic), 6 to 18 years old (mean age, 10.9 years). They received an average dose of 1.86 mg/kg/day (1.33-2.36 mg/kg/day) of levodopa and carbidopa (4:1 ratio) or a placebo in 3 divided doses over a 4-week period, combined with full-time occlusion. The occlusion was continued for the study duration of 3 months. Early Treatment Diabetic Retinopathy Study visual acuity charts and Cambridge low-contrast gratings for contrast sensitivity (CS) were used to assess visual functions. Tolerance and compliance with occlusion and capsule consumption were assessed. RESULTS: Visual acuity of the nonamblyopic eye did not deteriorate during the study in either group. CS decreased by 22 units in the levodopa group and increased in the placebo group by 53 units at the first month. The CS in the levodopa group recovered later by the third month of follow-up. Both the levodopa and the placebo groups showed significant improvement in visual function in the amblyopic eye (P <.001). Overall changes in logarithm of minimum angle of resolution values and CS in the amblyopic eyes were similar in both groups (P >.05). Strabismic and anisometropic amblyopes did not behave differently. Drug tolerance, occlusion compliance, and capsule ingestion compliance were similar between the groups, with no significant side effects. CONCLUSIONS: Clinically, levodopa supplementation does not offer any advantage over occlusion alone. Moreover, the risk of occlusion amblyopia could increase with the use of drugs like levodopa that might affect the plasticity of the visual cortex.