A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens.

INTRODUCTION: Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts. OBJECTIVE: This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India. RESULTS: The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated. CONCLUSION: The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.

Couching of cataractous lens in microphthalmic eyes with irido-fundal coloboma: revisiting the historical technique.

PURPOSE: Cataract surgery in microphthalmic eyes is challenging due to anatomical restraints, hard bulky nucleus. This series aims to evaluate the safety and efficacy of couching of intraocular lens in irido-fundal coloboma with microphthalmos. SETTING: Tertiary care centre in South India. DESIGN: Retrospective non-comparative study in eyes with irido-fundal coloboma, corneal diameter < 7 mm and brown cataract. Visual acuity less than 6/60 in other eye. METHODS: Anterior chamber entry made, zonules broken and lens dislocated into the vitreous cavity in a controlled manner. Baseline Clinico-demographic details, corrected distance visual acuity (CDVA), Intra-ocular pressure (IOP), corneal diameter, axial length, lens status and post-surgery CDVA, IOP and complications recorded and followed up for atleast 6 months. RESULTS: Fifteen eyes of 15 subjects were evaluated with a mean age 49.4 ± 10.9 years. At baseline, mean IOP 14.5 ± 3.8 mmHg, mean axial length 19.3 ± 0.5 mm, mean corneal diameter was 6.5 ± 0.34 mm and CDVA 2 logMAR which improved to 1.5 logMAR at 3 months (p value 0.002). Transient spike in IOP in 33.3% subjects was medically managed with no significant difference in IOP (p > 0.05) at baseline (14.5 ± 3.8 mmHg), 3 months post-surgery (16 ± 2.8 mmHg) and 6 months post-surgery (14.9 ± 2.5 mmHg). One patient underwent re-couching. No other major complications were noted. CONCLUSION: Couching of cataractous lens is an effective and safe method in microphthalmic eyes with irido-fundal coloboma as last resort procedure, where no other surgical procedure may work. It provides an ambulatory gain of visual acuity in previously non-ambulatory subjects. Corneal measurements help in determining the subset of patients where couching offers viable option.

Outbreak of toxic anterior segment syndrome following vitreoretinal surgery - A retrospective analysis.

BACKGROUND: Toxic anterior segment syndrome (TASS) is an uncommon complication of vitreoretinal surgery and is characterized by severe anterior chamber reaction, hypopyon, and limbus-to-limbus corneal edema. METHODS: Twenty-nine vitreoretinal surgeries were performed, of which 14 developed TASS in the early postoperative period. The operative records were reviewed retrospectively. RESULTS: The median age of patients was 49.07 ± 16.75 years and 14.28% of them were female. Also, 71.42% were operated in the left eye and 42.8% were pseudophakic. Recurrent retinal detachment, secondary scleral-fixating intraocular lens (SFIOL), and silicone oil removal (SOR) were the most common procedures. Severe anterior chamber reaction was seen in 14 patients, circumcorneal congestion in eight, corneal edema in 11 (78.6%), hypopyon in 13 (92.8%), and severe fibrin membrane in two patients. CONCLUSION: We describe the largest series of TASS following uneventful vitreoretinal surgery. Balanced salt solution was the instigating agent in this series. A prompt and thorough investigation is critical in obviating recurrences.

Varied Presentations of Posterior Keratoconus: A Clinical Case Series.

PURPOSE: To describe the varied presentations of posterior keratoconus. METHODS: This is a 3-year institute-based retrospective study report from June 2015 to June 2018 that describes 13 eyes of 12 patients with varied presentations of posterior keratoconus, evaluating tomographic changes using Scheimpflug corneal tomography and anterior segment optical coherence tomography. Slit-lamp examination revealed circumscribed nebular corneal opacity with posterior corneal depression. RESULTS: Eleven patients had unilateral and one had a bilateral presentation. Five patients presented in the first and second decade with a nebular opacity and circumscribed excavation of the posterior cornea. One patient was a 12-year-old girl who presented with systemic manifestations. Seven others were middle-aged adults with superior, central, or peripheral excavation. Two patients had microcornea. CONCLUSIONS: This is the largest case series on posterior keratoconus, depicting its varied features. Diagnosis of this uncommon condition requires a high index of suspicion, meticulous slit-lamp examination, and systemic evaluation to rule out other associated anomalies. We report a patient of unilateral posterior keratoconus with systemic associations, second such case in the literature.

Risk factors for endothelial cell damage in diabetics after phacoemulsification.

BACKGROUND: To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics. METHODS: It was a case control study with 80 eyes each in the diabetic group and the control group. Intraoperative mydriasis, effective phaco time (EPT) and postoperative inflammation were measured. Preoperative, 1st week, 6th week and 3rd month postoperative endothelial cell density (ECD), coefficient of variation (CV), hexagonality and central corneal thickness (CCT) were also measured using Konan noncon robo specular microscope (Model - NSP 9900). RESULTS: In the control group, patients in the age group of 60-69 years were 3.8 times more at risk of ECL compared to patients in the age group of 50-59 years. Patients in whom EPT was ≥0.50 min, were 8.8 times more at risk of ECL when compared to patients in whom EPT <0.25 min. In the diabetic group, patients who had an inflammatory score of 1+ in the first postoperative week; also had 5.7 times more risk of ECL when compared to patients in whom the inflammatory score was 0.5+ in the first postoperative week. There was a significant increase in CV (p-0.03) and CCT (p-0.03), significant decrease in the hexagonality (p-0.01) and no statistically significant difference in the endothelial cell loss (ECL) (p-0.34) in diabetics after phacoemulsification when compared to controls. CONCLUSION: The present study reveals postoperative inflammation as a risk factor for ECL in diabetics and not intraoperative mydriasis and EPT.

Primary orbital neuroblastoma with intraocular extension.

Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.